Engaging a broad network of stakeholders to support MNH services has great potential if implemented in ways that are context-appropriate and that build around full collaboration with government and civil society stakeholders.
Background Midwives face direct and indirect barriers in their workplaces that have negative consequences on their ability to provide quality care to women and neonates, however, they still carry on with their duties. This study aimed at investigating the coping strategies that Ghanaian midwives adopt to be able to complete their work. Methods Glaserian Grounded theory was used in this study. Data were collected through non-participant observations and semi-structured interviews. The study participants included 29 midwives who worked in labour/birthing environments and a pharmacist, a social worker, a national Health Insurance Scheme manager and a health services manager. Findings The midwives’ motivation due to their strong desire to save the lives of women and neonates and their strong affection for the midwifery profession was identified to help them cope with the barriers that they faced in their workplaces. The midwives’ motivation was found to spur actions such as improvising, taking control of the birthing process and the birthing environment and the maintenance of social and professional networks to help them to complete their duties. Conclusion Ghanaian midwives face myriad barriers in their workplaces; however, they are able to adopt coping strategies that enable them to complete their duties. The provision of care resources for maternity services in the country will reduce the barriers that the midwives face and improve the quality of maternal and neonatal care. In the short term however, pre and post midwifery educational programmes should focus on developing resilience in the midwifery workforce to help midwives cope more effectively with the challenges that they face in their workplaces.
PURPOSEThis study identified barriers that affected Ghanaian midwives' ability to provide quality care to prevent maternal and neonatal mortality.DESIGNGlaserian Grounded Theory was the framework of this study. Interviews were conducted with 33 participants from 10 facilities in seven districts in one region in southern Ghana.FINDINGSMidwives are committed to do their best to provide quality care to women and newborns. Barriers to their care included a lack of resources of care, unsupportive facility management, and client related barriers.CONCLUSIONSMeasures to reduce barriers for midwives to provide quality care must improve health financing at a national and facility level; the encouragement of supportive supervision and management at a facility level; and actions to enhance midwife engagement with clients and communities.
Despite global efforts to reduce maternal and neonatal mortality rates, the problem continues to persist, especially in Lower- and Middle-Income Countries like Ghana. For years it has been acknowledged that the deployment of well-trained and regulated midwives could provide a cost-efficient way of reducing maternal and neonatal mortality. However, multiple factors including; recently increasing demands made by birthing women, the growing complexity of midwifery work and a shortage of midwives as well as other barriers have affected the ability of midwives to provide quality maternal and neonatal care. This study aims to provide insight into some of the consequences of these barriers that midwives face in their workplaces.MethodsGlaserian Grounded Theory was applied in this study. Semi structured interviews were conducted with twenty-nine (29) midwives and four (4) other workers whose roles impacts on the work of midwives. In accordance with the requirements of grounded theory, data collection and analysis occurred concurrently while building on the data that has already been analyzed. Constant comparison was used throughout the data analysis.ResultsThe analysis of the data indicated that barriers to midwives’ ability to provide quality care have physiological, psychological and socioeconomic consequences on midwives thereby affecting the quality of the care that they offer to women and newborns. ConclusionThe effects of the barriers to midwives’ abilities to provide quality care are intertwined and have consequences on both the midwives as well as on the quality of the care that they provide to patients. By implementing measures to ameliorate or mitigate the effects of the barriers that midwives face in their work, the quality of the care that they provide to women and neonates will be enhanced, which in turn will positively affect the retention of midwives and maximize the benefits of implementing the midwifery model of care.
BACKGROUNDSkilled attendance at birth by well-educated and regulated midwives has been identified to reduce maternal and neonatal deaths, however, it has been established that midwives experience barriers that can affect their ability to provide quality care to women and neonates.AIMThis systematic review and meta-synthesis of qualitative data was conducted to investigate the barriers to midwives' ability to provide quality care focusing on African and developed countries.METHODSThe Joanna Briggs Institute process for conducting systematic reviews was followed for this review. Qualitative studies that reported on barriers to midwives' ability to provide quality care were identified by searching the following databases: CINAHL, PubMed, Web of Science, and PsychINFO. Studies reported in English in the last 10 years, within which most participants were midwives and the data reported on barriers to quality care provision by midwives were included in this review.RESULTS813 published research studies were screened, and 11 research papers were included in this review. The meta-synthesis of the findings resulted in six categories: the lack of equipment; inadequate skills and training, lack of space and infrastructure, staff shortages and high workloads, emotional barriers, and workplace culture. Using the Donabedian model of quality care, the barriers were grouped into structure, process, and outcome factors.CONCLUSIONCurrently efforts to improve quality care in African countries focus on structural factors. Efforts to improve quality care in developed countries focus on process factors. In order to improve quality care for women and neonates, efforts need to be focused on all the factors that promotequality care.
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