BackgroundDisrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery. As part of an implementation research study to improve women’s access to health care services in Rorya District, Mara, Tanzania, we conducted a pilot study training reproductive health care nurses to be more sensitive to women’s needs based on the “Health Workers for Change” curriculum.MethodsSix series of workshops were held with a total of 60 reproductive health care nurses working at the hospitals, health centres and dispensaries in the district. The participants provided comments on a survey and participated in focus groups at the conclusion of the workshop series. These qualitative data were analyzed for common themes.ResultsThe participants appreciated the training and reflected on the poor quality of health care services they were providing, recognizing their attitudes towards their women patients were problematic. They emphasized the need for future training to include more staff and to sustain positive changes. Finally, they made several suggestions for improving women’s experiences in the future.ConclusionsThe qualitative findings demonstrate the success of the workshops in assisting the health care providers to become aware of their negative attitudes towards women. Future research should examine the impact of the workshops both on sustaining attitudinal changes of the providers and on the experiences of pregnant women receiving health care services.

Community members and policy makers have similar priorities for improving maternal health, which involve both social and structural changes.

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Objectives: In order to improve maternal health and women’s access to maternity care services in Rorya District, Mara, Northern Tanzania, we introduced several interventions across the district from 2018 to 2019. The interventions were workshops with nurses to encourage respectful care of women and transportation subsidies for women to reach the health facilities for delivery. In addition, we trained community health workers to educate couples about safe birthing options using m-health applications, to collaborate with nurses to distribute clean birth kits with misoprostol and to hold village meetings to shift community norms. This article reports on the experiences of women, community health workers and nurses during the study. Methods: Focus group discussions were conducted with a convenience sample of these groups to understand the successes and challenges of the interventions. Results: The workshops with nurses to encourage respectful maternity care and the birth kits with misoprostol were appreciated by all and were an incentive for women to seek health services. While the m-health applications were innovative, the system required significant oversight and a stable network. The village meetings demonstrated some success and should be expanded. Travel subsidies were problematic to implement and only helpful to the minority who received them. Conclusion: Multiple intervention strategies are needed to help women access maternity care services in rural locations and should be designed to meet needs within the local context. In Rorya District, access to quality health care was improved through training nurses to provide respectful care and using community health workers to educate the population about safe birthing practices and to provide women with clean birth kits. Despite the current limitations of m-health, there is much potential for development. Finding solutions to women’s need for transport is a particular challenge and will likely require innovative community-based approaches.