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Telfer M, Zaslow R, Nalugo Mbalinda S, Blatt R, Kim D, Kennedy HP. A case study analysis of a successful birth center in northern Uganda. Birth 2024. [PMID: 38923627 DOI: 10.1111/birt.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Mothers and infants continue to die at alarming rates throughout the Global South. Evidence suggests that high-quality midwifery care significantly reduces preventable maternal and neonatal morbidity and mortality. This paper uses a case study approach to describe the social and institutional model at one birth center in Northern Uganda where, in over 20,000 births, there have been no maternal deaths and the neonatal mortality rate is 11/1000-a rate that is lower than many high-resource countries. METHODS This case study combined institutional ethnographic and narrative methods to explore key maternal and neonatal outcomes. The sample included birthing people who intended to or had given birth at the center, as well as the midwives, staff, stakeholders, and community health workers affiliated with the center. Data were collected through individual and small group interviews, participant observation, field notes, data and document reviews. Iterative and systematic analytical steps were followed, and all data were organized and managed with Atlas.ti software. RESULTS Findings describe the setting, an overview of the birth center's history, how it is situated within the community, its staffing, administration, clinical outcomes, and model of care. A synthesis of contextual variables and key outcomes as they relate to the components of the evidence-informed Quality Maternal and Newborn Care (QMNC) framework are presented. Three overarching themes were identified: (a) community knowledge and understanding, (b) community integrated care, and (c) quality care that is respectful, accessible, and available. CONCLUSIONS This birth center is an example of care that embodies the findings and anticipated outcomes described in the QMNC framework. Replication of this model in other childbearing settings may help alleviate unnecessary perinatal morbidity and mortality.
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Affiliation(s)
| | - Rachel Zaslow
- Mother Health International & Yale School of Nursing, Gulu & West Haven, Uganda
| | | | | | - Diane Kim
- Bronx Lebanon Hospital, The Bronx, New York, USA
| | - Holly Powell Kennedy
- Varney Professor of Midwifery Emeritus, Yale School of Nursing, West Haven, Connecticut, USA
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Esan OT, Maswime S, Blaauw D. Organisational and individual readiness for change to respectful maternity care practice and associated factors in Ibadan, Nigeria: a cross-sectional survey. BMJ Open 2022; 12:e065517. [PMID: 36414287 PMCID: PMC9685001 DOI: 10.1136/bmjopen-2022-065517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study assessed health providers' organisational and individual readiness for change to respectful maternity care (RMC) practice and their associated factors in Ibadan Metropolis, Nigeria. DESIGN A cross-sectional survey using standardised structured instruments adapted from the literature. SETTING Nine public health facilities in Ibadan Metropolis, Nigeria, 1 December 2019-31 May 2020. PARTICIPANTS 212 health providers selected via a two-stage cluster sampling. OUTCOMES Organisational readiness for change to RMC (ORCRMC) and individual readiness for change to RMC (IRCRMC) scales had a maximum score of 5. Multiple linear regression was used to identify factors influencing IRCRMC and ORCRMC. We evaluated previously identified predictors of readiness for change (change valence, informational assessments on resource adequacy, core self-evaluation and job satisfaction) and proposed others (workplace characteristics, awareness of mistreatment during childbirth, perceptions of women's rights and resource availability to implement RMC). Data were adjusted for clustering and analysed using Stata V.15. RESULTS The providers' mean age was 44.0±9.9 years with 15.4±9.9 years of work experience. They scored high on awareness of women's mistreatment (3.9±0.5) and women's perceived rights during childbirth (3.9±0.5). They had high ORCRMC (4.1±0.9) and IRCRMC (4.2±0.6), both weakly but positively correlated (r=0.407, 95% CI: 0.288 to 0.514, p<0.001). Providers also had high change valence (4.5±0.8) but lower perceptions of resource availability (2.7±0.7) and adequacy for implementation (3.3±0.7). Higher provider change valence and informational assessments were associated with significantly increased IRCRMC (β=0.40, 95% CI: 0.11 to 0.70, p=0.015 and β=0.07, 95% CI: 0.01 to 0.13, p=0.032, respectively), and also with significantly increased ORCRMC (β=0.47, 95% CI: 0.21 to 0.74, p=0.004 and β=0.43, 95% CI: 0.22 to 0.63, p=0.002, respectively). Longer years of work experience (β=0.08, 95% CI: 0.01 to 0.2, p=0.024), providers' monthly income (β=0.08, 95% CI: 0.02 to 0.15, p=0.021) and the health facility of practice were associated with significantly increased ORCRMC. CONCLUSION The health providers studied valued a change to RMC and believed that both they and their facilities were ready for the change to RMC practice.
