Peripartum care provision in a resource-constrained setting – a qualitative study from Guinea-Bissau

BACKGROUND: Guinea-Bissau has among the world's highest maternal-perinatal mortality. Here, the European Union financed a national health system strengthening initiative to improve access to quality peripartum care from 2013-21. Thereafter, the initiative was supported by the World Bank. We conducted a situational analysis to explore factors shaping the provision of timely and quality peripartum care amid this transition in rural Guinea-Bissau. METHODS: We conducted in-depth interviews with eight peripartum care providers in four rural regions, and participant observations (192 hours) at the regional hospital and a health center in one region in 2021-22. Interviews and observation notes were analyzed using thematic network analysis aided by theories of social practice and the WHO framework for quality maternal and newborn health care. RESULTS: Peripartum services were provided under severely resource-constrained conditions. Care providers especially experienced a lack of materials (e.g., essential drugs, consumables, appropriate equipment), space and staffing, and commonly voiced feeling overburdened. Material constraints were explained by discontinued donor supplies. To navigate this context, providers used several tactics, including: delegating monitoring and support tasks to birth companions; prescriptions of materials for purchase; omitting tests; and using materials thrifty, e.g., by shifting tasks requiring gloves to the staff member wearing them or rationing disinfectants. These tactics had several consequences: diffusion of health worker responsibilities; financial barriers to care; delays; unsanitary conditions; and compromised occupational and patient safety. CONCLUSIONS: With provision of quality peripartum care being highly dependent on external support amid scarce domestic resources, support disruptions led to severely compromised care. This highlights the need to strengthen donor-coordination warranting continuity and quality of essential health services. KEY MESSAGES: • Disruptions in donor support led to severely compromised peripartum care in rural Guinea-Bissau. • This underscores the need for strengthened donor-coordination warranting continuity of service quality.