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					                                      Request for Proposals
                                           2010-093

   The Oxytocin Initiative: Exploring use of uterotonic substances at or around
                          birth in three regions in Ghana

I. Summary of Deadlines

Release of request for proposals                     February 5, 2010
Confirmation of interest due                        February 12, 2010
Fact-finding questions due                          February 16, 2010
Response to fact-finding questions sent             February 19, 2010
Proposals due                                       February 24, 2010
Identification and notification of short-listed        March 1, 2010
organizations
Interview period for short-listed organizations       March 2-3, 2010
Notification of results                                March 8, 2010


II. PATH Business Statement

PATH is an international nonprofit organization that creates sustainable, culturally relevant solutions,
enabling communities worldwide to break longstanding cycles of poor health. By collaborating with
diverse public and private sector partners, PATH helps provide appropriate health technologies and vital
strategies that change the way people think and act. PATH’s work improves global health and well-
being.

Headquartered in Seattle, Washington, PATH has 33 offices in 19 countries. PATH currently works in
more than 70 countries in the areas of health technologies, maternal and child health, reproductive
health, vaccines and immunization, and emerging and epidemic diseases.

For more information, please visit www.path.org

III. Background and Introduction

Over 500,000 maternal deaths occur each year (1). Postpartum hemorrhage, defined as blood loss of
500ml or more, is one of the leading causes of maternal death globally (2). It is also one of the few
obstetric complication for which an effective preventive intervention is available. Active management of
the third stage of labor (AMTSL), a package of interventions generally defined as administration of a
uterotonic drug immediately following delivery, controlled cord traction and fundal massage following
delivery of the placenta, is recommended by the World Health Organization (WHO) for the prevention of
postpartum hemorrhage (3). A Cochrane review and meta-analysis of five clinical trials showed that
AMTSL reduced the risk of postpartum hemorrhage by 62% relative to no intervention in hospital-based
births (4).


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Given that approximately half of all births take place at home or in peripheral health facilities in low-
income countries (5), there is a need for further research to explore means of adapting AMTSL for use
outside of hospital settings; for example, in peripheral health facilities where there is no supervision by
higher level obstetric personnel or at home-based births. The WHO does not recommend AMTSL by
non-skilled birth attendants due to the potential risks that may result from inappropriate cord traction.
However, in the absence of AMTSL, WHO recommends that a uterotonic drug should be offered by a
health worker trained in its use for the prevention of postpartum hemorrhage (3). Oxytocin is the drug
of choice for postpartum hemorrhage prevention (3), but the feasibility of its use is limited in many
settings because it is only available in injectable form and requires cold chain storage.

Currently, no data are available to support or discourage the use of injectable uterotonics to prevent
postpartum hemorrhage by lower level birth attendants. However, recent calls to expand access to
oxytocin for postpartum hemorrhage prevention have been coupled with concern that the drug would
also be available for induction and augmentation of labor. Labor induction and augmentation should
only be performed by highly trained health workers in facilities with access to emergency obstetric care
due to the increased risk of obstetric complications accompanying these procedures. Inappropriate
administration of oxytocin prior to delivery in peripheral health facilities or by low-level health workers
is regarded as dangerous because the dosage may be difficult to monitor and cannot be adapted to the
level of uterine stimulation (6). Such inappropriate administration may result in hyper-stimulation of the
uterus which can lead to uterine rupture, fetal asphyxia and/or fetal demise (7, 8).

Inappropriate use of oxytocin injections to induce and augment labor at home births is well documented
in some parts of the world. The use of oxytocin to augment labor appears particularly common in South
Asia, based on descriptive reports from the medical and social science literature. A recent literature
review of uterotonic use at home-based births (9) found that from 1 to 69 percent of women laboring at
home received oxytocin to augment labor in India and Bangladesh (10-13). This practice was also
documented in Latin American and Africa. One study conducted in rural Guatemala reported that 60
percent of women whose labors were assisted by a traditional birth attendant received an injection of
oxytocin prior to delivery (14). Another qualitative report described oxytocin use to accelerate labor in
Mexico (15). Reports from two studies conducted in sub-Saharan Africa indicate that inappropriate use
of oxytocin occurs in this setting, but that traditional preparations thought to induce or augment labor
are commonly used as well. One study from Uganda described herbal preparations used by traditional
healers and birth attendants to induce and augment labor and to aid in removal of the placenta.
However, the uterotonic properties of the herbs were not assessed (16). The second report of a
hospital-based study from Sudan reported that 9 out of 86 cases of ruptured uterus occurred in women
who had received oxytocin at home (17). In Ghana, no published studies have been identified regarding
the use of traditional preparations for use during pregnancy, labor and the immediate postpartum
period in Ghana. However, it is well known that such preparations (herbs, roots, etc.) are available in
local markets throughout the country (19). In addition, no data from Ghana were identified to suggest
that pharmaceutical uterotonic drugs are being used at home.

