Nepal: Bringing Evidence-Based Practices to Scale (through MCHIP)
Start Date: 01/01/2009
End Date: 12/31/2014
The Maternal and Child Health Integrated Program (MCHIP) in Nepal builds on 10 years of maternal and newborn health technical assistance supported by the U.S. Agency for International Development (USAID) to the Government of Nepal to bring evidence-based practices to scale. Having successfully developed strategies to address the leading cause of maternal mortality–postpartum hemorrhage–in the past decade, the Government of Nepal is now focused on addressing pre-eclampsia/eclampsia (PE/E). A leading cause of maternal mortality and morbidity worldwide, PE/E contributes to 12% of maternal deaths (>60,000 deaths annually), and recent evidence in Nepal indicates that PE/E is now the second leading cause of maternal death, accounting for 21% of all maternal deaths. Based on this global evidence and emerging health priorities in Nepal, MCHIP employs a three-pronged strategy for preventing, detecting and managing PE/E: PE/E prevention: The World Health Organization (WHO) has identified calcium as one of the most effective and low-cost intervention among pregnant women for prevention of PE/E in a calcium-deficient setting such as Nepal. Use of calcium was found to reduce the incidence of PE/E by almost 65%. MCHIP is partnering with the USAID-funded bilateral Nepal Family Health Program II (NFHP II) under the leadership of the Family Health Division (FHD) of the Ministry of Health and Population (MOHP) to test the acceptability of calcium in two forms (tablets and powder) among pregnant women for three months in two village development committees (VDCs) of Banke district in southwestern Nepal. Based on this study, FHD plans to scale up the findings through community-based volunteers in several districts. MCHIP with NFHP II will implement calcium supplementation district-wide in one district and other districts supported by different development partners. This innovative project will demonstrate whether the government public health system, including female community health volunteers (FCHVs), can successfully distribute calcium for large-scale coverage and compliance. Screening and diagnosis of PE/E: To diagnose PE/E, pregnant women need to be screened for high blood pressure and protein in their urine to detect proteinuria. Unfortunately, many antenatal care (ANC) clinics in Nepal are not able to routinely offer screening. MCHIP will test a new low-technology proteinuria test that can be used in peripheral ANC clinics where proteinuria screening is not available, even at the household level. The Program will work with the largest, tertiary care hospital for maternal and newborn health in Nepal, The Paropakar Maternity and Women''s Hospital (PMWH), during the summer using this new test on routinely collected urine samples. The study will determine its specificity and sensitivity to existing standard tests. If the test is comparable, MCHIP will then bring the test to a rural ANC setting to determine whether health care workers, FCHVs and pregnant women can effectively use and interpret the test. Treatment and management of PE/E: WHO has identified magnesium sulphate as the best evidence-based practice to treat PE/E. While magnesium sulphate is included in the National Medical Standards Volume III and the Essential Drugs List, it is not yet systematically provided through the health care system to all women who require this lifesaving care. Under the ACCESS Program, Jhpiego worked with the Nepal Society of Obstetricians and Gynecologists (NESOG) to strengthen the use of magnesium sulphate to treat severe PE/E at 22 facilities throughout Nepal. Results showed that facilities can manage severe PE/E appropriately: 11 of the 22 facilities (i.e., 50%) were performing at 80% or higher. MCHIP will build on these results, working with FHD and development partners to further strengthen PE/E management, especially with the rapid increase of institutional deliveries with the national free maternity care program (Aama Programme). MCHIP will also provide technical assistance to strategic planning processes with national stakeholders–such as the national scale-up of postpartum hemorrhage prevention through distribution of misoprostol to women late in pregnancy who may not deliver in a facility or with a skilled provider. This work began under the ACCESS Program and contributed to global evidence on the safety and effectiveness of misoprostol at home births in saving lives. To help integrate this community-based intervention with other community-focused maternal and newborn health interventions, MCHIP also will support FHD to develop and carry out an implementation strategy and a training package. For more information about MCHIP, see full MCHIP description on this Web site or visit www.mchip.net. For more information about Jhpiego, the Prime on MCHIP, visit www.jhpiego.org.