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Maternal mortality remains a pressing concern globally, with postpartum hemorrhage (PPH) being a significant contributor. PPH remains a significant public health challenge in Zambia, contributing to 34% of maternal deaths, as per a recent study (
Women in Zambia often experience multiple pregnancies, with uterine fatigue increasing the risk of PPH (
This opinion manuscript explores the current landscape of PPH management in Zambia, highlighting the Zambian Ministry of Health’s initiatives and partnerships and proffers a perspective on opportunities for strengthening efforts to address PPH in the country.
The shortage of blood and blood products, coupled with delays in access, stands out as a major obstacle in managing PPH cases in Zambia (
The Provincial blood transfusion centers play a pivotal role in collecting, processing, testing, and distributing blood and blood products. The Ministry aims to bolster these centers by investing in capital infrastructure, including equipment procurement and staff training programs (
The Ministry of Health established hubs in two districts per province, strategically positioning already processed blood closer to communities (
Creating awareness within the community is paramount to ensure a steady supply of blood. The Ministry of Health routinely conducts comprehensive awareness campaigns, educating the public on the demand for blood and the critical role they play in donating (
Recognizing the need for skilled clinicians in conducting blood transfusions, the Ministry of Health is initiating targeted training programs (
Despite facing resource constraints, the Ministry of Health organizes blood transfusion camps to mobilize communities, including schools, for voluntary blood donations. While resource limitations pose challenges, these camps have been useful in propelling the country to align with the WHO requirements and contribute to building a sustainable supply of blood.
In addressing the challenge of PPH management and general maternal health service provision, the Ministry of Health in Zambia acknowledges the indispensable role of surgical interventions. The scarcity and uneven distribution of obstetric consultants across the country stand out as a critical issue, resulting in delayed interventions and tragic outcomes (
To confront the scarcity of obstetric specialists, particularly in remote areas, the Zambian government has launched an innovative abridged specialty training program (
Recognizing the resource constraints in many district hospitals, the Ministry is exploring task-shifting strategies (
Quality antenatal care remains a cornerstone in the prevention and early identification of high-risk pregnancies for PPH. However, in low-resource settings, additional challenges arise, necessitating targeted interventions to enhance ANC quality. There is a need to improve the skills of staff to recognize high-risk pregnancies for PPH with timely referral for management at an appropriate level of care in Zambia (
The Ministry of Health has undertaken an approach to provide each pregnant woman with an ANC card. ANC cards are updated at each contact, which allows for an accurate record of a woman's pregnancy (
To improve the referral of pregnant women who need the care of specialists, the Ministry of Health devised several mechanisms. One of the mechanisms is the development of referral protocols and guidelines for healthcare providers to use. While it might be challenging to quantify the precise impact of referral protocols on timeliness of care with available data, their implementation is a crucial step towards ensuring that high-risk pregnancies are identified and referred promptly. Studies conducted in India showed that establishing clear referral protocols led to a significant increase in the number of women receiving timely specialist care for high-risk pregnancies (
Although several strategies are being implemented to reduce the outcomes of PPH, there are some areas that need improvement. Blood transfusion-related challenges need to be addressed while the quality of ANC service should be improved.
The concerted efforts by the Ministry of Health to enhance blood transfusion services are promising steps toward reducing maternal mortality due to PPH. The strategic interventions outlined demonstrate a commitment to overcoming logistical challenges and ensuring a timely and sufficient supply of blood and blood products. However, some opportunities for improvement exist.
To increase blood donation, blood bank organizations should dispel myths and religious beliefs about blood donation. This can be achieved by strengthening community involvement in developing communication messages on the importance of blood transfusion. Where donation centers are located far from potential donors, the organizations should conduct outreach programs to target potential donors. Furthermore, organizations should create trusting relationships with donors so that they can keep donating blood in the future (
Furthermore, recent advancements in drone technology offer exciting possibilities for revolutionizing blood product delivery, particularly in remote areas with limited access to healthcare facilities. Studies have shown that drones can deliver blood products efficiently and rapidly, significantly reducing transportation times compared to traditional methods (
The Ministry of Health has undoubtedly led promising efforts to improve ANC service quality in the country. We suggest some opportunities for strengthening already existing efforts.
