The purpose of this report is to inform deliberations among policymakers and stakeholders. It summarises the best available evidence regarding community-based prevention of postpartum haemorrhage in Zambia. The report was prepared as a background document to be discussed at meetings of those engaged in developing policies for community-based prevention of postpartum haemorrhage and people with an interest in those policies (stakeholders). In addition, it is intended to inform other stakeholders and to engage them in deliberations about those policies. It is not intended to prescribe or proscribe specific options or implementation strategies. Rather, its purpose is to allow stakeholders to systematically and transparently consider the available evidence about the likely impacts of community-based prevention of postpartum haemorrhage. How this report is structured The executive summary of this report provides key messages and summarises each section of the full report. Although this entails some replication of information, the summary addresses the concern that not everyone for whom the report is intended will have time to read the full report. How this report was prepared This policy brief brings together global research evidence (from systematic reviews) and local evidence to inform deliberations about preventing postpartum haemorrhage at community level in Zambia. We searched for relevant evidence describing the problem, the impacts of options for addressing the problem, barriers to implementing those options, and implementation strategies to address those barriers. We searched particularly for relevant systematic reviews of the effects of policy options and implementation strategies. We supplemented information extracted from the included systematic reviews with information from other relevant studies and documents. (The methods used to prepare this report are described in more detail in Appendix 1.) Limitations of this report This policy brief is based largely on existing systematic reviews. For options where we did not find an up-to-date systematic review, we have attempted to fill in these gaps through other documents, through focused searches and personal contact with experts, and through external review of the report. Summarising evidence requires judgements about what evidence to include, the quality of the evidence, how to interpret it and how to report it. While we have attempted to be transparent about these judgements, this report inevitably includes judgements made by review authors and judgements made by ourselves. 6 Why we have focused on systematic reviews Systematic reviews of research evidence constitute a more appropriate source of research evidence for decision-making than the latest or most heavily publicized research study 1,2 . By systematic reviews, we mean reviews of the research literature with an explicit question, an explicit description of the search strategy, an explicit statement about what types of research studies were included and excluded, a critical examination of the quality of the studies included in the review, and a critical and transparent process for interpreting the findings of the studies included in the review. Systematic reviews have several advantages.3 Firstly, they reduce the risk of bias in selecting and interpreting the results of studies. Secondly, they reduce the risk of being misled by the play of chance in identifying studies for inclusion or the risk of focusing on a limited subset of relevant evidence. Thirdly, systematic reviews provide a critical appraisal of the available research and place individual studies or subgroups of studies in the context of all of the relevant evidence. Finally, they allow others to appraise critically the judgements made in selecting studies and the collection, analysis and interpretation of the results. While practical experience and anecdotal evidence can also help to inform decisions, it is important to bear in mind the limitations of descriptions of success (or failures) in single instances. They can be useful for helping to understand a problem, but they do not provide reliable evidence of the most probable impacts of policy options. Uncertainty does not imply indecisiveness or inaction Many of the systematic reviews included in this report conclude that there is “insufficient evidence”. Nonetheless, policymakers must make decisions. Uncertainty about the potential impacts of policy decisions does not mean that decisions and actions can or should not be taken. However, it does suggest the need for carefully planned monitoring and evaluation when policies are implemented. “Both politically, in terms of being accountable to those who fund the system, and also ethically, in terms of making sure that you make the best use possible of available resources, evaluation is absolutely critical.”