Country Team Action Plan

Scale –up of Misoprostol for Prevention of PPH

NEPAL

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2

Where do we want to be?GOALS

• To increase availability and accessibility to uterotonic (Inj oxytocin at HF, Misoprostol at community) for prevention of postpartum hemorrhage. Priority is the use of AMTSL, delivery at health facility.

• Misoprostol National level scale up in remote areas.

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3

Hard to Reach…….

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Where are we now?• One district piloted (Banke) in 2007• Scale-up in 8 more districts (population covered:

~ 10% ): – Roll out ongoing in 6 districts, Planned for 3 districts

• National Misoprostol Technical Working Group formed

• Remote Area Guidelines developed and implementation ongoing

• Implementation guidelines developed (Draft)• Monitoring and evaluation plan developed.• Misoprostol included into the National Essential

Drug List

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Where We Are Now

DOLPA

MUGU

JUMLA

KAILALI

BARDIYA

HUMLA

DOTI

SURKHET

NAWALPARASI

KAPIL-

BASTU RUPAN-DEHI

DANG

BANKE

ACHHAMKALIKOT

JHAPAMORANG

SIRAHA

SAPTARI

DARCHULA

BAJHANG

BAITADI

DADEL-DHURA

KANCHAN-PUR

BAJURA

PARSABARA RAUT-

AHAT

DHANUSA

MAHO-TARI

SUNSARI

SARLAHI

DHADING

MAKAWAN-PUR

CHITWAN

KASKIBAGLUNG

TANAHU

PALPA

SYANGJA

PARBAT

ARGHAKHACHI

GULMI

UDAYAPUR

SINDHULI

ILAM

BHOJ-PUR

DHAN-KUTA

TAPLEJUNG

RAMECHHAP

OKHAL-DHUNGA

TERHA-THUM

KHOTANG

LALIT

BHAK

KATHMMANDUSULUK-HUMBU

DOLAKHA

SANKHUWA-SABA

NUWAKOTSINDHU-PALCHOK

KAVRE

RASUWALAMJUNG

GORKHA

PYUT-HAN

ROLPA

SALYANMYAGDI

DAILEKHJAJARKOT

RUKUM

MUSTANG

MANANG

PANCHTHAR

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Mountain

Hills

Terai

Nepal

75 districts

Each district consists of

VDC

Each VDC has nine ward & Health Facility

FCHV

Mothers group

Each ward has 80-100 households and there is a Female Community Health Volunteer (FCHV) who provides maternal and child care services in the community. In each ward there is also a mother group coordinated by FCHV for community mobilisation

12

3

5

7

4

96

8

Nepal’s Administrative and

Health Structure

Settlement

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What are the gaps?

• PPH is one of the leading causes of maternal deaths

• Low uterotonic coverage (Oxytocin or Misoprostol)

• High home births, Low institutional deliveries,

• Low Staff retention in remote area

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What interventions can we use to close the

gap?• Promote institutional deliveries• Promote Active management of third

stage of labour for every birth conducted by SBAs

• Use of Misoprostol for prevention of postpartum hemorrhage at home birth

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What are the possible challenges to the

intervention?• Overcoming resistance from

Professional organizations and WHO• Preventing unintended use • Monitoring of coverage and

compliance• Ensuring proper counselling• Maintaining quality at scale

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Who are the possible partners, allies, and

stakeholders?• Government of

Nepal• USAID• UNICEF• INGOs • Professional

Organizations: NESOG, PESON, SOPHPN

• DPHO• HFs• FCHVs• HFOMC• Communities

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What are our action steps?

Action Step Responsible Person

Timeline

1. GON Approval for Program Scale-up

Dr Naresh P KC, FHD

May 2010

2. Develop Country Action Plan (Implementation Plan, M&E Plan, Cost)

FHD, jointly with partners

July 2010

3. Dissemination of program to wider audience (EDPs, Program Divisions, Professional Organization etc)

FHD July 2010

4. Develop Procurement Plan

FHD, LMD and partners

August 2010

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What are our action steps?

Action Step Responsible Person

Timeline

5. Revise, update and Print training and BCC materials

FHD, NHTC, NHEICC, HMIS/MD

and partners

June 2010

6. Update M&E tools and systems

FHD, HMIS/MD and partners

June 2010

7. District Planning and Orientation

FHD, RHD, D(P)HOs and

partners

August 2010

onwards

8. Conduct Training(ToT, District and HF Training, Community Training)

FHD, NHTC and partners

August 2010

onwards

9. Program Implementation and Monitoring

FHD, RHD, D(P)HO and

partners

August 2010

onwards

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