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Affiliation(s)
- Oluwaseun Taiwo Esan
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Gresh A, Abrams ET, Chirwa E, Jere DL, Chodzaza E, Chorwe-Sungani G, Kafulafula U, Kapito E, Patel DR, Jeremiah RD, Klima CS, MacDonald A, Norr KF, Patil CL. Experiential Training Workshops for Group Antenatal Care in Malawi. J Midwifery Womens Health 2022; 67:759-769. [PMID: 36433698 PMCID: PMC10239291 DOI: 10.1111/jmwh.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
The positive effects of the CenteringPregnancy group antenatal care (ANC) model on perinatal outcomes in the United States has led to its adaptation and implementation in many low- and middle-income countries. Facilitative discussions are a core component of this group ANC model. Facilitator training lays a critical foundation for delivery of this paradigm-shifting model as practitioners learn to adapt their approach to health education from didactive to facilitative. However, there is little rigorous research focused on best practices for training group health care facilitators and none that is guided by a theoretical framework. Kolb's experiential learning theory offers a theoretical framework to guide the development of training workshops that allow trainees to experience, reflect on, and practice the facilitation skills needed to deliver this evidence-based intervention. This article describes an experiential learning-based training workshop that was implemented as part of an ongoing effectiveness-implementation trial of a Centering-based group ANC model in Blantyre District, Malawi. We provide a blueprint for conducting group ANC facilitator trainings that, in addition to imparting knowledge, effectively builds confidence and buy-in to this paradigm-changing approach to ANC delivery. This blueprint can be adapted for use in designing and implementing group health care across settings in the United States and globally.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Elizabeth T Abrams
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Ellen Chirwa
- Department of Midwifery, School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Diana L Jere
- School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Chodzaza
- Department of Midwifery, School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Genesis Chorwe-Sungani
- Institute of Postgraduate Studies and Research, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ursula Kafulafula
- School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Esnath Kapito
- School of Maternal, Neonatal and Reproductive Health Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Dhruvi R Patel
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Rohan D Jeremiah
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Carrie S Klima
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Amy MacDonald
- Group Care Programs, Pomelo Care, Hillsborough, North Carolina
- Group Care Global, Philadelphia, Pennsylvania
| | - Kathleen F Norr
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
| | - Crystal L Patil
- Department of Human Development Nursing Science, University of Illinois Chicago, College of Nursing, Chicago, Illinois
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Hagaman A, Rodriguez HG, Barrington C, Singh K, Estifanos AS, Keraga DW, Alemayehu AK, Abate M, Bitewulign B, Barker P, Magge H. "Even though they insult us, the delivery they give us is the greatest thing": a qualitative study contextualizing women's experiences with facility-based maternal health care in Ethiopia. BMC Pregnancy Childbirth 2022; 22:31. [PMID: 35031022 PMCID: PMC8759250 DOI: 10.1186/s12884-022-04381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Globally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women's experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women's care experience and what women mean by satisfaction in two Ethiopian regions. METHODS Health center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women's experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction. RESULTS Maternal and newborn survival and safety were central to women's descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as 'satisfactory'. The texture behind this 'satisfaction', however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider's interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility's amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women's experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women's overall satisfaction, even in the context of poor-quality facilities and limited resources. CONCLUSION Our findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women's satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women's care experience.
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Affiliation(s)
- Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
- Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, USA.
| | - Humberto Gonzalez Rodriguez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
| | - Kavita Singh
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
| | - Dorka Woldesenbet Keraga
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
| | | | - Mehiret Abate
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | | | - Pierre Barker
- Institute for Healthcare Improvement, Boston, MA, USA
| | - Hema Magge
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
- Bill & Melinda Gates Foundation, Seattle, USA
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Moller AB, Welsh J, Ayebare E, Chipeta E, Gross MM, Houngbo G, Hounkpatin H, Kandeya B, Mwilike B, Nalwadda G, Petzold M, Sognonvi A, Hanson C. Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries-Benin, Malawi, Tanzania, and Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000605. [PMID: 36962507 PMCID: PMC10021168 DOI: 10.1371/journal.pgph.0000605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
This research sought to map midwifery pre-service training curricula as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity in sub-Saharan Africa (ALERT) project conducted in Benin, Malawi, Tanzania, and Uganda. We conducted the review in two phases. In the first phase, online interviews were performed with the lead project midwives in all four study countries to get an overview of midwifery care providers' pre-service training courses, registration, and licensing requirements. We performed a mapping review of midwifery care providers' pre-service training curricula from different training institutions in the four study countries during the second phase. Curricula were reviewed and mapped against the International Confederation of Midwives (ICM) Essential Competencies framework to assess whether these curricula included the minimum essential training components described in the ICM framework. We identified 10 different professional titles for midwifery care providers. The number of years spent in pre-service training varied from one and a half to four years. Ten pre-service curricula were obtained and the assessment revealed that none of the curricula included all ICM competencies. Main gaps identified in all curricula related to women-centred care, inclusion of women in decision making, provision of care to women with unintended or mistimed pregnancy, fundamental human rights of individuals and evidence-based learning. This review suggests that there are skills, knowledge and behaviour gaps in pre-service training curricula for midwifery care providers when mapped to the ICM Essential Competencies framework. These gaps are similar among the different training courses in participating countries. The review also draws attention to the plethora of professional titles and different pre-service training curricula within countries. Trial registration: PACTR202006793783148-June 17th, 2020.
