The effects of maternity waiting homes on the health workforce and maternal health service delivery in rural Zambia: a qualitative analysis

Abstract

BackgroundMaternity waiting homes (MWHs) are a potential strategy to address low facility delivery rates resulting from access-associated barriers in resource-limited settings. Within a cluster-randomized controlled trial testing a community-generated MWH model in rural Zambia, we qualitatively assessed how MWHs affect the health workforce and maternal health service delivery at their associated rural health centers.MethodsFour rounds of in-depth interviews with district health staff (n = 21) and health center staff (n = 73) were conducted at intervention and control sites over 24 months. We conducted a content analysis using a mixed inductive-deductive approach. Data were interpreted through the lens of the World Health Organzation Health Systems Framework.ResultsNearly all respondents expressed challenges with understaffing and overwork and reported that increasing numbers of facility-based deliveries driven by MWHs contributed substantively to their workload. Women waiting at MWHs allow staff to monitor a woman’s final stage of pregnancy and labor onset, detect complications earlier, and either more confidently manage those complications at the health center or refer to higher level care. District, intervention, and control site respondents passionately discussed this benefit over all time points, describing it as outweighing challenges of additional work associated with MWHs. Intervention site staff repeatedly discussed the benefit of MWHs in providing a space for postpartum women to wait after the first few hours of clinical observation through the first 48 h after delivery. Additionally, intervention site staff perceived the ability to observe women for longer before and after delivery allowed them to better anticipate and plan their own work, adjust their workloads and mindset accordingly, and provide better and more timely care. When understaffing and overwork were frequently discussed, this satisfaction in providing better care was a meaningful departure.ConclusionsMWHs may benefit staff at rural health centers and the health system more broadly, allowing for the provision of more timely and comprehensive obstetric care. We recommend future studies consider how MWHs impact the workforce, operations, and service delivery at their associated health facilities. Considering the limited numbers of skilled birth attendants available in rural Zambia, it is important to strategically select locations for new MWHs.Trial registrationClinicaltrials.gov, NCT02620436. Registered December 3, 2015, https://clinicaltrials.gov/ct2/show/NCT02620436

Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia

“…While midwives were briefed on use of MWH registers and their continued role in referring women to MWHs, they were not provided additional training as part of the intervention. While it is unlikely that upgraded MWHs increased delivery workloads substantially as reported in other settings [ 52 ], more engagement with midwives may have improved levels of MWH user monitoring.…”

A Qualitative Exploration of Community Ownership of a Maternity Waiting Home Model in Rural Zambia

“…In previous findings, health system stakeholders had similarly described the importance of the GCMU because its presence allows health system staff to attend to their clinical duties. 32 Although the community representatives on the GCMU are the instrumental link to the community, the health facility staff is the instrumental link to the district and government-level actors. This governing body where community representatives and health facility staff formally collaborate to ensure the smooth operations of the MWH serves as a key opportunity to connect the community with the formal health system.…”

“…34 It is also worth noting that even though respondents were blind to the official outcomes, such as district-wide skilled birth attendance rates, many respondents perceived the intervention to have had positive outcomes on maternal mortality and have been beneficial to the community. 32 We hypothesize that the sense of ownership may be stronger if the intervention is perceived to have a positive impact on maternal child health outcomes because community members would want to sustain these effects and the MWH model. We had posited that the intervention would continue after the end of the external support period, in part due to the project's goal of fostering community ownership.…”

Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia

“…As reported by various studies, women reported MWHs as very important institutions to creating opportunities for and facilitating communication platforms between providers and mothers to elevate trust, build mothers' con dence, and promote bonding (23) (24) (25). Additionally, they help health workers to adjust their schedule and ensure the availability of the required supplies and drugs (26).…”