Development of an implementation strategy for the new WHO postpartum hemorrhage bundle.

Abstract

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Reducing maternal mortality is a global concern and one of the Sustainable Development Goals (SDG). Reducing maternal deaths in the world implies reducing mortality due to hemorrhage, its main cause. Although there is algorithms that guide the treatment of PPH with demonstrated efficacy, there is a lack between the actual scientific knowledge and its application in daily practice. World Health Organization (WHO) let a meeting at Harvard Campus in December 2017 with PPH experts and created a "PPH Bundle" which is composed of a set of evidence-based recommendations aimed at reducing deaths and disabilities due to PPH in environments with limited financial resources. Objective: To create an adapted protocol, to implement, and to evaluate the effectiveness of the PPH Bundle. Methods: This is implementation research of an adapted PPH Bundle in two countries (probably Kenya and India) to be developed by Harvard University in partnership with the WHO and the Bill & Melinda Gates Foundation (BMGF). Initially, a bottleneck analysis of the health system will be carried out to identify the current gaps in services, policies, supply chain, commodities, financing, data management, etc. In close collaboration with the Ministry of Health and key stakeholders, a preliminary plan for the introduction of the package will be developed, taking into account the bottlenecks of the health system and local sustainability. Next, a strategic plan will be developed for the field entrance in which the "PPH Bundle" will be presented to the local context. An in-depth program of HPP approach will then be developed with the participation of local initiatives and enhancing existing local programs. Will be used the training package basis applied in the "ESM-UBT" study (a study already carried out by the Harvard team in 13 countries, including the countries involved) for the implementation of the "PPH Bundle". This training package uses information transmission strategies with training flipchart, checklists, charts and other training materials. Team training actions will be developed to use protocols, diagnosis and treatment techniques for PPH, as well as to stimulate the development of skills such as leadership and teamwork, optimization and performance behavior, accountability and quality assurance, vertical integration of the health system and supply chain of inputs. After the training, a pilot study will be conducted in order to obtain feedback from the countries on the introduction of the package. Acceptability, content adoption, appropriateness, feasibility and fidelity to the past content through a mixed methodology involving quantitative and qualitative evaluations, as well as assessing political interest, will be evaluated at this stage.