INTRODUCTION

1. POSTPARTUM HEMORRHAGE PREVENTION BENIN EXPERIENCE Prof. R-X PERRIN, Prof. Ag. S. ADISSO, Dr. S. ABOUDOUAddis – 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. 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 !!