Improving Access to and Delivery of Maternal Healthcare Services to Prevent Postpartum Haemorrhage: A Human-Centred Design Approach (Preprint)

BACKGROUND A significant cause of postpartum haemorrhage (PPH) is access to and delivery of maternal healthcare services. Several multi-sectoral strategies have been deployed to address the challenges with little success; thereby necessitating the use of HCD to enhance healthcare delivery, particularly in PPH management. OBJECTIVE Develop facility-level solutions for optimising uterotonic supply chain systems and health service delivery in the management of postpartum haemorrhage (PPH) through a Human-Centred Design (HCD) approach in selected Nigerian states. METHODS The research employed a four-phase HCD methodology: 1) co-research, 2) co-design, 3) co-refinement, and 4) implementation. However, this paper focuses on the first three phases. In the co-research phase, 221 interviews were conducted, involving pregnant women, healthcare workers, and key stakeholders. Additionally, 33 sites were observed across a three-level continuum of care. Interviews and focus group discussions revealed insights into the distribution of human health workers, PPH cases observed, knowledge of uterotonic use, and steps to administer uterotonics. Finally, 150 ideas were produced and translated into twelve solution prototypes in the co-design phase. RESULTS Progressive refinement following feedback from 140 stakeholders led to the selection of three final solutions: 1) implementing equitable telemedicine to improve the distribution of HRH to reduce waiting time and improve the quality of service, 2) increasing demand for ANC services among pregnant women and their families, and 3) delivering a comprehensive uterotonics logistics management program for stream-lined storage and management of uterotonics. CONCLUSIONS This approach aligns with global health trends advocating for HCD integration in healthcare programming and aims to empower local champions to drive sustainable improvements in maternal health outcomes. If the developed prototypes are judiciously implemented across the states, they can strengthen clinical care and reduce gaps in maternal health service delivery.