Ongoing Recruitment - (Mid National) - Clinical Resource Person (PPH): Obstetrician/Gynaecologist

Job details

One-Day Training on Prevention and Management of Postpartum Haemorrhage (PPH) For Health Managers and Lady Health Visitors (LHVs) at Maryam Nawaz Health Clinics across Punjab 1. Introduction 1.1. Background and Rationale Postpartum haemorrhage (PPH) remains the leading direct cause of maternal mortality in Pakistan, accounting for an estimated 27–30% of maternal deaths. PPH is preventable and treatable when frontline providers can apply evidence-based practices, including Active Management of the Third Stage of Labour (AMTSL), timely use of uterotonics, early recognition of danger signs, initial stabilisation, and prompt referral. The proposed support responds to a specific request from the Health and Population Department (H&PD), Punjab, to strengthen the capacity of frontline providers working in outsourced Maryam Nawaz Health Clinics (MNHCs). The intervention will build on existing approved and evidence-based materials. It will not develop a new curriculum from scratch; instead, it will support light contextualisation and packaging of relevant content into a practical one-day competency-based module for the MNHC setting. The approach is informed by international and Pakistan experience. Ethiopia’s integrated model demonstrates the value of embedding PPH care and postpartum family planning into routine maternal services, with midwives as core delivery agents and with commodities, supervision and reporting integrated into existing systems rather than parallel programmes. Similarly, the WHO-endorsed E-MOTIVE model, including its application in Pakistan through Bill and Melinda Gates Foundation (BMGF)-supported work and FIGO’s LDI-REACH programme, provides a strong evidence base for moving from partner-supported pilots towards government-led institutionalisation at scale. 1.2. Why Maryam Nawaz Health Clinics? The Government of Punjab has revitalised approximately 2,500 Basic Health Units as Maryam Nawaz Health Clinics across all 41 districts. These clinics are a key platform for Punjab’s primary healthcare reform agenda and are often the first point of contact for women seeking antenatal, intrapartum, postnatal and newborn care. The MNHC network provides a clear opportunity for rapid, province-wide capacity strengthening due to its scale and geographic reach, and because each clinic has an identifiable provider team, including a Health Manager and at least one LHV/Midwife/Nurse Midwife. The proposed training will therefore target approximately 5,000 providers across 2,500 MNHCs. This concept note focuses on MNHCs/BHUs in line with H&PD’s request. Rural Health Centres, THQ Hospitals, DHQ Hospitals and tertiary facilities are not the primary training target under this TA unless H&PD later expands the scope. However, they are critical referral partners and will be included in referral pathway mapping, emergency escalation protocols, facility readiness planning and supportive supervision linkages. 1.3. The Provider and System Gap PPH remains a leading cause of preventable maternal mortality not because evidence-based interventions are unavailable, but because they are not consistently applied at first-contact level. Facility-based reviews and programme evidence from Pakistan, Punjab and comparable LMIC settings point to recurring provider and system gaps, including delayed recognition of PPH, inconsistent use of AMTSL, uncertainty around uterotonic administration, weak documentation, variable facility readiness, and unclear referral and counter-referral pathways. At MNHC level, Health Managers and LHVs/Midwives are not expected to manage advanced obstetric emergencies independently. Their role is to prevent PPH where possible, recognise it early, initiate first-line response, stabilise the patient, document care appropriately, counsel on postpartum family planning where relevant, and ensure timely referral to the appropriate higher-level facility. Strengthening these competencies is therefore a practical and proportionate investment in reducing avoidable delays and improving continuity of care. Punjab has already benefited from recent government and partner-supported EmONC investments, including training of approximately 3,081 providers in BEmONC and CEmONC-related areas during 2024–25. This TA is designed to complement, not duplicate, those investments. 2. Goals and Objectives Goal: To strengthen the capacity of frontline healthcare providers at MNHCs to prevent, recognize, initiate first-line response to postpartum haemorrhage, and to improve timely referral and follow-up, thereby contributing to preventing maternal morbidity and mortality across Punjab. Objectives • Improve MNHC Health Managers’ and LHVs/Midwives’ knowledge and understanding of PPH prevention, early recognition, risk factors, danger signs, AMTSL, uterotonic use, first-line response and postpartum family planning counselling/linkages. • Strengthen hands-on skills in AMTSL, objective blood loss management, uterotonic administration, uterine massage, initial stabilisation, emergency communication and timely escalation/referral. • Improve MNHC preparedness for PPH through use of minimum readiness standards, essential commodity checks, referral pathway mapping, documentation tools and linkage with higher-level facilities and emergency transport. • Embed the adapted PPH/PPFP training package and reporting/follow-up mechanisms within existing H&PD/MNCH systems, including the LMS, to support refresher training and future government-led scale-up. 3. Target Participants and Scale The training will target two priority cadres at Punjab’s 2,500 Maryam Nawaz Health Clinics: • Health Managers: Facility-level medical officers responsible for clinic operations, service delivery oversight, commodity readiness, staff coordination and referral decision-making. Their participation will help ensure that PPH readiness, documentation and referral protocols are understood and applied at facility level. • LHVs/Midwives/Nurse Midwives: Frontline maternal health providers responsible for antenatal, intrapartum and postnatal care at MNHCs. They are most likely to be present when PPH occurs or is first recognised and will therefore be the primary clinical focus of the competency-based training. The TA will focus on MNHCs/BHUs only, in line with H&PD’s request. RHCs, THQs, DHQs and tertiary facilities will be engaged as referral partners, not as primary training targets, unless H&PD later expands the scope. Before rollout, E4H/DU and H&PD/PIU will verify facility lists, participant nominations and existing EmONC/PPH-trained providers/trainers to avoid duplication and make use of available government and partner-trained capacity. The proposed training programme will cover all 41 districts of Punjab, reaching approximately 2,500 Maryam Nawaz Health Clinics (MNHCs)/BHUs and training around 5,000 participants, comprising one Health Manager and one LHV, Midwife, or Nurse Midwife from each facility. Training will be delivered in 25–30 participant batches, resulting in an estimated 170–200 batches (approximately 4–5 batches per district, depending on the number of facilities). The programme will utilise the existing pool of PPH/EmONC-trained master trainers, with approximately two trainers per district, who will receive a regional orientation/refresher through three orientation batches before rollout. Each training will be delivered as a one-day, competency-based course, with implementation expected over four to five months using a cluster-based approach. Trainings will be conducted at government training venues, including DHDCs, nursing schools, and DHQ/THQ training facilities. 4. Methodology and Approach The training will be a one-day, competency-based module focused on the practical role of MNHC Health Managers and LHVs/Midwives in preventing, recognising and initiating first-line response to PPH. It will be skills-oriented and aligned with the MNHC scope of care, with emphasis on AMTSL, early detection, objective blood loss recognition, uterotonic use, initial stabilisation, emergency communication, documentation, referral and postpartum family planning counselling/linkages. The training will complement, not replace, existing EmONC/BEmONC/CEmONC training supported by government and partners. Previously trained providers and trainers will be mapped during microplanning to avoid duplication and to identify existing trainers/resource persons for rollout. 4.1 Training Methods The one-day module will combine short technical inputs with practical demonstrations, skills practice and scenario-based exercises. Methods will include: • Short contextualised presentations on PPH prevention, early detection and first-line response. • Demonstration and supervised practice of AMTSL, uterotonic preparation/administration, uterine massage and initial stabilisation. • Case scenarios and role plays on emergency communication, referral decision-making, patient/family communication and documentation. • Skills drills us