South Sudan Integrated Service Delivery Program PREVENTION OF PPH: AMTSL AT HEALTH FACILITY & MISOPROSTOL AT HOME BIRTH Why a Learning Phase? May 15 th 2013 Edward Eremugo Luka, Central Equatoria State Program Manager, MCHIP

South Sudan Integrated Service Delivery Program Outline of Presentation  Background  Global Response to PPH  Why Miso?  Objectives of Learning Phase  Implementing Partners and their roles 2

South Sudan Integrated Service Delivery Program Background to Learning Phase  South Sudan has the highest MMR at avg 2,054/100,000 live births in the world  PPH is a leading cause of maternal death in Africa  Every intervention is needed to reduce MMR  Participation of South Sudan at the Global Meeting in Addis Ababa in February 2011 indicated a government commitment 3

South Sudan Integrated Service Delivery Program Global Response to PPH  Uterotonics (oxytocin or misoprostol) are effective in preventing PPH at birth  Active Management of Third Stage of Labour (AMTSL) is a proven effective strategy  Successful community distribution of Misoprostol is found to be effective in many other settings 4

South Sudan Integrated Service Delivery Program Why Miso?  Administered orally  Tablet form (3 tablets)  In-expensive  Stable in field conditions  Easy to store  Excellent safety record (when used as directed) 5

South Sudan Integrated Service Delivery Program Overall aim  Generate evidence to inform future policy and programme planning to ensure uterotonic coverage for all women giving birth to prevent PPH using both facility-based and community-based approaches in S. Sudan. 6

South Sudan Integrated Service Delivery Program Specific objectives  To assess if the use of antenatal care visits (ANC) and community-based distribution through community health workers is an effective mechanism  To assess the use and coverage of misoprostol for home births  To determine if misoprostol is acceptable to South Sudanese women and their families for PPH prevention. 7

South Sudan Integrated Service Delivery Program  To assess if the availability of misoprostol for preventing PPH at home births affects skilled birth attendance coverage at facilities  To determine the proportion of women with vaginal births who receive a uterotonic immediately after birth to standard by skilled providers. 8

South Sudan Integrated Service Delivery Program Why Mundri East and Mvolo? 9  SHTP II managed by MSH was supported by USAID  USAID will be the principle donor for CES and WES, to ensure continuity  Community structures in Mvolo in place through CCM program of Save the Children  Accessibility for follow-up

South Sudan Integrated Service Delivery Program Implementing Partners 10

South Sudan Integrated Service Delivery Program Key Partners Roles  MoH: Approval, supervision  USAID: Funder,  MCHIP: Oversight, technical support, training  MSH/SHTP II: Program development, training 11

South Sudan Integrated Service Delivery Program Partners Roles  Save the Children: implementer in Mvolo  Mundri Relief Development Association (MRDA): Implementer in Mundri East.  Venture Strategies Innovations (VSI): supplied misoprostol  Systems for Improved Access to Pharmaceuticals and Services Program (SIAPS - implemented by MSH) repacked and distributed the misoprostol. 12

South Sudan Integrated Service Delivery Program Have we succeeded in learning anything useful? Let us find out in the results 13