Health
Kaduna PHCs where health workers save women from severe bleeding after childbirth
At 77 primary healthcare centres across nine Local Government Areas in Kaduna State, trained community health extension workers have been equipped to manage women who develop severe bleeding after delivery using the E-MOTIVE approach. The intervention, according to the health workers, has significantly reduced maternal deaths linked to postpartum haemorrhage in the LGAs while strengthening PHCs to manage other childbirth complications. ANGELA ONWUZOO reports
When Mrs Hadiza Umar went into labour in April 2026, the 28-year-old mother of six never anticipated any life-threatening complications during delivery of her sixth child, having had five successful births without any health issues.
The groundnut seller, whose husband is a tricycle rider, expected the delivery to go as smoothly as those of her other five children. But that expectation was shattered when, a few minutes after hearing the cry of her newborn, she began bleeding excessively.
Though she had been regular with her antenatal visits at Mando Primary Healthcare Centre in Igabi Local Government Area of Kaduna State, Hadiza developed postpartum hemorrhage a few minutes after delivery, a situation she wasn’t sure of the outcome.
But the community health extension workers, also known as CHEWs, who conducted the delivery remained calm and composed, knowing exactly what to do and how to do it using the E-MOTIVE intervention, without delay or referral to a secondary facility.
The excited mother shared with PUNCH Healthwise how E-MOTIVE saved her during her last childbirth.
The trader told our correspondent that she was shocked that the health workers at Mando PHC were able to effectively manage her bleeding without a blood transfusion or referral to a general hospital.
“I have six children, and the last one, a girl, is five months old now. I never experienced bleeding during any of my deliveries except with my last child. I started having labour by 5 pm that fateful Wednesday in April 2026. By 8 pm, the labour became unbearable.
“I called my husband, who was not done with his Keke business for the day, to come and take me to Mando PHC. Two hours after getting to the health centre, I gave birth,” she recounted.
E-MOTIVE reduces severe bleeding after childbirth
Hadiza said her baby was healthy after delivery, but she had to battle postpartum hemorrhage before the health workers effectively controlled the bleeding using the E-MOTIVE intervention.
“I suffered anaemia during the pregnancy. About 30 minutes after my delivery, I started bleeding heavily. I was afraid I might not make it because I thought I was going to lose a lot of blood and die. I was particularly worried because we did not have money for any emergency.
“But I was shocked when the health workers asked me to calm down. They told me the situation was under control and that they could handle it. So, the health workers acted swiftly, using the E-MOTIVE intervention to control the bleeding, and it stopped without me losing much blood. I really appreciate the health workers for their competence,” she said.
PPH management and prevention
During a visit to Mando PHC, PUNCH Healthwise found that the health workers’ competence in using the E-MOTIVE intervention in PPH management and prevention had become a game changer.
The CHEWs were trained in PPH management using the E-MOTIVE intervention under the Task Shifting and Task Sharing project implemented by Pathfinder International with support from the Gates Foundation.
The World Health Organisation defines postpartum haemorrhage (PPH) as excessive bleeding after childbirth, which affects millions of women annually.
Severe bleeding leading cause of maternal deaths — WHO
WHO’s Director-General, Dr Tedros Ghebreyesus, states that severe bleeding in childbirth is one of the most common causes of maternal mortality, yet it is highly preventable and treatable.
According to the WHO, over 85 percent of deaths from PPH happen in sub-Saharan Africa and South Asia.
It identified risk factors, including anaemia, placental abnormalities, and other complications in pregnancy such as infections and pre-eclampsia.
Experts say delayed diagnoses are among the key reasons for complications or death during PPH.
A game changer
For 24-year-old Mrs Aishatu Isah, a housewife and mother of four who benefited from the E-MOTIVE intervention at PHC ABDU Kwari in Sabon Gari LGA of the state during the delivery of her fourth child after developing PPH shortly after delivery described the intervention as a lifesaver.
“When I started bleeding after giving birth to my last baby in March 2026, I thought my family would lose me. But with the help of the health workers, I successfully came out of it after they deployed the E-MOTIVE intervention.
“My son, who was struggling to cry after his delivery, was also quickly resuscitated by the health workers. I never knew we could have such quality of care at the PHC,” she told PUNCH Healthwise, beaming with smiles.
The stories of Hadiza, Aishatu and other mothers who benefited from the E-MOTIVE intervention reflect a significant reduction in maternal deaths in the selected LGAs linked to PPH and major impact on the access to essential health services and response to emergency cases, especially among the vulnerable groups.
