Lay and healthcare providers’ experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: an Appreciative Inquiry

Abstract

ObjectivesDisrespectful care, which remains prevalent in low and middle-income countries (LMICs), acts as a barrier to women accessing skilled birth attendance, compromising care when services are available. Building on what was positive in facilities, we aimed to explore lay and healthcare providers’ experience of respectful care to inform future interventions.SettingFive maternity facilities in Mwanza Tanzania and Lilongwe Malawi.Participants94 participants in Malawi (N=46) and Tanzania (N=48) including 24 women birthing live baby within the previous 12 months; 22 family members and 48 healthcare providers who regularly provided maternity care in the included facilitiesDesignThe study was guided by Appreciative Inquiry (AI). Semistructured, one-to-one interviews were conducted between January and December 2019. Interviews were audio-recorded, translated where necessary, transcribed verbatim, and analysed using the framework approach.ResultsFour main themes describing participants positive experience and their vision of respectful care were identified: (1) empathic healthcare provider–woman interactions including friendly welcome and courteous language, well-timed appropriate care and information sharing, (2) an enabling environment, characterised by improvement of physical environment, the use of screens, curtains and wall partitions for privacy, availability of equipment and provision of incentives to staff, (3) supportive leadership demonstrated by the commitment of the government and facility leaders to provision of respectful care, ensuring availability of guidelines and policies, supportive supervision, reflective discussion and paying staff salaries timely, (4) providers’ attitudes and behaviours characterised by professional values through readiness, compassionate communication and commitment.ConclusionThe positive experiences of service users, families and healthcare providers provided insight into key drivers of respectful care in facilities in Tanzania and Malawi. Interventions targeting improved environment and privacy, healthcare provider communication and developing positive leadership structures in facilities could provide the basis for sustained improvement in respectful and dignified maternal and newborn care in LMICs.

“If I am alive, I am happy”: Defining quality of care from the perspectives of key maternal and newborn health stakeholders in Papua New Guinea

“…Allowing and encouraging companionship was a strong sub-theme highlighted by many participants, especially women and partners, and has also been found as an important aspect in defining quality of care in several qualitative studies across Nigeria, Malawi, Tanzania, and Afghanistan 20,[36][37][38] , as well as PNG. Though barriers such as maintaining women's privacy on the ward, and cultural taboo were present, our study found companions were not only emotional and physical supports for women in labour but could assist with workforce shortage issues in completing tasks like delivering food, changing sheets and assist with after birth hygiene and cleaning.…”

“…Previous research across low and middle income countries (LMICs) has found that definitions of quality of care from both women and providers of maternal and newborn health care include aspects such as timeliness of care, autonomy, adequate human and physical resources, respectful care, and privacy, and there can be similarity between stakeholder groups [20][21][22][23] .…”

“…Previous research across low and middle income countries (LMICs) has found that definitions of quality of care from both women and providers of maternal and newborn health care include aspects such as timeliness of care, autonomy, adequate human and physical resources, respectful care, and privacy, and there can be similarity between stakeholder groups 20–23 . While there can be similarities in quality of care priortities between stakeholder groups, women tend to have a greater focus on the care experience, such as positive relationships with caregivers and patient-centred care, while providers of care tend to emphasise structural elements relating to the provision of care, such as availability of resources 24, 25 .…”

Women’s preferences for antenatal care in Tanzania: a discrete choice experiment

“…The attributes and levels included in the DCE are summarised in Table 1. Based on qualitative interviews conducted as part of the broader research programme a long list of potential attributes for the DCE was generated [14,15]. The attributes on this list were: cleanliness of clinic, ease of travel (distance, availability of transport), facility comfort, waiting time to be seen, incentive to attend (e.g.…”

Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia

“…Maternity care experiences are influenced by many factors, including patients’ expectations, providers’ beliefs and biases, and a range of contextual variables related to the health system and the social environment. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 These latter contextual factors include health system management, financing, infrastructure, and policies, as well as community norms and population characteristics. Understanding these factors is key to effectively design and target respectful maternity care interventions.…”