Understanding the implementation of maternity waiting homes in low- and middle-income countries: A qualitative thematic synthesis

  • BMC Pregnancy and Childbirth, Volume 17, No. 1, Year 2017

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Study Justification:
– Maternity waiting homes (MWHs) are accommodations near health facilities that provide essential childbirth care or care for complications.
– This study aims to understand the factors related to the implementation of MWHs in low- and middle-income countries.
– MWHs have been implemented for over four decades, but different operational models exist.
– By exploring the perceptions of stakeholders and barriers and facilitators for implementation, this study provides valuable insights for improving MWH implementation.
Study Highlights:
– Key problems of MWH implementation include challenges in maintenance and utilization by pregnant women.
– Poor utilization is due to lack of knowledge and acceptance of MWHs, long distances to reach MWHs, and culturally inappropriate care.
– Poor MWH structures, such as inadequate toilets and kitchens, and lack of space for family and companions, are identified as major barriers.
– Facilitators include reduced or no costs associated with using MWHs, community involvement in design and upkeep, awareness-raising activities, and culturally-appropriate practices.
– MWHs should be designed using a health systems perspective, considering women and community perspectives, MWH structure quality, and care provided at health facilities.
Recommendations for Lay Reader and Policy Maker:
– MWHs should not be isolated interventions but should be integrated into the health system.
– Consider women’s accommodation, social and dietary needs when designing MWHs.
– Ensure low direct and indirect costs associated with using MWHs.
– Implement MWHs within a functioning health system.
– Improve and harmonize documentation of implementation experiences for better understanding of successful implementation factors.
Key Role Players:
– Pregnant women and communities
– Health care providers
– Ministry of Health
– Community stakeholders
Cost Items for Planning Recommendations:
– Design and construction of MWHs
– Maintenance and upkeep of MWHs
– Awareness-raising activities
– Training and capacity building for health care providers
– Integration of culturally-appropriate practices
– Monitoring and evaluation of MWH implementation
Please note that the cost items provided are for planning purposes and not actual costs.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it is based on a qualitative thematic analysis of 29 studies across 17 countries. The study used the Supporting the Use of Research Evidence framework (SURE) to guide the analysis and explored the perceptions of various stakeholders and barriers and facilitators for implementation. The abstract provides clear findings on key problems and facilitators of MWH implementation. However, to improve the evidence, the abstract could include more specific details about the methodology used in the qualitative thematic analysis, such as the criteria for selecting the 29 studies and the process of data extraction. Additionally, it would be helpful to include information on the limitations of the study and suggestions for future research.

Background: Maternity waiting homes (MWHs) are accommodations located near a health facility where women can stay towards the end of pregnancy and/or after birth to enable timely access to essential childbirth care or care for complications. Although MWHs have been implemented for over four decades, different operational models exist. This secondary thematic +analysis explores factors related to their implementation. Methods: A qualitative thematic analysis was conducted using 29 studies across 17 countries. The papers were identified through an existing Cochrane review and a mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and barriers and facilitators for implementation. The influence of contextual factors, the design of the MWHs, and the conditions under which they operated were examined. Results: Key problems of MWH implementation included challenges in MWH maintenance and utilization by pregnant women. Poor utilization was due to lack of knowledge and acceptance of the MWH among women and communities, long distances to reach the MWH, and culturally inappropriate care. Poor MWH structures were identified by almost all studies as a major barrier, and included poor toilets and kitchens, and a lack of space for family and companions. Facilitators included reduced or removal of costs associated with using a MWH, community involvement in the design and upkeep of the MWHs, activities to raise awareness and acceptance among family and community members, and integrating culturally-appropriate practices into the provision of maternal and newborn care at the MWHs and the health facilities to which they are linked. Conclusion: MWHs should not be designed as an isolated intervention but using a health systems perspective, taking account of women and community perspectives, the quality of the MWH structure and the care provided at the health facility. Careful tailoring of the MWH to women’s accommodation, social and dietary needs; low direct and indirect costs; and a functioning health system are key considerations when implementing MWH. Improved and harmonized documentation of implementation experiences would provide a better understanding of the factors that impact on successful implementation.

This article is a secondary thematic analysis of studies identified in a systematic review of MWHs commissioned by WHO whose findings are summarized in the above-mentioned guidelines: [4] four existing systematic reviews [3, 18–20] and a systematic mapping of maternal health literature published from 2000 to 2012 were identified [21]. For this paper we included 29 studies identified through the above systematic reviews: 14 of these were included in the WHO-commissioned review and an additional 15 papers which were not included in the WHO-commissioned evidence review but included here as they described the implementation of MWHs, through qualitative or quantitative studies. The characteristics of the 29 studies included in this analysis are listed in Table ​Table11. General characteristics of included studies 1 Year of study or report; 2 Catchment population reportedly covered by MWH and number of MWH included in article; 3 Health indices reported as background levels in the article only, pertinent to locality, population of interest and time period where available. Health indices as a result of the MWH intervention not included Abbreviations: MMR = maternal mortality ratio/100000, PMR = perinatal mortality/1000, SBA = skilled birth attendance, IDR = institutional delivery rate, HB = home births, ANC = antenatal care, PHC = primary health centres, TBA = traditional birth attendants, MOH = ministry of health nr = not reported We used the Supporting the Use of Research Evidence framework (SURE) framework [22] to identify different contextual and health system factors that affect implementation of MWHs and conducted data extraction on the key themes (See Table ​Table2).2). The relevant information extracted on perspectives of women who used MWHs, community stakeholders, health care providers and other stakeholders; health service delivery factors; and social and political factors is presented in Table ​Table33 and summarized below. Guide for extracting data and emergent themes Barriers and enablers to implementation of MWHs analysed using the SURE framework Articles that are highlighted in bold are those that were included in the systematic review of effectiveness of MWHs

