INTERNATIONAL CONSULTANT: Postpartum Prevention Hemorrhage (PPH)

The Position:

The consultant will work under the direct supervision by Sandile Simelane, Population and Development Specialist, under the guidance/ co-supervision by Rinko Kinoshita, Representative, UNFPA Angola.  

How you can make a difference:

UNFPA is the lead United Nations agency for delivering a world where every pregnancy is intended, every childbirth is safe, and every young person's potential is fulfilled. The UNFPA Strategic Plan for 2026-2029 articulates the organization’s response to a complex global environment, providing a roadmap for resilience and renewal. It is designed to accelerate the implementation of the Programme of Action of the International Conference on Population and Development (ICPD) and the achievement of the Sustainable Development Goals by 2030. This mandate is pursued through a focus on four interconnected outcomes: ending the unmet need for family planning; ending preventable maternal deaths; ending gender-based violence and harmful practices; and adapting to demographic change through evidence and rights-based policies. 

In a world where fundamental human rights are at risk, we need principled and ethical staff, who embody these international norms and standards and who will defend them courageously and with full conviction.

UNFPA is seeking candidates who transform, inspire, and deliver high-impact and sustained results and ensure effective external relations, communications, and partnership-building and resource mobilization in a rapidly changing development and funding landscape. We need staff who are transparent, exceptional in how they manage the resources entrusted to them, and who commit to delivering excellence in programme results.

Job Purpose:

Background Maternal Mortality continues to be a key public health issue in the Southern African Development Community (SADC) countries. Two-thirds of SADC Member States have made progress in lowering the Maternal Mortality Ratio (MMR). Still, this region is far from achieving Sustainable Development Goal (SDG) 3.1, which aims to reduce the MMR to at least 70 deaths per 100,000 live births. Angola serves as an example of a SADC Member State that has significantly decreased its MMR from 239/100,000 live births (DHS/MICS, 2016) to 170/100,000 live births (DHS/MICS, 2023-2024). Despite this progress, it is still far above the SDG target by 2030. This requires the country to take immediate and additional measures to accelerate the efforts to reduce the MMR. Postpartum hemorrhage (PPH) is one of the main causes of maternal death worldwide (Macmullen, 2019). Similarly in Angola, complications during and after childbirth, such as hemorrhage, pre-eclampsia, infections, and unsafe abortions are among the top causes of maternal deaths, particularly for pregnant adolescents (Ministry of Health, 2024).  Currently, Angola follows a standard PPH management protocol recommended by WHO’s previous guideline (WHO 2012). Despite the existence of national guidelines that recommend using oxytocin as the primary medication for preventing postpartum hemorrhage and misoprostol as a backup medication, these guidelines are not always followed because of a lack of knowledge among healthcare professionals and a shortage of essential drugs at health facilities. Additionally, other drugs recommended by WHO for the prevention and treatment of PPH, such as heat-stable carbetocin (HSC) and tranexamic acid (TXA), are not yet registered by the Ministry of Health in Angola as uterotomic medicines, while the tertiary level hospitals are allowed to use TXA for PPH treatment in very specific cases. There is also a need to assess which process of the current protocol of the PPH management is not fully implemented by health providers, and what challenges they face in implementing the protocol for every childbirth. Based on the new WHO guideline (published on 5th October 2025) and the findings from this assessment study, the national PPH protocol for Angola and training modules for health providers should be revised.   

Against this background, this assessment or pilot study aims to assess the impact of introducing a standardized PPH prevention and early detection bundle, initially tapping into the already approved medications in Angola. This bundle includes universal uterotonic (either prophylactic oxytocin or misoprostol), trained health providers, and the use of reusable maternal trays for early detection of PPH and other interventions in the PPH bundle. The goal is to assess how this approach can prevent PPH and lower the incidence of moderate and severe PPH, and other outcomes such as PPH related blood transfusions within 24 hours of birth in selected health facilities in Luanda, Malanje and Namibe provinces of Angola.

You would be responsible for:

● To assess changes in maternal health outcomes related to postpartum hemorrhage (PPH) management (e.g., the incidence of PPH, need for blood transfusions, and PPH-related referral and maternal deaths) in the study sites before and after the PPH bundle is implemented.   

● To qualitatively evaluate the practice of measuring blood loss using a calibrated drape (or reusable MaternaWell Trays or drapes), along with its acceptability and practicality in various settings in Angola. 

● To measure the effectiveness of training programs in SBA-supported regions by evaluating improvements in the PPH management knowledge and skills of nurses, midwives and healthcare providers from pre-training to post-training. 

● To document key barriers and enabling factors to the implementation and long-term sustainability of PPH bundle interventions adapted to the Angolan context. 

