Helping Mothers Survive Bleeding after Birth: An innovative training approach to prevent and manage PPH

Blami Dao MD, FWACS

Director, MNH, Jhpiego

FIGO Africa Meeting 2013

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Introduction

Reduction of maternal mortality at the global level from 500,000 to 287,000 per year (WHO 2010)

PPH still remains the leading cause of maternal death worldwide (Lancet 2006)

PPH prevention and management = high priority for MNH programs

In many developing countries, health workers are not well-trained to prevent and manage PPH

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Objectives

Describe Helping Mothers Survive (HMS)/ Bleeding after Birth (BAB) materials and training approach

Share country experiences in implementing HMS/BAB

Discuss how HMS/BAB can be used by Ob/Gyns

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HMS/BAB Training Materials

Training package validated through field studies in India, Malawi and Zanzibar

Material highly graphic Four main components

Provider’s guide Flipbook Action plan MamaNatalie anatomic model

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Provider’s Guide

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Flipbook Facilitates Facility-Based Training

Builds Essential Clinical Decision- Making Skills

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Tri-colored Action Plan using the HBB style

MamaNatalie Birthing Simulator

8Field test, February 2011

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Training Approach

Principles: learning by doing and simulation- based practice

A one-day, skills-building focused training: Active management of third stage of labor PPH management: uterine massage, management of genital

track injury, bimanual compression of the uterus and timely referral

Skills maintained through onsite, short, repetitive practices called Low-Dose, High-Frequency (LDHF) practices led by a peer practice coordinator.

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HMS/BAB Trainer Terminology

TITLE ROLE QUALIFICATIONNational/Regional LevelHMS Champion National advocate

May be preparatory for HMS trainer role

Proficient MNH provider Trained as HMS champion

HMS Master Trainer National advocate Trainer of trainers (HMS) M&E guidance Training commodities support

Qualified master trainer (Jhpiego training pathway or other pathway recognized by the person’s country)

Proficient MNH provider Trained as HMS champion Mentored as HMS trainer of trainers Positioned – association, NGO, government council

District/Facility LevelHMS Trainer District advocate

Introduce initial HMS training module to facility

Select PPC Support LDHF practice

Qualified trainer (Jhpiego training pathway or other pathway recognized by the person’s country)

Proficient MNH provider Trained as HMS trainer Mentored as HMS trainer Trained in PPC selection, training and mentoring

HMS Peer Practice Coordinator (PPC)

Facility advocate Coordinate LDHF practice Coordinate with HMS trainer

Competent MNH provider Trained as PPC Mentored as PPC

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Countries’ Experience

India: XX Trainers + XX Providers in XX districts

Malawi: 62 Trainers + 222 providers in 15 districts

Kenya: 31 Trainers + XX Providers in XX districts

Uganda: 21 Trainers + XX Providers in XX districts

Global Distribution of HMS Trainers

1–5

6–10

> 10

FIGO Africa Meeting 3–5 October 2013

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HMS/BAB and Ob/Gyns

Primary audience = anyone who conducted deliveries

Inclusion in training of Ob/Gyns Residency training Continuous medical education with credits

Ob/Gyns as trainers of other cadres: nurses/midwives, medical students, residents, medical/clinical officers

Global Partnership and Local Ownership

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Jhpiego-FIGO Partnership

On the 2nd of October, representatives from 7 countries within Africa were trained by Jhpiego on HMS/BAB.

Detailed, country-level action plans for building provider capacity were developed with a view to improving the quality of care in delivery services.

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Conclusion

HMS/BAB is a complement of Ob/Gyn training for surgical management of PPH.

Expansion of training in peripheral health centers could decrease the number of PPH that Ob/Gyns have to manage.

MHS/BAB has the potential to reduce PPH prevalence and save many lives.

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Learn More about HMS

Helping Mothers Survive: Access the training package at: www.jhpiego.org/hms/