Transcript Scale up schematic, Jeff Smith (MCHIP)

Tracking Scale Up of
Maternal and Newborn
Health Interventions
Jeffrey M. Smith
MCHIP
Interventions for Impact in
Essential Obstetric and Newborn Care
Africa Regional Meeting, 21-25 February, 2011
Child Mortality: 4 countries in Africa
Chad
Kenya
Ethiopia
2
Zambia
Maternal Mortality: 4 countries in Africa
Chad
Kenya
Ethiopia
3
Zambia
Scale up of PPH and PE/E interventions
Where are we?
How far do we
have to go?
4
And how do
we know?
Awoonor-Williams, et al. H
POLICY AND PLANNING;
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 Actions
National Strategic
Choices
Health system
governance:
Proactive financing of
maternal health
services
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
Program Implementation
Introduction
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
MCHIP/USAID active programs
Other partners active programs
Addressed previously, not active
No programs
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies in
pre-service and inservice curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all skilled
birth attendant
cadres
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use of
a uterotonic; Public
and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies in
government routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
M&E
Mature
Community
mobilization:
Awareness raising of
PPH;
Birth preparedness
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Drugs & equipment:
Oxytocin/ misoprostol
procurement,
logistics, distribution
Early
Sustainability /
Institutionalization
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
PATHWAY TO IMPLEMENTATION OF
POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing of
maternal health
services
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
Program Implementation
Introduction
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
MCHIP/USAID active programs
Other partners active programs
Addressed previously, not active
No programs
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies in
pre-service and inservice curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all skilled
birth attendant
cadres
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use of
a uterotonic; Public
and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies in
government routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
M&E
Mature
Community
mobilization:
Awareness raising of
PPH;
Birth preparedness
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Drugs & equipment:
Oxytocin/ misoprostol
procurement,
logistics, distribution
Early
Sustainability /
Institutionalization
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
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 Actions
National Strategic
Choices
Health system
governance:
Proactive financing of
maternal health
services
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
Program Implementation
Introduction
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies in
pre-service and inservice curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all skilled
birth attendant
cadres
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use of
a uterotonic; Public
and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies in
government routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
M&E
Mature
Community
mobilization:
Awareness raising of
PPH;
Birth preparedness
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Drugs & equipment:
Oxytocin/ misoprostol
procurement,
logistics, distribution
Early
Sustainability /
Institutionalization
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
MOZAMBIQUE - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
Standardization:
Quality of care
approaches;
Government led
training expansion
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
Introducing innovation
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
Moving toward sustainable impact at scale
GHANA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Sustainability /
Institutionalization
GHS and partners active
programing
Other partners, with GHS support
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Addressed previously, not
active
No programs
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
SOUTH SUDAN - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing of
maternal health
services
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
Program Implementation
Introduction
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies in
pre-service and inservice curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all skilled
birth attendant
cadres
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use of
a uterotonic; Public
and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies in
government routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
M&E
Mature
Community
mobilization:
Awareness raising of
PPH;
Birth preparedness
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Drugs & equipment:
Oxytocin/ misoprostol
procurement,
logistics, distribution
Early
Sustainability /
Institutionalization
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
LIBERIA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
ETHIOPIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
MADAGASCAR- PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
MALAWI - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Health workers
training systems:
For PPH prevention
and management
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Readiness
assessment
Program Implementation
Introduction
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Programmatic
growth:
Adding districts,
partners, financing
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Sustainability /
Institutionalization
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
NIGERIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
RWANDA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
SENEGAL: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Program Implementation
Introduction
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
National advocacy:
Expansion of
national program
and highlight work
of champions
Pilot programs:
Phase 1
implementation
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Drugs & equipment:
Oxytocin/procureme
nt, logistics,
distribution
Early
Mature
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
MCHIP/USAID active programs
Other partners active programs
Addressed previously, not active
No programs
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Sustainability /
Institutionalization
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
25%
50%
75%
100%
81%
M&E
Readiness
assessment
Pilot project
data
INTRODUCING INNOVATION
Survey data
Indicators in
HMIS
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
UGANDA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
ZAMBIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
ZIMBABWE: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National Strategic
Choices
Health system
governance:
Proactive financing
of maternal health
services
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
Introduction
Pilot programs:
Phase 1
implementation of
misoprostol and/or
AMTSL for all
skilled birth
attendant cadres
Service delivery
capacity at sites:
Reliable
infrastructure,
personnel, and
systems to deliver
services
Program initiatives
in obstetric and
postpartum
management:
Quality of care;
Clinical training;
Supervision
Health workers
training systems:
For PPH prevention
and management
Pharmaceutical
systems:
Uterotonics on
Essential Drug List
and in Drug
Registration; Supply
chain management
Readiness
assessment
Early
Mature
Community
mobilization:
Awareness raising
of PPH;
Birth preparedness
PPH policy:
AMTSL/misoprostol
use; Expanded job
descriptions for
skilled birth
attendant cadres
managing PPH; PPH
service delivery
guidelines
Drugs & equipment:
Oxytocin/
misoprostol
procurement,
logistics, distribution
M&E
Program Implementation
Sustainability /
Institutionalization
Training programs:
Government
budgeted training
programs on PPH;
PPH competencies
in pre-service and
in-service curricula
National advocacy:
Expansion of
national program
and highlight work
of champions
REDUCTION
OF PPH
AND
IMPROVED
MATERNAL
HEALTH
STATUS
Clinical coverage:
High coverage use
of a uterotonic;
Public and private
implementation
Standardization:
Quality of care
approaches;
Government led
training expansion
Programmatic
growth:
Adding districts,
partners, financing
Drug & equipment
availability:
Drugs and supplies
in government
routine
procurement
mechanisms
Coverage of uterotonic in third stage of labour
0%
Pilot project
data
INTRODUCING INNOVATION
25%
Survey data
50%
75%
Indicators in
HMIS
100%
Routine monitoring
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
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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