Post on 11-Jan-2016
Country Team Action Plan
Scale –up of Misoprostol for Prevention of PPH
NEPAL
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2
Where do we want to be?GOALS
• To increase availability and accessibility to uterotonic (Inj oxytocin at HF, Misoprostol at community) for prevention of postpartum hemorrhage. Priority is the use of AMTSL, delivery at health facility.
• Misoprostol National level scale up in remote areas.
Tracks 1 & 2
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Hard to Reach…….
Tracks 1 & 2
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Where are we now?• One district piloted (Banke) in 2007• Scale-up in 8 more districts (population covered:
~ 10% ): – Roll out ongoing in 6 districts, Planned for 3 districts
• National Misoprostol Technical Working Group formed
• Remote Area Guidelines developed and implementation ongoing
• Implementation guidelines developed (Draft)• Monitoring and evaluation plan developed.• Misoprostol included into the National Essential
Drug List
Tracks 1 & 2
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Where We Are Now
DOLPA
MUGU
JUMLA
KAILALI
BARDIYA
HUMLA
DOTI
SURKHET
NAWALPARASI
KAPIL-
BASTU RUPAN-DEHI
DANG
BANKE
ACHHAMKALIKOT
JHAPAMORANG
SIRAHA
SAPTARI
DARCHULA
BAJHANG
BAITADI
DADEL-DHURA
KANCHAN-PUR
BAJURA
PARSABARA RAUT-
AHAT
DHANUSA
MAHO-TARI
SUNSARI
SARLAHI
DHADING
MAKAWAN-PUR
CHITWAN
KASKIBAGLUNG
TANAHU
PALPA
SYANGJA
PARBAT
ARGHAKHACHI
GULMI
UDAYAPUR
SINDHULI
ILAM
BHOJ-PUR
DHAN-KUTA
TAPLEJUNG
RAMECHHAP
OKHAL-DHUNGA
TERHA-THUM
KHOTANG
LALIT
BHAK
KATHMMANDUSULUK-HUMBU
DOLAKHA
SANKHUWA-SABA
NUWAKOTSINDHU-PALCHOK
KAVRE
RASUWALAMJUNG
GORKHA
PYUT-HAN
ROLPA
SALYANMYAGDI
DAILEKHJAJARKOT
RUKUM
MUSTANG
MANANG
PANCHTHAR
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Mountain
Hills
Terai
Nepal
75 districts
Each district consists of
VDC
Each VDC has nine ward & Health Facility
FCHV
Mothers group
Each ward has 80-100 households and there is a Female Community Health Volunteer (FCHV) who provides maternal and child care services in the community. In each ward there is also a mother group coordinated by FCHV for community mobilisation
12
3
5
7
4
96
8
Nepal’s Administrative and
Health Structure
Settlement
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What are the gaps?
• PPH is one of the leading causes of maternal deaths
• Low uterotonic coverage (Oxytocin or Misoprostol)
• High home births, Low institutional deliveries,
• Low Staff retention in remote area
Tracks 1 & 2
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What interventions can we use to close the
gap?• Promote institutional deliveries• Promote Active management of third
stage of labour for every birth conducted by SBAs
• Use of Misoprostol for prevention of postpartum hemorrhage at home birth
Tracks 1 & 2
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What are the possible challenges to the
intervention?• Overcoming resistance from
Professional organizations and WHO• Preventing unintended use • Monitoring of coverage and
compliance• Ensuring proper counselling• Maintaining quality at scale
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Who are the possible partners, allies, and
stakeholders?• Government of
Nepal• USAID• UNICEF• INGOs • Professional
Organizations: NESOG, PESON, SOPHPN
• DPHO• HFs• FCHVs• HFOMC• Communities
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What are our action steps?
Action Step Responsible Person
Timeline
1. GON Approval for Program Scale-up
Dr Naresh P KC, FHD
May 2010
2. Develop Country Action Plan (Implementation Plan, M&E Plan, Cost)
FHD, jointly with partners
July 2010
3. Dissemination of program to wider audience (EDPs, Program Divisions, Professional Organization etc)
FHD July 2010
4. Develop Procurement Plan
FHD, LMD and partners
August 2010
Tracks 1 & 2
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What are our action steps?
Action Step Responsible Person
Timeline
5. Revise, update and Print training and BCC materials
FHD, NHTC, NHEICC, HMIS/MD
and partners
June 2010
6. Update M&E tools and systems
FHD, HMIS/MD and partners
June 2010
7. District Planning and Orientation
FHD, RHD, D(P)HOs and
partners
August 2010
onwards
8. Conduct Training(ToT, District and HF Training, Community Training)
FHD, NHTC and partners
August 2010
onwards
9. Program Implementation and Monitoring
FHD, RHD, D(P)HO and
partners
August 2010
onwards
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