Ghana is an appropriate setting in which to conduct this research for several reasons. Pregnancy-related
mortality is high. A special Demographic and Health Survey on maternal health conducted in 2007
estimated the pregnancy-related mortality ratio to be 416 deaths per 100,000 live births (18). This same
survey attributed 24% of maternal deaths to obstetric hemorrhage . Forty-five percent of births occur at
home, and approximately 30 percent are assisted by a lay birth attendant, a proportion which has not
changed since the mid 1980’s.For this landscape review on uterotonic use we have selected three


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geographically representative regions in Ghana: Northern Region in the Northern Belt, Brong Ahafo in
the Central Belt and Western Region in the Coastal Belt.

Results from this research will inform policy makers on the current status of uterotonic use in the
selected study districts in the Northern Region, Brong Ahafo and the Western Region. The proposed
study will also provide valuable background information for the development of future interventions
that aim to explore the safety and feasibility of expanding access to uterotonic drugs for the prevention
of postpartum hemorrhage at the community level while simultaneously avoiding or decreasing
inappropriate use of these drugs.

IV. Scope of Work and Deliverables

A. Scope of Work
   PATH and the Johns Hopkins Bloomberg School of Public Health, with funding from the Bill &
   Melinda Gates Foundation, have undertaken the Oxytocin Initiative to explore the safety and
   feasibility of expanding access to oxytocin to trained health care cadres (lower level health care
   providers) for the prevention of postpartum hemorrhage in peripheral health facilities and home-
   based births. In preparation for future community-based trials, the Oxytocin Initiative project
   includes a landscape review which explores the use of uterotonics at or around birth in three
   regions of Ghana. With this RFP, PATH asks interested applicants to propose a work plan which
   incorporates all aspects of the landscape review as outlined below.

     The aim of the landscape review is to broadly explore how uterotonics are being used and
    distributed at or around birth in three regions of Ghana. The following are specific objectives of the
    research:

    1. Document provider knowledge of and attitudes toward uterotonic use during labor and delivery
       at all levels of the public health system;
    2. Document community knowledge of and attitudes toward uterotonic use during labor and
       delivery;
    3. Attempt to purchase uterotonic drugs and/ or traditional preparations believed to have
       uterotonic properties from various sources;

    Research activities have been developed to meet each objective. The selected organization will be
    responsible for implementing the following research activities, as designated by objective.

    Objectives 1 and 2 – Qualitative Interviews

    These objectives will be addressed through in-depth, qualitative interviews of health care providers
    and community members. Table 1.1 specifies the topic areas that will be addressed during
    interviews with each cadre. Data collection tools have been prepared (see appendix A) and will be
    pretested prior to implementation of field work.

    All interviews should be conducted at a location convenient for the participant. Potential locations
    may include the participant’s home or place of employment. Interviews must be conducted in the
    language most comfortable for the participant and therefore, interviewers must be fluent in
    regional languages found in selected districts. Proposals should detail the organization’s capacity to
    work in regional languages found in the Northern Region (Yendi municipal district), Brong Ahafo

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(Kintampo North municipal district) and the Western Region (Ahanta West district). Proposals
should also include a detailed plan for maintaining participant confidentiality during data collection
and security of the data afterwards, as well as a plan for management of all data collected.

Ten interviews should be conducted in each cadre of interest in each selected district. This
corresponds to a total of 210 interviews for the entire project.