Recognizing the limitations of rural health centers, the Ministry of Health can strengthen community-based ANC initiatives. Community-based ANC initiatives such as trained community health workers hold immense potential to improve access and quality of care. These workers can be equipped to conduct basic pregnancy screenings and identify potential risk factors through monitoring blood pressure, weight gain, and other key indicators. Furthermore, they can be trained to deliver essential ANC services in remote areas, including providing prenatal vitamins, administering vaccinations, and offering education on healthy pregnancy practices. Finally, community health workers can play a vital role in referral and care coordination by effectively linking high-risk pregnant women with appropriate healthcare facilities at district hospitals or higher levels of care, facilitating communication and transportation arrangements. This decentralized approach will bridge the gap in ANC accessibility, ensuring that even those in remote settings receive timely and adequate care (
To overcome geographical barriers and enhance ANC quality, there is a need to pilot and scale up telemedicine initiatives. This involves leveraging technology to connect pregnant individuals in remote areas with skilled healthcare providers for virtual consultations. This innovative approach not only improves the reach of ANC services but also facilitates early identification of high-risk pregnancies, minimizing complications during labor and delivery (
To reduce PPH during delivery, there should be correct and consistent use of the partogram, as well as constant availability of uterotonic drugs.
Ineffective monitoring during labor contributes to delays in identifying deviations from normal progression, leading to increased PPH cases. In a study conducted to determine the impact of maternal death reviews in the country, partogram use and/or interpretation errors were identified as challenges associated with maternal deaths (
Because prophylactic uterotonic drugs can prevent PPH, they are routinely advised. They cause the uterus to contract, which lessens excessive bleeding after birth. A few of the uterotonic drugs that are used are carbetocin, misoprostol, and oxytocin (
Healthcare professionals should be trained in emergency obstetric care, the use of anti-shock garments, and balloon tamponade so that they can manage PPH appropriately.
Training healthcare workers in the use of the anti-shock garment is a vital aspect of PPH management. Although the availability of these garments poses a challenge due to their cost, a study conducted in Zambia and Zimbabwe revealed that the use of anti-shock garments was cost-effective in Zambia (
Empowering midwives and medical doctors with emergency obstetric care training is fundamental to managing obstetric emergencies effectively. The Ministry of Health should invest in scaling up specialized training for midwives and medical doctors, enabling them to handle a range of obstetric complications promptly. This initiative aligns with the broader goal of decentralizing emergency obstetric care, ensuring that timely interventions are possible at different healthcare facilities (
While medical doctors are essential for managing severe PPH cases, a critical skill gap exists in Zambia regarding the use of balloon tamponade, a lifesaving procedure (
To further enhance the skillset of healthcare professionals managing PPH, particularly at lower-level facilities, the Ministry of Health should increase its investment in targeted clinical mentorship programs. Obstetrics and gynaecology specicialists, midwives, and anesthesiologists can offer dedicated, on-site mentorship to doctors and nurses responsible for PPH management. These programs could focus on areas like managing blood loss, applying anti-shock garments, performing specific procedures like uterine tamponade, and interpreting clinical signs. Regular sessions (e.g., monthly) over a sustained period (e.g., 6 months) would facilitate knowledge transfer and skill development. Studies have shown that clinical mentorship programs can significantly improve maternal health outcomes, including reducing PPH-related mortality (
The comprehensive approach undertaken by the Ministry of Health in Zambia reflects a commitment to addressing the complex challenges associated with PPH. While commendable progress has been made in blood transfusion services, surgical skills development, and antenatal care, gaps remain. Strengthening infrastructure and resource mobilization for blood services, expanding surgical training through task shifting and community engagement, intensifying community-based ANC efforts, and continuously enhancing intrapartum care – from labor monitoring to emergency obstetric training – are key opportunities for further improvement.
MM: Writing – original draft. JM: Writing – review & editing. EM: Writing – original draft, Writing – review & editing. TD: Conceptualization, Writing – original draft.
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