Implementing Organizations

Goal

Objectives

Activities

Society of Obstetricians and Gynecologists of Pakistan (SOGP)

General Secretary: Razia Korejo

Midwives Association of Pakistan (MAP):

President: Imtiaz Kamal

To reduce the incidence of postpartum hemorrhage in Pakistan.

Promote active management of the third stage of labor (AMTSL).

Complete a training of trainers (TOT) in selected facilities of Punjab and Sindh.

Implement AMTSL in Punjab & Sindh.

Strengthen collaboration between ob/gyns and midwives.

Print and disseminate leaflets.

Implement pilots in five facilities each in Lahore and Karachi in year one.

Expand pilot projects to include four more facilities in each city in year two.

Updates :

July 2006: The project members of SOGP and MAP have met to discuss the project and finalize the list of health facilities to include in both Karachi and Lahore. Five facilities were chosen for each area using the previously outlined criteria. The content of the leaflet to be used for training and distribution was finalized, and its Urdu translation was reviewed. The members also selected four people for the consensus group, which consisted of ob/gyns and midwives.

SOGP and MAP members meeting with Deborah Armbruster in January 2006.

Implementing Organizations

Goal

Objectives

Activities

Nursing Association of Nepal (NAN) President: Sarala KC

Nepal Society of Obstetricians and Gynecologists (NESOG)

President: Chanda Karki

To strengthen the use of AMTSL in selected health facilities of four regions of Nepal.

Advocate.

Build the capacity of nurse midwives/doctors in four regions.

Increase access/utilization in four regions.

Share information with NESOG and NAN members.

Create a joint taskforce with members of NAN and NESOG.

Develop training materials.

Complete a half-day advocacy workshop for policymakers/trainers.

Complete two-day trainings in four regions.

Monitor project activities.

Updates:

January 2006: NAN and NESOG conducted an advocacy workshop for policymakers, decision makers, and program managers. This was the first activity of the project. All concerned Directors in-country gave their best wishes for a successful start and expressed their appreciation for this joint initiative.

July 2006: The associations formed the consensus group, which consists of five leadership members of both NAM and NESOG. The consensus group completed the national-level baseline survey.

NESOG members in PPH workshop.

Implementing Organizations

Goal

Objectives

Activities

Bolivian Society of Obstetrics and Gynecology
President: Luis Zárate Pereira

National Scientific Society of Obstetric Nurses

President: Emiliana Pallares Camargo

To train 33% of doctors and midwives in AMTSL in Bolivia’s nine departments.

Develop cognitive skills.

Develop practical skills.

Create multiplier agents in each region (nine national departments/states).

Develop materials for training.

Run three workshops (three departments/states will attend each workshop.

Select three health centers to run pilot tests (probably one from each region where workshop took place).

Develop a plan of action for creating multiplier agents.

Updates:

Implementing Organizations

Goal

Objectives

Activities

Peruvian Society for Obstetrics and Gynecology (SOGP)

President: Miguel Gutiérrez Ramos

Peruvian Midwifery Association (COP)

President: Rosa Elena Lara Valderrama

To sensitize 600 social actors in AMTSL and to train 200 professionals (32 doctors and midwives at a national level) in 100 health facilities to conduct AMTSL with quality.

Increase the attention to AMTSL in order to contribute to the decrease of maternal mortality in the selected areas.

Sensitize social actors.

Develop and accredit competencies in professional medical doctors and midwives in AMTSL through training. 

Increase number of health services that treat and register AMTSL with quality.

Sensitize.

Train providers.

Train trainers/facilitators.

Conduct AMTSL services.

Implementing Organizations

Goal

Objectives

Activities

Association of Obstetricians and Gynaecologists of Uganda (AOGU)

President: Wasswa Ssalogo

Uganda Private Midwives Association (UPMA)

President: Sakina Kuggundu

To expand the use of AMTSL and reduce postpartum-related maternal deaths through collaboration between policymakers and other professional bodies.

Establish functional collaboration between UPMA and AOGU and establish a training and advocacy task force of five members from each association.

Review training schools’ curricula and clinical guidelines to emphasize AMTSL and train private and public midwives, doctors, and related auxiliary staff on contemporary postpartum and newborn care.

Create networks and develop partnerships with the Ministry of Health (MOH), education, finance, and local government to change uterotonic drug practices in the country.

