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We have endeavored to include policy makers at the earliest possible stages of project planning. The CLIP Package of care comprises of a combination of evidence-based interventions; and thus to understand implementation issues, it is imperative to understand the context of where CLIP will be employed. Furthermore, it is important to recognize that components of the CLIP package of care target multiple individual, group and organization levels and may consist of tasks that need support from all these levels to achieve objectives, such as task-shifting to cHCP roles or administration of injections in the community. We have endeavored to include policy makers at the earliest possible stages of project planning. The first objective of the CLIP Feasibility Study, focussed on “Obtaining Key Stakeholder Support for the CLIP cRCT”, has been carried out in Nigeria, Pakistan and India and has begun in Mozambique. These key stakeholders have been identified in collaboration with the CLIP site PIs, and include the state chapters and national Societies of Obstetricians and Gynecologists, cHCP professional association and programmes, maternal-child health programmes, district and facility health organization leads, provincial Ministries of Health, and other identified relevant key stakeholders. Through individual interviews, focus group discussions and site visits, we have engaged the Societies of Obstetricians and Gynecologists and medical officer leads at referral centres. The CLIP team has met individuals in clinical facilities, and presented at obstetric grand and/or sign-over rounds upon their invitation.A crucial element of the CLIP Feasibility Study has been/ will be to be able to identify potential beliefs and attitudes that may impact the CLIP study. These, along with barrier assessment to identify potential barriers to project success and/or stakeholder support and commitment to CLIP, have undertaken to modify the CLIP cRCT in each site.

Recently, PRE-EMPT has been actively engaged with the Canadian Network for Maternal, Newborn & child Health, which is a project undertaken with the financial support of the Government of Canada provided through the Canadian International Development Agency (CIDA).

Previous efforts to ensure that antihypertensive agents are listed as priority medicine include lobbying in the form of formal written communication to the WHO Department of Essential Medicines to add antihypertensive agents for the treatment of pregnancy related severe hypertension. The 2012 Priority life-saving medicines for women and children list then included hydralazine iv/po and methyldopa.

In addition to this, through our Continuous Professional Development (CPD) sessions in CLIP Trial countries, and international conferences, we have continued to highlight the latest in evidence-based practice around MgSO4 and methyldopa. Members of the PRE-EMPT team have been very engaged in working with the Maternal Health Technical Resource Team (MH TRT) around issues of resource mobilisation, advocacy and commodity security. In addition to this, at the PRE-EMPT-organised- preeclampsia symposium at Women Deliver 2013; the conference in Kuala Lumpur, Malaysia included over 4500 participants from 139 countries and over 2200 organisations. The symposium had participants from over fifteen different organizations and thirteen different countries. The symposium was designed for ministers of health, health managers and administrators, doctors, pharmacists, midwives, nurses, politicians and patient advocates committed to decreasing the global burden of maternal and perinatal mortality and morbidity related to pre-eclampsia and eclampsia. Interactive panel and group activities included discussion of the WHO pre-eclampsia and eclampsia recommendations, implementation strategies, global commodity issues, quality indicators and current research initiatives.