Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions

Abstract

BackgroundDespite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) collaborate to promote and deliver ANC to women in these communities, but little research has been conducted on the professional working relationships between these two health providers. This study aims to generate a better understanding of the strength and quality of professional interaction between these two key actors, which is instrumental in improving healthcare performance, and thereby community health outcomes.MethodsWe conducted eleven in-depth interviews with midwives from three rural districts within Jimma Zone, Ethiopia (Gomma, Kersa, and Seka Chekorsa) as a part of the larger Safe Motherhood Project. Interviews explored midwives’ perceptions of strengths and weaknesses in ANC provision, with a focus as well on their engagement with HEWs. Thematic content analysis using Atlas.ti software was used to analyse the data using an inductive approach.ResultsMidwives interacted with HEWs throughout three key aspects of ANC promotion and delivery: health promotion, community outreach, and provision of ANC services to women at the health centre and health posts. While HEWs had a larger role in promoting ANC services in the community, midwives functioned in a supervisory capacity and provided more clinical aspects of care. Midwives’ ability to work with HEWs was hindered by shortages in human, material and financial resources, as well as infrastructure and training deficits. Nevertheless, midwives felt that closer collaboration with HEWs was worthwhile to enhance service provision. Improved communication channels, more professional training opportunities and better-defined roles and responsibilities were identified as ways to strengthen midwives’ working relationships with HEWs.ConclusionEnhancing the collaborative interactions between midwives and HEWs is important to increase the reach and impact of ANC services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening.

Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

“…For instance, HEWs are not currently permitted to practice in some areas within their scope; specifically, they are not permitted to administer clean and safe delivery despite having been trained in this area. This may be demotivating for HEWs (who, in our previous study, expressed a desire to use their training to assist with childbirth [48]) even as the training demands on HEWs are growing, as Isaac explains: I think those packages [training components] have increased gradually from before … The Health Extension Program was so successful at the initial stages of the program, that other sectors of the government started using the Health Extension Worker for other initiatives in agriculture, and for political purposes … But still we tend not to address the root causes most of the time. -Isaac This failure to address 'root causes' reflects how the HEW role has come to be seen by others working in the Ethiopian health system, and by community members themselves.…”

Contributing barriers to loss to follow up from antenatal care services in villages around Addis Ababa: a qualitative study

“…Based on this assessment, the support and linkage between facilities and the management was found to be weak, affecting the timely supply of the required essential supplies, and enhancement of knowledge and skills of service providers. A qualitative study conducted in Jimma zone of South West Ethiopia reflected that the linkage between midwives and HEWs were found to be poor because of resource limitations and poor infrastructure [ 13 ].…”

Contributing barriers to Defaulting from Antenatal Care Services in Villages Around Addis Ababa: A Qualitative Study

“…Based on this assessment, the support and linkage between facilities and the management was found to be weak, affecting the timely supply of the required essential supplies, and enhancement of knowledge and skills of service providers. A qualitative study conducted in the Jimma zone in South West of Ethiopia re ected that the linkage between midwives and HEWs were found to be poor because of resource limitations and poor infrastructure (15).…”