Developing a community driven sustainable model of maternity waiting homes for rural Zambia

  • Midwifery, Volume 41, Year 2016

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Study Justification:
– The study aimed to explore the beliefs of Zambian stakeholders regarding the acceptability, feasibility, and sustainability of maternity waiting homes (MWHs) in rural Zambia.
– MWHs are residential dwellings near health facilities that allow pregnant women to stay and receive immediate postpartum services, overcoming distance and transportation barriers.
– The study aimed to inform the development of a community-driven sustainable model of MWHs in rural Zambia.
Study Highlights:
– Participants overwhelmingly supported MWHs as a way to improve access to facility-based childbirth and address the barrier of distance.
– Participants were able to describe features of high-quality care and the type of care they expected from MWHs.
– Stakeholders recognized the need for community involvement and contribution to the maintenance of MWHs for their sustainability.
– Access to facility childbirth remains challenging in rural Zambia, and delays in seeking care exist.
– MWHs offer a feasible and acceptable intervention to reduce delays in seeking care, potentially improving maternal outcomes.
– The study contributes to the growing literature on the acceptability, feasibility, and sustainability of MWHs.
Recommendations for Lay Reader and Policy Maker:
– Implement MWHs as a strategy to increase facility-based births with skilled birth attendants in rural, low-resource areas of Zambia.
– Ensure that any initiative, such as MWHs, addresses local deficiencies in the quality of care simultaneously.
– Promote community involvement and contribution to the maintenance of MWHs for their sustainability.
– Support initiatives that reduce distance and transportation barriers to accessing facility-based childbirth.
– Consider MWHs as a potential solution to improve maternal and neonatal morbidity and mortality rates in rural areas.
Key Role Players:
– Community leaders
– Safe Motherhood Action Groups
– Husbands
– Women of childbearing age
Cost Items for Planning Recommendations:
– Construction and maintenance of MWHs
– Training and capacity building for healthcare providers
– Community engagement and awareness campaigns
– Transportation services for pregnant women
– Monitoring and evaluation of MWH programs
– Support for quality improvement in healthcare facilities

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Background maternity waiting homes (MWHs) are residential dwellings located near health facilities where women in the late stages of pregnancy stay to await childbirth and receive immediate postpartum services. These shelters help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care. Objective the purpose of this study was to explore Zambian stakeholders’ beliefs regarding the acceptability, feasibility, and sustainability of maternity waiting homes (MWHs) to inform a model for rural Zambia. Design a qualitative design using a semi-structured interview guide for data collection was used. Setting two rural districts in the Eastern province of Zambia. Participants individual interviews were conducted with community leaders (n=46). Focus groups were held with Safe Motherhood Action Groups, husbands, and women of childbearing age in two rural districts in Zambia (n=500). Measures latent content analysis was used to analyze the data. Findings participants were overwhelmingly in support of MWHs as a way to improve access to facility-based childbirth and address the barrier of distance. Data suggest that participants can describe features of high quality care, and the type of care they expect from a MWH. Stakeholders acknowledged the need to contribute to the maintenance of the MWH, and that community involvement was crucial to MWH sustainability. Key conclusions access to facility childbirth remains particularly challenging in rural Zambia and delays in seeking care exist. Maternity waiting homes offer a feasible and acceptable intervention to reduce delays in seeking care, thereby holding the potential to improve maternal outcomes. Implications for practice this study joins a growing literature on the acceptability, feasibility, and sustainability of MWHs. It is believed that MWHs, by addressing the distance and transportation barriers, will increase the use of skilled birth attendants, thereby reducing maternal and neonatal morbidity and mortality in rural, low resource areas of Zambia. We recommend that any initiative, such as MWHs, seeking to increase facility-based births with a skilled birth attendant also concurrently addresses any local deficiencies in quality of care.

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Based on the information provided, here are some potential innovations that can be used to improve access to maternal health in rural Zambia:

1. Mobile Maternity Waiting Homes: Develop a mobile unit that can travel to different rural areas, providing temporary shelter and care for pregnant women who are awaiting childbirth. This can help overcome transportation barriers and ensure that women have access to skilled obstetric care.

2. Telemedicine and Teleconsultation: Implement telemedicine technologies to connect pregnant women in rural areas with healthcare professionals in urban areas. This can enable remote consultations, monitoring, and guidance, ensuring that women receive timely and appropriate care without the need for long-distance travel.

3. Community-Based Maternal Health Education: Establish community-led programs that educate women and their families about the importance of skilled birth attendance and the availability of maternity waiting homes. This can help increase awareness and encourage more women to seek facility-based childbirth.

4. Public-Private Partnerships: Foster collaborations between government agencies, non-profit organizations, and private sector entities to support the establishment and maintenance of maternity waiting homes. This can ensure sustainable funding, resources, and expertise to improve access to maternal health services in rural areas.

