Jeffrey M. Smith

1
Tracking Scale Up of Maternal and Newborn
Health Interventions

• Jeffrey M. Smith
• MCHIP

Interventions for Impact in Essential Obstetric
and Newborn Care Africa Regional Meeting, 21-25
February, 2011
2
Child Mortality 4 countries in Africa
Chad
Ethiopia
Zambia
Kenya
3
Maternal Mortality 4 countries in Africa
Chad
Ethiopia
Zambia
Kenya
4
Scale up of PPH and PE/E interventions
And how do we know?
Where are we?
How far do we have to go?
5
Awoonor-Williams, et al. HEALTH POLICY AND
PLANNING 20(1) 2534
6
Conceptual Map for Scale Up

• Phases of implementation
• Sequential in logic, not linear in time
• An attempt to graphically represent the elements
  of a scale up approach
• Not exhaustive or able to capture all details

7
PATHWAY TO IMPLEMENTATION OF POSTPARTUM
HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
8
PATHWAY TO IMPLEMENTATION OF POSTPARTUM
HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
9
Mapping Scale up Process at National Level

• Analysis of national/MOH situation
• Participants and local counterparts
• Consideration of USAID supported efforts or other
  partner/donor supported efforts
• Previous efforts that were fully addressed in the
  past

10
ANGOLA PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
11
MOZAMBIQUE - PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
Introducing innovation Moving toward sustainable impact at scale
12
GHANA - PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
13
SOUTH SUDAN - PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
14
LIBERIA - PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
15
ETHIOPIA PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
16
MADAGASCAR- PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
17
MALAWI - PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Health workers training systems For PPH
prevention and management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
18
NIGERIA PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
19
RWANDA - PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
20
SENEGAL PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
MCHIP/USAID active programs
Other partners active programs
Addressed previously, not active
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
No programs
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation AMTSL for
all skilled birth attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/procurement,
logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
81
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
21
UGANDA PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
22
ZAMBIA PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
23
ZIMBABWE PATHWAY TO IMPLEMENTATION OF PPH
PREVENTION AND MANAGEMENT AT SCALE
Global Actions National Strategic Choices Program Implementation Program Implementation Program Implementation Sustainability / Institutionalization
Global Actions National Strategic Choices Introduction Early Mature Sustainability / Institutionalization
Health system governance Proactive financing of
maternal health services
Community mobilization Awareness raising of
PPH Birth preparedness
Training programs Government budgeted training
programs on PPH PPH competencies in pre-service
and in-service curricula
National advocacy Expansion of national program
and highlight work of champions
PPH policy AMTSL/misoprostol use Expanded job
descriptions for skilled birth attendant cadres
managing PPH PPH service delivery guidelines
Global advocacy and partnerships Global action
to support work on reduction of PPH
Pilot programs Phase 1 implementation of
misoprostol and/or AMTSL for all skilled birth
attendant cadres
REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH
STATUS
Clinical coverage High coverage use of a
uterotonic Public and private implementation
Standardization Quality of care approaches
Government led training expansion
Service delivery capacity at sites Reliable
infrastructure, personnel, and systems to deliver
services
Program initiatives in obstetric and postpartum
management Quality of care Clinical
training Supervision
Global clinical and program approaches
Evidence-based interventions for prevention and
management of PPH demonstrated
Programmatic growth Adding districts, partners,
financing
Drug equipment availability Drugs and supplies
in government routine procurement mechanisms
Health workers training systems For PPH
prevention and management
Pharmaceutical systems Uterotonics on Essential
Drug List and in Drug Registration Supply chain
management
Drugs equipment Oxytocin/ misoprostol
procurement, logistics, distribution
Coverage of uterotonic in third stage of labour
0 25
50 75
100
ME Readiness assessment Pilot project data Survey data Indicators in HMIS Routine monitoring
INTRODUCING INNOVATION MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
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National Maps of Scale up Process

• Tracking progress over time
• Platform for national and international
  conversation about progress
• Identifying gaps and securing additional support
  / resources.
• Please view the posters in the corridor!!

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