Role: Consultant for Needs Assessment of Post Partum Hemorrhage (PPH) And Point-of-Care Ultrasound (POCUS) in Ghana
Location of assignment: Sampled EMONC facilities across all regions
Duration of contract: 8 weeks
Project Background
Obstetric hemorrhage is the leading cause of maternal mortality in Ghana, with postpartum hemorrhage (PPH) accounting for 38% of maternal deaths, despite advancements in maternal health interventions[1]. PPH, requires prompt and effective management to prevent severe complications such as organ damage, hysterectomy, maternal cardiac arrest, or death.
Point-of-care ultrasound (POCUS) has emerged as a valuable adjunct in maternal health care, particularly in strengthening early detection and clinical decision-making in obstetric emergencies. POCUS supports rapid identification of retained products of conception, uterine atony, placental abnormalities, intra-abdominal bleeding, and complications associated with hypertensive disorders, thereby informing timely and appropriate management and referral decisions. Despite its potential, there is limited visibility into the availability, functionality, provider competency, and integration of POCUS into routine maternal health service delivery across levels of care in Ghana.
Effective PPH management however depends on early detection of blood loss, prompt administration of uterotonics, access to blood transfusion services, efficient emergency referral systems, and availability of life-saving procedures. However, limited market insights in Ghana continue to hinder the introduction of innovative solutions and scale-up of essential PPH products, thereby impeding efforts to improve pregnancy outcomes. Ghana adopted the emergency obstetric care (EmONC) services to address conditions such as PPH across the country. Facilities are classified either as Basic Emergency Obstetric Care (BEmONC) or Comprehensive Emergency Obstetric Care (CEmONC) based on the defined metrics which include the availability of services and workforce capacity. Ghana has approximately 1472 facilities offering comprehensive emergency obstetric and newborn care (CEmONC) services.
The GHS with the support of the obstetric haemorrhage expert working group and Clinton Health Access Initiative (CHAI) is introducing the E-MOTIVE (Early detection, massaging of the uterus, Oxytocic drugs, Tranexamic acid, Intravenous (IV) fluids, Examination, and Escalation) to improve PPH outcomes. This intervention aims to strengthen PPH management by ensuring the timely and accurate assessment of blood loss and the prompt administration of appropriate interventions.
To facilitate the introduction and scale up of E-MOTIVE and introduction of other lifesaving interventions, gaining a clear understanding of the current state and needs across health facilities that provide PPH services and the roles of stakeholders’ contribution to PPH work in Ghana are critical to informing interventions being instituted to reduce the high burden of maternal deaths associated with PPH. The exercise will assess the needs of PPH management, including staff capacity, available resources, protocols and health systems and POCUS readiness. It will also identify barriers, gaps, and opportunities to enhance PPH management and strengthen health systems, which would ultimately reduce maternal morbidity and mortality.
Purpose
The primary purpose of conducting a needs assessment of PPH management in the country is specifically to understand the availability and adequacy of essential PPH products and devices, clinical protocols, trained health staff, and blood transfusion services and enabling diagnostic tools such as POCUS across the primary, secondary and tertiary levels of care. This assessment aims to gain insights, identify gaps and provide recommendations for informed interventions, to ensure that facilities are well equipped to manage PPH effectively and reduce maternal morbidity and mortality.
Submission information
For more detail about qualifications and submission information, please download the Terms of Reference (ToR) document below:
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[1] Ghana Reproductive Maternal Newborn, Child and Adolescent Health and Nutrition (RMNCAH&N) Strategic Plan. 2020-2035
