Facility readiness in the management of primary postpartum Haemorrhage among comprehensive emergency obstetric care facilities in eastern Uganda

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.