S Arulkumaran Professor & Head of Obstetrics & Gynaecology St George’s University of London
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Transcript of S Arulkumaran Professor & Head of Obstetrics & Gynaecology St George’s University of London
Overcoming Barriers to Implementing PPH prevention
at the Facility Level The Role of Professional
Organisations
S ArulkumaranProfessor & Head of
Obstetrics & Gynaecology St George’s University of London
President Elect - FIGO
Objectives 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
Service provisionData collection
Policy developmentAdvocacy Training
Facilitation
Champion
Implementation
consultatio
n
The Role of Professional Associations
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
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
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
Global leadership: FIGO / MCHIP
FIGOAchievements:1. Development of a joint Statement FIGO/ICM on
active and physiological management of post partum haemorrhage
2. Production of a ‘flow chart’ to show how initial excessive bleeding should be managed
2. Production of models to demonstrate balloon techniques - suturing- manual removal
3. Guidelines for surgical techniques of balloon tamponade and compression sutures (vs internal iliac artery ligation or embolisation)
4. Guidelines for misoprostol use for prevention and treatment of PPH
Advocacy 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 statementsA 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 promoteInformation on the joint statement can be
used to: Develop clinical guidelines Develop national action plans
Signing joint statements – Mali, Benin, and Ghana
Mali
Benin
Ghana
During Ghana joint statement signing: Issues raised to ensure access to PPH interventions
1. Potency of the uterotonics 2. Low midwifery tutor: student ratios3. Insufficient numbers of clinical instructors to
support midwifery students in the acquisition of practical skills
4. Motivation and equipment for midwives posted to Community-based Health Planning and Services (CHPS) sites
5. Policy governing the use and application of misoprostol at the community level to manage PPH
6. Training of midwives in the seven basic functions of emergency obstetric and newborn care (EMONC)
7. Policy changes to enlarge midwives’ scope of practice to include selected EmONC interventions
Training 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 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 Misoprostol Conservative surgical treatment for PPH
Misoprostol could play an important role in saving lives of thousands of women, particularly in low-resource settings
Conservative Surgical Treatment for PPH
MethodMethod No of CasesNo of Cases Success ratesSuccess rates
B-Lynch + other B-Lynch + other Compression Compression suturessutures
9494 90.4%90.4%
Arterial Arterial embolizationembolization
218218 91%91%
Arterial ligationArterial ligation 264264 83.7%83.7%
Uterine balloon Uterine balloon tamponadetamponade
135135 83.7%83.7%
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
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
Solutions to challenges facing professional organisations
Recommendations for Country Professional Organisations (1) 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) 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