Presentation at the Global Maternal Newborn Health Conference, October 19, 2015
Postpartum Hemorrhage (PPH) is a major cause of the nearly 300,000 maternal deaths that occur annually. Nearly 34% of maternal deaths in Africa are due to PPH (WHO 2012). South Sudan has the highest maternal mortality ratio in the world; 2,054 per 100,000 live births, along with a high rate of home deliveries and limited access to health care facilities (MOH RSS 2011). With the support of USAID through JHPIEGO, World Vision South Sudan has rolled out prevention of PPH and community distribution of misoprostol using community health volunteers (CHV) WV South Sudan aimed to prevent deaths due to PPH in an area of extremely high need by training CHVs to counsel pregnant women, families and other community members about the importance of taking misoprostol tablets for prevention of PPH and what actions to take in case of PPH incidence. 72 CHVs from Bazungua payam were selected by their community leaders to receive training on PPH prevention between July and October 2014. The training had three days of classroom interactive sessions, lecture, role-plays and group work. The fourth day was community-based practice of counseling of pregnant women and their families using PPH prevention, birth preparedness and complication readiness flipcards. In 9 months of implementation, 1270 pregnant women received counseling on PPH prevention and use of misoprostol. 702 women received misoprostol through HHPs. 184 women delivered at health facilities assisted by skilled birth attendants and received oxytocin immediately after delivery, 508 women delivered at home and took misoprostol within 3 minutes of delivery. There have been no reported cases of PPH in the communities where the program is operating. This project demonstrates that CHVs can effectively distribute misoprostol to prevent PPH in a setting of extremely high need and very low access to health facilities.