Experts say addressing PPH needs a multipronged approach focusing on both prevention and response – preventing risk factors and providing immediate access to treatments when needed.
E-MOTIVE intervention
In 2023, the WHO issued a global plan to tackle the leading cause of death in childbirth- postpartum hemorrhage by recommending a set of interventions and a new solution known as E-MOTIVE, which can reduce deaths from childbirth-related bleeding.
This followed a landmark study by researchers from the WHO and the University of Birmingham, which showed that the E-MOTIVE initiative could provide a breakthrough in reducing deaths from childbirth-related bleeding.
The E-MOTIVE intervention included a blood-collection drape with calibrated lines to accurately measure blood loss, enabling early detection of PPH.
The use of the E-MOTIVE treatment bundle (comprising early detection of PPH, massage of the uterus, oxytocics, tranexamic acid, intravenous fluids, and examination and escalation of care) improved the consistency and speed of response to PPH.
Through the TSTS project, aimed at strengthening the capacity of frontline healthcare workers, particularly CHEWs, Pathfinder International is promoting the use of E-MOTIVE in selected primary healthcare centres in Kaduna State for the treatment and management of PPH with the goal of reducing maternal deaths linked to the condition.
The PHCs were selected using the Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH+N) scorecard. The selection of the health workers was based on facilities without trained health workers.
77 CHEWs trained
Data made available to PUNCH Healthwise by Pathfinder officials showed that the TSTS project began in 2024 and has so far trained 77 CHEWs and nine clinical mentors in the management of PPH using E-MOTIVE. The trained workers were drawn from 77 wards across nine Local Government Areas, with one clinical mentor per LGA, spanning the three senatorial zones of the state.
The nine LGAs are Kaduna North, Kaduna South, Igabi, Soba, Sabon Gari, Makarfi, Kaura, Jema’a and Zangon Kataf.
Besides the promotion of E-MOTIVE to cut maternal deaths linked to PPH, the TSTS project, health workers say marks a major step toward expanding access to healthcare services—especially in underserved communities in the state.
The initiative seeks to boost healthcare outcomes by redistributing responsibilities among health workers, thereby improving service delivery and optimizing workforce efficiency.
The programme is designed to equip CHEWs and midwives with the necessary skills and knowledge in the use of E-MOTIVE, as well as the prevention, early detection, and effective treatment of PPH.
Available data showed that Kaduna State has a high burden of maternal deaths linked to PPH, with a maternal mortality ratio of 452.6 deaths per 100,000 live births and a neonatal mortality rate of 63 deaths per 1,000 live births.
Clinical mentors and CHEWs who have benefited from the training shared with PUNCH Healthwise how their new knowledge and skills in the management of PPH using E-MOTIVE is curbing maternal deaths and improving pregnancy outcomes in communities.
Health workers’ impact stories
A Clinical Mentor on the E-MOTIVE intervention and PPH management at Mando PHC, Tabibat Isiaka, told our correspondent that the training had significantly improved the knowledge and skills of the mentees, particularly junior community health extension workers, enabling them to prevent and manage PPH in their various facilities and reduce maternal mortality.
The Public Health Midwife said, “I mentored health workers in nine health facilities, and all the mentees in these facilities are doing well. I can boldly say that whenever there is a delivery associated with postpartum haemorrhage, the mentees can manage and treat the women to prevent further complications.”
Besides mentoring and training other health workers on E-MOTIVE and PPH management, Isiaka also shared her clinical experience and outcomes in managing and treating PPH after undergoing the training before becoming a mentor.
“Honestly, this training on PPH management has been very impactful and lifesaving. I was at this PHC, Mando, one day for a mentoring session when I met a woman in labour and saw my mentees conducting the delivery.
“The woman was fully dilated, and she told me that she did not usually deliver on the bed but on the ground. With my knowledge of E-MOTIVE, I knew that for a successful delivery, we normally allow women to deliver in any position of their choice. So, we were able to conduct the delivery without any complications as she delivered her baby on the floor,” she narrated.
According to her, the successful outcome of the delivery would not have been possible without their knowledge of E-MOTIVE.
“What we did was to make the environment clean, place a clean material on the floor, and allow her to deliver there. We did everything that was necessary, and she had a successful delivery.
“Immediately after she delivered her baby, we took her to the bed, where we applied the calibrated drape to measure the blood loss and ensured that she was stable.