Objective 3 – Simulated Client Research

 The selected organization will be responsible for compiling a list of pharmacies, chemical shops and
markets where drugs can be purchased for use as a sampling frame. Two research assistants in each
district will be assigned to visit a randomly selected list of 25 pharmacies, chemical shops and/or
markets and attempt to purchase two units of oxytocin or misoprostol. A third research assistant
will be assigned to purchase any traditional preparations available for use during labor and delivery.
If prompted for an explanation or justification of why the drugs/traditional preparations are being
sought, the research assistant will recount a false scenario in which a pregnant relative is expected
to deliver soon. Each research assistant will be asked to present the same scenario, which will be
scripted and presented during training.

Immediately after visiting each point of sale, the research assistants will complete a brief data
collection form. Information recorded will include the identification of items purchased, volume,
cost, and any unsolicited advice offered to the research assistant upon purchase of the drug and/or
traditional preparation. All pharmaceuticals purchased will be stored under the manufacturer’s
recommended conditions from the time of purchase. Following completion of field work, the
selected research institution will be expected to deliver all uterotonic drugs and substances
collected to Oxytocin Initiative study staff at PATH.




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Table 1.1 Topics of Interest by Interview Cadre
Interview Category          Topics of Interest
Physicians                        Clinical experience and practice with uterotonics;
                                  Frequency of use;
                                  Attitude toward uterotonic use during labor and delivery;
                                  Availability of uterotonics within the facility;
Midwives (including               Clinical experience with uterotonics;
Community Health                  Perceived effect of uterotonic substances on labor/delivery processes;
Nurse Midwives and                Attitude toward uterotonic use during labor and delivery;
Staff Nurse Midwives)
Public Health Nurses              Role in delivery processes at home and in facilities;
                                  Clinical experience with uterotonics;
                                  Perceived effect of uterotonic substances on labor/delivery processes;
Traditional Birth                 Perceived effect of uterotonic substances on labor/delivery processes;
Attendants                        How effective they believe various substances to be;
                                  Indications for use;
                                  Uterotonic stock procurement;
Pharmacist Assistants             Stock procurement;
and attendants at                 Pricing;
chemical shops                    Storage;
                                  Knowledge of prescription policy;
                                  Selling practices, i.e. any advice, qualifying questions, contraindications;
Women who delivered               Personal experience with use of uterotonics;
within six months prior           Attitude toward use (i.e. did they request uterotonics? If so, why?)
to interview                      Cost associated with uterotonic purchase/administration;
Older mothers (50+)               Role in delivery process;
                                  Attitude toward uterotonic use during labor and delivery;
                                  Cost associated with purchase and/or administration of uterotonics;
                                  Their personal recollection of this practice; when did it become commonplace?




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B. Deliverables
   The organization contracted to conduct the landscape review in Ghana will be responsible for the
   deliverables listed below. All proposed work plans should address plans to achieve the following:

   Objectives 1 and 2, Qualitative Interviews:

          Provide PATH with a written project management plan detailing roles and responsibilities of
           all personnel involved in this research activity;
          Provide PATH with a written plan outlining recruitment and training of data collectors,
           conduct of field work, and a timeline for completion of field work;
          Finalized copies of questionnaires in all local languages;
          Official copy of the back translation of all questionnaires;
          Communicate with PATH and JHSPH staff regarding the number of interviews completed in
           each cadre in each district and other ongoing project activities on a regular basis to be
           determined during contract negotiations;
          Short written report at the end of data collection period;
          An electronic data file containing copies of all transcribed interviews in English;
          A list of ‘key themes’ identified in conjunction with PATH and JHSPH staff from preliminary
           analysis of the textual data;
          A brief report detailing analysis of inter-coder reliability between all team members involved
           in data analysis;
          An electronic data file containing coded qualitative data, formatted with qualitative data
           management software to be agreed upon between the selected organization, PATH and
           JHSPH;
          Final report of results to be prepared jointly with PATH and JHSPH staff (data analysis to be
           done collaboratively)

Objective 3, Purchase of Uterotonics

          Provide PATH with a written project management plan detailing roles and responsibilities of
           all personnel involved with this research activity;
          Provide PATH with a sampling frame of all places where uterotonics are sold, including
           pharmacies and chemical shops in the selected districts (this sampling frame need not be
           100% comprehensive, as the difficulty in compiling such a sampling frame is recognized)
          Written report outlining recruitment and training of research assistants
          Timeline for completion of training and field work
          Finalized data collection forms;
          Interim reporting on number of pharmacies/chemical shops visited and volume of samples
           purchased
          Electronic file containing all data resulting from the research activity (format to be
           determined)
          Final report of results to be prepared jointly with PATH and JHSPH staff (data analysis to be
           done collaboratively)
          Provide PATH with ALL samples of uterotonic drugs and/or traditional preparations
           purchased during this research activity