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Affiliation(s)
- Ann-Beth Moller
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joanne Welsh
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | | | - Effie Chipeta
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Gisele Houngbo
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Hashim Hounkpatin
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Bianca Kandeya
- Kamuzu University of Health Sciences, Centre for Reproductive Health, Blantyre, Malawi
| | - Beatrice Mwilike
- School of Nursing, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Antoinette Sognonvi
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Claudia Hanson
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Patterson PB, Mumtaz Z, Chirwa E, Mambulasa J, Kachale F, Nyagero J. Culture's Place in Quality of Care in a Resource-Constrained Health System: Comparison Between Three Malawi Districts. QUALITATIVE HEALTH RESEARCH 2021; 31:2528-2541. [PMID: 34581657 PMCID: PMC9207986 DOI: 10.1177/10497323211037636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Public health scholars describe "culture of quality" in terms of desired values, attitudes, and practices, but this literature rarely includes explicitly stated theories of culture formation. In this article, we apply Fredrik Barth's transactional model to demonstrate how taking a theory-centered approach can help to identify what would be necessary to foster "cultures of quality" outlined in the public health literature. We draw on data from a study of the Republic of Malawi's Performance and Quality Improvement for Reproductive Health initiative. These data were generated in 2017-2018 through a 6-month organizational ethnography in three facilities selected to represent a range of districts with differing social and economic contexts. Our analysis revealed facility-level organizational cultures in which staff valued providing care, but responded to structural constraints by normalizing divergence from quality-of-care protocols. These findings indicate that sustaining a quality-oriented organizational culture requires addressing underlying conditions that generate routine experiences and practices.
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Affiliation(s)
| | - Zubia Mumtaz
- University of Alberta, Edmonton, Alberta, Canada
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Vestering A, de Kok BC, Browne JL, Adu-Bonsaffoh K. Navigating with logics: Care for women with hypertensive disorders of pregnancy in a tertiary hospital in Ghana. Soc Sci Med 2021; 289:114402. [PMID: 34600357 DOI: 10.1016/j.socscimed.2021.114402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
This paper explores how care for women with hypertensive disorders of pregnancy (HDP) is practiced in a tertiary hospital in Ghana. Partly in response to the persistently high maternal and neonatal mortality rates in Low- and Middle-income countries, efforts to improve quality of maternity care have increased. Quality improvement initiatives are shaped by the underlying conceptualisation of quality of care, often driven by global (WHO) standards and protocols. However, there are tensions between global standards of care and local clients' and providers' understandings of care practices and quality of care. Implementation of standards is further complicated by structural and organisational restrictions that influence providers' possibilities and priorities. Based on ethnographic fieldwork, we explore how clinical guidelines and professionals' and patients' perspectives converge and, more importantly, diverge. We illuminate local, situated care practices and show how professionals creatively deal with tensions that arise on the ground. In this middle-income setting, caring for women with HDP involves tinkering and navigating in contexts of uncertainty, scarcity, varying responsibilities and conflicting interests. We unravelled a complex web of, at times, contradictory logics, from which various forms of care arise and in which different notions of good care co-exist. While practitioners navigated through and with these varying logics of care, the logic of survival permeated all practices. This study provides important initial insights into how professionals might implement and innovatively adapt the latest quality of maternity care guidelines which seek to marry clinical standards and patients' needs, preferences and experiences.
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Affiliation(s)
| | | | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Kwame Adu-Bonsaffoh
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Epistemic injustice in academic global health. LANCET GLOBAL HEALTH 2021; 9:e1465-e1470. [PMID: 34384536 DOI: 10.1016/s2214-109x(21)00301-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022]
Abstract
This Viewpoint calls attention to the pervasive wrongs related to knowledge production, use, and circulation in global health, many of which are taken for granted. We argue that common practices in academic global health (eg, authorship practices, research partnerships, academic writing, editorial practices, sensemaking practices, and the choice of audience or research framing, questions, and methods) are peppered with epistemic wrongs that lead to or exacerbate epistemic injustice. We describe two forms of epistemic wrongs, credibility deficit and interpretive marginalisation, which stem from structural exclusion of marginalised producers and recipients of knowledge. We then illustrate these forms of epistemic wrongs using examples of common practices in academic global health, and show how these wrongs are linked to the pose (or positionality) and the gaze (or audience) of producers of knowledge. The epistemic injustice framework shown in this Viewpoint can help to surface, detect, communicate, make sense of, avoid, and potentially undo unfair knowledge practices in global health that are inflicted upon people in their capacity as knowers, and as producers and recipients of knowledge, owing to structural prejudices in the processes involved in knowledge production, use, and circulation in global health.
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