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Spot-light on Preventing Postpartum Hemorrhage US AID Support

Spot-light on Preventing Postpartum Hemorrhage US AID Support. PPH Working Group April 6, 2009 Lily Kak. Background. USAID interest in addressing the biggest killer on a global scale

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Spot-light on Preventing Postpartum Hemorrhage US AID Support

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  1. Spot-light on Preventing Postpartum HemorrhageUSAID Support PPH Working Group April 6, 2009 Lily Kak

  2. Background USAID interest in addressing the biggest killer on a global scale • <2002 - R&D:Uniject – Indonesia, Vietnam (PATH), Angola (WHO), Misoprostol -Indonesia (MNH), review of off-label use (USP) • >2002 – Special initiative in four countries (Prime II, MNH, RPMplus), and FIGO/ICM Jt. Statement, Bangkok regional conference • 2004 – Special initiative to expand the use of AMTSL (POPPHI, ACCESS). Identified three key bottle-necks to expansion: • Lack of knowledge of evidence and lack of practice of AMTSL (policy change, advocacy, correct info on uterotonics and skills needed) • Uterotonics not available in quantities needed to scale up AMTSL (systems strengthening for drug logistics needed) • 50% of births take place at home (new policy, technology needed)

  3. Program Coverage Total countries: 32. Total MCH priority countries: 22 65% to 99% coverage in target areas

  4. Comprehensive Program Approach Program Support POPPHI, ACCESS, Bilateral projects PVOs: HealthRight, MIHV Global & Country policies & guidelines, research WHO, Govts, Drug Logistics RPMPlus/SPS Technology HealthTech

  5. Strategies to Achieve Scale Global: PPH working grp, global/national policy (WHO, FIGO&ICM, USP, govt), global survey Regional: SOTA workshops by USAID, POPPHI, ACCESS National: Taskforce, operations research, national consensus Catalytic Influence Collaboratives Using systematic peer learning sessions by HCI for quality improvement & national expansion WHO, USP, FIGO, ICM, Ventures Str., Govts, national prof. assns, & global, bilateral, PVO projects Partnerships Balanced approach for 100% uterotonic protection Everywhere, Every time:facility & home births Remove bottle-necks (e.g., task-shifting policy for Malian matrones, Uniject technology, storage)

  6. Catalytic Influence on Policy • Influenced change in oxytocin storage requirements in USP monograph • Pushed to replace ergometrine with oxytocin.  FIGO advocated for countries to delegate use of oxytocin to midwives (many countries in Africa allowed midwives at the periphery to use only ergometrine & not oxtyocin). • Supported 2006 WHO Technical Consultation leading to policy changes re misoprostol and delayed cord clamping • POPPHI shift to integrate immediate postpartum/essential newborn care with AMTSL • WHO research to evaluate simplified AMTSL (minus CCT) • Review of induction/ augmentation influenced WHO to develop induction guidelines for low resource settings.

  7. National surveys in 10 countries Percent of observed deliveries w/ uterotonic given during 3rd/4th stages of labor and correct use of AMTSL (uterotonic administration within 1 mn) Low AMTSL practice in national surveys served to inform and influence policy and strategies for scaling up PPH prevention activities Source: POPPHI

  8. Niger: Working at Scale through Collaboratives 7 of 8 regions; 64 districts; 27% of annual facility births Source: HCI

  9. Bangladesh: Comprehensive approach for national expansion National taskforce National SOTA conference National AMTSL survey Broad consensus to reach all births regardless of place National District approach to reach all district and Upazila facilities with AMTSL (25 districts so far) District hospital Upazila Health Complex (7%)* Misoprostol approved by Drug Authority Pilot in 1 district MOHFW plans for expansion Home Births (85%) *8% in pvt sector but not included in program

  10. Afghanistan: Successful Pilot Catalyzes National Expansion Source: ACCESS

  11. Uniject: Yes, it’s real! Source: HealthTech

  12. Gland-Pharma: Skeptical about market demand Worst-case scenario: Drop project Best-case scenario: FDA approval in 2010 Asia Program Status Way Forward Ensure commercial supply: WHO prequalification2009-2010 Plan for roll-out in 2010/11 • Previous • Indonesia • Vietnam • Current • Mali • Guatemala • Honduras • South Africa • Argentica Generate demand through additional country pilots 2009-2010 Uniject: Status Development Status Marketing launch in Argentina (July 09) Apply for WHO prequalification (July 09) BIOL: Received Argentine FDA approval Oct 08 LAC countries: submit request for approval LAC • BIOL production capacity relatively low but can grow with paying demand

  13. Challenges to Scaling Up • Tracking information not mainstreamed in HMIS • Getting knowledge/skills to providers; motivation • Misoprostol: Mixed messages • Quality of drugs questionable – non-optimal storage conditions, fake drugs on market, (possible misuse) • Control cord traction limits program to skilled birth attendants • Uniject still very new; promising but has not developed a niche yet

  14. Way Forward for USAID Support • Continued support to global expansion of PPH reduction • Expand to include PPH treatment • Expand to include pre/eclampsia prevention and management A goldmine of information on PPH and Uniject materials: http://www.pphprevention.org http://www.path.org/projects/uniject-oxytocin-resources.php

  15. Acknowledgements

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