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V. Costs

Provide itemized costs for the proposed work plan based on the scope of work outlined in section IV.
The final scope of work may be subject to negotiation; however, evaluation of submissions will be
conducted using the originally proposed budget. The budget should be submitted in both Ghana cedis
and U.S. dollars. A budget narrative including data to support actual costs and methodologies to support
cost estimates for all major line items listed in the budget must be provided. See Appendix B for a
budget template.

A. Direct Research Costs
   This section of the proposed budget should indicate and justify the remuneration requested.
   Research expenses encompass services and materials required to carry out the research. Research
   expenses may include remuneration to research assistants, vehicle hire, consumable goods or non-
   capital equipment such as photocopier supplies, maintenance of research equipment, computer
   services and local travel.
       a. Personnel Costs
            For each person or category of personnel, specify the exact activity the person will be
            working on, the amount of days spent and what total salary this represents for each person.
            Separately list any consultants used.
       b. Travel and Transportation
            Indicate modes of travel, estimated number of trips, cost per trip (transportation and
            expenses or per diem) and number of travel days per trip. Include local travel expenses such
            as gasoline and mileage, vehicle hire, etc.
       c. Workshops and Training
            This budget category includes the cost of project-related training organized by the
            submitting organization. Include the number of interviewers or participants for each training
            session, their rates and the number of expected training days. List the cost of the venue, any
            transportation costs and per diem rates for each person involved.
       d. Project Supplies and Equipment
            The budget should include an estimate for the printing of all training materials and data
            collection tools as well as costs incurred for the printing and distribution of the final report.
            This estimate can also include a modest amount for IT, graphics and equipment.
       e. Other Direct Project Costs
            This budget category should only include those administrative costs that are not directly
            related to the research. They may include items such as general office expenses or
            communication and postage expenses.

B. Indirect Costs
   Indirect costs are overhead expenses incurred as a result of the project but not easily categorized
   within the project activities. These are generally administrative expenses that are related to the
   overall operations and are shared among projects and/or functions. Examples include executive
   oversight, accounting, grants management, legal expenses, utilities and facility maintenance. Please
   note that to the extent possible, allocable costs should be documented and justified in the proposed
   budget as direct costs.




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    Indirect rate allowances are maximum amounts allowed by PATH under projects funded by the Bill &
    Melinda Gates Foundation. If the organization has lower rates, the lower rates should be used. To
    the extent that indirect costs are applicable, they are subject to the following limits:
              Up to 10% for U.S. universities and other academic institutions
              Up to 15% for non-U.S. academic institutions and all private, voluntary and
                 nongovernmental organizations, regardless of location
              No indirect costs will be paid to U.S. government agencies
              Rates apply to the primary grantee, sub-grantees and subcontracts that are part of the
                 proposed work plan.

VI. Overall Qualifications

Please provide the following information regarding the qualifications of your organization:

       A profile of relevant corporate qualifications
       A profile detailing professional experience in the context of public health
       Qualifications of the project team leader and key members of the proposed project team,
        detailing experience with qualitative research (please provide CVs for all proposed personnel
        and details of back-up/standby teams)
       Contact information for at least two references who have worked with your organization
        previously
       Number of years in business
       Annual revenue

If your organization has multiple locations, please indicate these qualifications for the site that is
responding. Organizations must provide complete contact information for the location responding.

VII. Proposal Evaluation Criteria

Proposals will be assessed based upon the criteria listed below. All proposals will be evaluated by a team
from PATH and the Johns Hopkins Bloomberg School of Public Health. Other technical experts may be
consulted when evaluating submitted proposals as determined appropriate by PATH.