“Since I have been practising as a midwife for many years, it was the first time I conducted a delivery with a woman lying on the ground. With the training on E-MOTIVE and the skills I have acquired, I can conduct a delivery with the woman in any position. We have had many successful deliveries like that following the E-MOTIVE training,” she recounted.
Citing research indicating that PPH is a leading cause of maternal deaths after childbirth, Isiaka said the E-MOTIVE intervention had helped reduce maternal deaths in communities where healthcare workers had received the training.
Explaining how E-MOTIVE works, she said, “Once a woman starts bleeding after delivery, measuring the blood loss with a calibrated drape helps you determine whether she is bleeding excessively and how many millilitres of blood she has lost.
“If the blood loss is above 300ml, which is a warning sign, you will know that the woman may be developing postpartum haemorrhage. That is early detection.
“Once you have detected that she is bleeding, the next thing to do is to start massaging the uterus to see if it has contracted. If the uterus has not contracted, you repeat the oxytocin. After that, you give tranexamic acid, establish an IV line, and start monitoring her.
“If her condition is not improving, you document all the interventions you have given her and escalate the case. When you follow the steps and apply the intervention, the bleeding should stop, especially when tranexamic acid is administered promptly.”
The midwife further noted, “With the E-MOTIVE intervention in our PHCs, we now have a reduction in cases of postpartum haemorrhage. Our health workers in rural communities can now manage women with postpartum haemorrhage after delivery, and they know what to do because they have acquired this training.”
No more referrals
A CHEW and mentee at Mando PHC, Hadiza Abdullahi, described the E-MOTIVE training programme as life-transforming, saying she can now effectively manage women with PPH at the facility without referral.
“Before the training, I could not handle a PPH case. We usually referred our patients with PPH to a general hospital, but after the E-MOTIVE training, we no longer refer them. “We now manage women with PPH. I no longer panic when I see such cases because I have been trained on step-by-step interventions to manage the women, and I have been recording huge success stories since we were trained on the intervention in August 2025,” she said.
Further sharing the benefits of the training, Abdullahi said, “There were things I was doing wrong when taking deliveries, like combining drugs, but after the training, I now know better how to manage PPH. It really upscaled my knowledge. I now know about tranexamic acid and how to administer it, which I didn’t know before.
“I now know how to use the action plan for step-by-step management of bleeding after birth. I also know how to apply anti-shock garments and calibrated drapes, and I know the importance of preparing a pregnant woman during delivery in case of an emergency. I now know how to resuscitate a child with birth asphyxia, which I didn’t know before.
“We also have an action plan for the resuscitation of babies, which we didn’t have before the training. I now know how to manage women with abnormal labour after I was taught the National Labour Care Guide, which enables me to conduct deliveries without complications and know when to refer patients when there are obvious dangers beyond our control. I also learnt manual removal of the placenta, which I didn’t know before.
“So, the benefits of the training are enormous. We have been witnessing an increase in antenatal attendance since the training.”
Stepping down training
Following her training, Abdullahi began stepping down the E-MOTIVE intervention to other CHEWs at Mando PHC, helping to build their capacity to prevent and manage PPH and further strengthening the facility’s ability to handle postpartum haemorrhage without unnecessary referrals.
Another CHEW at Mando PHC, Hajara Yunusa, who learnt PPH prevention and management using the E-MOTIVE approach from Abdullahi, said the training had transformed her confidence and skills in managing childbirth complications.
“I learnt E-MOTIVE from Hadiza Abdullahi. I now know how to manage a woman with PPH at the PHC. There were a lot of things I didn’t know about conducting deliveries before, which I now know after the training”, Yunusa said.
The World Development Committee Chairman, Afaka Ward, Igabi LGA, Abdu Saidu Zaria, also expressed satisfaction with the outcome of the intervention, saying reports of women dying during pregnancy had become a thing of the past in the community.
Strengthening PHCs’ capacity
At Abdu Kwari PHC in Sabon Gari LGA, PUNCH Healthwise observed another example of how the TSTS and E-MOTIVE interventions are strengthening the capacity of frontline health workers to provide safer childbirth care.
Before the training, many of the CHEWs at the facility were not skilled birth attendants and lacked the capacity to conduct deliveries or manage childbirth complications effectively.
Abdu Kwari PHC was among the facilities selected for the E-MOTIVE intervention because it previously lacked adequately trained health workers, underscoring the gaps the TSTS programme was designed to address.
