USAID Technical Series: Prevention and Management of PPH and PE/E

Yesterday afternoon, a group of maternal health practitioners met at the Ronald Reagan Building in Washington, DC. Dr. Jeffrey M. Smith of MCHIP gave a presentation on a report he co-authored called “Prevention and Management of Postpartum Hemorrhage and Pre-Eclampsia/Eclampsia” (PDF) as part of the USAID Maternal Health Technical Series.

The paper reports on various themes and topics such as the active management of the third stage of labor, education and training, misoprostol, and magnesium sulfate. Dr. Smith and his colleagues collected survey responses from groups in 31 countries on their maternal health policies, implementation and management.

They developed some binary metrics (Yes/No) to determine how far along a given country is in their maternal health efforts to provide a global snapshot. Then, the answers were represented in graphs to allow readers to see where gaps may exist. For example, their research found that all 31 countries surveyed had national policies in place for the use of magnesium sulfate use for preeclampsia/eclampsia, however, in only 48% of countries was magnesium sulfate regularly available in facilities. Dr. Smith argues that this indicates that we do not necessarily need to worry about national policy but drug availability.

Finally, the conversation turned towards the need for better data and more detail on maternal health. Most of our metrics, number of antenatal care visits or percentage of births attended by a skilled professional, are based simply on contact with the health system, but do not reveal anything about the content or quality of those visits. Dr. Smith also lamented the fact that we only have regional data for causes of maternal death, while for child mortality, country level data is available.

The report then lays about concept maps to show the progress being made (or lack thereof) in the 31 surveyed countries. Each indicates where programming is completed, exists, or does not exist on topics relating to PPH and PE/E.

The report concludes:

Findings from this survey indicate a disparity between nationally approved policies and education guidelines to reduce PPH and PE/E and actual services delivered. Multiple, creative approaches are needed—and are being implemented—to address this gap between policy and practice. Possible approaches include quality improvement initiatives, change management strategies and mHealth approaches…More emphasis must be placed on training and supervision to increase utilization of high impact interventions, specifically use of AMTSL and MgSO4. This analysis also demonstrated the need to consider and address indirect utilization barriers for these high-impact interventions.