Pilot AMTSL in two selected districts.

Debrief AOGU and UPMA members about the East Africa Regional Workshop on AMTSL held in Lusaka, Zambia and select the task force and its terms of reference.

Hold consensus meetings with the heads of training institutions and MOH, ministry of education, and the World Health Organization (WHO) country office on uterotonic drug use and the updating of training curricula for all cadres and clinical guidelines to include current version of AMTSL.

Train health workers in the two selected districts on contemporary postpartum care and newborn care using the available training modules.

Carry out support supervision of the trainees and carry out AMTSL-related surveys.

Updates:

April 2006: Representatives of UPMA and AOGU participated in the Preventing Postpartum Hemorrhage in Africa Conference in Entebbe.

Implementing Organizations

Goal

Objectives

Activities

Ethiopian Nurse Midwives Association (ENMA)

President: Kiros Kebede

Ethiopian Society of Obstetricians and Gynecologists (ESOG)

President: Solomon Kumbi Hawas

To contribute towards the reduction of maternal mortality and morbidity through introduction and implementation of AMTSL.

Increase the number of nurse, midwifery, health officer, and medical graduates with knowledge and skills of AMTSL in ten training institutions in one year.

Introduce and disseminate AMTSL standard treatment guideline and quick reference management posters nationwide.

Sensitize and orient 10 heads of schools; train 20 tutors/instructors on AMTSL; and develop and distribute 36 training materials and evidence.

Dialogue, sensitize, and orient 12 health mangers; print, duplicate, and distribute 2,000 guidelines; print and distribute 2,000 quick reference management posters.

Solomon Kumbi Hawa, President, ESOG

Sr. Kiros Kebede, President, ENMA

Updates:

April 2006: Representatives of ESOG and ENMA participated in the Preventing Postpartum Hemorrhage in Africa Conference in Entebbe.

Ethiopia country team at the Entebbe conference.

Implementing Organizations

Goal

Objectives

Activities

Association of Malawian Midwives (AMAMI)

President: Lennie Kamwendo

Association of Malawian Obstetricians and Gynecologists

Interim Chairperson: G.E. Kafulafula

Networks: White Ribbon Alliance for Safe Motherhood and The Reproductive Health Unit of the MOH.

To halt the current trend of rising maternal mortality.

Train all obstetricians, midwives, doctors, and 100 clinical officers in AMTSL.

Achieve relevant policy changes regarding oxytocics through collaboration with MOH’s Reproductive Health Unit.

Carry out training activities to ensure that all district Safe Motherhood Trainers (29 districts) attain knowledge, skills and appropriate attitudes regarding AMTSL.

Train at least 5 key persons from the Health/Training Institutions so that they can participate in influencing curricular changes.

Advocate for oxytocin to become the first-line drug for AMTSL at all levels of the health care system in Malawi and that the drug should be available at all times. Advocate that Ergometrine, which is the current first-line drug, should be withdrawn from health centers and only be available at district and central hospitals.

Updates:

April 2006: Representatives of AMAMI and the Association of Malawian Obstetricians and Gynecologists participated in the Preventing Postpartum Hemorrhage in Africa Conference in Entebbe.

Ausbert Thoko Msusa and Lennie Kamwendo at the Entebbe conference.

July 2006: The Malawi project group met with several key government and health officials in the country in an effort to garner support for the training to disseminate AMTSL and proposed policy changes to replace ergometrine with oxytocin as the first-line drug throughout the health care system. The baseline survey tool was administered to all prospective participants at the training, with a 42 percent response rate. Additionally, the survey tool will be administered again to all the participants at the training who did not respond. The team continues to plan the first of the training activities to take place at the end of July, tentatively July 20 and 21.

Implementing Organizations

Goal

Objectives

Activities

Society of Obstetrician and Gynecologist of Ghana (SOGOG)

President: K. Apea-Kubi

Ghana Registered Midwives Association (GRMA)

President: Ernestina Djokotoe

To ensure universal application of AMTSL in the ten regions of Ghana.

Disseminate the practice of AMTSL to 100 trainers in various hospitals, clinics, and maternity homes in the country.

To take trainers through the practice of AMTSL, first on the model and then on a laboring client.

Encourage trainers to teach and practice AMTSL in their institutions.

Promote the use of oxytocin as the drug of choice in AMTSL.

