Preparedness of emergency care providers to manage obstetric haemorrhage in KwaZulu-Natal province, South Africa: A mixed-methods study

Abstract

Background: Obstetric haemorrhage (OH), particularly postpartum haemorrhage, is a leading cause of maternal mortality in sub-Saharan Africa. Emergency medical services (EMS) play a critical role in early recognition, intervention and transport; however, evidence on EMS preparedness for OH remains limited. This study assessed the system-level preparedness of public-sector emergency care providers in KwaZulu-Natal (KZN) across four domains: administration, resources, training and response capacity. Methods: A concurrent convergent mixed-methods design was used. Quantitative data were collected using structured questionnaires (n = 417) and analysed descriptively. Qualitative data were obtained through semi-structured interviews (n = 10) and thematically analysed. Findings were integrated to identify convergence and divergence across data sources. Results: Key gaps were identified across all four domains. Administrative weaknesses included inconsistent policy implementation and limited supervisory oversight. Resource constraints reflected ambulance shortages and variable access to essential equipment. Training gaps included limited hands-on obstetric exposure and variable practical skills on scene. Response capacity was affected by the absence of maternal-specific surge planning. Conclusion: Emergency medical services in KZN play a central role in the prehospital management of OH but operate within significant system-level constraints. Strengthening governance, improving fleet and equipment availability, expanding practical obstetric training and integrating maternal health into surge and disaster planning may enhance preparedness in KZN and similar resource-limited settings. Contribution: This study provides evidence on EMS preparedness to manage obstetric haemorrhage, informing system strengthening and maternal emergency care planning.