1. Country Team Action Plan Scale –up of Misoprostol for Prevention of PPH NEPAL

2. Tracks 1 & 2 2 Where do we want to be? GOALS To increase availability and accessibility to uterotonic (Inj oxytocin at HF, Misoprostol at community) for prevention of postpartum hemorrhage. Priority is the use of AMTSL, delivery at health facility. Misoprostol National level scale up in remote areas.

3. Tracks 1 & 2 3 Hard to Reach…….

4. Tracks 1 & 2 4 Where are we now? One district piloted (Banke) in 2007 Scale-up in 8 more districts (population covered: ~ 10% ): –Roll out ongoing in 6 districts, Planned for 3 districts National Misoprostol Technical Working Group formed Remote Area Guidelines developed and implementation ongoing Implementation guidelines developed (Draft) Monitoring and evaluation plan developed. Misoprostol included into the National Essential Drug List

5. Tracks 1 & 2 5 Where We Are Now DOLPA MUGU JUMLA KAILALI BARDIYA HUMLA DOTI SURKHET NAWAL PARASI KAPIL- BASTU RUPAN- DEHI DANG BANKE ACHHAM KALIKOT JHAPA MORANG SIRAHA SAPTARI DARCHULA BAJHANG BAITADI DADEL- DHURA KANCHAN- PUR BAJURA PARSA BARA RAUT- AHAT DHANUSA MAHO- TARI SUNSARI SARLAHI DHADING MAKAWAN- PUR CHITWAN KASKI B A G L U N G TANAHU PALPA SYANGJA PARBAT ARGHAK HACHI GULMI UDAYAPUR SINDHULI ILAM BHOJ- PU R DHAN- KUTA TAPLEJUNG R A M E C H H A P OKHAL- DHUNGA TERHA- THUM KHOTANG LALIT BHAK KATHMMANDU SULUK- HUMBU DOLAKHA SANKHUWA- SABA NUWAKOT SINDHU- PALCHOK KAVRE RASUWA LAMJUNG GORKHA PYUT- HAN ROLPA SALYAN MYAGDI DAILEKH JAJARKOT RUKUM MUSTANG MANANG PANCHTHAR

6. Tracks 1 & 2 6

7. 7 What are the gaps? PPH is one of the leading causes of maternal deaths Low uterotonic coverage (Oxytocin or Misoprostol) High home births, Low institutional deliveries, Low Staff retention in remote area

8. Tracks 1 & 2 8 What interventions can we use to close the gap? Promote institutional deliveries Promote Active management of third stage of labour for every birth conducted by SBAs Use of Misoprostol for prevention of postpartum hemorrhage at home birth

9. Tracks 1 & 2 9 What are the possible challenges to the intervention? Overcoming resistance from Professional organizations and WHO Preventing unintended use Monitoring of coverage and compliance Ensuring proper counselling Maintaining quality at scale

10. Tracks 1 & 2 10 Who are the possible partners, allies, and stakeholders? Government of Nepal USAID UNICEF INGOs Professional Organizations: NESOG, PESON, SOPHPN DPHO HFs FCHVs HFOMC Communities

11. Tracks 1 & 2 11 What are our action steps? Action StepResponsible Person Timeline 1. GON Approval for Program Scale-up Dr Naresh P KC, FHD May 2010 2. Develop Country Action Plan (Implementation Plan, M&E Plan, Cost) FHD, jointly with partners July 2010 3. Dissemination of program to wider audience (EDPs, Program Divisions, Professional Organization etc) FHDJuly 2010 4. Develop Procurement PlanFHD, LMD and partners August 2010

12. Tracks 1 & 2 12 What are our action steps? Action StepResponsible PersonTimeline 5. Revise, update and Print training and BCC materials FHD, NHTC, NHEICC, HMIS/MD and partners June 2010 6. Update M&E tools and systems FHD, HMIS/MD and partners June 2010 7. District Planning and Orientation FHD, RHD, D(P)HOs and partners August 2010 onwards 8. Conduct Training (ToT, District and HF Training, Community Training) FHD, NHTC and partners August 2010 onwards 9. Program Implementation and Monitoring FHD, RHD, D(P)HO and partners August 2010 onwards

13. Tracks 1 & 2 13