Improving access to essential medicines to reduce postpartum haemorrhage (PPH) morbidity and mortality (IAP)

Project contact

Rachel Gooden – Project Manager 

Supported by 

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The activities outlined in this project are supported by funding from MSD, through its MSD for Mothers initiative and are the sole responsibility of the authors. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, USA.

The importance of improving access to essential medicines to reduce PPH

Globally, postpartum hemorrhage (PPH) remains the largest cause of direct maternal deaths. The situation is especially important in sub-Saharan Africa due, among other health systems challenges, to frequent use of substandard or falsified products.

The PPH landscape changed significantly between 2010 and 2020 with several successful research projects. As a result of two large randomized controlled trials and a new Uterotonic Network Meta-Analysis, WHO revised its guidance and published - WHO Recommendation on Tranexamic Acid for the treatment of PPH in 2017 and the new, updated, recommendations on the use of uterotonics for the prevention of postpartum haemorrhage (PPH) in 2018.

For these recommendations to impact PPH prevention and treatment, policy makers, practitioners and supply chain experts need to be updated on the new recommendations and have access to quality uterotonics and the antibrinolytic drug Tranexamic acid. WHO recommendations, while critical to quality care, are often slow to be disseminated at country level and suffer from limited support for translation of these recommendations into policy and practice.

What we do

This project has been granted from Concept Foundation (CF), by MSD for Mothers. CF have been working with WACI Health for the last 2 years, to support countries in updating their national policy/protocols in line with the WHO recommendations 2017/18, as well as updating their EML to reflect the recommended use of TXA and Heat-stable Carbetocin.  

FIGO are now heading up a project to continue this effort for the next phase. We are working with those countries, to adopt and adapt these guidelines and recommendations into frontline clinical practice, disseminating best practice, supporting countries to develop appropriate tools so that frontline clinicians are able to implement the WHO recommendations in reality. Activities will aim to close the gap between global evidence-based recommendations and the actual implementation of these life-saving medicines in countries by ensuring health care providers are trained and empowered in implementing these interventions at the frontline of the health care system.

Project objectives

The Project’s aims include:

1. To facilitate adoption of updated WHO PPH Recommendations (2017 and 2018), at a country level into practice through dissemination of updated clinical guidelines and protocols.
2. Normative clinical standards are in place to support the implementation of effective practices at different levels of health care.
3. WHO Recommendations translated from guidelines into clinical protocols and appropriate implementation resources for PPH prevention and treatment.
4. Dissemination efforts to facilitate replication and scale-up of the approach.

FIGO will support each country to undertake to form an expert working group to develop national protocols into usable clinical protocols, publish the Country PPH protocols and identify Champions to lead this effort in dissemination and adoption at the local level.

Improving access to essential medicines to reduce PPH morbidity and mortality in Sub-Saharan Africa

FIGO and its partners the International Confederation of Midwives (ICM), Concept Foundation and MSD for Mothers, work to improve the adoption of the WHO PPH guidelines 2017/2018, into frontline clinical practice. The aim is to strengthen the adoption into practice of the recommendations and raise awareness of newer elements, including the use of tranexamic acid (TXA) and heat-stable carbotocin (HSC) as tools in the fight to reduce maternal morbidity and mortality from PPH.

Project details

Improving access to essential medicines to reduce PPH is a project that will run for 20 months.

We are currently working with Uganda, Rwanda, Ghana and Liberia and will be extending the effort to a further 4 countries over the course of the project.

Our current partners include:

• The Association of Obstetricians and Gynecologists of Uganda (AOGU)
• The Uganda Nurses and Midwives Union (UNMU)
• The Uganda Private Midwives Association (UPMA)
• The Rwanda Society of Obstetricians and Gynecologists (RSOG)
• The Rwanda Association of Midwives (RAM)
• The Society of Obstetricians and Gynecologists of Ghana (SOGOG)
• The Ghana Registered Midwives’ Association (GRMA).

To access further information, resources and case studies connected to PPH and the global movement to prevent and manage PPH please visit our microsite – savemothers.org.