1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. South Sudan Integrated Service Delivery Program Implementing Partners 10

11. 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

12. 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

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