Introduction of Heat-Stable Carbetocin through a Public-Private Partnership Model in India: A Retrospective Study to Determine Feasibility and Its Optimal Use in Public Health Settings.

Abstract

Background and objective: The optimal use of oxytocin for preventing postpartum hemorrhage (PPH) faces challenges in many low-middle income countries (LMICs) owing to its storage and transportation prerequisites. We demonstrated Heat-Stable Carbetocin (HSC) for PPH prevention through an innovative Public-Private Partnership (PPP) model in 15 public health facilities of the Dewas District of Madhya Pradesh (MP) state in India. This study evaluates the feasibility and appropriate utilization of HSC in public health settings.

Methods: We analyzed facility-level data collected between August 2022 and July 2023 from selected 15 health facilities, where HSC was introduced. Prior to the introduction of HSC, all healthcare providers received training on Active Management of the Third Stage of Labor (AMTSL), use of HSC, and recording and reporting procedures. The supply of HSC in health facilities was ensured, and a robust mechanism was set up to monitor the progress.

Results: A total of 18,497 women were admitted for delivery in the 15 selected facilities. Uterotonic administration within one minute of delivery was almost universal (99.9%). No instance was recorded of using HSC either for induction of labor or management of PPH. In 636 cases (3.43%), HSC was not given for PPH prevention. Pearson's chi-square test was conducted to assess the relationship between HSC usage and the health facility's level. The HSC use was significantly higher in First Referral Unit (FRU) facilities compared to non-FRUs (p < 0.001). Moreover, the administration of HSC within one minute of delivery was also more prevalent in FRU facilities compared to non-FRUs (p < 0.001). The PPH incidence and case referral rates noted in this study were 0.7% and 16.7%, respectively, with no reported adverse drug events or deaths.

Conclusion and global health implications: Our study suggests the safe and appropriate use of HSC within India's public health system.