Evaluating the effects of an intervention to improve the health environment for mothers and children in health centres (BECEYA) in Mali: a qualitative study

INTRODUCTION: an intervention aiming to improve the maternal and children environment in healthcare facilities (BECEYA) was launched in three regions of Mali. This study aimed to explore the perceptions and experiences of patients and their companions, community actors, and healthcare facilities staff on the effects of the BECEYA intervention in two regions of Mali. METHODS: we conducted a qualitative study using an empirical phenomenological approach. Through purposive sampling, women who attended antenatal care in the selected healthcare centres, companions, and health facility staff members were recruited. Data were collected during January and February 2020 through semi-structured individual interviews and focus groups. According to Braun and Clarke's approach, audio recordings were transcribed verbatim, and a thematic analysis was conducted in five main steps. Donabedian conceptual framework of quality of care was used to present the perceived changes following the implementation of the BECEYA project. RESULTS: we recruited 26 participants in individual interviews (20 women attending prenatal care and maternity services, 10 per health centre, four companions, and two healthcare centre managers) and 21 healthcare centre staff members (10 in Babala, 11 in Wayerma 2) in focus groups. Themes that emerged from data analysis are perceived changes in terms of infrastructure (perceived changes in the characteristics of the healthcare facilities setting, including the infrastructure introduced by the BECEYA project), process (changes in the delivery and use of care introduced or resulting from BECEYA activities), and outcome (the direct and indirect effects of these changes on the health status of patients and the population). CONCLUSION: the study highlighted some positive effects on women users of the services, their companions, and health centre staff following the implementation of the intervention. This study contributes to showing some links between improving the environment of healthcare centres and the quality of care in developing countries.