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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