1. POSTPARTUM HEMORRHAGE PREVENTION BENIN EXPERIENCE Prof. R-X PERRIN, Prof. Ag. S. ADISSO, Dr. S. ABOUDOU Addis – Ababa, 2011

2. INTRODUCTION MMR: 397 DEATHS/ 100 000 live births MAJOR CAUSES OF MATERNAL DEATHS: ◦ HEMORRHAGE ◦ ECLAMPSIA ◦ INFECTION (SEPSIS) ◦ ABORTION ◦ OBSTRUCTED LABOR MMR : Maternal Mortality Ratio

3. INTRODUCTION 1999: EmOC 2003: Prevention of postpartum hemorrhage initiative (introduction of AMTSL) 2007: AMTSL national survey 2009: Joint statement for prevention of PPH signed by midwifery and ob/gyn associations

4. IMPLEMENTATION STEPS National level action plan developed AMTSL integrated into clinical guidelines Financial resources mobilized Training strategy developed Learning materials validated AMTSL integrated into supervisory tools Studies implemented AMTSL : Active Management of the Third Stage of Labor

5. Studies Two studies initiated in Benin validated international studies showing the benefits of AMTSL ◦ One study comparing physiologic and active management of the third stage of labor (University Centre of Gynecology and Obstetrics (CUGO)) ◦ A second study with AMTSL as routine practice (Hôpital de la Mère et de l’Enfant – Lagune ‘’Mother and Child Hospital’’ (HOMEL))

6. Baseline data Final Assessment Number% % Vaginal delivery 66281006186100 Vaginal Delivery with AMTSL -- 468776 Cases of PPH4146.21532.4 Deaths from PPH 210.31120.19 POSTPARTUM HEMORRHAGE STUDY RESULTS at HOMEL

7. TRAINING CARE PROVIDERS Training of trainers: ◦ Sub regional training in Bamako, Mali (PRIME II) - 2 national trainers for Benin ◦ National training of trainers Training of providers: ◦ Midwives and Obstetrician/Gynecologists serving in maternity hospitals ◦ Ideally all birth attendants serving in public and private maternity hospitals Integration of AMTSL into pre-service curricula for midwives and physicians

8. TRAINING METHOD Humanistic approach Competency-based: ◦ Validation of theoretical knowledge (nac: 85%) ◦ Demonstration on manikin ◦ Pratice in delivery room(in vivo) ◦ Qualification: All providers who meet the minimum criteria NAC : Acceptable Level of Knowledge

9. Providers trained 33/34 Health Zones : 97% 2461 Care Providers Trained ◦ 1500 Midwives ◦ 480 Health Nurses ◦ 220 State Registered Nurses ◦ 19 Nurses’ Aides ◦ 82 Obstetrician/gynecologists ◦ 60 General Practitioners

10. SUCCES FACTORS Development Partners National Budget (Ministry of Health / Directorate of Health of the Mother and Child) Health Zones Budget (EmOC) Training Mobile Team

11. SUCCES FACTORS Involvement of Doctors Coordinators / Administrative Staff Training fellowship (funded at no cost) Tutoring (Monitoring and Correcting of Imperfection in the delivery room on the site - 2 weeks).

12. SUPERVISION Trainers Clinical supervisors Qualified care providers serving in maternity hospitals

13. RESULTS (THE 3 AMTSL GESTURES)

14. CONCLUSION MOH pushing PPH prevention agenda Public and private sector involved Postpartum hemorrhage prevention effective in Benin Coverage in correct AMTSL brought to 22% in 2010 Extension in process in order to maintain continuity Follow up and better practice hoped for Implication of reinforcement by SGOBT and ASFB SGOBT : Gynecology and Obstetrics Society of Benin-Togo ASFB : Benin Midwives Association

15. Thanks !!