Advocacy & Health Policy: Saving Mothers, Giving Life: A Collaboration to Prevent Postpartum Hemorrhage in Sub-Saharan Africa

“My district has had a high number of maternal deaths due to postpartum hemorrhage (PPH). The [Uterine Balloon Tamponade (UBT)] training [will] give me skills to manage PPH at my facility and thus contribute to the reduction of maternal deaths,” said Mulenga Mangala, a nurse from Nklanga Health Centre in the Lundazi Health District.

Mangala is one of 618 nurses, midwives, medical doctors and licentiates who have been trained as part of ACOG’s work in Zambia with Saving Mothers, Giving Life (SMGL).

Launched in 2012, SMGL was created to help mothers during labor, delivery and the first 24 hours postpartum—the period when two out of every three maternal deaths and 45 percent of newborn deaths occur. SMGL is a public-private partnership to dramatically reduce maternal and newborn mortality in sub-Saharan African countries. The latest SMGL report shows declines in maternal mortality by 55 percent in target facilities in Zambia.

ACOG and the Inclusion of Midwives in Preventing PPH

ACOG began working in Zambia in 2013 to implement the inclusion of UBT as an effective, low-cost method of prevention of PPH. UBT has been recognized as a relatively easy to use and effective second-line option for managing severe PPH. The low-cost (less than $5) uterine balloon kit consists of a condom tied to a Foley catheter and inflated with clean water or normal saline through a syringe and a one-way valve. It has been exceedingly successful in managing hemorrhage when health providers are properly trained. 

ACOG was charged with aligning UBT with Zambia’s national approach to PPH management, advocating for the inclusion of midwives in the UBT trainings, and creating a pool of in-country trainers to conduct Training of Trainers (TOT) workshops that would be able to provide training in all 16 health districts in Zambia.

When the project began, midwives were not allowed to participate in UBT trainings. To include midwives in the trainings, approval was needed from the Ministry of Health (MOH). Since then, the MOH changed their national scope of practice for midwives to include placement of UBT, and UBT has been successfully integrated into the Emergency Obstetric and Newborn Care (EmONC) curriculum in Zambia per a Ministry of Health directive.

In July 2015, ACOG held a demonstration training in UBT for representatives from the Emergency Obstetric Newborn Care (EmONC) working group, Zambian Association of Obstetricians and Gynecologists (ZAGO), the University Training Hospital (UTH), and the SMGL local working group. Forty-nine maternal health care providers were introduced to UBT. They included doctors (ob-gyns and general physicians), midwives, nurses from the SMGL districts, midwifery nursing association leaders and members. It was after this training that the change to the national policy was proposed and accepted for the inclusion of midwives in all the district trainings.

In April 2016, ACOG successfully co-led a UBT TOT workshop at Lusaka and Livingstone with ACOG Fellow, Dipak Delvadia, MD, from Drexel University. Twenty-four ob-gyns and midwives were trained at Lusaka, and an additional 17 were trained at Livingstone.

The training covered a PPH refresher, UBT training and shock management overview. It also included the elements of respectful care, teamwork, facilitation skills and supportive mentoring.  The response and engagement from participants was excellent. A pretest and posttest was conducted—100 percent of participants showed improved scores.

Implementing partners included USAID, ZAGO, the Centers for Disease Control and Prevention, the USAID Mission in Zambia, the Centre for Infectious Disease Research in Zambia (CIDRZ) and the Zambian Ministry of Health.


From left to right: Masuka Musumali, MD;
Andrea Momoh; Dipak Delvadia, MD

2017 ACOG Case Study: Results of a Historic Partnership with SMGL

This year, ACOG conducted qualitative interviews in Zambia with the teams trained in UBT.

The case study focused on the strategic engagement and advocacy efforts that led to the UBT scale-up in Zambia. ACOG’s Office of Global Women’s Health shared the case study and program accomplishments during an informational session on October 5, 2017. The session highlighted our work with local partners to nationally scale up the UBT intervention.

Presentations were made by Herbert Peterson, MD, director of the World Health Organization’s Collaborating Center for Research Evidence for Sexual and Reproductive Health at the University of North Carolina-Chapel Hill; Dipak Delvadia, MD, assistant professor, Drexel University College of Medicine; Andrea Momoh, program administrator at the Office of Global Women’s Health; and Masuka Musumali, MD, from the United States Agency for International Development, Zambia.

The case study report represents the final report of our activities with SMGL. ACOG was pleased with the opportunity to be a part of this historic public-private partnership and will continue to look for ways to make lasting, impactful contributions in the future.

Read the case study.

Visit the Saving Mothers, Giving Life website to learn more

American Congress of Obstetricians and Gynecologists
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