Challenges in day-to-day midwifery practice; a qualitative study from a regional referral hospital in Dar es Salaam, Tanzania

Abstract

Background: Maternal and infant mortality rates in Tanzania have decreased over the past decades, but remain high. One of the challenges the country faces, is the lack of skilled health care workers. High fertility rates make midwives and their patients particularly susceptible to stress as a result of understaffing. Objective: This paper explores the challenges midwives face in their day-to-day practice at a regional referral hospital in Tanzania, and investigates which measures the midwives themselves find necessary to implement to improve their situation. Methods: A qualitative study design with focus group discussions (FGDs) was employed to explore which challenges the midwives experienced. Each focus group consisted of five to six midwives. A FGD topic guide covering challenges, consequences, motivation, ideal situation and possible solutions was used. These data were analyzed using Systematic Text Condensation. Results: A total of 28 Midwives, six men and 22 women, participated in five FGDs. Four categories emerged from the collected material: Feelings of demoralization, shortage of resources, societal challenges and personal struggles. A feeling of demoralization was especially prevalent and was caused by a lack of support from the leaders and little appreciation from the patients. Shortage of resources, and shortage of personnel in particular, was also highlighted as it led to an excessive workload resulting in difficulties with providing adequate care. These difficulties were intensified by lack of equipment, facilities and a non-optimal organization of the healthcare system. Conclusion: The challenges revealed during the FGDs prevent the midwives from providing sufficient midwifery care. To improve the situation, measures such as supportive leadership, reduction of workload, increasing availability of equipment and increasing knowledge of reproductive health in society, should be taken.

Challenges Experienced by Midwives Working in Rural Communities of the Bongo District in the Upper East Region of Ghana. A Qualitative Study

“…The midwives felts neglected and their concerns were not addressed. Our study nding is similar to a study by Bremnes, Wiig, Abeid and Darj [23] where midwives felt they were not motivated to provide quality care. In the World Health report on improving healthcare performance, the WHO emphasized that supportive supervision contributes to a positive performance by health workers [33,34].…”

“…Midwives had to improvise with the insu cient basic medical equipment at their disposal in order to meet the health needs of the expectant women but knowing that it wasn't the best practice. This study nding is consist with a study conducted in Tanzania with midwives reported that they had inadequate supply of medical equipment to provide quality care for women [23]. A recent study in Ghana also reported inadequate medical equipment for childbirth services in rural northern Ghana [19].…”

“…The nding of this study is consistent with ndings of previous studies conducted globally and in sub-Saharan Africa, where insu cient personnel were the most important reasons for poor conditions at work cited by midwives [14,22]. For instance, a study conducted by Bremnes, Wiig, Abeid and, Darj in 2018 to explores the challenges midwives face in their day-to-day practice at a health facility in Tanzania found that one of the challenges experienced by midwives was shortage of midwifery personnel in the health facilities which led to an excessive workload resulting in di culties with providing adequate care [23]. Similarly other studies indicates that inadequate sta ng levels and increasing workload among health professionals was challenge across both rural and urban settings [4,24,25,26].…”

'Going off track': The consequences of barriers to Ghanaian midwives’ ability to provide quality care.

“…Furthermore, our participants indicated that failure of management to provide essential equipment for work causes them to be demotivated, especially when the unavailability of essential equipment results in negative outcomes. This supports the nding in work by Bremmes, Wiig, Abeid et al (24), who found out that that the lack of support from leaders and low appreciation causes demotivation in midwives, and that of an earlier study by Lavender and Chapple (35) in which midwives were reported to perceive that their immediate supervisors were not doing enough to help improve the di culties in the course of their work.…”

“…Further, midwives who work in small communities have been found to experience sadness and fear of recriminations when they experience negative outcomes (23). Heavy workloads and challenging working conditions in the face of lack of support from leaders, and low appreciation have also been reported to cause midwives demotivation and depersonalization (24). Midwives' mental and emotional wellbeing has been found to have a reverse impact on the quality of care that they provide.…”