African Journal of Public Health and Health Systems | 19 April 2004
Evaluating a Bundled Intervention for Postpartum Haemorrhage Management by Midwives in Oromia, Ethiopia: A Qualitative Study
M, e, r, o, n, G, i, r, m, a, ,, T, a, d, e, s, s, e, A, b, e, b, e
Abstract
Postpartum haemorrhage (PPH) is a leading cause of maternal mortality in Ethiopia. Primary health centres, predominantly staffed by midwives, are critical first points of care, yet the consistent application of evidence-based PPH management in these settings faces challenges. This study explored midwives’ perceptions and experiences regarding the effectiveness of a bundled PPH management intervention, comprising clinical training and job aids, in primary health centres in Oromia, Ethiopia. A qualitative, descriptive study was conducted using semi-structured interviews. A purposive sample of 24 midwives from six primary health centres participated. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Three primary themes were identified. First, the intervention enhanced midwives’ knowledge and confidence in PPH management, with most reporting improved structured assessment. Second, the physical job aids were valued as critical memory prompts during high-stress situations. Third, systemic barriers persisted, notably inconsistent availability of essential medicines and supplies, which undermined protocol adherence. Midwives perceived the bundled intervention as effective for building individual competency and providing practical support. However, its full potential is constrained by enduring health system weaknesses. To sustain gains, complementary health system strengthening is needed, focusing on reliable supply chains for uterotonics and essential commodities. Regular supportive supervision is recommended to reinforce training and address ongoing challenges. Postpartum haemorrhage, midwives, bundled intervention, job aids, qualitative research, Ethiopia, maternal health This study provides insights from frontline healthcare workers on the contextual facilitators and barriers to implementing a practical PPH management intervention in a low-resource setting.