Transforming Healthcare Across Africa.

Quality Improvement for Postpartum Haemorrhage (PPH) Bundle

Improving maternal health through better prevention and management of postpartum haemorrhage.

Nigeria

Project Overview

Every year, thousands of women lose their lives from complications related to childbirth, with postpartum haemorrhage (PPH) remaining one of the leading causes of maternal mortality. While effective interventions for preventing and managing excessive bleeding after birth are well established, consistent implementation of these practices remains a challenge in many healthcare settings.

To address this challenge, the Health Strategy and Delivery Foundation (HSDF), with support from Merck for Mothers, implemented the Quality Improvement for Postpartum Haemorrhage (PPH) Bundle project. The initiative focused on strengthening the quality of maternal healthcare services by supporting health facilities to adopt and consistently implement evidence-based practices for the prevention, early detection, and management of postpartum haemorrhage.

The project formed part of broader efforts to improve maternal health outcomes and ensure that women receive timely, high-quality care during childbirth.

Postpartum haemorrhage accounts for a significant proportion of maternal deaths, particularly in low- and middle-income countries where health facilities may face challenges related to clinical protocols, provider skills, emergency preparedness, and timely response systems.

Although proven interventions exist, variations in clinical practice and gaps in quality of care can prevent women from receiving the care they need when complications arise. Improving maternal outcomes therefore requires not only access to services but also consistent adherence to best practices across the continuum of care.

HSDF supported the implementation of a quality improvement approach that strengthened the capacity of health facilities and healthcare providers to prevent and manage postpartum haemorrhage effectively. The project focused on:

Supporting the adoption of evidence-based PPH prevention and management practices.
Strengthening quality improvement systems within maternity services.
Enhancing provider capacity through training, coaching, and continuous learning.
Promoting the use of standardised clinical protocols and care pathways.
Supporting early detection and timely management of obstetric emergencies.
Encouraging routine monitoring and learning to improve service quality.

By combining clinical best practices with quality improvement methodologies, the project helped facilities strengthen their readiness to manage maternal complications and deliver safer childbirth services.

The PPH Bundle project is demonstrating the importance of translating evidence into routine clinical practice. By supporting healthcare providers and facilities to consistently implement proven interventions, the initiative contributed to efforts aimed at reducing preventable maternal deaths and strengthening the quality of maternity care.

The project also reinforced the role of quality improvement as a critical strategy for achieving better maternal health outcomes, helping health systems move beyond access to focus on the quality and effectiveness of care delivered to women and newborns.

Our Approach

Through partnerships with state governments and development stakeholders, we drive sustainable solutions that save mothers’ lives.

We provide comprehensive training to healthcare providers on evidence-based PPH prevention, early detection, and clinical management. This includes practical skills in emergency obstetric care, simulation exercises, and mentoring to ensure that providers are confident in responding to complications. By strengthening the competencies of frontline staff, we improve patient outcomes and reduce delays in life-saving care.

HSDF works to enhance the readiness of health facilities by improving essential infrastructure, ensuring consistent availability of medical supplies, and optimizing referral systems. This approach ensures that health facilities are fully equipped to provide timely and effective emergency obstetric care, reducing preventable maternal deaths. Strengthened systems also include standardized protocols and accountability mechanisms for sustained quality improvement.

We strengthen health information systems to capture accurate, timely, and actionable data on PPH incidence and outcomes. By analyzing trends and identifying gaps in service delivery, we guide targeted interventions and policy decisions. This data-driven approach enables continuous monitoring, evaluation, and adaptation of strategies to maximize impact.

Recognizing that community awareness is critical, HSDF mobilizes communities to recognize danger signs during pregnancy and postpartum. We engage local leaders, community health workers, and women’s groups to promote timely access to skilled care and support families in navigating the health system. This participatory approach helps reduce delays in seeking care and fosters a culture of maternal health advocacy.