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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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