"We have decided women’s lives are worth saving," said Dr. Alex Dmiti, Acting Director of the Reproductive Health Department of the Ministry of Health (MOH) in the Republic of South Sudan, at the opening of a two-day meeting on Prevention of Postpartum Hemorrhage (PPH) at Birth in Juba on April 11-12, 2012.
In the world’s newest country, a woman is more likely to die in childbirth than complete secondary school. With the highest maternal mortality in the world (2,054 maternal deaths for every 100,000 live births), the MOH are taking bold steps to reach the many women who live far from skilled care and functional health facilities. Officials emphasized the need to work with existing resources and services with the statement: "Let us not make this different but build on what is there as well as generating evidence in the learning phase of the new program."
As the country moves towards increasing the number of skilled midwives, existing community-based health workers will be trained with the skills to prevent deaths from PPH – the excessive vaginal bleeding that can occur after childbirth and is the main cause of maternal death globally. MCHIP is supporting the MOH in South Sudan in partnership with Management Sciences for Health and Venture Strategies Innovations to implement an innovative program using a community focused approach to reducing PPH. Community workers will be trained to assist women prepare for birth and will distribute misoprostol – three little pills that save lives.
Misoprostol tablets cause the womb to contract after birth to reduce bleeding and are ideally suited for PPH treatment at home births and in resource-poor settings due to their ease of use, effectiveness and safety. The learning phase of the program will take place in Mvolo and Mundri East Counties in Western Equatoria through Save the Children and Mundri Relief and Development Association, respectively.
Over the course of the meeting, stakeholders from different departments in the MOH, UN agencies, nongovernmental organizations, and community representatives reviewed various materials including the implementation plan, training materials, and community messaging. Dr. Samson Baba, Director General for Community and Public Health, emphasized in his opening remarks that this program will impact the lives of women of South Sudan and that everything possible will be done to ensure the program succeeds.
South Sudan faces many challenges in the reconstruction of their health system and the MOH remain optimistic seeing challenges as an opportunity to think about the solutions in innovative ways. Community-level distribution of misoprostol is the only strategy for prevention of PPH in rural and remote areas where accessibility to facility based delivery services by skilled birth attendants is limited and 90% of women deliver at home.
The MOH also demonstrated a strong commitment to humanizing care – to ensuring cultural appropriateness and quality of services as the health facilities. Janet Michael, the Chief Nursing Officer, emphasized that women will only come to health facilities to deliver if they can get the care they receive at home and more, such as giving birth in a squatting position and having a family member with them. As efforts are made to increase facility births, attention will be given to respectful care and creating a welcoming environment in the delivery room.
Sheena Currie, MCHIP Senior Maternal Health Adviser
Khatidja Jivani, MCHIP Program Officer