Tracking Scale Up of Maternal and Newborn Health Interventions Jeffrey M. Smith MCHIP Interventions for Impact in Essential Obstetric and Newborn Care Africa Regional Meeting, February, 2011

Child Mortality: 4 countries in Africa 2 ChadEthiopia Kenya Zambia

Maternal Mortality: 4 countries in Africa 3 ChadEthiopia Kenya Zambia

Scale up of PPH and PE/E interventions 4 Where are we? And how do we know? How far do we have to go?

Awoonor-Williams, et al. HEALTH POLICY AND PLANNING; 20(1): 25–34

Conceptual Map for Scale Up  Phases of implementation  Sequential in logic, not linear in time  An attempt to graphically represent the elements of a scale up approach  Not exhaustive or able to capture all details 6

PATHWAY TO IMPLEMENTATION OF POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in- service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100% MCHIP/USAID active programs Other partners active programs Addressed previously, not active No programs

PATHWAY TO IMPLEMENTATION OF POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in- service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100% MCHIP/USAID active programs Other partners active programs Addressed previously, not active No programs

Mapping Scale up Process at National Level  Analysis of national/MOH situation  Participants and local counterparts  Consideration of USAID supported efforts or other partner/donor supported efforts  Previous efforts that were fully addressed in the past 9

ANGOLA : PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in- service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

MOZAMBIQUE - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring Introducing innovationMoving toward sustainable impact at scale Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

GHANA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100% GHS and partners active programing Other partners, with GHS support Addressed previously, not active No programs

SOUTH SUDAN - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in- service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

LIBERIA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

ETHIOPIA : PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

MADAGASCAR - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

MALAWI - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

NIGERIA : PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

RWANDA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

SENEGAL: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/procureme nt, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100% MCHIP/USAID active programs Other partners active programs Addressed previously, not active No programs 81%

UGANDA : PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

ZAMBIA : PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

ZIMBABWE : PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE Global Actions National Strategic Choices Program Implementation Sustainability / Institutionalization IntroductionEarlyMature Global advocacy and partnerships: Global action to support work on reduction of PPH Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines Health system governance: Proactive financing of maternal health services Drugs & equipment: Oxytocin/ misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services Health workers training systems: For PPH prevention and management Community mobilization: Awareness raising of PPH; Birth preparedness Pilot programs: Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres Program initiatives in obstetric and postpartum management: Quality of care; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management National advocacy: Expansion of national program and highlight work of champions Standardization: Quality of care approaches; Government led training expansion Programmatic growth: Adding districts, partners, financing Training programs: Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula Clinical coverage: High coverage use of a uterotonic; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS M&E Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring INTRODUCING INNOVATIONMOVING TOWARDS SUSTAINABLE IMPACT AT SCALE Coverage of uterotonic in third stage of labour 0% 25% 50% 75% 100%

National Maps of Scale up Process  Tracking progress over time  Platform for national and international conversation about progress  Identifying gaps and securing additional support / resources.  Please view the posters in the corridor!! 24

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