EVERY WOMEN EVERY CHILD UN COMMISSION ON LIFE-‐SAVING

community level. However the policy is in the process of being reviewed, in light of the recent evidence from local studies already described above, to allow use of misoprostol for prevention and management of PPH at community level (in home births) under the management of community health workers (VHT). Its use in management of PPH at community level is in the context of giving immediate treatment prior to referral/ transfer to a health facility. Implementation plan a) Immediate plan Develop an integrated policy on oxytocin and misoprostol for use in the prevention and treatment of PPH. In line with this policy update national clinical guidelines and Print and disseminate guidelines on use of Misoprostol at all health facility levels b) Intermediate plan Conduct implementation research to inform scale up of use of misoprostol for prevention of PPH in home births in a real life setting so as to benefit more women in need of this service and to foster policy and program development. Key issues to be considered include 1) Distribution of misoprostol in antenatal care clinics 2) The roles of the village health teams in this context-­‐ besides providing information and referring women 3) Ensuring that the gains made in increasing access to skilled attendance at birth are not lost 4) Ensuring that the drugs are not misdirected for use in unlawful terminations of pregnancies. Incorporate misoprostol in pre service training for tutors and midwives. Conduct community sensitization on the importance of accessing misoprostol in health facilities for prevention and treatment of PPH and provide them with regular messages /reminders using sms. Sensitize VHT on the importance of misoprostol, use sms to provide information and reminders about its use and emphasize referral of bleeding mothers to health facilities 3.2.2 Magnesium Sulphate for prevention, treatment of severe pre-­‐eclampsis and eclampsia Problem statement The main issue with Magnesium Sulfate is insufficient use by health workers. Despite global evidence from over a decade ago that magnesium sulphate is superior to diazepam in treating eclampsia and that Magnesium sulphate is effective in prevention of eclampsia in mothers with severe preeclampsia. The Ministry of health developed protocols and guidelines on its use in these contexts but these have not been widely disseminated. Communities are also generally not aware of the existence of this drug for management of eclampsia, a disease