Prevention of Postpartum Hemorrhage at Homebirths Using Community Health Workers in Afghanistan

Purpose: This project intended to demonstrate that the quality of an intervention to prevent postpartum hemorrhage (PPH) at homebirth through community-based counseling of pregnant women and distribution of Misoprostol could be maintained during scale up.

Methods: A pilot study conducted in 2005 in Afghanistan demonstrated that community-based distribution of misoprostol to prevent PPH at homebirths is safe, acceptable, feasible, and effective . Based upon the promising results, the program was expanded to an additional five provinces. Trained community health workers (CHWs) were used to identify and counsel pregnant women during household visits on prevention of PPH and use of Misoprostol if delivering in the presence of a skilled provider was not possible.

Monitoring and supervision systems were developed to ensure smooth implementation of the intervention. The data collected through the systems was manually reviewed for completion and accuracy. Data entry and analysis were conducted at the field and central project levels on a monthly basis to inform program decision making.

Results: Between January 2011 and January 2012, 8,664 women were registered for the intervention, among which 8,671 were educated and counseled by the CHWs. To date, of the women whom received education, 3,337 women delivered at home without skilled provider and 3,166 took Misoprotol.

Recommendations: Results reveal that the quality and effectiveness of the intervention can be maintained during scale up with adequate monitoring and supervisions systems to assure quality. This intervention can serve as a model for other countries where universal access to skilled birth attendance is a challenge.