The Challenge:

In Malawi, health system utilization has been increasing, currently skilled birth attendances rates are at 90%, and institutional delivery rates are at 60.3%. However this increased utilization has created new issues and challenges to care since there has been very little infrastructure investment or changes in the number of health providers. To address these challenges, a variety of activites are being employed. Please visit the APPHC webpage for additional information on each of the activities listed below:

Qualitative interviews and secondary analysis of calls to the national health hotline will detail how health providers respond to women experiencing obstetric emergencies, including PPH, as well as identify the concerns and characteristics of these callers to improve responding providers’ ability to provide actionable, timely health advice in cases of obstetric emergency.

Mixed methods study to understand PPH knowledge, practice and the level of burnout and stress that prevents optimum provision of care in busy maternity units including poor management of PPH. Two interventions will be introduced 1) PRONTO simulation training (see below) and 2) co-designed intervention following review of baseline data with in-country stakeholders. Subsequently an endline evaluation will take place.

To better understand the use of non-pneumatic anti-shock garments (NASG), a case study comprising qualitative interviews with a selection of providers working in maternity units is underway. Some quantitative data will also be incorporated from the provider interviews regarding knowledge of use and actual

To assess the use of MWHs as they relate to PPH prevention and treatment, a case study incorporates qualitative interviews describing women and provider perceptions of use MWH use and whether it is feasible for women at risk of PPH to remain in the MWH after discharge and before they return home. use of the NASG.

This study examines intervention strategies for implementing a sustainable and effective mentoring system for improving the management of PPH at community and district levels by testing an innovative simulation-based mentorship approach. In addition to strengthening individual provider skills and knowledge, the approach aims to strengthen teamwork, communication, inter-professional collaboration, and woman-centered maternal care (WCMC). 

This study on blood banking will the elucidate the supply side gaps and challenges in blood banking, storage, and distribution processes as well as the demand side requests and uses of blood. This information is critical to implement actions to minimize blood shortages particularly for life-threatening obstetric hemorrhage.  

This study evaluates the integration of Maternal near-miss case reviews into the preexisting MDSR process to improve the identification and management of PPH. Formative data demonstrated that properly documenting the numbers of saved cases was a motivator to the health care workers and led improved reporting at the local, regional and national levels of PPH related obstetric emergencies.