       Submitted proposals will be evaluated based on the technical quality and creativity of the plan
        proposed to address the research questions outlined in this RFP. Proposals should illustrate the
        team’s knowledge, experience and a clear plan for accomplishing the deliverables listed.
       Experience of the team leader, all team members working on the project and overall relevant
        corporate experience
       Capacity to perform the work within the desired timeline
       Propriety and cost effectiveness of the proposed budget, as well as the level of cost detail
        provided
       Demonstrated knowledge of quality control mechanisms
       Responsiveness to this RFP

PATH reserves the right to disqualify proposals that are not responsive or that do not illustrate sufficient
technical knowledge.


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VIII. Instructions for Responding

A. Confirmation of Interest
   Please send a statement acknowledging receipt of this solicitation and your intent to respond no
   later than February 12, 2010 to Ms. Patricia Boison (pboison@path.org) and copied to Mr. Keith
   Neroutsos (kneroutsos@path.org).

B. Fact-finding Questions
   All questions regarding this RFP must be submitted in English no later than February 16, 2010 in
   order to ensure that responses can be provided in a timely manner. Inquiries received after this date
   will not be accommodated. All questions should be addressed to Ms. Patricia Boison
   (pboison@path.org) and copied to Mr. Keith Neroutsos (kneroutsos@path.org). Responses to all
   inquiries will be provided no later than February 19, 2010. Please note that responses will not be
   confidential except in cases where proprietary information is involved. Those submitting inquiries
   must provide an email contact in order to receive responses.

C. Proposal Submission
   Completed proposals should be received no later than close of business, 17:30 hours, on February
   24, 2010. Note that a hard copy and an electronic copy are required.

    An electronic copy of the proposal submission should be directed to Ms. Patricia Boison
    (pboison@path.org) and copied to Mr. Keith Neroutsos (kneroutsos@path.org). Please send
    electronic submissions as Microsoft Word or PDF files. PATH will not accept responsibility for
    resolving technical transmission problems with proposals. Submission content should be limited to
    information pertaining to the scope of work described in this RFP. Any information submitted
    outside of the scope of work will be reviewed at PATH’s discretion.

    Please direct hard copies to:

    Ms. Patience Cofie
    Research Coordinator, The Oxytocin Initiative
    PATH
    20 Orphan Street
    Labone, Accra
    Ghana

D. Selection of Short-Listed Applicants
   PATH reserves the right to select a short list of applicants based upon the qualifying information
   detailed in section VI. All shortlisted applicants will be notified by March 1, 2010. PATH has the
   option to interview and discuss specific details of the submitted proposals with short-listed
   organizations. All organizations submitting proposals for consideration should have representatives
   available during the interview period (March 2-3, 2010). All applicants selected for an interview will
   be contacted by PATH.

E. Notification of Results
   Applicants will be notified of PATH’s decision by March 8, 2010. The final award is subject to the
   terms and conditions included in this solicitation, as well as successful final negotiations of all
   applicable terms and conditions affecting this work.

                                                                                                            9
IX. Terms and Conditions of the Solicitation

A. Notice of Non-Binding Solicitation
   PATH reserves the right to reject any and all bids received in response to this solicitation, and is in
   no way bound to accept any proposal.

B. Confidentiality
   All information provided by PATH as part of this solicitation must be treated as confidential. In the
   event that any information is inappropriately released, PATH will seek appropriate remedies as
   allowed. Proposals, discussions, and all information received in response to this solicitation will be
   held as strictly confidential, except as otherwise noted.

C. Communication
   All communications regarding this solicitation shall be directed to appropriate parties indicated in
   Section VIII. Contacting third parties involved in the project, the review panel, or any other party
   may be considered a conflict of interest, and could result in disqualification of the proposal.

D. Acceptance
   Acceptance of a proposal does not imply acceptance of its terms and conditions. PATH reserves the
   option to negotiate on the final terms and conditions. In addition, PATH reserves the right to
   negotiate the substance of the finalist’s proposals, as well as the option of accepting partial
   components of a proposal if appropriate.

E. Right to Final Negotiations
   PATH reserves the option to negotiate on the final costs and final scope of work, and also reserves
   the option to limit or include third parties at PATH’s sole and full discretion in such negotiations.

F. Third-Party Limitations
   PATH does not represent, warrant, or act as an agent for any third party as a result of this
   solicitation. This solicitation does not authorize any third party to bind or commit PATH in any way
   without our express and written consent.

