Community-Based Distribution of Misoprostol for the Prevention of ...

Orientation and planning workshop for the district- and upazila -level managers: At the onset of the project,
a district-level orientation and planning workshop was conducted for district- and upazila-level managers to
provide an intensive orientation on the program implementation process, technical issues related to the use of
misoprostol tablets for PPH prevention at the community level, and the role of district and upazila managers in
the pilot project implementation. Resource persons from the national level and from the Mayer Hashi Project
conducted the sessions. During the workshop, a plan was finalized for the upazila-level training program for
the field workers and the orientation for the facility-based service providers.
Training of government and NGO field workers and their supervisors: The next step was a day-long training
for the field workers and their supervisors, which was held at the upazila level. The training sessions involved
PowerPoint presentations and pictorial materials, followed by a question-and-answer session and group work.
The contents of the training included the background of the project and the rationale of community-based
interventions; technical details on PPH and on PPH prevention; technical details of misoprostol; the project
implementation process, including area distribution; identification and registration of pregnant women;
distribution of misoprostol and follow-up of postpartum women; community awareness activities; record
keeping and reporting; and the field workers’ roles and responsibilities in the implementation of the program.
In addition, the training provided detailed discussion on how to fill in the registers for pregnant women and
the monitoring forms. Supervisors were taught what to monitor and how to supervise the field workers’
registration of pregnant women, got acquainted with the new working areas for the field workers, and learned
how to distribute, follow up, and report on the use of misoprostol tablets.
The field workers also received their first supply of misoprostol tablets, stickers, leaflets, flipcharts, and a bag
in which to carry everything. As a result, field workers were able to start implementation of the activities
immediately after their training. Facility-based service providers joined the field workers during the technical
sessions of the training program to receive an orientation on the details of misoprostol, the management of its
side effects, and their roles in managing complicated and referred cases.
Distributing field worker’s working areas: During the training, the existing working areas of the field workers
were distributed among the field workers of government organizations and NGOs to avoid overlap and to
ensure that all areas were covered for the distribution of misoprostol tablets. In Bangladesh, DGHS and DGFP
each distributed working areas to their field workers for community-based health and family planning services.
These areas often did not correspond. At the same time, NGOs were assigned to work in certain areas, and
their field workers sometimes covered areas that overlapped with the Government of Bangladesh (GOB) field
workers. For the purpose of this project, to ensure that all pregnant women in Tangail were visited by a field
worker from DGHS, or DGFP, or an NGO, the field workers’ working areas were mapped out and distributed.
This generally meant that field workers covered a slightly smaller area for the misoprostol project than they
normally do, as the DGHS and DGFP areas often overlap. As for the distribution of misoprostol, it was
important to ensure that all pregnant women were registered and visited by one worker and that the women
received only one packet of three misoprostol tablets. The distribution of working areas among the health,
family planning, and NGO workers was conducted in a participatory manner in the presence of program
managers and supervisors.
Identifying and registering pregnant women: After being prepared through training and acquiring the
necessary supplies, the trained government and NGO field workers identified the pregnant women
(self-reported) in their working areas and registered them by using the supplied “Misoprostol use and
follow-up” auto-carbon register forms. The information to be recorded over the course of a woman’s
pregnancy included the woman’s name, age, and address; her expected date of delivery; the date she received
misoprostol tablets; place of delivery; the status of misoprostol use; any side effects or complications after she
used misoprostol tablets; and places she was referred to if any complications occurred, including contact
details. Mayer Hashi Project staff collected one of the duplicate completed forms for monitoring and record
keeping. Mayer Hashi Project staff maintained a detailed database of all registered pregnant women, and
updated it regularly based on the monthly reports from the field workers.
Mayer Hashi project Community-Based Distribution of Misoprostol for the Prevention of PPH 5