Local health workers' perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi

Background: To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers. Methods: Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians ('medical assistants' and 'clinical officers'). Results: Factors contributing to facility-based obstetric hemorrhage mentioned by participants were categorized into four major areas: (1) limited availability of basic supplies, (2) lack of human resources, (3) inadequate clinical skills of available health workers and (4) substandard referrals by traditional birth attendants and lack of timely self-referrals of patients. Conclusion: Health workers in this district mentioned important community, system and provider related factors that need to be addressed in order to reduce the impact of obstetric hemorrhage.