● To assess any differences between the selected provinces in terms of challenges in implementing the PPH bundle, and its impact on reducing PPH-related outcomes. 

● To identify a set of recommendations for the Ministry of Health in Angola in terms of the current standard PPH protocol and training modules to improve PPH management and reduce PPH-related maternal deaths. 

Methodology   

● A mixed-methods approach will be used, combining quantitative and qualitative methods. 

● Primary interventions to be assessed: modified E-MOTIVE PPH bundle, adapted to Angolan context that include prophylactic uterotonic—oral misoprostol 600 µg if oxytocin is unavailable, or oxytocin 10 IU IM/IV where available—plus provider training and calibrated drape or MaternaWell Tray to measure bleeding at birth/postpartum period within 24 hours of childbirth ● Primary outcome: Incidence of overall PPH (≥500 mL) within 24 hours after delivery, measured per woman.   

● Secondary outcomes: number of blood transfusion required due to PPH, PPH-related referrals, change in maternal hemoglobin, PPH-related maternal mortality (if feasible), time to first uterotonic dose, acceptability and feasibility of using a drape or MaternaWell Tray to measure the bleeding within 24 hours following childbirth 

Targeted population and health facilities: 

●  Health Facilities: 

The study will target secondary and tertiary healthcare facilities with more than 50 deliveries per day, including the Norway program’s implementation regions (Luanda, Malanje and Namibe). 

● Healthcare Workers: Midwives, nurses, and doctors in targeted health facilities who are trained on PPH management bundle. 

● Direct beneficiaries/participants: Postpartum women, delivering vaginally, receiving care in the targeted health facilities during the study period. Inclusion criteria (e.g., ≥28 weeks’ gestation or other locally appropriate threshold). Exclude women who decline or have contraindications to misoprostol or oxytocin according to local protocol (documented allergies, etc.).   

● Data collection period: Two Months to reach a sample size described below:

Activities: 

• Data collection for baseline (routine practice): review information from selected hospitals prior to the intervention (1 month) 

• Consecutive enrollment of eligible women at selected high volume facilities to receive Bundled intervention: (1 month). 

● Sample size:  estimated 3,000 pregnant women in labor in selected (Luanda 83%, Malanje: 11%, and Namibe 6%) – to be adjusted in consultation with the consultant (note that this is an assessment or evaluation study. The sample size needs to be sufficient to provide evidence on the efficiency of PPH bundle intervention in reducing PPH related outcomes.)   

Interventions to be assessed:   

● Uterotonic prophylaxis at delivery: oral misoprostol 600 µg if oxytocin is unavailable, or oxytocin 10 IU IM/IV if available and according to standard practice. Record which uterotonic was given.   

● Health provider training: standardized hands-on training modules on active management of the third stage, use of calibrated drapes or maternal, and recognition and initial management of PPH. Maintain a training log and competency checklists.   

● Calibrated blood-loss drapes or MaternaWell Tray will be available at deliveries along with instructions and job aids. Health workers must use them for all vaginal deliveries.   

● Supply and supervision: Ensure a reliable supply chain for misoprostol, oxytocin, and drapes, along with supportive supervision visits.   

● Introduction of Maternawell trays (reusable maternal trays) to measure the quality of bleeding due to PPH - feasibility, acceptability and practicability. 

Data Collection Methods 

1. Facility-Based Assessment: 

● Medical record review: PPH incidence (if recorded using a calibrated drape or MaternaWell Tray), oxytocin, misoprostol or HSC use, blood transfusions and referrals, and maternal deaths. ● Medicine availability (Review of stock cards and conducting physical count of commodities): Oxytocin, misoprostol, heatstable carbetocin, and Tranexamic acid. 

● Facility readiness: Equipment, protocols, infrastructure (challenges and solutions). 

2. Survey of Healthcare Workers: 

● Pre- and post-training knowledge and practice assessments by a questionnaire and observation on site by supervisors (hired by the study) 

● Focus group discussions with health workers to identify challenges and solutions in delivering PPH bundle interventions including the use of calibrated drapes or maternawell trays to measure bleeding at childbirths. 

3. Patient Experiences: 

● Interviews with postpartum women who received PPH management bundle through a semi-structured questionnaire 

4. Stakeholder Interviews:

● Key informant interviews with Ministry of Health officials, provincial health departments, hospital clinical directors, and others.

● Focus group discussions with trained health providers in targeted health facilities who implemented PPH bundle 

Data Analysis

● Quantitative Analysis: Descriptive and inferential statistics to compare maternal health indicators before and after SBA interventions, disaggregated by region (rural/Urban) and other maternal factors (age, number of previous pregnancies, education level, etc), controlling or adjusted for potential risk factors / underlying factors that affect the PPH outcomes such as maternal anemia, bleeding during the pregnancy, signs of placenta previa, and other PPH risk factors. 