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The article titled “Understanding the implementation of maternity waiting homes in low- and middle-income countries: A qualitative thematic synthesis” provides insights into the implementation of maternity waiting homes (MWHs) and explores factors related to their implementation. The article highlights several innovations and recommendations for improving access to maternal health through MWHs. These include:

1. Raising awareness and acceptance: Efforts should be made to involve the community in the design and upkeep of MWHs and to educate and inform family and community members about the benefits of MWHs.

2. Improving MWH structures: Poorly maintained MWHs with inadequate facilities can deter women from utilizing them. It is important to ensure that MWHs are well-equipped and meet the accommodation, social, and dietary needs of pregnant women.

3. Reducing or removing costs: Financial barriers can prevent women from accessing MWHs. Efforts should be made to make MWHs affordable or free of charge.

4. Integration into the health system: MWHs should be integrated into the existing health system and linked to health facilities to ensure culturally-appropriate care at both the MWHs and the health facilities.

5. Documentation and sharing of implementation experiences: It is recommended to document and share implementation experiences to gain a better understanding of the factors that impact successful implementation and to inform future efforts to improve access to maternal health through MWHs.

The article provides further details and insights on these recommendations and can serve as a valuable resource for those interested in improving access to maternal health through MWHs.
AI Innovations Description
The recommendation to improve access to maternal health is to implement and improve maternity waiting homes (MWHs). MWHs are accommodations located near a health facility where pregnant women can stay towards the end of pregnancy and/or after birth. This allows for timely access to essential childbirth care or care for complications.

To effectively implement MWHs, several factors need to be considered. First, there should be efforts to raise awareness and acceptance of MWHs among women and communities. This can be achieved through community involvement in the design and upkeep of the MWHs, as well as activities to educate and inform family and community members about the benefits of MWHs.

Second, the design and quality of MWH structures should be improved. Poorly maintained MWHs with inadequate facilities such as toilets, kitchens, and space for family and companions can deter women from utilizing them. Therefore, it is important to ensure that MWHs are well-equipped and meet the accommodation, social, and dietary needs of pregnant women.

Third, the cost associated with using MWHs should be reduced or removed. Financial barriers can prevent women from accessing MWHs, so efforts should be made to make them affordable or free of charge.

Lastly, MWHs should be integrated into the existing health system and linked to health facilities. This ensures that women receive culturally-appropriate care at both the MWHs and the health facilities. A functioning health system is crucial for the successful implementation of MWHs.

It is also recommended to document and share implementation experiences to gain a better understanding of the factors that impact successful implementation. This can help inform future efforts to improve access to maternal health through MWHs.

The article titled “Understanding the implementation of maternity waiting homes in low- and middle-income countries: A qualitative thematic synthesis” provides further details and insights on the implementation of MWHs and can serve as a valuable resource for those interested in improving access to maternal health.
AI Innovations Methodology
To simulate the impact of the main recommendations mentioned in the abstract on improving access to maternal health, a mixed-methods approach could be used. Here is a brief description of the methodology:

1. Quantitative Analysis:
– Conduct a survey or interviews with pregnant women and community members to assess their awareness and acceptance of maternity waiting homes (MWHs).
– Measure the distance between health facilities and potential MWH locations to determine the accessibility factor.
– Analyze the cost associated with using MWHs and assess the financial barriers that pregnant women may face.
– Evaluate the utilization rates of MWHs before and after implementing awareness and acceptance activities, as well as reducing or removing costs.

2. Qualitative Analysis:
– Conduct focus group discussions or interviews with pregnant women, community members, and healthcare providers to explore their perceptions and experiences related to MWHs.
– Identify barriers and facilitators for MWH implementation, such as lack of knowledge, culturally inappropriate care, and poor MWH structures.
– Explore the impact of community involvement in the design and upkeep of MWHs on their utilization.
– Assess the integration of culturally-appropriate practices into the provision of maternal and newborn care at MWHs and linked health facilities.

3. Integration and Analysis:
– Combine the quantitative and qualitative data to gain a comprehensive understanding of the impact of the recommendations on improving access to maternal health.
– Identify common themes and patterns that emerge from the data.
– Analyze the data to determine the effectiveness of raising awareness, improving MWH structures, reducing costs, and integrating MWHs into the existing health system.
– Compare the findings with the existing literature and guidelines to validate the results.

By using this methodology, researchers can assess the impact of the recommendations on improving access to maternal health through MWHs. The findings can inform future efforts to implement and improve MWHs in low- and middle-income countries.


Statistics:
Citations: 37
Identifiers:
DOI: 10.1186/s12884-017-1444-z
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Design:
Cross Sectional Study, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative, Systematic Review
Participants Gender:
Female
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