Abstract:
Background: Facility readiness, encompassing the availability of trained personnel, essential
medicines, equipment, and functional protocols, is pivotal in preventing and managing
postpartum haemorrhage (PPH), the leading direct cause of maternal mortality in low-resource
settings. Despite multiple initiatives to enhance facility preparedness, reductions in PPH-related
morbidity and mortality remain minimal. In Eastern Uganda, gaps in facility readiness persist.
This study assessed the readiness of Comprehensive Emergency Obstetric and Newborn Care
(CEmOC) facilities in the Elgon region to manage primary PPH.
Methods: A cross-sectional study was conducted in 22 Comprehensive Emergency Obstetric and
Newborn Care (CEmOC) facilities across 14 districts in the Elgon sub-region. Data were
collected using an adapted World Health Organization (WHO) facility readiness audit tool,
assessing infrastructure, human resources, essential medicines, equipment, and clinical
guidelines. Facility readiness, the primary outcome, was defined as the facility’s capacity to
prevent and manage postpartum haemorrhage (PPH) based on the availability of these key
components. Quantitative data were analyzed using Stata 18, with facilities scoring ≥80%
classified as ready. Qualitative data from 20 key informant interviews conducted in 10
purposively selected facilities (five highland and five lowland) were analyzed thematically using
ATLAS.ti 9.
Results: Overall, 13/22 (62%) facilities demonstrated moderate readiness for PPH management,
with an average readiness score of 67.4%. Infrastructure was adequate in 18/22(81.8%) facilities,
and essential medicines such as oxytocin and misoprostol were available in 16/22(72.7%).
However, staffing levels were adequate in only 9/22 (40.9%), and fully functional critical
equipment was found in 8/22 (36.4%). Clinical guidelines for PPH management were present in
12/22 (54.5%) facilities. Qualitative findings identified teamwork, mentorship, and steady drug
supply as facilitators, while human resource gaps, poor supervision, and erratic equipment
maintenance were key barriers.
Conclusions: Facility readiness for PPH management in the Elgon region remains suboptimal,
with the most critical deficits in staffing and equipment functionality. Addressing these systemic
gaps through targeted resource allocation, staff capacity building, and sustained supervision is
essential to reducing preventable maternal deaths and achieving Sustainable Development Goal
3.1.
