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

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

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

HMS/BAB Training Materials

Training package validated through field studies in India, Malawi and Zanzibar Material highly graphic Four main components
Providers guide
Flipbook Action plan MamaNatalie anatomic model

Providers Guide

Flipbook Facilitates Facility-Based Training

Builds Essential Clinical Decision- Making Skills

Tri-colored Action Plan using the HBB style

MamaNatalie Birthing Simulator

Field test, February 2011

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.

HMS/BAB Trainer Terminology

TITLE ROLE National/Regional Level HMS Champion National advocate May be preparatory for HMS trainer role HMS Master Trainer National advocate Trainer of trainers (HMS) M&E guidance Training commodities support QUALIFICATION Proficient MNH provider Trained as HMS champion Qualified master trainer (Jhpiego training pathway or other pathway recognized by the persons country) Proficient MNH provider Trained as HMS champion Mentored as HMS trainer of trainers Positioned association, NGO, government council

District/Facility Level HMS Trainer District advocate Introduce initial HMS training module to facility Select PPC Support LDHF practice HMS Peer Practice Coordinator (PPC) Facility advocate Coordinate LDHF practice Coordinate with HMS trainer

Qualified trainer (Jhpiego training pathway or other pathway recognized by the persons country) Proficient MNH provider Trained as HMS trainer Mentored as HMS trainer Trained in PPC selection, training and mentoring
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

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Global Distribution of HMS Trainers

15 610 > 10 FIGO Africa Meeting 35 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

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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/

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