Tracking Scale Up of Maternal and Newborn Health Interventions Jeffrey M. Smith MCHIP Interventions...

Tracking Scale Up of Maternal and Newborn Health InterventionsJeffrey M. Smith MCHIP

Interventions for Impact in Essential Obstetric and Newborn CareAfrica Regional Meeting, 21-25 February, 2011

Child Mortality: 4 countries in Africa

2

Chad Ethiopia

Kenya Zambia

Maternal Mortality: 4 countries in Africa

3

Chad Ethiopia

Kenya Zambia

Scale up of PPH and PE/E interventions

4

Where are we? And how do we know?

How far do we have to

go?

Awoonor-Williams, et al. HEALTH POLICY AND PLANNING; 20(1): 25–34

Conceptual Map for Scale Up

Phases of implementation Sequential in logic, not linear in time An attempt to graphically represent the

elements of a scale up approach Not exhaustive or able to capture all

details

6

PATHWAY TO IMPLEMENTATION OF POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships: Global action to support work on reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job

descriptions for skilled birth

attendant cadres managing PPH; PPH

service delivery guidelines

Health system governance:

Proactive financing of maternal health

services

Drugs & equipment:

Oxytocin/ misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or

AMTSL for all skilled birth

attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug List

and in Drug Registration; Supply chain management

National advocacy:

Expansion of national program

and highlight work of champions

Standardization: Quality of care approaches;

Government led training expansion

Programmatic growth:

Adding districts, partners, financing

Training programs: Government

budgeted training programs on PPH; PPH competencies in pre-service and

in-service curricula

Clinical coverage:

High coverage use of a uterotonic;

Public and private implementation

Drug & equipment availability:

Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

MCHIP/USAID active programsOther partners active programsAddressed previously, not activeNo programs

PATHWAY TO IMPLEMENTATION OF POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships: Global action to support work on reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job

descriptions for skilled birth

attendant cadres managing PPH; PPH

service delivery guidelines

Health system governance:

Proactive financing of maternal health

services

Drugs & equipment:

Oxytocin/ misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or

AMTSL for all skilled birth

attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug List

and in Drug Registration; Supply chain management

National advocacy:

Expansion of national program

and highlight work of champions

Standardization: Quality of care approaches;

Government led training expansion

Programmatic growth:

Adding districts, partners, financing

Training programs: Government

budgeted training programs on PPH; PPH competencies in pre-service and

in-service curricula

Clinical coverage:

High coverage use of a uterotonic;

Public and private implementation

Drug & equipment availability:

Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

MCHIP/USAID active programsOther partners active programsAddressed previously, not activeNo programs

Mapping Scale up Process at National Level

Analysis of national/MOH situation Participants and local

counterparts

Consideration of USAID supported efforts or other partner/donor supported efforts

Previous efforts that were fully addressed in the past

9

ANGOLA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships: Global action to support work on reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job

descriptions for skilled birth

attendant cadres managing PPH; PPH

service delivery guidelines

Health system governance:

Proactive financing of maternal health

services

Drugs & equipment:

Oxytocin/ misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or

AMTSL for all skilled birth

attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug List

and in Drug Registration; Supply chain management

National advocacy:

Expansion of national program

and highlight work of champions

Standardization: Quality of care approaches;

Government led training expansion

Programmatic growth:

Adding districts, partners, financing

Training programs: Government

budgeted training programs on PPH; PPH competencies in pre-service and

in-service curricula

Clinical coverage:

High coverage use of a uterotonic;

Public and private implementation

Drug & equipment availability:

Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

MOZAMBIQUE - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

Introducing innovation Moving toward sustainable impact at scale

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

GHANA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

GHS and partners active programingOther partners, with GHS support

Addressed previously, not active

No programs

SOUTH SUDAN - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships: Global action to support work on reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job

descriptions for skilled birth

attendant cadres managing PPH; PPH

service delivery guidelines

Health system governance:

Proactive financing of maternal health

services

Drugs & equipment:

Oxytocin/ misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or

AMTSL for all skilled birth

attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug List

and in Drug Registration; Supply chain management

National advocacy:

Expansion of national program

and highlight work of champions

Standardization: Quality of care approaches;

Government led training expansion

Programmatic growth:

Adding districts, partners, financing

Training programs: Government

budgeted training programs on PPH; PPH competencies in pre-service and

in-service curricula

Clinical coverage:

High coverage use of a uterotonic;

Public and private implementation

Drug & equipment availability:

Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

LIBERIA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

ETHIOPIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

MADAGASCAR- PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

MALAWI - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

NIGERIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

RWANDA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

SENEGAL: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment:

Oxytocin/procurement, logistics,

distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation AMTSL for all skilled birth attendant

cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour0% 25% 50% 75%

100%

MCHIP/USAID active programsOther partners active programsAddressed previously, not activeNo programs

81%

UGANDA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

ZAMBIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

ZIMBABWE: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE

Global ActionsNational Strategic Choices

Program ImplementationSustainability /

InstitutionalizationIntroduction Early Mature

Global advocacy and partnerships:

Global action to support work on

reduction of PPH

Global clinical and program approaches:

Evidence-based interventions for prevention

and management of

PPH demonstrated

PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth

attendant cadres managing PPH;

PPH service delivery

guidelines

Health system governance:

Proactive financing of

maternal health services

Drugs & equipment: Oxytocin/

misoprostol procurement,

logistics, distribution

Service delivery capacity at sites:

Reliable infrastructure, personnel, and

systems to deliver services

Health workers training systems: For PPH

prevention and management

Community mobilization:

Awareness raising of PPH;

Birth preparedness

Pilot programs:Phase 1

implementation of misoprostol and/or AMTSL for all skilled

birth attendant cadres

Program initiatives in obstetric and postpartum

management: Quality of care; Clinical training;

Supervision

Pharmaceutical systems:

Uterotonics on Essential Drug

List and in Drug Registration; Supply chain management

National advocacy:

Expansion of national

program and highlight work of champions

Standardization: Quality of care approaches;

Government led training

expansion

Programmatic growth:

Adding districts, partners, financing

Training programs:

Government budgeted training

programs on PPH; PPH

competencies in pre-service and

in-service curricula Clinical

coverage:High coverage

use of a uterotonic; Public and

private implementation

Drug & equipment availability:Drugs and supplies in

government routine

procurement mechanisms

REDUCTION OF PPH

AND IMPROVE

D MATERNAL HEALTH STATUS

M&EReadiness

assessmentPilot project

dataSurvey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE

Coverage of uterotonic in third stage of labour

0% 25% 50% 75% 100%

National Maps of Scale up Process

Tracking progress over time

Platform for national and international conversation about progress

Identifying gaps and securing additional support / resources.

Please view the posters in the corridor!!

24

Thank you!

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