We have good news to report that Ethiopia is demonstrating global leadership in involving traditional birth attendants (TBAs) in the use of misoprostol for safe delivery. The endorsement of TBAs was spurred largely by the training of the government’s rural health extension workers on misoprostol that VS supported in four zones. A subsequent evaluation of that project documented positive results where TBAs and health extension workers were linked. Moreover our pioneering work with traditional midwives demonstrated that they could administer misoprostol safely to women after childbirth. Both projects demonstrate that these front-line health workers who operate in the most rural and underserved areas are the best means to deliver the life-saving misoprostol tablets to the women who need them most. The government is now moving ahead with plans to apply this health worker model to prevent maternal mortality from postpartum hemorrhage with misoprostol throughout the country.

Moreover, awareness on the importance of misoprostol has gained popularity among both the health care providers and the communities where misoprostol is being used. One head of a rural district health center had this to say to our program monitoring team, “Misoprostol has gained momentum so fast that women request for ‘the life saving drug which you have given to my neighbor when she delivered at your health center’. Referral for [complications of] postpartum hemorrhage has stopped [since we] started using misoprostol in the health center.”

In February 2008, Misoprostol Day, an innovative and successful information, education and communication campaign, was held at the annual Women’s Association meeting in the remote region of Tigray. The purpose of the campaign was to engender dialogue among influential women about misoprostol and develop a means to increase availability of the life-saving tablets. Women immediately identified with the message of birth preparedness and misoprostol as a feasible option for their deliveries. The conference highlighted education and empowered women to understand how misoprostol works, its importance for preventing death from excessive bleeding after childbirth and where they will be able to obtain the tablets in the near future. The results of the VSHD-sponsored operations research study with misoprostol distributed by traditional birth attendants in Tigray were also presented.

More than 800 female delegates representing constituents from the regional to village level attended, including high ranking representatives from other women’s groups from SNNPR, Dire Dawa, Harar, and Addis Ababa regions. Mrs. Azeb Mesfin, wife of the Prime Minister of Ethiopia and chair of the Social Affairs Committee in Parliament, expressed her commitment to ensuring that misoprostol is available throughout the entire country and women understand how to use it.

Ethiopia is the first country in the world to engage women’s groups on a large scale for share the knowledge of postpartum hemorrhage and misoprostol. Since the initial launch in Tigray, VSHD has implemented a similar strategy in Ahmara, Dira Dawa and Harar regionals and additional campaigns are planned throughout Ethiopia, as well as in other countries.

Pictures:

• Attendees at the Women's Association meeting in Tigray (JPG)

In preparation for the expected regulatory approval of misoprostol for the control of postpartum hemorrhage (PPH), Venture Strategies, with the Family Health Department of the Ethiopian Ministry of Health and with our collaborating agency DKT-Ethiopia, has initiated trainings for the prevention of PPH by introducing misoprostol at the community level.

In December 2006, the Family Health Department, having recognized PPH as the major cause of maternal mortality in the country, initiated the project titled, “Misoprostol for the prevention of PPH at the community level.” A key project strategy targets training for the lowest level health care professionals in Ethiopia, the health extension worker, in an effort to meet the needs of the predominantly rural populations of Ethiopia.

As of May 2007, 128 heath extension workers and 29 nurse-midwife trainers representing 84 rural health posts throughout four regions of the country have been trained in the administration of oral misoprostol tablets to women during the third stage of labor to prevent PPH.

The Ethiopian Ministry of Health, in response to overwhelming interest in making misoprostol available to stop deaths from postpartum hemorrhage, has started planning on a rollout covering 24%. Ethiopia is the second largest country in Africa, with 77 million people.

The program will include training of health care workers through the public sector, from hospitals to community health workers in rural villages. Monitoring and evaluation will be put in place in order to understand the appropriate level of access and distribution channels for a countrywide implementation.

Venture Strategies for Health and Development has helped to develop this project and will provide monitoring and evaluation throughout. We are pleased to be able to support the Ministry of Health in this historic endeavor for Ethiopian women.

In the spring of 2006, traditional midwives from the rural Tigray region of Ethiopia were trained to administer misoprostol to women after delivery during home births. The off-patent drug is used for controlling postpartum hemorrhage, the leading cause of maternal death.

By September 2006, the study had been implemented in over 100 births. Early results show that traditional midwives are capable of safely and effectively providing this life-saving drug to their clients.

The Ethiopian doctor heading the study recently visited one of the villages where the drug was in use. As he arrived, he was surprised to be surrounded by women singing and dancing, a spontaneous welcome party. "We are so grateful to have this drug at home," they sang.

Venture Strategies is proud to be a part of this demonstration project with the Ethiopian Ministry of Health.

Ethiopia has taken an historic step to become the second country in the world to approve an old drug, misoprostol, for a new use, controlling postpartum hemorrhage. Postpartum hemorrhage, life-threatening bleeding following childbirth, is the leading cause of maternal deaths worldwide.

Our non-profit organization, Venture Strategies for Health and Development, worked with UC Berkeley's School of Public Health to help the Ethiopian Ministry of Health obtain this regulatory approval. Now the drug will be imported and made available for saving the lives of the approximately 8,200 Ethiopian women who die each year from this condition.

Our team helped Nigeria become the first country to obtain a similar regulatory approval in January.

Venture Strategies for Health and Development and UC Berkeley will continue to assist the Ethiopian Ministry of Health develop their rollout of misoprostol throughout the country with specific focus on distribution to rural areas.

Our nonprofit organization works to improve the health of low income people in resource-poor settings, by making use of existing market forces around the world. We are providing policy, medical, and distribution strategy support to several countries evaluating the introduction of misoprostol to save mothers' lives. By facilitating South-South trade, we help countries obtain high-quality low-cost health products from generic manufacturers, at their request.

If you would like to read more about our misoprostol projects and related publications, we invite you to see our web site.

Attachments:

• Press Release (DOC)