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Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions

BACKGROUND: Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and...

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Autores principales: Bergen, Nicole, Hudani, Alzahra, Asfaw, Shifera, Mamo, Abebe, Kiros, Getachew, Kurji, Jaameeta, Morankar, Sudhakar, Abebe, Lakew, Kulkarni, Manisha A., Labonté, Ronald
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805645/
https://www.ncbi.nlm.nih.gov/pubmed/31639001
http://dx.doi.org/10.1186/s12913-019-4596-x
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author Bergen, Nicole
Hudani, Alzahra
Asfaw, Shifera
Mamo, Abebe
Kiros, Getachew
Kurji, Jaameeta
Morankar, Sudhakar
Abebe, Lakew
Kulkarni, Manisha A.
Labonté, Ronald
author_facet Bergen, Nicole
Hudani, Alzahra
Asfaw, Shifera
Mamo, Abebe
Kiros, Getachew
Kurji, Jaameeta
Morankar, Sudhakar
Abebe, Lakew
Kulkarni, Manisha A.
Labonté, Ronald
author_sort Bergen, Nicole
collection PubMed
description BACKGROUND: Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) collaborate to promote and deliver ANC to women in these communities, but little research has been conducted on the professional working relationships between these two health providers. This study aims to generate a better understanding of the strength and quality of professional interaction between these two key actors, which is instrumental in improving healthcare performance, and thereby community health outcomes. METHODS: We conducted eleven in-depth interviews with midwives from three rural districts within Jimma Zone, Ethiopia (Gomma, Kersa, and Seka Chekorsa) as a part of the larger Safe Motherhood Project. Interviews explored midwives’ perceptions of strengths and weaknesses in ANC provision, with a focus as well on their engagement with HEWs. Thematic content analysis using Atlas.ti software was used to analyse the data using an inductive approach. RESULTS: Midwives interacted with HEWs throughout three key aspects of ANC promotion and delivery: health promotion, community outreach, and provision of ANC services to women at the health centre and health posts. While HEWs had a larger role in promoting ANC services in the community, midwives functioned in a supervisory capacity and provided more clinical aspects of care. Midwives’ ability to work with HEWs was hindered by shortages in human, material and financial resources, as well as infrastructure and training deficits. Nevertheless, midwives felt that closer collaboration with HEWs was worthwhile to enhance service provision. Improved communication channels, more professional training opportunities and better-defined roles and responsibilities were identified as ways to strengthen midwives’ working relationships with HEWs. CONCLUSION: Enhancing the collaborative interactions between midwives and HEWs is important to increase the reach and impact of ANC services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening.
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spelling pubmed-68056452019-10-24 Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions Bergen, Nicole Hudani, Alzahra Asfaw, Shifera Mamo, Abebe Kiros, Getachew Kurji, Jaameeta Morankar, Sudhakar Abebe, Lakew Kulkarni, Manisha A. Labonté, Ronald BMC Health Serv Res Research Article BACKGROUND: Despite improvements in recent years, Ethiopia faces a high burden of maternal morbidity and mortality. Antenatal care (ANC) may reduce maternal morbidity and mortality through the detection of pregnancy-related complications, and increased health facility-based deliveries. Midwives and community-based Health Extension Workers (HEWs) collaborate to promote and deliver ANC to women in these communities, but little research has been conducted on the professional working relationships between these two health providers. This study aims to generate a better understanding of the strength and quality of professional interaction between these two key actors, which is instrumental in improving healthcare performance, and thereby community health outcomes. METHODS: We conducted eleven in-depth interviews with midwives from three rural districts within Jimma Zone, Ethiopia (Gomma, Kersa, and Seka Chekorsa) as a part of the larger Safe Motherhood Project. Interviews explored midwives’ perceptions of strengths and weaknesses in ANC provision, with a focus as well on their engagement with HEWs. Thematic content analysis using Atlas.ti software was used to analyse the data using an inductive approach. RESULTS: Midwives interacted with HEWs throughout three key aspects of ANC promotion and delivery: health promotion, community outreach, and provision of ANC services to women at the health centre and health posts. While HEWs had a larger role in promoting ANC services in the community, midwives functioned in a supervisory capacity and provided more clinical aspects of care. Midwives’ ability to work with HEWs was hindered by shortages in human, material and financial resources, as well as infrastructure and training deficits. Nevertheless, midwives felt that closer collaboration with HEWs was worthwhile to enhance service provision. Improved communication channels, more professional training opportunities and better-defined roles and responsibilities were identified as ways to strengthen midwives’ working relationships with HEWs. CONCLUSION: Enhancing the collaborative interactions between midwives and HEWs is important to increase the reach and impact of ANC services and improve maternal, newborn and child health outcomes more broadly. Steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening. BioMed Central 2019-10-21 /pmc/articles/PMC6805645/ /pubmed/31639001 http://dx.doi.org/10.1186/s12913-019-4596-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Bergen, Nicole
Hudani, Alzahra
Asfaw, Shifera
Mamo, Abebe
Kiros, Getachew
Kurji, Jaameeta
Morankar, Sudhakar
Abebe, Lakew
Kulkarni, Manisha A.
Labonté, Ronald
Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions
title Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions
title_full Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions
title_fullStr Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions
title_full_unstemmed Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions
title_short Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives’ perceptions
title_sort promoting and delivering antenatal care in rural jimma zone, ethiopia: a qualitative analysis of midwives’ perceptions
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805645/
https://www.ncbi.nlm.nih.gov/pubmed/31639001
http://dx.doi.org/10.1186/s12913-019-4596-x
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