Experiences with and expectations of maternity waiting homes in Luapula Province, Zambia: a mixed–methods, cross-sectional study with women, community groups and stakeholders

Abstract

BackgroundLuapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. To examine the experiences with maternity homes, formative research was undertaken in four districts of Luapula Province to assess women’s and community’s needs, use patterns, collaboration between maternity homes, facilities and communities, and promising practices and models in Central and Lusaka Provinces.MethodsA cross-sectional, mixed-methods design was used. In Luapula Province, qualitative data were collected through 21 focus group discussions with 210 pregnant women, mothers, elderly women, and Safe Motherhood Action Groups (SMAGs) and 79 interviews with health workers, traditional leaders, couples and partner agency staff. Health facility assessment tools, service abstraction forms and registers from 17 facilities supplied quantitative data. Additional qualitative data were collected from 26 SMAGs and 10 health workers in Central and Lusaka Provinces to contextualise findings. Qualitative transcripts were analysed thematically using Atlas-ti. Quantitative data were analysed descriptively using Stata.ResultsWomen who used maternity homes recognized the advantages of facility-based births. However, women and community groups requested better infrastructure, services, food, security, privacy, and transportation. SMAGs led the construction of maternity homes and advocated the benefits to women and communities in collaboration with health workers, but management responsibilities of the homes remained unassigned to SMAGs or staff. Community norms often influenced women’s decisions to use maternity homes. Successful maternity homes in Central Province also relied on SMAGs for financial support, but the sustainability of these models was not certain.ConclusionsWomen and communities in the selected facilities accept and value maternity homes. However, interventions are needed to address women’s needs for better infrastructure, services, food, security, privacy and transportation. Strengthening relationships between the managers of the homes and their communities can serve as the foundation to meet the needs and expectations of pregnant women. Particular attention should be paid to ensuring that maternity homes meet quality standards and remain sustainable.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1649-1) contains supplementary material, which is available to authorized users.

Health care expenditure for delivery care between maternity waiting home users and nonusers inEthiopia

“…The findings of our study on health care expenditures for delivery care among MWH users than nonusers and associated factors could not directly be compared with other previous studies on MWH in Ethiopia or other countries because those studies had no comparisons of health care expenditures for delivery care among MWH users and nonusers . Studies on the costs of using MWHs are limited, and further studies are needed to understand the approximate amount of fees and their effect on the use of these facilities . We found that mode of delivery, the distance from home to facility, and type of transportation were independent factors for higher OOP payments.…”

“…6,10,14,15 Studies on the costs of using MWHs are limited, and further studies are needed to understand the approximate amount of fees and their effect on the use of these facilities. 28 We found that mode of delivery, the distance from home to facility, and type of transportation were independent factors for higher OOP payments. A study from Ethiopia reported that the higher rates of CS among MWH users could potentially increase OOP expenses.…”

Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed‐methods study based on 45 years of experience

“…Several studies have prioritised the need to improve facilities and quality of care at the MWH and lower barriers to increase MWH utilisation . This study, however, found that the quality of care at the health facility is more important.…”

“…These were useful for analysis of providers' and users' perspectives, but less appropriate for describing the interrelatedness of these perspectives and the complex interplay of factors impacting on access to MWHs. Several studies have prioritised the need to improve facilities and quality of care at the MWH and lower barriers to increase MWH utilisation [21,[25][26][27][28]. This study, however, found that the quality of care at the health facility is more important.…”

Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis

“…This study utilized a cross-sectional, concurrent triangulation mixed-methods design to cross-validate findings. 16 , 17 Data for this analysis were collected for the baseline observation of an impact evaluation (NCT 02620436) 40 of a maternity waiting home (MWH) intervention designed from formative research 18 – 21 being implemented in 40 primary health facility catchment areas (HFCAs) within seven districts across Zambia. A quantitative HHS was administered and qualitative IDIs were conducted concurrently to triangulate and corroborate findings ( Figure 1 ).…”