Ensure proper storage procedures for uterotonics used in AMTSL.

In the medium to long term, develop monitoring and evaluation of the practice of AMTSL by the service providers.

Organize two in-country workshops involving the northern and southern parts of the country. The southern part will comprise: Western, Central, Volta, Eastern, and Greater Accra regions. The northern part will include the Upper West, Upper East, Northern, Ashanti, and Brong Ahafo regions.

Brief the MOH and the Director of Reproductive Health about the POPPHI and AMTSL workshop in Lusaka, Zambia.

Updates:

April 2006: Representatives of SOGOG and the GRMA participated in the Preventing Postpartum Hemorrhage in Africa Conference in Entebbe.

Kwasi Apea Kubi and Ernestina Djokotoe at the Entebbe Conference

July 2006: The joint SOGOG and GRMA program planning committee organized its first of two dissemination workshops on AMTSL in the southern city of Accra, March 22 to 24, 2006. The workshop was comprised of lectures and discussions aimed to ensure the application of AMTSL throughout the ten regions of Ghana. 27 health professionals (including an ob/gyn specialist, doctors in charge of reproductive health, and midwives from both the public and private sector) attended the workshop, which was designed for the southern sector of Ghana. Attendees were given information on AMTSL and evidence-based research supporting its utility; presented with data on regional statistics of postpartum maternal hemorrhage and pre-workshop management of the third stage of labor; presented with and then practiced the skills in AMTSL; and participated in a discussion of the role of health professionals in the dissemination of AMTSL. As a result of this workshop, the attendees were encouraged to develop and implement further dissemination of the important benefits and skills involved in AMTSL within their local regions.

Country

Implementing Organizations

Goal

Objectives

Activities

TANZANIA

Tanzania Midwives Association (TAMA)

President: Freddy Mwanga

Association of Gynaecologists and Obstetricians of Tanzania (AGOTA)

Richard S.M. Lema

Private Nurses and Midwives Association (PRINMAT)

Representative: Keziah May Kapesa

To update the knowledge and skills of health care providers on current practice of AMTSL in the three Municipal hospitals.

Review the two types of placenta delivery (physiology vs. active management).

Discuss the current practice of third stage of labor.

Demonstrate and return demonstrate AMTSL using an obstetrical model.

Conduct regular supportive supervision, monitoring, and evaluation to the trained health providers.

Conduct a needs assessment using baseline survey; select 45 appropriate maternity health care providers (private and public).

Conduct 2-day workshop in each municipal hospital on AMTSL. Each session will have 15 participants from one municipality.

Hold a dissemination workshop for stakeholders, including MOH officials and members of the academic institutions (medical schools, midwifery schools, and nursing schools).

Updates:

April 2006: Representatives of TAMA and AGOTA participated in the Preventing Postpartum Hemorrhage in Africa Conference in Entebbe.

Mary Chuwa and Richard Lema at the Entebbe conference.

Implementing Organizations

Goal

Objectives

Activities

Society of Obstetricians and Gynecologists of Benin and Togo—Benin section

President: José de Souza

The Association of Midwives of Benin

President: Laurence Odounlami Monteiro

To promote maternal and child health.

To contribute to the reduction of the maternal and child morbidity and mortality rates.

To lead health service providers to strive for the reduction of mothers’ morbidity and mortality rates due to postpartum hemorrhage.

To carry out a situational analysis of the management of the third stage of labor.

To build the capacities of the various service providers in managing postpartum hemorrhage.

To mobilize the community for support and attendance of health centers.

Design the baseline evaluation project, work out a chronogram, implement the situational analysis (operational research of postpartum hemorrhage, inventory of service providers, drugs, and material resources), and disseminate the results.

Purchase didactic, audiovisual, and logistical materials.

Complete training of trainers and training of service providers (in total 60 midwives and 30 ob/gyns in 30 districts).

Organize information and awareness meetings of women’s associations; present programs on community radios; inform religious leaders and development associations.

Participants of ASFB and SGOBT joint meeting.