The Reproductive Health Coordinator for Sabon Gari LGA, Aisha Sambo, who monitors deliveries at health facilities across the LGA, said nine health workers had been trained under the programme.
Speaking on the impact of the programme, Sambo said, “We have achieved a remarkable outcome since the training began. Before, many of these facilities used to refer women with PPH to secondary facilities, and some did not even make it to the facilities due to delays. “But that is in the past now, as our PHCs where health workers have been trained on PPH and E-MOTIVE no longer records maternal mortality. After the training, our facilities can manage PPH consistently and effectively.”
The Officer-in-Charge of Abdu Kwari PHC, Sabon Gari LGA, Rabi Abdullahi, told PUNCH Healthwise that before the training, the facility didn’t have skilled birth attendants but now has trained health workers.
“We usually referred patients with PPH to a secondary facility because we did not have the competence and skills to handle it. But after the training, we can now manage the condition effectively. We now know how to monitor patients in labour to detect danger signs. We have stepped down the training to other CHEWs. Five health workers were trained in the facility,” Abdullahi said.
Another beneficiary of the training, the ANC provider at the PHC, Zainab Garba, described the training as a game changer.
“The training has improved our delivery outcomes in the facility,” she said.
Zero maternal deaths linked to PPH
Giving deeper insight into the impact of the programme, the State Team Lead and Manager, TSTS, Pathfinder International, Dr Tanimu Salisu, told PUNCH Healthwise that the TSTS project had made a significant impact since the state government adopted the policy.
Salisu said the programme had significantly bridged the skilled birth attendant gap in the selected PHCs, which previously lacked adequately trained health workers and were largely staffed by CHEWs and JCHEWs.
He said more than 50 per cent of maternal deaths could be prevented if the intervention were expanded across the 255 wards and 23 LGAs in the state.
“We first supported the state to adopt the policy and see how to implement it properly. We realised that many of the PHCs in Kaduna State were manned by CHEWs and JCHEWs. Community health extension workers, from inception, are not trained to manage deliveries.
“Hence, the Kaduna health system was reporting a lot of maternal mortality. Due to the lack of trained midwives and skilled birth attendants at these PHCs, maternal mortality was high. When we came in with the investment, what we did was to identify those PHCs that were reporting the highest number of maternal deaths. We then trained the CHEWs within those facilities,” he said.
Salisu said the programme adequately strengthened the capacity of the PHCs to manage women with PPH after delivery, a service not available before the training.
“After the training in the management of PPH and E-MOTIVE, we now send them to the facilities to step down the training to the health workers there, be it CHEW, JCHEW or nurse. Since that training, there has been a drastic reduction in maternal mortality associated with PPH in these LGAs.
“From the data that we have, we have recorded zero maternal mortality linked to PPH. None of our facilities has reported maternal mortality since August 2025, when we went back to the facilities to implement the training. This shows you how impactful this training has been.
“We have implemented the programme in 77 facilities across nine LGAs in three senatorial zones — three LGAs per senatorial zone. We used the RMNCAH Scorecard to identify the facilities. The project started in 2024, and 77 health workers have been trained, one health worker per facility,” he noted.
Programme sustainability
He urged the state government to take ownership of the programme and sustain it, citing the gains recorded.
Salisu also appealed to the Kaduna State Government to train more health workers, stressing that sustaining the programme was crucial because of the state’s high maternal mortality burden.
He also stressed the need to expand the training to other local government areas.
“The number one cause of maternal mortality in the state is PPH, so when PPH is tackled, the MMR will drop. Capacity training is key. Mentorship sessions are very important. If the programme is sustained and implemented in the 23 LGAs, they will record a drop in maternal mortality rate. More than 50 per cent of maternal mortality will be reduced if implemented across the 255 wards and 23 LGAs in the state,” he said.
Programme Officer, TSTS Project at Pathfinder International, Fatimah Muhammad Muazu, said the TSTS project had enabled Pathfinder to train 77 CHEWs across nine LGAs in Kaduna State to prevent and manage PPH in their respective facilities.
“We attach them to clinical mentors so that they can be mentored in areas where there are gaps and develop the capacity to close those gaps at the facility level. So far, so good, we have recorded zero maternal mortality as a result of PPH, and we have reduced referrals because the CHEWs can prevent and manage PPH when it happens.
“So, we have zero maternal mortality across facilities in these nine LGAs,” she said.
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