G. Proposal Validity
   Proposals submitted under this request shall be valid for 90 days from the date the proposal is due.
   The validity period shall be stated in the proposal submitted to PATH.




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References

1. World Health organization, UNFPA, UNFPA. Maternal Mortality in 2000: Estimates developed by
         WHO, UNICEF, UNFPA. Geneva: World Health Organization; 2004.
2. Ronsmans C, Graham WJ. Maternal mortality: who, when, where and why. Lancet. 2006 September
         30, 2006;368:1189-200.
3. World Health Organization. WHO Recommendations for the Prevention of Postpartum Haemorrhage.
         Geneva: World Health Organization; 2007.
4. Prendiville WJP, Elbourne D, McDonald S. Active versus expectant management in the third stage of
         labour. The Cochrane Library. 2000(2).
5. Stanton C, Blanc AK, Croft T, Choi Y. Skilled Care at Birth in the Developing World: Progress to Date
         and Strategies for Expanding Coverage. Journal of Biosocial Science. 2007;39:109-20.
6. World Health Organization. Managing Complications in Pregnancy and Childbirth: A guide for
         midwives and doctors. Geneva: World Health Organization; 2000.
7. Zheng QL, Zhang XM. Analysis of 39 cases of maternal deaths caused by incorrect use of oxytocin.
         Zhonghua Fu Chan Ke Za Zhi. 1994 May 1994;29(5):276-7.
8. Konje JC, Odukoya OA, Ladipo OA. Ruptured uterus in Ibadan - A twelve year review. International
         Journal of Gynecology and Obstetrics. 1990;32(3):207-13.
9. Flandermeyer D, Stanton C, Armbruster D. Uterotonic Use in Home Births in Low-income countries: A
         Structured Literature Review. 2009.
10. Jeffery P, Das A, Dasgupta J, Jeffery R. Unmonitored Intrapartum Oxytocin Use in Home Deliveries:
         Evidence from Uttar Pradesh, India. Reproductive Health Matters. 2007;15(30):172-8.
11. Sharan M, Strobino D, Ahmed S. Intrapartum oxytocin use for labor acceleration in rural India.
         International Journal of Gynecology and Obstetrics. 2005;90:251-7.
12. Matthews Z, Ramakrishna J, Mahendra S, Kilaru A, Ganapathy S. Birth Rights and Rituals in Rural
         South India: Care Seeking in the Intrapartum Period. Journal of Biosocial Science. 2005;37:385-
         411.
13. Fronczak N, Antelman G, Moran AC, Caulfield LE, Baqui AH. Delivery-related complications and early
         postpartum morbidity in Dhaka, Bangladesh. International Journal of Gynecology and Obstetrics.
         2005;91:271-8.
14. Bartlett AV, Paz de Bocaletti ME. Intrapartum and Neonatal Mortality in a Traditional Indigenous
         Community in Rural Guatemala. Acta Paediactrica. 1991.
15. Berry NS. Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala:
         Contextualizing the choice to stay at home. Social Science & Medicine. 2006 April
         2006;62(8):1958-69.
16. Kamatenesi-Mugisha M, Oryem-Origa H. Medicinal plants used to induce labour during childbirth in
         western Uganda. Journal of Ethnopharmacology. 2007;109:1-9.
17. Ahmed SM, Daffalla SE. Incidence of uterine rupture in a teaching hospital, Sudan. Saudi Medical
         Journal. 2001;22(9):757-61.




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Appendix A – Data Collection Tools

Separate data collection tools have been developed for interviews with each of the seven cadres of
interest and the simulated client activity. Two examples of qualitative interview guides are included
below; one developed for interviews with midwives and another for interviews with new mothers. Data
collection tools for the other cadres of interest follow a very similar format and will be provided upon
request.

The Oxytocin Initiative, Ghana
Guide for Qualitative Interviews with Midwives

Introductory statement [suggested wording to be read aloud by interviewer]

Thank you for agreeing to participate in this interview. My name is [name of interviewer] and I work for
[name of organization]. I am conducting research to better understand labor and delivery practices in
Ghana. As part of this research I am speaking with midwives in [name of district] about their role in the
labor and delivery process and their past experiences assisting with deliveries. Your participation in this
interview is completely voluntary. You do not have to answer any questions that you don’t feel
comfortable with, and you may stop the discussion at any time.