Updates:

July 2006:  A joint team of representatives from the Public Health Ministry, ASFB, and SGOBT carried out their preliminary analysis of the use of AMTSL among doctors and midwives working in 17 private and public maternity hospitals located in two areas of the country.  The survey found that out of 52 midwives interviewed, 22 (42.3 percent) performed AMTSL at every labor; only 4 of the 10 ob/gyns surveyed followed AMTSL protocol during delivery. It was also found that implementation of oxytocin as a first-line drug was favorable; 14 of the hospitals surveyed had cold-chain capabilities. Deaths due to PPH were found to be around 1,608 deaths per 100,000 live births. The group found that there were areas in which significant improvement and dissemination of information on AMTSL would help to reduce the number of maternal deaths due to postpartum hemorrhage.

Implementing Organizations

Goal

Objectives

Activities

Malian Society of Gynecologists and Obstetricians (SOMAGO)

President: Mariam Diakité

Association of Midwives of Mali (ASFM)

President:

Mrs. Dicko Fatoumata Maïga

To improve AMTSL coverage in Mali.

Improve the frequentation of health centers in terms of birth.

Reinforce the competencies in AMTSL of providers in the region of Mopti.

Broadcast radio announcements to the intended households/ community.

Hold conference/debates intended for the women’s association leaders and the communities.

Ensure the training of health workers in the region of Tombouctou in AMTSL.

Ensure the follow-up/evaluation of trained health workers.

Complete the activity report for Mali.

Updates:

April 2006:  Representatives of SOMAGO and ASFM participated in the Preventing Postpartum Hemorrhage in Africa Conference in Entebbe.

Boubacar Traore, Fatoumata Dicko, and Cheick Touré (IntraHealth/Mali Country Director) at the Entebbe conference.  

Implementing Organizations

Goal

Objectives

Activities

Société des Gynécologues obstétriciens du Cameroun (SOGOC)

President: Robert Ivo Leke

Ordre national des professionnels médico-sanitaires (ONPMS)

President: Amungwa Nche

To use the two national professional associations to accelerate the diffusion and implementation of active management of the third stage of labor.

Establish the baseline to assist in measuring impact at could and serve as a lobbying instrument.

Ensure the training of providers in AMTSL in pilot sites that will serve as models for the dissemination of the technique that will follow.

Conduct a preliminary survey to establish baseline data; will collect registry information for 8 selected sites. The information collected will permit us to know the number of people who know or use AMTSL and to appreciate the mortality and morbidity connected to postpartum hemorrhage.

Train 25 providers over a period of 3 days organized in Yaoundé. Training will consist of 2 days of theoretical training and practice on the mannequins and one day of field practice in the maternities.

Evaluation and supervision after 3 months. This will take place over one week. This is for the purpose of determining new pilot sites that will be chosen, the impact of the training, and the difficulty in putting AMTSL in place. Use of the baseline survey data will enable us to better appreciate the change.

Implementing Organizations

Goal

Objectives

Activities

Société d’obstétriciens gynécologues Burkinabé (SOGOB)

President: Jean Lankoande

Association Burkinabé de Sage-femme et de maïeuticiens (ABSF/M)

President: Maimouna Foro

To contribute to the reduction of maternal mortality through the use of AMTSL.

Train personnel in AMTSL.

Ensure the availability of materials needed for AMTSL.

Implement AMTSL in sites with trained personnel.

Measure the impact of the training in AMTSL.

Advocate to the authorities and sensitize the population as to the importance of AMTSL.

Conduct a needs assessment to demonstrate the problem and the needs in human resources, materials, and training.

Evaluate prospective sites.

Identify midwives and state nurses of Ouagadougou who are not already trained in AMTSL.

Manage the identification and gathering of equipment.

Mobilize additional resources, if necessary.

Train all the providers in the pilot zone (create the curricula for training, complete the training sessions).

Ensure the monitoring and evaluation of the implementation of the intervention.

Implementing Organizations

Goal

Objectives

Activities

Sociedad Paraguaya de Ginecología y Obstetricia

President: Andrés Ginés

Asociación de Obstetras del Paraguay

President: Wilfrida Sosa

To achieve a 60% reduction in postpartum hemorrhage in the targeted services.

To implement AMTSL in targeted sites.

To implement evidence-based practices in obstetric emergencies.

