Challenges

Postpartum hemorrhage is the most important reason for death of pregnant women in low-income countries due to very poor quality of delivery and low usage rate of available services and so on. Postpartum hemorrhage was one of the leading causes of maternal death in Bangladesh (maternal mortality ratio was over 150 per 100,000 live births). The project provided safe and appropriate comprehensive interventions to prevent postpartum hemorrhage and reduce maternal mortality in Bangladesh to achieve SDG Goal 3. The Government of China provided the Global Development and South-South Cooperation Fund to Bangladesh for using Chinese rich experience and technology in the prevention of postpartum hemorrhage. The practice experience from this project will provide capacity building for the sustainable and standardized use of cost-effective and easily accessible methods for preventing postpartum hemorrhage under limited obstetric conditions.

Toward a Solution

The project aimed to provide safe and appropriate comprehensive interventions to prevent postpartum hemorrhage (PPH) and reduce maternal mortality in the recipient country to achieve SDG goal 3.1 and 3.7.

Both Partners in Population and Development (PPD) and Partner agency China National Research Institute for Family Planning (NRIFP) worked together with Directorate General of Family Planning (DGFP) of Ministry of Health and Family Welfare, Government of Bangladesh successfully implemented the project in Bangladesh. The project was implemented in 6 Upazillas of Bangladesh.

The main contributions and achievements are as follows:

1. Technical and managementtraining at different levels 

Training modules including textbook, multimedia electronic courseware of PPH prevention with misoprostol were developed by Chinese experts and translated to Bengali by Bangladeshi experts which were approved and recognized by the Government of Bangladesh to use for conducting training at national levels for medical professionals/health workers. This training on PPH and misoprostol administration was very unique and had never been held in Bangladesh with high level expertise.

• Local government representatives including membersof parliament engaged in training on management of PPH prevention. About 50 administrators/high level officials joined in the training program who had never been aware of PPH.
• A total of 270 medical professionals received the training on PPH and effective use of misoprostol.
• The training conducted for 494 health workers inthe targeted 6 Upazillas utilized a multifaceted approach, combining lectures, interactive discussions, live demonstrations, and hands-on practical sessions.
• The training at satellite levels covered 56 Unions, the lowest unit of local government. A total of 676 pregnant mothers and their nearest relations received training on uses of misoprostol for preventing PPH, which was a unique innovation and contribution of this project.

2. Promotion and advocacy

Promotion and advocacy materials of misoprostol and PPH for pregnant mothers and health workers were developed by both Chinese and Bangladesh experts. The drama-video on misoprostol was appreciated by the government stakeholders and the government bought it for their use at facilities.

3. Misoprostol and Postpartum Care kits from China for distribution

A total of 61,700 boxes of Misoprostol 200mcg tablets and 160,596 Postpartum Care Kits were shipped from China to DGFP for distribution. PPD, in collaboration with DGFP, Government of Bangladesh organized a handover ceremony.

4. Achievement and sustainable development

• Capacity building

Comprehensive intervention measures were undertaken to advocate the use of misoprostol and improve the medical workers in the project area using misoprostol for PPH prevention in terms of skills and knowledge and the corresponding management level and training ability. Furthermore, the ability of primary medical institutions was improved. About 54 Union Health and Family Welfare Centers, 18 Community Health Centers, 18 Union sub-Health Centers and 8 Upazilla Health Complexes were facilitated to build their capacity on PPH prevention with misoprostol through our training, supplying of training materials, providing misoprostol and postpartum kits.

• Reducing the incidence of PPHin target areas

A total of 29 Union Health and Family Welfare Centers were chosen to collect retrospective data from health workers. The evaluation for the incidence of PPH in the evaluated areas showed that during the project implementation from 2020 to 2023, the incidence of PPH decreased by over 70%.

• Extension of project achievements

Training modules have received great demand from the Bangladesh government for sharing the experiences of this project with other PPD member countries.

The clinical guideline of PPH prevention with misoprostol developed based on the experience of project sites will provide support for the sustainable and standardized use of cost-effective and easily accessible methods for preventing PPH under limited obstetric conditions.

Overall, the successful implementation of the project cannot be achieved without the cooperation of all partners. During the implementation of the project, not only did the project area benefit, but the capabilities of all partners were also enhanced. For example, the COVID-19 epidemic was serious at the beginning of the project, the project team formulated emergency plans and optimized strategy to start the development of multimedia videos as soon as possible, providing strong support for online training during the epidemic. Although the progress of on site practical training were affected, the effectiveness of the training was not affected due to efforts from all partners.