By The PPH Foundation
In Kenya, the minutes between a woman’s first signs of labour complications and her arrival at a well-equipped facility can determine whether she survives postpartum haemorrhage. Delays in recognising danger, delays in reaching care, and delays in receiving the right treatment remain the three critical barriers. Strengthening referral systems, especially for rural and hard-to-reach communities, is emerging as one of the most powerful solutions.
Professor Moses Obimbo, the End PPH Initiative Project Lead at the PPH Foundation, says that effective referral systems are the backbone of emergency obstetric care. He explains that PPH can escalate dangerously fast and that any delay beyond the first hour after birth drastically increases the risk of severe bleeding. He adds that rapid transfer and coordinated care can mean the difference between timely intervention and preventable loss.
Yet, in many communities, women still travel long distances to reach facilities with surgical capacity, blood products, or skilled personnel. A 2024 report by the Kenya Health Information System shows that up to 60 per cent of obstetric emergencies come from rural sub-counties where the nearest comprehensive emergency care facility is often more than 20 kilometres away. Access is further complicated by poor roads, limited ambulance coverage, and high transport costs.
The government, counties, and civil society have been working to close these gaps. The Ministry of Health has prioritised upgrading sub-county hospitals with maternity theatres, stabilisation rooms, and trained emergency teams. Community health promoters are also being equipped to recognise danger signs early, mobilise rapid transport and coordinate referrals.
Case studies from Turkana, West Pokot, and Migori have highlighted how coordinated referral systems have saved mothers. In one instance from Migori, community transport teams organised a motorcycle evacuation for a woman experiencing prolonged labour. She was stabilised at a nearby health centre before being transferred to a county referral theatre, where she received timely surgical and transfusion support. Clinicians say she would not have survived without the speed and structure of the referral process.
Dr Eunice Atsali, a midwife and a co-lead at the End PPH Initiative, emphasises that the referral system is not just about ambulances. It depends on communication flow, emergency readiness and collaboration between lower and higher-level facilities. She adds that every minute counts, and every link in the referral chain must work.
Strengthening Kenya’s referral system remains one of the most powerful shields against postpartum haemorrhage. With coordinated transport, skilled teams, community vigilance and early detection, the pathway from village to theatre becomes a lifeline capable of saving thousands of mothers every year.
Photo by Erik Mclean: https://www.pexels.com/photo/white-and-red-ambulance-truck-on-green-grass-field-9391904/
Sources
Ministry of Health Kenya, Kenya Health Information System 2024 data on maternal emergencies
UNFPA reports on emergency obstetric referral systems
Public statements by Prof Moses Obimbo and Dr Eunice Atsali on emergency referrals and PPH
Case studies reported by county departments of health in Migori, West Pokot, and Turkana