Overcoming Barriers to Implementing PPH prevention at the Facility Level
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Overcoming Barriers to Implementing PPH prevention at the Facility Level The Role of Professional Organisations. S Arulkumaran Professor & Head of Obstetrics & Gynaecology St George’s University of London President Elect - FIGO. Objectives.

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Overcoming Barriers to Implementing PPH prevention at the Facility Level The Role of Professional Organisations

S Arulkumaran

Professor & Head of

Obstetrics & Gynaecology

St George’s University of London

President Elect - FIGO


Objectives
Objectives Facility Level

  • Describe success stories of professional organisations that have worked to reduce barriers to access interventions to prevent and treat PPH

  • Provide recommendations for Country Professional Organisations

  • List major challenges/ solutions to using professional organisations to overcome barriers to implementation of interventions for PPH control


General principle to promote access to effective interventions

Implementation Facility Level

Service provision

Data collection

Policy development

Advocacy

Training

Champion

consultation

Facilitation

General Principle to Promote access to effective interventions


The role of professional associations
The Role of Professional Associations Facility Level

  • Provide leadership on issues surrounding PPH

  • Advocate for PPH control initiatives

  • Support research to update clinical practices

  • Promote best practices in clinical guidelines and health care policies

  • Facilitate knowledge and skill transfer

  • Support efforts to assure quality


Global leadership figo and icm popphi
Global leadership: FIGO and ICM / POPPHI Facility Level

  • FIGO and ICM were partners in the Prevention of Postpartum Haemorrhage Initiative (POPPHI) that ended in November, 2009

  • FIGO and ICM provided input into:

    • Task forces

    • Development of learning materials and job aids

    • Strategies to promote expansion and improve the quality and availability of AMTSL at the facility level and community level through work with their member associations around the world

    • Development and signing of joint statements work with their member associations around the world

    • Promoting best practices for the prevention and treatment of PPH

  • FIGO conducted workshops on post partum haemorrhage


Global leadership: FIGO / MCHIP Facility Level

  • FIGO’s collaboration with global partners on PPH reduction continues, and has expanded to address PE/E as well.

  • FIGO, ICM and MCHIP will be working together on a program to build collaboration of midwives and obstetricians for implementation of key interventions in numerous African countries


FIGO Facility Level

Achievements:

  • Development of a joint Statement FIGO/ICM on active and physiological management of post partum haemorrhage

  • Production of a ‘flow chart’ to show how initial excessive bleeding should be managed

  • Production of models to demonstrate balloon techniques - suturing- manual removal

  • Guidelines for surgical techniques of balloon tamponade and compression sutures (vs internal iliac artery ligation or embolisation)

  • Guidelines for misoprostol use for prevention and treatment of PPH


Advocacy
Advocacy Facility Level

  • Reputation and position of health professionals in society makes them ideal advocates at local, regional and national levels

    • Make the public aware of MNCH national problems and solutions

    • Lobby the government for better health and hold it accountable through MNCH progress reviews

  • Example

    • Uganda ObGyn society advocates parliamentary commission on MNCH progress. As a result of the review the President calls for maternal death audits


Joint statements
Joint statements Facility Level

A joint statement

  • Defines the public health problem

  • Defines necessary actions that governments and MOHs need to take to promote PPH control

  • Describes best practices to promote

    Information on the joint statement can be used to:

  • Develop clinical guidelines

  • Develop national action plans



During ghana joint statement signing issues raised to ensure access to pph interventions
During Ghana joint statement signing: Issues raised to ensure access to PPH interventions

  • Potency of the uterotonics

  • Low midwifery tutor: student ratios

  • Insufficient numbers of clinical instructors to support midwifery students in the acquisition of practical skills

  • Motivation and equipment for midwives posted to Community-based Health Planning and Services (CHPS) sites

  • Policy governing the use and application of misoprostol at the community level to manage PPH

  • Training of midwives in the seven basic functions of emergency obstetric and newborn care (EMONC)

  • Policy changes to enlarge midwives’ scope of practice to include selected EmONC interventions


Training
Training ensure access to PPH interventions

  • Members of professional associations promote best clinical practices and training techniques by:

    • Collaborating with medical/ midwifery schools in the development and deployment of curricula for all professional cadres

    • Collaborating with the MOH:

      • in the design and implementation of curricula for non-professional workers – community health workers and non professional birth attendants

      • in the design and implementation of curricula for in-service education, e.g. promoting training activities at point of service, promoting interdisciplinary training activities


Examples associations involved in training activities
Examples: Associations involved in training ensure access to PPH interventionsactivities

  • DRC: Representatives of the ob/gyn association participate in validation and review of curriculum for pre-eclampsia/eclampsia

  • Mali: Representatives of the midwifery and oby/gyn associations are members of the national maternal health task force that reviews curricula for in-service training and provides guidance on program implementation


Support research to update clinical practices
Support research to update clinical practices ensure access to PPH interventions

  • Misoprostol

  • Conservative surgical treatment for PPH


Misoprostol could play an important role in saving lives ensure access to PPH interventions

of thousands of women, particularly in low-resource settings


Conservative surgical treatment for pph
Conservative Surgical Treatment for PPH ensure access to PPH interventions


Major challenges to using professional organisations to overcome barriers to implementation of interventions for PPH control

  • Professional associations

    • May not have any legal standing in the country (e.g. they do not certify professionals, set national exams, etc.)

    • May be excluded from program implementation activities because they are not donors

    • Usually have budgetary constraints because they depend on meagre membership dues and sporadic grants

    • May not be systematically included in country-level maternal task forces


Solutions to challenges facing professional organisations overcome barriers to implementation of interventions for PPH control

  • Gain visibility by seeking funding to support research activities

  • Promote membership by professionals working in the MOH, teaching institutions, etc., who can advocate for the presence of the professional institutions when developing and updating curricula, etc.

  • Develop champions who can serve as representatives of the professional organizations in activities involving maternal health

  • Garner support for the local associations by associating with the international professional associations


Recommendations for country professional organisations 1
Recommendations for Country Professional Organisations (1) overcome barriers to implementation of interventions for PPH control

  • Keep abreast of research – you can only promote best practices if you are aware of them

  • Advocate for the presence of representatives of the midwifery and ob/gyn associations on national maternal task forces

  • Foster close relationships with the MoH, Hospitals, and Training institutions

  • Keep abreast of health policies that may serve as barriers to access to important maternal health care


Recommendations for country professional organisations 2
Recommendations for Country Professional Organisations (2) overcome barriers to implementation of interventions for PPH control

  • Serve as champions for policy change, where needed, to increase access to PPH interventions

  • Advocate for the presence of representatives of the midwifery and ob/gyn associations on committees developing learning materials

  • Advocate for adequate Teaching and Training material and time for training

  • Advocate for adequate financial resources to carry out the proposed actions, medications and facilities

  • Lead the implementation of better monitoring and evaluation practices


“Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.”

Mahmoud Fathalla - 1997

THANK YOU


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