1. South Sudan Integrated Service Delivery Program Building Capacity for Implementation and Supportive Supervision for PPH prevention Isabella Ochieng, PPH Technical Officer, MCHIP

2. South Sudan Integrated Service Delivery Program Background  MCHIP, in partnership with the MOH and implementing partners (MRDA & Save the Children/NPA), supported the learning phase of a post-partum haemorrhage (PPH) prevention programme in two counties, Mundri East (MRDA) and Mvolo (previously Save the Children, now NPA) over a six month period (from Sep 2012 to March 2013).  The programme offers a comprehensive package of interventions to prevent and manage PPH, from the household to health facility.   s a combined facility and community-focused programme for prevention of PPH

3. South Sudan Integrated Service Delivery Program Key Activities- Health Facility  Training of health care workers (SBA/MCHWs) to strengthen the provision of Active Management of Third Stage of Labour (AMTSL), especially the use of an uterotonic immediately after birth, at health facility level  Distribution of misoprostol during ANC visits to women at 8 months gestation by providers

4. South Sudan Integrated Service Delivery Program Key Activities- Community  Training of HHPs in:  Counseling, and  Distribution of misoprostol to women in the 8 th month of pregnancy at the community level

5. South Sudan Integrated Service Delivery Program Initial Preparations at County Level Awareness/advocacy meetings were held before the launch of the programme with:  Community leaders  Village health committees  Community members  Health facility staff Meetings were intended to help the community understand the significance of the program and support activities.

6. South Sudan Integrated Service Delivery Program IEC Materials  Information Education and Communication materials were adapted to suit the South Sudan context  Field testing was done in Mundri East and Mvolo counties  A local artist adjusted the pictures based on recommendations after field testing  Review by the PPH TAG  Approval by the Health Education Department, MOH, for the learning phase.

7. South Sudan Integrated Service Delivery Program Training Approach TOTs conducted for:  Health facility staff (HFS)  Home health promoters (HHPs) Standard training packages were developed by MCHIP After TOTs, trainers conducted trainings in both counties for HFS and HHPs.

8. South Sudan Integrated Service Delivery Program Health Facility Staff (HFS) Training Goal: To provide the participants with essential knowledge, skills and attitudes in prevention of PPH at community and health facility level and manage cases of PPH at health facilities. Training methodology The course was an interactive, skills-based training which updated participants on key skills using both classroom training as well as simulated clinical sessions.

9. South Sudan Integrated Service Delivery Program HFS Course Overview 4-day training provided updates on best practices needed to teach service providers the most current evidence-based care:  safe and clean birth including AMSTL for SBAs and modified AMSTL for MCHWs  management of PPH cases at the health facility and refer cases to higher level facilities as appropriate  support and supervision of HHPs, specifically counselling and use of misoprostol during home births and record keeping

10. South Sudan Integrated Service Delivery Program HFS training practical sessions

11. South Sudan Integrated Service Delivery Program Home Health Promoter Training Goal: To provide the participants with knowledge, skills and attitudes needed to counsel pregnant women and family members about the importance of delivery with a SBA and for home births the correct use of misoprostol tablets for prevention of PPH, as well as emergency preparedness. Course overview  4 days training, classroom interactive sessions, role plays and group work for the first 3 days  4 th day community practice on counselling of pregnant women and their families using PPH prevention and Birth Preparedness/Complication Readiness (BP/CR) flip cards.

12. South Sudan Integrated Service Delivery Program HHP Training and Counseling Sessions

13. South Sudan Integrated Service Delivery Program Participants trained in the two counties

14. South Sudan Integrated Service Delivery Program Supportive Supervision Supportive supervision was conducted on regular basis by MCHIP with the implementing partners and CHDs. Supervision included:  Review of HHP forms for accuracy and completeness  Check availability of misoprostol at different points of distribution  Strengthening HHPs counseling skills through community visits and role plays  On-the-job training of HFS  Supervision of data collection process

15. South Sudan Integrated Service Delivery Program Supportive Supervision

16. South Sudan Integrated Service Delivery Program Completed HHP reporting form.

17. South Sudan Integrated Service Delivery Program HHP Regular Supervision  HHPs were linked to the nearest facility  HF Supervisors received and reviewed HHP reporting forms, restocked miso and reporting forms, supervised counseling sessions and provided other support as needed  Implementing partner focal person held meetings with HHPs on a monthly basis to review and collect reporting reporting forms, restock miso, meetings with community leaders

18. South Sudan Integrated Service Delivery Program Lessons Learned  Pictures, role plays, group discussion and supervised community practice were effective in training HHPs.  Classroom training and supervised community practice helped HHPs gain confidence in counseling.  HHPs need close supportive supervision during counseling sessions and for data collection.  Training HFS using models (MamaNatalie) added a value to the skills training since facility caseload for practice is low.  Misoprostol can be used as an option in the absence of oxytocin  MCHWs can still provide modified AMTSL using misoprostol.

19. South Sudan Integrated Service Delivery Program Thanks!! Shukran!! Arobuya!!