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

Mdoe, Paschal Francis, Mills, Tracey ORCID: https://orcid.org/0000-0002-2183-7999, Chasweka, Robert, Nsemwa, Livuka, Petross, Chisomo, Laisser, Rose, Chimwaza, Angela and Lavender, Tina (2021) 'Lay and healthcare providers’ experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: An Appreciative Inquiry'. BMJ Open, Vol 11, Issue 9, e046248.

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Abstract

Objectives Disrespectful 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.

Setting Five maternity facilities in Mwanza Tanzania and Lilongwe Malawi.

Participants 94 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 facilities

Design The 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.

Results Four 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.

Conclusion The 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.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care WQ Obstetrics > Pregnancy > WQ 200 General works WS Pediatrics > By Age Groups > WS 420 Newborn infants. Neonatology
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjopen-2020-046248
Depositing User:	Rachel Dominguez
Date Deposited:	08 Oct 2021 09:25
Last Modified:	08 Oct 2021 09:25
URI:	https://archive.lstmed.ac.uk/id/eprint/18942

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