PATH

PATH is an international, nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public- and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH’s work improves global health and well-being. For more information, please visit www.path.org.

Oxytocin Initiative (OI) Project

The overall goal of the Oxytocin Initiative (OI) Project is to improve maternal health and survival in resource-poor settings. The project will do this through creating a strong evidence base to support expanded use of the lifesaving drug oxytocin, particularly at the peripheral level and in the community.

PATH works in collaboration with the Johns Hopkins Bloomberg School of Public Health ; RTI International; and research partners in India and Ghana, including the Social and Rural Research Institute, Kintampo Health Research Centre, and the Regional Institute for Population Studies, to implement this project, which builds on experience gained through the USAID-funded Prevention of Postpartum Hemorrhage Initiative (POPPHI). The current OI Project is supported by the Bill & Melinda Gates Foundation.

The primary objectives of the OI Project are to:

  • Increase the evidence needed to maximize the safe use of oxytocin in one country.
  • Improve the knowledge base and define the factors leading to misuse of oxytocin and other uterotonics in two selected countries.
  • Improve the availability of evidence on how to maximize safe use and minimize misuse of oxytocin.

To achieve these objectives, the OI Project will carry out two distinct types of research:

  • Landscape reviews to explore how uterotonics are being used and distributed at or around birth in Uttar Pradesh and Karnataka in India, and the Northern, Brong Ahafo, and Western regions in Ghana.
  • Community-based trials in the Kintampo and Nkoranza districts in the Brong Ahafo region, Ghana.

The primary objective of the community-based trials is to determine the effectiveness of intramuscular administration of 10 IU of oxytocin in the Uniject™ device during the third stage of labor at reducing the risk of PPH, and the secondary objectives are to:

  • Document the frequency of inappropriate use of oxytocin.
  • Document the occurrence of adverse maternal and fetal/newborn outcomes associated with inappropriate use of oxytocin.
  • Document logistical issues pertaining to expanded coverage of oxytocin for PPH prevention, i.e., adequate storage, appropriate disposal of the Uniject™ device, and changes over time in health worker practices.
  • Assess the reliability of women’s self-report on medical and traditional care received during labor and delivery (Ghana only).

The strength of the project is its focus on rigorous evaluation and research of new strategies to maximize the safe use of oxytocin, and its documentation of key issues related to oxytocin’s misuse. A commodity supply component complements the research work, and the project will provide technical support for the manufacture of oxytocin in Uniject™ in India, and will support establishment of import and supply chains in Ghana.

Fact Sheet for the Oxytocin Initiative Project.

Prevention of Postpartum Hemorrhage Initiative (POPPHI)

The Prevention of Postpartum Hemorrhage Initiative (POPPHI) was a five-year project awarded to a partnership of PATH, RTI International, EngenderHealth, the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) on July 29, 2004. The project officially ended on December 31, 2009.

The POPPHI Project was part of the United States Agency for International Development’s (USAID’s) broader Special Initiative to reduce postpartum hemorrhage, the single most important cause of maternal deaths worldwide, through expanded use of Active Management of the Third Stage of Labor (AMTSL). AMTSL is an intervention that reduces the incidence of postpartum hemorrhage by up to 60 percent. The Special Initiative worked to achieve the following results:

  • Expand AMTSL through non-training approaches to improve provider practice.
  • Improve the quality and availability of AMTSL at facilities.
  • Improve the quality and availability of AMTSL at the community level.
  • Make uterotonic drugs and devices available at low cost to countries.

Under the umbrella of the Special Initiative, POPPHI provided technical and managerial support for leadership and implementation of the Special Initiative. POPPHI’s role was to:

  • Assist USAID to coordinate and collaborate with all implementing partners and new partners, especially regulatory agencies in countries and partners in the private sector.
  • Support professional associations for the launch of the November 2003 joint ICM/FIGO statement on AMTSL.
  • Develop and implement a small grants program to assist local country professional associations to promote AMTSL.
  • Provide USAID Missions and Regional Bureaus with technical assistance for focused activities in countries and regionally as needed.
  • Monitor the uptake of AMTSL globally, whether funded centrally, through field support or Mission bilateral programs, or by other donor and/or host country health programs.

The final document created by the POPPHI team, which highlights the work done over its five year history can be found here.