5. Transportation Support: Develop initiatives that provide transportation assistance to pregnant women in rural areas, ensuring they can easily access maternity waiting homes and healthcare facilities. This can involve partnerships with local transportation providers or the use of community-owned vehicles.

6. Strengthening Quality of Care: Alongside the implementation of maternity waiting homes, focus on improving the quality of care provided at healthcare facilities. This can involve training healthcare professionals, ensuring the availability of necessary medical equipment and supplies, and implementing quality assurance mechanisms.

These innovations aim to address the challenges of distance and transportation barriers, increase awareness and utilization of skilled birth attendance, and ensure sustainable access to maternal health services in rural Zambia.
AI Innovations Description
The recommendation to improve access to maternal health is to develop a community-driven sustainable model of maternity waiting homes (MWHs) for rural Zambia. MWHs are residential dwellings located near health facilities where women in the late stages of pregnancy can stay to await childbirth and receive immediate postpartum services. These shelters help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care.

The objective of this recommendation is to explore Zambian stakeholders’ beliefs regarding the acceptability, feasibility, and sustainability of MWHs to inform a model for rural Zambia. The study used a qualitative design, conducting individual interviews with community leaders and holding focus groups with Safe Motherhood Action Groups, husbands, and women of childbearing age in two rural districts in Zambia.

The findings of the study indicate that participants overwhelmingly support MWHs as a way to improve access to facility-based childbirth and address the barrier of distance. Participants were able to describe features of high-quality care and the type of care they expect from a MWH. Stakeholders also acknowledged the need to contribute to the maintenance of the MWH and emphasized that community involvement is crucial to its sustainability.

The key conclusion is that access to facility childbirth remains challenging in rural Zambia, and delays in seeking care exist. MWHs offer a feasible and acceptable intervention to reduce these delays, thereby potentially improving maternal outcomes. The recommendation suggests that any initiative, such as MWHs, aiming to increase facility-based births with a skilled birth attendant should also address any local deficiencies in the quality of care.

Implementing this recommendation is believed to increase the use of skilled birth attendants, thereby reducing maternal and neonatal morbidity and mortality in rural, low-resource areas of Zambia. It is important to consider the acceptability, feasibility, and sustainability of MWHs, as well as address any local quality of care issues, when developing and implementing this innovation.
AI Innovations Methodology
In order to improve access to maternal health in rural Zambia, the development of community-driven sustainable models of maternity waiting homes (MWHs) is recommended. MWHs are residential dwellings located near health facilities where pregnant women in the late stages of pregnancy can stay to await childbirth and receive immediate postpartum services. These homes help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology can be employed. Here is a brief description of a possible methodology:

1. Study Design: A mixed-methods approach can be used, combining qualitative and quantitative data collection methods.

2. Qualitative Data Collection: Conduct semi-structured interviews with key stakeholders, including community leaders, healthcare providers, and women of childbearing age. These interviews can explore their beliefs, opinions, and expectations regarding MWHs, their acceptability, feasibility, and sustainability.

3. Quantitative Data Collection: Conduct surveys or focus groups with a larger sample of participants, including Safe Motherhood Action Groups, husbands, and women of childbearing age. These surveys can gather data on the current barriers to accessing maternal health services, perceptions of MWHs, and willingness to contribute to the maintenance of MWHs.

4. Data Analysis: Analyze the qualitative data using latent content analysis to identify themes and patterns in stakeholders’ beliefs and expectations regarding MWHs. Quantitative data can be analyzed using statistical methods to determine the level of support for MWHs and the willingness of the community to contribute to their sustainability.

5. Simulation Modeling: Develop a simulation model that incorporates the findings from the qualitative and quantitative data analysis. The model can simulate the impact of implementing MWHs on improving access to maternal health by considering factors such as reduced travel time, increased utilization of skilled birth attendants, and potential reductions in maternal and neonatal morbidity and mortality.

6. Impact Assessment: Use the simulation model to assess the potential impact of MWHs on improving access to maternal health in rural Zambia. This can include estimating the number of additional facility-based births, reductions in delays in seeking care, and improvements in maternal and neonatal outcomes.

7. Recommendations: Based on the simulation results, provide recommendations for the implementation of MWHs and any additional interventions needed to address local deficiencies in the quality of care. These recommendations can inform policy and programmatic decisions to improve access to maternal health in rural, low-resource areas of Zambia.

By following this methodology, stakeholders can gain insights into the acceptability, feasibility, and sustainability of MWHs and make informed decisions to improve access to maternal health services in rural Zambia.


Statistics:
Citations: 34
Identifiers:
DOI: 10.1016/j.midw.2016.08.005
ISSN: 02666138
Research Areas:
Community Interventions, Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Workforce
Study Countries:
Zambia
Study Design:
Grounded Theory, randomised-control-trial
Study Approach:
Qualitative
Participants Gender:
Female
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