Prevention of Postpartum Hemorrhage Special Initiative

Project Title: Prevention of Postpartum Hemorrhage Special Initiative.

Project Area: This pilot project is launched in 24 selected sites in Amhara, Oromia and Addis Ababa.

Project coordinator: Dr. Asheber Getachew

The PPH project was initiated by ESOG in February 2003 in collaboration with INTRAH/ PRIME II and the Ministry of Health the main objective being reduction of maternal mortality and morbidity through preventing the occurrence of PPH. This project promotes the universal application( for all vaginal deliveries) of  active management of the third stage of labor as evidence based and low cost intervention to prevent PPH. Major activities include base line assessment , stakeholders meeting, trainings for primary health care providers, development of guideline and community  mobilization and sensitization activities addressing components of safe motherhood  in general focusing on danger signals and importance of utilization of the health institutions.

Project output

Results:

Table 1. Characteristics of the study sites

 Table 2. AMTSL knowledge & practice changes

Table 3 AMTSL knowledge & practice changes, Management of complications

Table 4. Changes in performance factors, Availability of drugs & supplies

Table 5. Changes in performance factors availability/use of guidelines/job aids

Acceptability & support of AMTSL practice

The majority of health workers at the project sites have a very positive attitude towards AMTSL.

An e.g. of  Positive Provider Response.

!“It’s a good procedure, all the staff thinks things are better.  Before this program, it took 15-30 minutes for the placenta to deliver, now it’s 1-3 minutes in most cases. Bleeding is minimal & PPH has decreased.

--Sister Dinbushe Debele, Shashemene Hospital.

Baseline

There was no linkages/activities (1/24).

End evaluation

1. Danger signs posters in use in all institutes.

2. Increased use & demand for BP/CR.

The policy component

• Is favorable from the Ministry of health side. National and facility level formularies include the drugs required for AMTSL.

• Guideline development will be done in collaboration with the MOH.

• Scaling-up of the activities in collaboration with the MOH.

 Challenges & lessons learnt

1. Supply of oxytocic is a great problem (Some sites have problem with constant supply of oxytococs).

2. Lack of refrigerators (few sites have storage problems).

3. Shortage of SBA.

4. Lack of standardized delivery log books to monitor key PPH & RH indicators.

5. Failure to involve providers working in areas of drug management.

6. Low rates of deliveries at facilities.

Conclusion & recommendations

1. Widespread scale-up of AMTSL into a country’s existing maternal and newborn health services is feasible with little inputs and dedicated efforts.

2. The increased demands by providers & community on the availability of BP/CR is an indicator of a need for better care and we recommend its wider use.

3. Working with MOH & related institutes to incorporate AMTSL (WHO standard) and address oxytocin & related supply issues.

4. Development & dissemination of guidelines.

5. Efforts should also focus on integrating PPH training into pre-service training programs [medical, midwifery and nursing school].

6.  Increase an In-service training capacity (TOT), development of in service training curriculum, distance learning approaches.

7. Low institutional delivery may necessitate the use of misoprostol as an additional intervention.

8. Dissemination of results in all forums.

Current status: Phased out.