If it is alright with you, I would like to record our discussion. I will not be able to write as fast as we
speak, and I don’t want to miss any of the topics we discuss. Our conversation and the recording are
completely confidential. No one outside of the research team will hear the recording or know what
information you shared with me. Do you have any questions about this? May I have your permission to
record our discussion?

[If the participant does not want to be recorded, interviewer should request permission to take hand-
written notes on paper.]

I have a list of topics that I would like to discuss with you, but please feel free to speak about any related
issues that you feel are important. There are no correct or incorrect answers to the questions I will ask
you. I am primarily interested in your personal experiences and thoughts, so please say what you
honestly feel. May we begin the discussion now?

[If the individual does not want to participate in the interview after hearing this statement, please thank
them for their time. Otherwise, please proceed with the questions below.]


Interview Setting

1. Name of Interviewer:

2. District:




                                                                                                           12
Training and Experience

Let’s begin by talking about your experience as a midwife.

3. How long have you been practicing as a midwife?

4. How did you learn the skills necessary to become a midwife?
       Who taught you these skills?


Role in Labor and Delivery

5. What is your role in labor and delivery?
        Where do you usually attend deliveries?
        Do you ever assist in deliveries that take place at governmental or private health facilities?
                     Which facilities?
       Do you ever assist in deliveries that take place at a woman’s home?

6. What services do you provide the woman in labor and her family when assisting with deliveries?

7. Where do you think women prefer to give birth? Why?


Knowledge of and Experience with Uterotonics

[I would like to know more about some specific events that may occur during labor.]

8. What happens when a woman’s labor is very long?
       How do you know when the labor has been too long?
       How long should the labor normally last?

9. What can be done to help a woman whose labor has lasted too long?
       Do you do anything to speed up the labor?
       Are there any treatments available to help a woman whose labor has lasted too long?

[Interviewer should attempt to focus the discussion on any specific drugs, traditional preparations
and/or practices believed to augment labor. Please ask the following questions with regard to each drug,
preparation and/or practice mentioned by the participant.]

10. Would you explain to me how this [drug/preparation/practice] works?

11. What effect does [drug/preparation/practice] have on the labor process?

12. What are the benefits of giving a woman who is in labor this [drug/preparation/practice]?

13. When is the most appropriate time to administer [drug/preparation/practice] to a woman in labor?



                                                                                                         13
        How does the person who administers [drug/preparation/practice] determine when it should be
        given?

14. Who decides that [drug/preparation/practice] should be administered?
       How is this decision made?

15. Who usually administers the [drug/preparation/practice]?

16. How does he/she/they determine how much of the [drug/preparation] should be given?
       What is the maximum amount that can be given?

17. Are there any additional reasons that a woman in labor might be given [drug/preparation/practice],
other than to assist when labor is too long?
        What happens if a woman bleeds after delivery?

18. Are there any dangers associated with giving a woman in labor [drug/preparation/practice]?
        Are there situations in which these [drug/preparation/practice] should NOT be given to laboring
        women?
        Have you ever experienced a situation in which using [drug/preparation/practice] caused
        problems for the laboring woman or her infant? Please describe this situation and how you
        handled it.

19. Do you know of any other drugs, preparations or practices that effect labor in a similar way?
        How do you choose which methods to use?

20. What other traditional preparations are available to help a woman during her pregnancy?
       What are these preparations intended for?
       Which of these preparations do you use?
       What effect do they have on pregnancy?
       Where can these preparations be obtained?


Distribution and Cost of Uterotonics

[Interviewer: Please ask the following questions for each drug/preparation mentioned during your
discussion with the participant.]

21. How do you obtain a supply of these [drugs/preparations] for use during labor?
       Where do you obtain [drugs/preparations]?
       What happens when you run out of [drug/preparation]?

22. Where do you store these drugs/preparations?

23. What costs are associated with obtaining [drugs/preparations]?

24. What is the charge for administering [drug/preparation/practice] during a woman’s labor?



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History of Intra-partum Uterotonic Use

[I am very interested in learning about when the practice of administering drugs/preparations to help a
woman during labor first became commonplace.]

