Overall ResponsibilitiesThe purpose of this consultant is to Review the National Level Policies for Community-Based Distribution of Misoprostol for Prevention of Postpartum Hemorrhage and Subsequent Status of Implementation and Scale-Up. Principal Work Location:
Abuja with visits to selected states
Specific ResponsibilitiesSpecific Activities:The consultant is responsible for the following tasks:
Hold in-briefing meeting with USAID/Mission and Ministry of Health if requested;
Coordinate submission of study protocol to appropriate in-country ethical review board if required;
Collect relevant documents for a desk-review including but not limited to national policies, strategies, guidelines, etc (with support from MSH Country Office);
Conduct desk-review of documents;
Identify key informants (with support from MSH Country Office);
Contact key informants, introducing the study, and scheduling interviews (with support from MSH Country Office);
Conduct key informant interviews using study interview guides;
Conduct site visits for additional data collection as needed;
Translate (as needed) and transcribe recorded oral interviews into written form;
Conduct any follow-up interviews as necessary;
Organize data and conduct preliminary analysis of findings;
Organize and lead Findings Validation Workshop with key stakeholders (with support from MSH Country Office);
Hold out-briefing with USAID/Mission and Ministry of Health if requested;
Conduct final data analysis and synthesis of findings.
Draft five-ten page case study report on findings which can be adapted into a technical brief and the final consolidated cross-country findings report. A report template and outline will be provided.
Outputs and Deliverables:
Electronic copies of desk review documents submitted to ASH MNCH Advisor by the end of the first week following engagement.
Lists of key stakeholders and key informants submitted to ASH MNCH Advisor by end of first week.
Written brief outlining key findings from document review submitted to ASH MNCH Advisor by end of second week.
Transcriptions of at least 10 key informant interviews sent electronically to ASH MNCH Advsior by third week.
Five-ten page case study report synthesizing findings submitted to ASH MNCH Advisor by end of 4th week.
Qualifications
Experience conducting qualitative public health research;
Relationships/contacts with relevant maternal health stakeholders in-country (MOH, donor representatives, implementing partners);
Familiarity with maternal health issues including postpartum hemorrhage preferred;
MD, MPH, or PhD preferred;
Excellent communication skills and flexibility in responding to comments and requests;
Excellent verbal and written English skills.
Background InformationProject Background:The African Strategies for Health (ASH) project is a five-year (2011-2016) contract funded by the United States Agency for International Development (USAID). ASH works to improve the health status of populations across Africa through identification of and advocacy for best practices, enhancing technical capacity, and engaging African regional institutions to address health issues in a sustainable manner. ASH provides information on trends and developments in the continent to USAID and other development partners to enhance decision making regarding investments in health.Activity Background:Despite a 45 percent global decline in the number of annual maternal deaths from 1990 to 2013, maternal mortality remains unacceptably high, particularly in the developing world where 99 percent of these deaths occur. The sub-Saharan Africa region alone accounted for 62 percent of global maternal deaths in 2013 and has the highest regional maternal mortality ratio (MMR) at 510.[i] Postpartum hemorrhage (PPH) defined as blood loss of 500mL or more, is the leading cause of maternal mortality in low-income countries and is the primary cause of nearly one quarter of all maternal deaths globally.[ii] Postpartum hemorrhage currently accounts for 34 percent of maternal deaths in Sub-Saharan Africa where the lifetime risk of dying from pregnancy or childbirth is 1 in 38.[i] [iv]The vast majority of postpartum hemorrhage cases can be effectively prevented or treated with evidence-based interventions such as uterotonics which are used to induce contraction or greater tonicity of the uterus. Oxytocin is currently the most widely used uterotonic and is the World Health Organization’s uterotonic of choice for administration in the third stage of labor for prevention of PPH. Although oxytocin is the recommended drug, it requires both administration via injection by a skilled provider and refrigeration, making it unfeasible in resource-poor settings or in areas where the majority of women deliver in the home. In a region where 50 percent of births occur without attendance by skilled health personnel, access to an alternative uterotonic or intervention for the prevention of postpartum hemorrhage is critical to achieving maternal mortality reduction in Africa[i].Misoprostol is an alternative uterotonic increasingly used in obstetrical and gynecological practice including for the prevention and treatment of PPH. The utilization of misoprostol for PPH prevention in the developing world has gained increasing interest over the past decade as it is inexpensive, does not require cold chain storage, and recent studies have shown it can be safely and effectively administered by a lay/unskilled health worker. Since the first misoprostol placebo controlled trial for prevention of PPH in home births was conducted in India in 2005, dozens of studies of community-based misoprostol distribution have been conducted globally as well as various reviews and evaluations of implementation.[ii] [iii] The findings overwhelmingly support community-based distribution of misoprostol for prevention of PPH as a safe and effective strategy in settings where skilled birth attendance is low. Despite this body of evidence, the addition of misoprostol to the WHO Model List of Essential Medicines for the prevention of PPH, the inclusion of misoprostol in various global clinical guidelines (FIGO/ICM, ACOG, RCOG) and the World Health Organization’s 2012 recommendation for the administration of misoprostol by a lay health worker in the absence of a skilled birth attendant, very few countries in Africa have adopted national policies or service delivery guidelines for the scale-up of this intervention.[iv] In 2011 and 2012, “A Global Survey on National Programs for the Prevention and Management of Postpartum Hemorrhage and Pre-Eclampsia/Eclampsia” found that of 20 African countries surveyed, misoprostol is on the essential medicines list (EML) for prevention of PPH in 16, 11 countries have conducted pilots on community-based distribution, but only four are beginning to scale-up misoprostol at home births through the ratification of national policies (Ethiopia, Equatorial Guinea, Mozambique, and Nigeria).The Review of National Misoprostol Policies for Community-Based Distribution of Misoprostol for Prevention of Postpartum Hemorrhage and Subsequent Status of Implementation and Scale-Up study will explore the policy-making process and subsequent roll-out of the intervention in four of the seven African countries which have national policies in place for the use of misoprostol at home-births for prevention of postpartum hemorrhage. These countries include Madagascar, Mozambique, Nigeria, and South Sudan.
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