Smith_Tracking the Progress of PPH and PE E Programs a Multi Country
Transcript of Smith_Tracking the Progress of PPH and PE E Programs a Multi Country
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NATIONAL PROGRAMSTOPREVENTAND MANAGEPPH AND PE/E
2012 MULTICOUNTRY ANALYSISUSAID-SUPPORTED COUNTRIES
Jeffrey M. Smith
Sheena Currie
Tirza Cannon
Julia Perri
6 May 2012
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Purpose and Objectives
Address the need for better qualitative andoverarching quantitative data on maternalhealth programs
Provide some broad global and nationaltrends on program priorities in maternalhealth
Identify areas of focus for future programming Both at national and global level
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Methodology
41 Countries
January March 2012
National level
Self reporting of nationalstakeholder group
Data collection
44 item questionnaire
Scale up maps: PPH & PE/E
English, French, Spanish
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2012 Questionnaire on PPH and PE/E
PPH and PE/E
Policy
Training
Logistics
M&E
Programming
Scale Up / Expansion
2011 and 2012questionnaires sameexcept for few questions.
Results comparable butmore precise.
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Collaboration from otherpartners: MSH and VSI
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Results
Responses from 37 countries: All responses complete
7 new countries included: Cambodia, East Timor, Ecuador, El Salvador, Pakistan, Philippines,
Yemen
One country unable to participate this year
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Presentation of Results
Findings in 8 themes 1A: Availability of medicines: Uterotonics
1B: Availability of medicines for PE/E MgSO4and antihypertensives
2: Medicines approved at national level
3: AMTSL
4: Misoprostol
5: Midwife/SBA scope of practice
6: Education / Training in PPH and PE/E
7: Monitoring and evaluation
8: Scale up and bottlenecks
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Presentation of Results
Findings in 8 themes Global status of 2012
Comparisons of questions between 2011 and
2012 Changes by country from 2011 to 2012
Qualitative review of certain data
Full responses to questionnaires
Scale up maps
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THEME 1A: Availability of Uterotonics
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THEME 1A: Availability of Uterotonics
Availability ofUterotonics in
HealthFacilities,
2011 and 2012
n = 31 n = 37
2011
19%
8%
35%
38%
Misoprostol regularly available in facilities
Regularly More than half the time
Less than half the time Never
54%35%
11%
0%
Oxytocin regularly available in facilities
Regularly More than half the time
Less than half the time Never
2012
n = 37
2012
74%
26%
Oxytocin regularly available at facility
Yes No
Message: Oxytocin
availability increasing ;misoprostol availability
needs to be watched
closely
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THEME 1A: Availability of Uterotonics
Misoprostolinclusionon EML,
2011 and 2012
2011 2012
n = 37
57%
43%
Misoprostol on the EML for prevention of PPH
Yes No
61%
39%
Misoprostol on the EML for prevention of PPH
Yes No
n = 31
Message: Misoprostol inclusion on EML is lagging
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Progress in Countries, 2011 2012Oxytocin regularly available in facilities Misoprostol on the EML
2011 2012 2011 2012yes no yes no yes no yes no
Afghanistan Angola Bangladesh Bolivia DRC Ethiopia Eq. Guinea Ghana Guatemala Guinea Honduras India Indonesia Kenya Liberia Madagascar Malawi Mali Mozambique Nepal Nicaragua Nigeria Paraguay Rwanda Senegal South Sudan Tanzania Uganda Zanzibar Zimbabwe
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THEME 1B: Approval and Availability of MgSO4
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THEME 1B: Approval and Availability of MgSO4
Availability of MgSO4 in Health Facilities, 2011 and 2012
2011
2012
49%
27%
24%
0%
MgS04 regularly available in facilities
Regularly More than half the timeLess than half the time Never
2012
48%52%
MgSO4 regularly available in facility
Yes No
n = 31
n = 37
Message: Magnesium availability increasing
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THEME 1B: Approval and availability of MgSO4
Change in the Availability of MgSO4,by Region, 2011 and 2012
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THEME 2: Medicines Approved at the National Level, data 2012, n = 37
First line
anticonvulsants forsevere PE/E
Anti-hypertensivesapproved on national EML
for use in severe PE
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THEME 3: Use of Active Management to prevent PPH, 2012 (n=37)
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THEME 4: Programs to prevent PPH at homebirth using misoprostol
Preventing PPH withmisoprostol: Programpiloting and scale up,
2012 data, n = 37
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What progress have we seen
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Mixed Progress
Increased availability of oxytocin
2011: 74% of countries (23 of 31)
2012: 89% of countries (33 of 37)
Increased availability of MgSO4 2011: 48% of countries (15 of 31)
2012: 76% of countries (28 of 37)
Mixed picture of misoprostol on national EML
Recall that in 2011 misoprostol added to WHO EML 2011: 61% of countries (19 of 31)
2012: 57% of countries (21 of 37)
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Conclusions
Some drugs are more available
We lack coverage data for use of these drugs
Variety in approval of different antihypertensives
Mixed picture of misoprostol on national EML
Some movement in initial programs on use ofmisoprostol
PPH Programs more robust than PE/E Programs
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Thank you
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