Postpartum Haemorrhage (PPH) affects approximately 2% of all women who give birth. It is the primary cause of maternal mortality in Low-Income Countries (LIC), and the leading cause of approximately. 25% of maternal deaths globally [1] . In Zambia, approximately 250 deaths/annum were attributed to PPH in 2016. Tranexamic Acid (TXA) was included in the WHO's 2017 recommendations for the prevention and treatment of PPH. TXA has been shown to reduce death due to bleeding in women with clinically

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... agnosed PPH by approximately 30% if the treatment is administered intravenously (and in addition to the pre-2017 standard of care) within 3 hours of giving birth [2] . It is available as part of a PPH treatment package free of charge in all hospitals in Zambia, demonstrating the commitment of the Zambian government to reducing deaths due to PPH. However, the drug appears to be underutilised, indicating that there are barriers to the uptake of TXA to treat PPH that are not associated with its availability. We aimed to identify some of these barriers whilst simultaneously boosting the confidence and competence of healthcare professionals to treat PPH in five Zambian Provinces through training programmes. Methodology As a starting point, a baseline assessment of existing status of utilisation of TXA to prevent treat PPH was established by collecting the information from routine data collected at the Ministry of Health (MOH) Zambia by engaging the procurement office and Directorate of Monitoring & Evaluation. This was done by using TXA-utilisation data (proxy-measure) and data on PPH-related deaths reported to the Ministry of Health MOH. We subsequently conducted a day training workshop with representatives from five provinces of Central, Eastern, Copperbelt, Lusaka and Southern from selected hospitals. The hospitals were selected on the basis that they receive patients at high risk of PPH or receive referred patients with PPH according to information provided by the MOH. Abstract Objective: To identify barriers to utilization of TXA to treat PPH and conduct training and mentorship programs to improve uptake. Design: A cross sectional study encompassing a sample of 25 health workers among them Doctors, Nurses and Midwives. Participants were drawn from selected hospitals in five provinces namely Central, Eastern, Copperbelt, Lusaka and Southern. The hospitals were selected on the basis that they receive patients at high risk of PPH or receive referred patients with PPH according to information provided by Ministry of Health. Methods: The study began with a baseline assessment on the availability and usage of Tranexamic Acid (TXA) by collection of information on barriers to uptake captured via questionnaire and checklist sent to trainees of a one-day workshop that took place centrally in Lusaka on 12 September 2019. The training covered the following topics: The Woman Trial -Over view, Accelerating the Uptake TXA to treat PPH in Zambia, Management of PPH, Maternal Mortality in Zambia-Causes (2016-2018 DHIS2 Data/MDSR), Key strategies to addressing maternal mortality in Zambia, The TXA Study Questionnaire, consent form and checklist. Following the training these representatives were tasked to go and disseminate this information to their sites by making presentations with regard to utilisation of TXA with the hope of influencing change at their hospitals. A mentorship visit was conducted between 7 and 16 October 2019 by two specialist obstetricians with criteria for adequacy of TXA availability and use for PPH. An endline visit took place after 07 months in May 2020 to determine the impact of the training and the mentorship visit to all the sites. The same checklist that was used at baseline was administered at this time to determine the availability of items required to treat PPH, including availability of TXA. Results: Lack of availability of Tranexamic acid was the cause of no increased uptake of TXA. There were limited supplies of TXA from the Ministry of Health (MOH), Zambia at baseline and one hospital had a donation at baseline. At endline, a part from limited supplies from the MOH, most health institutions were buying TXA from their own internally generated funds. Knowledge on benefits of use of TXA was now universal at endline with algorithms for PPH that included TXA in all the sites. Conclusion: Training and mentorship improved knowledge and usage of TXA among health workers with regard to PPH. Most supplies are done centrally by MOH, not regularly, and not in appropriate amounts to meet the needs of each hospital. There is a need to advocate for TXA to treat PPH, improve the supply chain of this life saving drug and evidence-based practice in Zambia.