Strategic Approach
The MCHIP Maternal Health Program focused on three main areas to improve maternal health: prevention of postpartum hemorrhage (PPH); prevention and treatment of pre-eclampsia/eclampsia (PE/E); and expanding access to and improving the capacity of skilled birth attendants (SBAs) through global leadership, advocacy and integration. As a lead implementing and technical assistance organization for global standards, MCHIP helped develop and disseminate essential WHO guidelines on prevention of PPH, prevention and treatment of PE/E, and task-shifting. The Program was also a global leader in supporting activities that increase coverage and use of services to prevent PPH, such as the active management of third stage of labor (AMTSL) at the health facility, and community-based distribution of misoprostol. Evidence from these programs helped MCHIP to inform and be a key contributor to revised WHO recommendations that approved advanced distribution of misoprostol for self-administration to prevent PPH.
MCHIP also worked to improve quality of care (QoC) through competency-based training, supportive supervision, QoC surveys, an ongoing goal-oriented performance improvement approach, and development of user-friendly resources (such as the PE/E toolkit). The MCHIP Maternal Health Program worked with other MCHIP programs to ensure an integrative approach to improve maternal and newborn health, such as through:
- Nutrition – to improve maternal anemia;
- Malaria and HIV – to prevent/treat in pregnancy;
- Newborn Health – to delay cord clamping to prevent infant anemia, prevent/manage prematurity (including the administration of antenatal corticosteroids); and
- Family Planning – for healthy spacing and timing of pregnancy.
Key Contributions to Maternal Health
- Multi-Country Analysis Survey: MCHIP undertook its second annual survey of national programs for the management of PPH and PE/E from January to March 2012. This country-level program analysis included countries from Africa, Asia and Latin America, focusing on those USAID priority countries that face the highest burden of maternal morbidity. Through this widely used survey and advocacy tool, which has been presented and disseminated at numerous venues, MCHIP has been able to raise critical quality of care issues related to maternal health commodities and achieved several programmatic results at the country level, especially in the areas of PE/E and PPH prevention and treatment. At the global level, the survey results have been used widely and helped provide much needed information to inform the global recommendations of the UN Commission on Life-Saving Commodities. At the country level, it has aided governments and implementing agencies to identify and address gaps, enabling them to work toward scaling up interventions related to reducing PPH and PE/E.
- MCHIP was a key contributor to WHO recommendations on PPH, which were revised to include a recommendation in support of advanced distribution of misoprostol for self-administration to prevent postpartum hemorrhage at home birth. This came through MCHIP’s extensive advocacy and programmatic work in the field, including the implementation of operations research on introduction of PPH prevention programs in four countries under MCHIP funding. These programs promoted the use of AMTSL at the health facility as well as advanced distribution of misoprostol for home birth, demonstrating a comprehensive approach to the issue of PPH. The resulting peer-reviewed publications, along with an integrative review article on community-based distribution, contributed to the growing body of evidence which fed into the new guidelines, thus ensuring that all women are reached with this life-saving intervention.
- MCHIP showed leadership by adopting an integrated approach that targeted key interventions for mothers that addressed prematurity and improved outcomes for countless newborns. In close collaboration with other key stakeholders such as Born too Soon, Survive and Thrive, and the Gates Foundation, MCHIP spearheaded the development of a prematurity toolkit as well as advocacy and technical briefers and a job aid promoting the use of Antenatal Corticosteroids (ACS) for fetal lung maturation.