Implement training workshops in the following sites:

Hospital Materno Infantil San Pablo

Hospital General Barrio Obrero

Hospital Regional de Ciudad del Este

Hospital Regional de San Estanislao

Hospital Regional de la ciudad de Encarnación

Hospital Regional de la ciudad de Luque

Hospital Central del Instituto de Previsión Social

Implementing Organizations

Goal

Objectives

Activities

Sociedad Dominicana de Obstetricia Ginecologia

President: Jose Figueroa Mendez

Nursing School of the Autonomous University of Santo Domingo

Representative: Ana Julia del Rosário

To decrease the rate of maternal morbidity and mortality as a result of postpartum hemorrhage in 10 selected hospitals of the public health sector.

Update and strengthen labor providers’ skills in AMTSL in 10 selected hospitals.

Implement AMTSL strategy in the 10 selected hospitals.

Monitor, evaluate, and document project progress and results.

Develop a training program on AMTSL based on the guidelines, evidence-based documents, and curricula developed by WHO and Cooperative Agencies.

Coordinate with local stakeholders on program training activities and timeline for the project implementation.

Identify and acquire the needed training and clinical materials (anatomical models, delivery kits, oxytocin, and reference documents).

Implement 10 one-day training workshops, at each selected hospital for 20 service providers (doctors and nurses from labor and delivery rooms).

Hold a motivational and induction meeting with local stakeholders to guarantee the implementation of the active management protocol.

Hold information and education activities to involve and empower the community to request AMTSL.

Identify and distribute the needed educational materials for clients.

Gather quali-quantitative information baseline data related to labor care and availability of human resources.

Develop and implement a monitoring plan to assess the implementation process and performance and develop needed modifications.

Hold an evaluation at the end of the project and gather information to share with providers, regional and MOH stakeholders, opinion leaders, and funding agencies.

Updates:

July 2006:  The project team has been coordinating with SESPAS (public health ministry). They held a meeting with the Director of DIGEMIA (MOH, Maternal, Infant and Child Health Division) and the maternal mortality coordinator to reevaluate hospitals previously selected to participate. Hospitals were selected based on SESPAS' planned activities within the strategic framework of Zero Tolerance that is being implemented by the Health Secretary. The group selected two additional hospitals in Azua and Salcedo provinces to participate.Hospitals in La Vega, Santiago, and Barahona districts were excluded, resulting in a final total of nine hospitals involved in the project.

DIGEMIA arranged visits to the hospitals to meet with hospital personnel to provide them with details and objectives of the POPPHI activity.

The project group formed a consensus group responsible for the surveys and administered the baseline survey to each participating hospital. 

In preparation for the in-hospital trainings, the group designed a poster on AMTSL that targets service personnel and will be placed in a strategic location within health centers. It will be distributed to participating health centers and, if possible, to other centers that did not participate. The group also selected a bibliography of evidence-based research, including materials from FCI and WHO, which will be distributed during the training. SDOG is developing an informational manual on AMTSL that is in the process of being reviewed and will be distributed to training participants once finalized. The group carried out trainings in four of the nine hospitals using participatory methodology and focusing on theory and practice. The hospitals that have received training are: Dr. Juan Pablo Pina, Hospital Ing. Luis E. Bogaert, Hospital San Vicente de Paul, and Hospital Nuestra Senora de la Altagracia.

Implementing Organizations

Goal

Objectives

Activities

Indonesian Midwives Association (IMA)

Representatives: Ruslidjah Siahaan and Laurensia Lawintono

To reduce the maternal mortality rate in Indonesia attributed to PPH, especially those caused by uterine atony or retained placenta, through socialization/expansion of the use of AMTSL in collaboration with the DIII Midwifery Schools (preservice program).

To maintain or upgrade the midwifery teachers’ understanding of AMTSL.

To ensure that AMTSL is in the midwifery training curriculum and that it is included or applied in clinical practice/teaching.

To ensure that midwifery teachers are able to transfer AMTSL knowledge and skills to all midwifery school students.

To conduct a two-day AMTSL workshop in Jakarta, Indonesia with 94 participants, including 8 midwifery teachers from 2 DIII Institution located in Jakarta and West Java Provinces, 72 midwifery students, 4 POGI (ob/gyn association) members, 8 IMA representatives, and 2 organizing committee representatives.

Updates:

July 2006:  IMA has been organizing and preparing for its two-day AMTSL workshop in Jakarta on July 14 to 15, 2006. IMA has registered 94 participants, including teachers and students from the D III Institution, POGI members, and IMA members. The workshop will provide training and other materials to help promote the use of AMTSL.