25. Do you remember when this practice became common?

26. How did you learn about this practice?

27. Who taught you how to do this?


Conclusion of Interview

[Suggested wording for interviewer: We are almost finished with the discussion. I have one final
question I would like to ask you. What do you believe is the most important issue to consider when a
woman is in labor?]

[Please thank the participant for their time and responses and ask if they have any questions.]




The Oxytocin Initiative, Ghana
Guide for Qualitative Interviews with postpartum women

Introductory statement [suggested wording to be read aloud by interviewer]

Thank you for agreeing to participate in this interview. My name is [name of interviewer] and I work for
[name of organization]. I am conducting research to better understand labor and delivery practices in
Ghana. As part of this research I am speaking with women who have recently given birth about their
experiences during labor and delivery. Your participation in this interview is completely voluntary. You
do not have to answer any questions that you don’t feel comfortable with, and you may stop the
discussion at any time.

If it is alright with you, I would like to record our discussion. I will not be able to write as fast as we
speak, and I don’t want to miss any of the topics we discuss. Our conversation and the recording are
completely confidential. No one outside of the research team will hear the recording or know what
information you shared with me. Do you have any questions about this? May I have your permission to
record our discussion?

[If the participant does not want to be recorded, interviewer should request permission to take hand-
written notes on paper.]

I have a list of topics that I would like to discuss with you, but please feel free to speak about any related
issues that you feel are important. There are no correct or incorrect answers to the questions I will ask
you. I am primarily interested in your personal experiences and thoughts, so please say what you
honestly feel. May we begin the discussion now?


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[If the individual does not want to participate in the interview after hearing this statement, please thank
them for their time. Otherwise, please proceed with the questions below.]


Interview Setting

1. Name of interviewer:

2. Region:


Birth History

[Let’s begin by talking about your birth history.]

3. How many children have you had?

4. When was your youngest child born?

[I would like to discuss your labor experiences during the birth of all of your children.]

5. Would you please describe the progression of your labor to me?
       How long was your labor?
       Who was present during your labor?
       Were any of your labors particularly difficult?
               How so?
               What happened?

6. What differences were there between the birth of your youngest child and your delivery of your older
child(ren)?

7. Where did you deliver your child(ren)?
       Did you want to deliver here? Why?


Uterotonic Use during Labor and Delivery

8. Did you receive any drugs, traditional preparations or specific practices to assist with your labor?
        What were they?

[Please ask the following questions with regard to each drug/traditional preparation/practice believed
to augment labor.]

9. What were the drugs/preparations/practices intended to do?

10. Whose initial idea was it for you to receive [drug/preparation/practice]?


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        How did [he/she/they] determine that you should receive [drug/preparation/practice]?

11. Did you want to receive this [drug/preparation/practice]?
        Why?
        Did you ask to receive this [drug/preparation/practice]?
        Were you asked if you wanted to receive [drug/preparation/practice]?

12. Who administered the [drug/preparation/practice]?

13. What happened after you received [drug/preparation/practice]?
       How did you feel after you received [drug/preparation/practice]?

14. Would you recommend other women receive [drug/preparation/practice] during labor?
       Why?
       What would you say to them about this drug?

15. What other kinds of traditional preparations are commonly used during the course of pregnancy?
       What are these preparations intended to do?
       What are these preparations called?
       Did you receive any of these preparations during your pregnancy?
       How did you feel?
       Would you recommend?


Cost of Delivery Procedures

16. Do you know what the cost of the drugs/preparations you received was?

17. Do you know how much your family paid for the delivery assistance?


Conclusion of Interview

[We are almost finished with the discussion. I have one final question I would like to ask you. What do
you think is the most important issue a woman and her family must consider when her labor begins?]

[We are now finished. Thank you for your time and responses. Do you have any questions you would like
to ask me?]




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Appendix B – Budget Template

Please see section V of this document for a detailed description of the costs listed below.

Detailed Project Budget
S. No. Major Line Items                             Unit       Rate      Total Budget         Total Budget
                                                                         (GHC)                (USD)
A1       Personnel
         salary

A2       Consultants
         honorarium

B        Travel and Per Diem


C        Workshop and Training costs


D        Project Supplies and Equipment


E        Other Direct Project Costs


         TOTAL DIRECT COSTS
         Indirect Costs (rate and total)


         TOTAL




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