Continuum of Care: Addressing PPH in India and Nigeria

Vidhya Kumawat, 29-year-old woman arrived at the hospital in Udaipur, in critical condition. Earlier that night, at a private hospital close to her home, Vidhya delivered her third child, but there were complications; she began to hemorrhage.

Though the medical staff at the private hospital was not trained to treat postpartum hemorrhage, they recognized Vidya’s dire condition and advised her husband, Suresh, to get her to a higher level facility for treatment.

Across 50 kilometers, Vidhya’s condition worsened. By 4 AM, when she finally arrived at RNT Medical College Hospital in Udaipur, she had lost a significant amount of blood. Her blood pressure had plunged, so the hospital staff wasted no time.

Within twenty minutes, the trained team at Zanana hospital applied an NASG and wheeled Vidhya into the operating room. They performed a hysterectomy and gave her five units of blood, donated by her husband and extended family.

Following surgery, Vidhya’s condition stabilized, and the staff was able to remove the NASG. In time, she was able to return to her village. She was able to return to her family and to a life she came so close to losing.

With funding from the MacArthur Foundation, Pathfinder implements its second phase of the continuum of care project with the goal of contributing to the reduction of maternal mortality and morbidity due to PPH. The first phase of the project sought to prevent PPH, manage PPH when it occurred, and in more extreme cases, managed and treated shock (utilizing the non-pneumatic anti-shock garment [NASG]). The project extended from the community, where women are most likely to give birth at home or at the lowest levels of the health system, to higher level facilities where women can receive care for complications. In Nigeria, the project was implemented in 60 health facilities in seven states, and in India, the RAKSHA (Sanskrit for protection) project was implemented in 51 facilities in the state of Rajasthan.

In both Nigeria and India, the projects improved linkages from communities to facilities by supporting the establishment of community emergency transport systems and funds. These systems have been used to transport women to facilities for obstetric emergencies. Facility upgrades were also carried out to equip staff with delivery, surgical, and infection prevention materials, and in Nigeria, provision of alternate source of running water. Both countries observed improved facility readiness to provide emergency obstetric care and community awareness for birth preparedness. For example, the use of NASG for women in shock increased in both countries since project start, a testament to the improved ability of providers to recognize the signs of shock and apply the NASG. Pathfinder’s project in India focused on building partnerships, supporting and strengthening existing health systems, and promoting the presence of skilled birth providers during delivery at all levels to address and prevent PPH and pre-eclampsia.

The MacArthur Foundation recently awarded Pathfinder additional funding for activities in both India and Nigeria to build on our current work, significantly expanding the scope and scale of activities to reach more women, while focusing on building the capacity of the local and state governments in these countries to take ownership of the approach.

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