Are national policies and programs for prevention and management of postpartum hemorrhage and preeclampsia adequate? A key informant survey in 37 countries

Abstract

Introduction: Although maternal mortality has declined substantially in recent years, efforts to address postpartum hemorrhage (PPH) and preeclampsia/eclampsia (PE/E) must be systematically scaled up in order for further reduction to take place. In 2012, a key informant survey was conducted to identify both national and global gaps in PPH and PE/E program priorities and to highlight focus areas for future national and global programming.

Methods: Between January and March 2012, national program teams in 37 countries completed a 44-item survey, consisting mostly of dichotomous yes/no responses and addressing 6 core programmatic areas: policy, training, medication distribution and logistics, national reporting of key indicators, programming, and challenges to and opportunities for scale up. An in-country focal person led the process to gather the necessary information from key local stakeholders. Some countries also provided national essential medicines lists and service delivery guidelines for comparison and further analysis.

Results: Most surveyed countries have many elements in place to address PPH and PE/E, but notable gaps remain in both policy and practice. Oxytocin and magnesium sulfate were reported to be regularly available in facilities in 89% and 76% of countries, respectively. Only 27% of countries, however, noted regular availability of misoprostol in health facilities. Midwife scope of practice regarding PPH and PE/E is inconsistent with global norms in a number of countries: 22% of countries do not allow midwives to administer magnesium sulfate and 30% do not allow them to perform manual removal of the placenta.

Conclusions: Most countries surveyed have many of the essential policies and program elements to prevent/manage PPH and PE/E, but absence of commodities (especially misoprostol), limitations in scope of practice for midwives, and gaps in inclusion of maternal health indicators in the national data systems have impeded efforts to scale up programs nationally.

Figure 1.

Availability of Uterotonics, 37 Surveyed Countries, 2012 Abbreviations: DRC, Democratic Republic of Congo; MOH, Ministry of Health.

Figure 2.

Availability of Magnesium Sulfate, 37 Surveyed Countries, 2012 Abbreviations: DRC, Democratic Republic of Congo; MOH, Ministry of Health; MgSO4, magnesium sulfate; PE/E, preeclampsia/eclampsia.

Figure 3.

Medicines Approved at the National Level, 37 Surveyed Countries, 2012 Abbreviations: DRC, Democratic Republic of Congo; EML, essential medicines list; MgSO4, magnesium sulfate; PE/E, preeclampsia/eclampsia; PPH, postpartum hemorrhage.

Figure 4.

National Policy and Guidelines on AMTSL, 37 Surveyed Countries, 2012 Abbreviations: AMTSL, active management of the third stage of labor; DRC, Democratic Republic of Congo; HMIS, health management information system.

Figure 5.

Availability and Use of Misoprostol, 37 Surveyed Countries, 2012 Abbreviations: DRC, Democratic Republic of Congo; EML, essential medicines list.

Figure 6.

Midwifery Scope of Practice, 37 Surveyed Countries, 2012 Abbreviations: AMTSL, active management of the third stage of labor; DRC, Democratic Republic of Congo; MgSO4, magnesium sulfate; PE/E, preeclampsia/eclampsia.

A midwife in Tanzania checks in on a mother and her newborn baby.