● Qualitative Analysis: Thematic analysis of interviews and focus group discussions to identify key insights on implementation challenges and best practices. 

4. Expected Outcomes 

●   Evidence on the impact of PPH management interventions in improving maternal health care outcomes. 

● Recommendations for enhancing the implementation and scale-up of PPH bundled interventions. 

● Identification of key barriers of life-saving maternal health medicines uptake related to prevention and treatment of PPH in Luanda and across different provinces. 

● Contribution to policy decisions on maternal health interventions in Angola

 Key outputs/deliverables for the consultancy:

The consultant is expected to deliver the following outputs: 

● An inception report outlining the research methodology and work plan 

● Review and finalize the study protocol, especially the sample size parts, based on the statistics power etc.   

● Develop or fine tune, pre-test and finalize data collection tools (some of them exist as draft, others may need to be developed newly)- pre-test will be done by study coordinators/ supervisors in each province. 

● Contribute to the training of supervisors and staff in health facilities on study protocol and data collection 

● A draft report presenting the findings of the quantitative and qualitative data analysis for the review by supervisors 

● Presentation of the findings to the Steering Committee for the study, led by Ministry of Health and UNFPA for validation. 

● A final report detailing the research findings, including evidence on the impact of the bundled interventions of the PPH management, key barriers to implementing life-saving maternal health medicines for prevention and treatment of PPH across different provinces. The final report should be submitted in both electronic and hard copy versions. 

Duration:

The assignment will be undertaken within 60 working days (or total 12 weeks). The assignment will take place during the period between Nov  2025 - March 30th 2026 depending on the progress of the PPH study on the ground.  

Travel:

 Most of the work will be done remotely. However the consultant will be required to travel to Angola for one week. Travel cost (airplane ticket and DSA for the stay in Angola will be paid separately)  

Other relevant information or special conditions, if any: 

• The Consultant will also travel to Angola during the Phase I – in Luanda and possibly in selected provinces.  

• The consultant will closely collaborate with the provincial study coordinators recruited by the study.  

• The consultant will use her or his own office materials and equipment such as a laptop
 
Qualifications, Education and Experience: 

Required expertise, qualifications, and competencies, including language requirements: 

● At least a Master’s degree, preferably a PhD degree in a relevant field such as Public Health, Medicine, Obstetrics and Gynaecology, Biostatistics, Health Management, Epidemiology or a related field in Social Science  

● At least 7 years’ experience in SRH research or programmes, with a focus on Maternal Health and Emergency Obstetric and Newborn Care, preferably in sub-Saharan African countries or countries with similar to Angola (low middle income countries).   

● Demonstrated experience in conducting similar an operational research, implementation research, or monitoring and evaluation, and other work related to the consultancy. ● Previous experience in conducting qualitative and quantitative data analysis is a must  

● Recent publications through peer-reviewed journals in related fields (within 1-3 years)   

Languages: 

Required Competencies: 

Values:

Exemplifying integrity, 

Demonstrating commitment to UNFPA and the UN system, 

Embracing cultural diversity, 

Embracing change

Core Competencies: 

Achieving results,

Being accountable,

Developing and applying professional expertise/business acumen,

Thinking analytically and strategically,

Working in teams/managing ourselves and our relationships,

Compensation and Benefits:

This position offers an attractive remuneration package including a competitive gross salary.
 

UNFPA Work Environment:

UNFPA provides a work environment that reflects the values of gender equality, diversity, integrity and healthy work-life balance. We are committed to ensuring gender parity in the organization and therefore encourage women to apply. Individuals from the LGBTQIA+ community, minority ethnic groups, indigenous populations, persons with disabilities, and other underrepresented groups are highly encouraged to apply. Reasonable accommodation may be provided to applicants with disabilities upon request, to support their participation in the recruitment process. UNFPA promotes equal opportunities in terms of appointment, training, compensation and selection for all regardless of personal characteristics and dimensions of diversity. Diversity, Equity and Inclusion is at the heart of UNFPA's workforce - click here to learn more.

Disclaimer:

Selection and appointment may be subject to background and reference checks, medical clearance, visa issuance and other administrative requirements. 

UNFPA does not charge any application, processing, training, interviewing, testing or other fee in connection with the application or recruitment process and does not concern itself with information on applicants' bank accounts. 

Applicants for positions in the international Professional and higher categories, who hold permanent resident status in a country other than their country of nationality, may be required to renounce such status upon their appointment.