Pathfinder International
Pathfinder’s Clinical and Community Action to Address Postpartum Hemorrhage (PPH) Project is a comprehensive approach to reducing deaths and morbidity from PPH, with a three-component, integrated model, which includes:
- Advocacy to promote government support. Creating an enabling environment around policy and protocols, drugs and blood supply, sustainability, and eventual scale-up.
- Clinical interventions. Prevention of PPH with active management of the third stage of labor (AMTSL), promoting misoprostol for prevention and treatment, standardized skills to estimate blood loss accurately, recognition and treatment of PPH, and prevention and treatment of shock. The non-pneumatic anti-shock garment (NASG) is used to reverse shock, slow bleeding, and stabilize women until they can reach definitive treatment, i.e., surgery and blood replacement.
- Community engagement and transport at the ready. Raising awareness of PPH and other pregnancy and childbirth complications, through government outreach workers and community-based organizations, and enabling action through organized transport developed by each village and neighborhood, accessible to all community members, for rapid transfer to an appropriate, prepared facility.
Different adaptations of the model include the following:
In India and Nigeria, initially, the programs include all three components. Since 2007, thousands of providers have been trained; hundreds of thousands of births have been affected; and hundreds of thousands of community members are being engaged in information sharing, birth and transport planning, in blood donation promotion, anemia correction, etc. Nigeria’s program is in seven states; India’s is in four, and adding one more. Both are currently engaging and assisting their governments in scale-up activities.
In Bangladesh, the project is almost entirely directed at women having births at home. Community agents conduct careful teaching and follow-up of families and distribute birth kits, including misoprostol to take immediately after the birth and a standardized blood mat to recognize PPH promptly. In Tanzania, the three-level model is being implemented in a Congolese refugee camp and its surrounding communities, including training of midwives and physicians in emergency obstetric care and use of the NASG. In Peru, the project focuses on the Ministry of Health, medical schools, and societies around the model, particularly the NASG to address shock.
The model can easily address the other leading causes of mortality, through clinical updates and addition of community messages, and pre-eclampsia is currently being rolled into the Nigeria, India, and Bangladesh programs.
For more information, visit our website at www.pathfinder.org.