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MAJOR PROJECTS
Continuum of Care: Addressing Postpartum Hemorrhage in India, Nigeria, Bangladesh, Peru and Tanzania
Nearly 350,000 women die annually worldwide from complications of pregnancy and childbirth. More than 99 percent of these deaths occur in developing countries, where skilled healthcare providers, quality facilities, and adequate transportation and communication systems are largely unavailable to the poor. Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality in the world—causing at least one quarter of all maternal deaths worldwide and nearly 60 percent in the developing world.
In 2007, the John D. and Catherine T. MacArthur Foundation provided funding to Pathfinder International to implement a project to address postpartum hemorrhage in India and Nigeria, in collaboration with Dr. Suellen Miller of the University of California, San Francisco, and Dr. Stacie Geller of the University of Illinois at Chicago. The project aims to reduce morbidity and mortality associated with postpartum hemorrhage. This innovative project has since led to the creation of the Pathfinder International model to address postpartum hemorrhage, known as Clinical and Community Action.
In 2009, the Pathfinder Board of Directors directed private funds to expand the project to pilot efforts in remote and underserved regions of Bangladesh and Peru. Through the new Clinical and Community Action model, Pathfinder is improving access to technologies and services to prevent and manage postpartum hemorrhage, as well as building the evidence base around Pathfinder’s approach to postpartum hemorrhage and use of the non-pneumatic anti-shock garment (NASG). Later that year the MacArthur Foundation allocated additional funding to pilot an effort to reduce postpartum hemorrhage in refugee and displaced persons camps in Tanzania.
In all five countries, Pathfinder’s postpartum hemorrhage work focuses on prevention and care from the community level—where women are most likely to give birth at home or in poorly equipped health centers—to higher level facilities where they can receive care for complications. The Clinical and Community Action model incorporates, as needed, active management of the third stage of labor including administration of an appropriate drug (uterotonic); a blood collection device (which estimates blood loss more accurately and can signal when a woman is in imminent danger); the non-pneumatic anti-shock garment (which is placed on a woman to control PPH until she reaches emergency obstetric care); and improved communication and transportation systems to help move women to emergency care. The project also engages in sustained advocacy to lay groundwork for the further expansion of these intervention technologies.
The ultimate goal of the project is to prevent postpartum hemorrhage and reduce maternal mortality and morbidity. To do so, the project objectives are to:
- Increase awareness among community members of the availability of care in project health facilities and of the danger signs of PPH so they can make timely decisions to seek medical care
- Improve the capacity of providers to provide high-quality, appropriate care to prevent and manage postpartum hemorrhage
- Educate target audiences about new technologies available to address PPH, and how they fit into the continuum of care model
- Mobilize policy makers, government officials, media, NGOs, and communities to advocate for use of the full continuum of care model
- Engage communities to develop emergency transportations systems and community blood banks to fill gaps in existing structures
Key highlights of the project so far:
- In Nigeria, the Cloverleaf Foundation is funding a cost effective modern blood transfusion service powered by three solar panels and a battery that will provide refrigerated storage of up to 200 pints of blood and serve as a power source to the labor and delivery rooms.
- In Bangladesh, the Pathfinder project focuses specifically on helping women who deliver at home to prevent PPH. Every pregnant woman in the project area is registered and tracked by a government or NGO community worker and given a PPH bag containing three misoprostol tablets, a blood measuring mat, and safe delivery kit.
- In India, the PPH training curriculum has been incorporated into state-level basic emergency obstetric care and training and is now part of continuing education for private providers.
- In Peru, Pathfinder is doing considerable advocacy with the Ministry of Health to ensure the project’s eventual adoption and sustainability on a national level.
- In Tanzania, Pathfinder is supporting existing community health workers in refugee camps who are being trained in self-care during pregnancy, how to develop birth plans, and the danger signs and symptoms in pregnancy, labor, and delivery.
Published materials relating to Pathfinder’s work in addressing postpartum hemorrhage, including our curriculum and toolkit, can be found here.
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