Report on the POPPHI / FIGO trip to Mali and Benin

The POPPHI Project is part of the United States Agency for International Development’s (USAID’s) broader Special Initiative to reduce postpartum haemorrhage, the single most important cause of maternal deaths worldwide, through expanded use of Active Management of the Third Stage of Labour (AMTSL). AMTSL is an intervention that reduces the incidence of postpartum haemorrhage by up to 60 percent.

The goals of POPPHI are to expand AMTSL, to improve the quality and availability of AMTSL at facilities and at the community level and to make uterotonic drugs and devices available at low cost to countries. POPPHI works closely with professional associations and has disseminated joint statements and declarations of the ICM and FIGO for the prevention and treatment of PPH and the promotion of AMTSL.

Mali and Benin are among the first francophone West African countries where AMTSL was introduced through regional training and monitoring programs. In spite of the fact that a relatively large number of skilled birth attendants have been trained in the practice of AMTSL in Benin and Mali, the actual rate of AMTSL practiced to standard remains relatively low in these countries. It was felt that uptake of AMTSL could improve with leadership from the national professional associations of obstetrician/gynaecologists and midwives. To this end, Ms Susheela Engelbrecht, a nurse-midwife working for the POPPHI project, and Dr Bruno Carbonne, a FIGO representative, visited Mali and Benin from May 9 through 13, 2008.

The main objectives of this visit were to strengthen the relations between the national associations of midwives and obstetrician/gynaecologists in these two countries, to develop joint statements for the prevention of PPH, and most importantly, to help these associations work together to promote initiatives to prevent PPH, including AMTSL and the rational use of uterotonic drugs.

Bamako (Mali) 10-11 May 2008

The trip began with Dr Carbonne’s and Ms Engelbrecht’s participation in the 11th annual International Day of the Midwife in Mali sponsored by the Malian midwives’ association, the ASFM (Association des Sages-Femmes du Mali). The national midwives’ active participation and enthusiasm at this meeting were very impressive, and more than 500 midwives from all the regions of Mali were present, all dressed in outfits tailored from this year’s “uniform” for the international day of the midwife (see photo 1). Ms Touré Lobo Traoré, the wife of the President of the Republic of Mali and a midwife herself, opened the meeting. The Ministry of Health’s Secretary General and several ministers and ambassador’s wives also participated in the opening ceremony.

The ASFM is a very well organised professional association, whose extremely active President (Ms Dicko Fatoumata Maïga) has created strong links with numerous health agencies (WHO, USAID, UNFPA, UNICEF?). Several Obstetricians (Prof. Amadou Dolo, Dr Teguete, Dr Traore?), representing the Malian obstetrics/gynaecology society, the SOMAGO (Société Malienne de Gynécologie et Obstétrique), also participated actively in planning for and presenting scholarly papers during the two days.

Dr Carbonne made presentation on new recommendations by FIGO/ICM for the prevention of PPH as well as an overview of studies on misoprostol use at the community level for the prevention of PPH. Ms Engelbrecht presented new information on the prevention of PPH, the latest WHO recommendations for the prevention of PPH, results of the AMTSL study conducted by POPPHI, and strategies for scaling up AMTSL. 

Ms Engelbrecht, together with representatives of SOMAGO and ASFM developed a joint statement for the prevention of PPH based on the FIGO/ICM joint statement on Prevention and Treatment of Postpartum Haemorrhage in Low Resource Settings (2006). This joint statement was presented at the 11th International Day of the Midwife, accepted, and then signed by the President of the ASFM, Ms Dicko Fatoumata Maïga, and the Secretary General of the SOMAGO, Dr Youssouf Traoré (see photo 4).

A small group of obstetrician/gynaecologists and the President of the ASFM developed a summary list of recommendations for midwifery practice (see photo 3). The midwives were encouraged to find ways to implement the recommendations in their places of practice.

Mali was the first sub-Saharan African country to officially sign a joint statement for the prevention of postpartum haemorrhage. This was acknowledged during the closing ceremony (see photo 5).

Cotonou (Benin) 13 May 2008

The morning of May 13th was dedicated to the process of reviewing selected national protocols for maternal and newborn health in Benin (photo 6). The POPPHI and FIGO representatives and a representative of Management Sciences for Health, Dr Gbangbadé Sourou, worked with a technical advisory group (TAG) comprised of midwives and physicians on the protocols for normal labour and childbirth and the immediate management of PPH. There were active discussions and exchanges. The evidence for the WHO/FIGO recommendations was emphasized in order to give members of the TAG the necessary information to make decisions about revising existing Beninese protocols with the ad hoc national committee.

The afternoon was spent in discussion and revision of a joint statement of the Beninese Midwives’ Association (ASFB - Association des Sages Femmes du Bénin) and the Beninese Society of Obstetrics/Gynaecology (SGOTB - Société de Gynécologie et d’Obstétrique du Togo et du Bénin) (Mme Monteiro, Pr Takpara, Pr Lokossou, Dr Sosthene Alionou) on the prevention of PPH in low resource settings and rational use of uterotonic drugs. Unfortunately, there was not enough time during this trip to finalize and sign this document.

Conclusion

This short, but very intense trip was felt to be very useful. FIGO participation in the POPPHI project was further encouraged by this visit in Western Africa. The direct contacts with key persons in the perinatal field let us believe that increased collaboration between Doctors and Midwives is on its way, and that a lot more is going to happen on the ground.