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Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care

Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with provi...

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Autores principales: Asefa, Anteneh, McPake, Barbara, Langer, Ana, Bohren, Meghan A., Morgan, Alison
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888043/
https://www.ncbi.nlm.nih.gov/pubmed/33308051
http://dx.doi.org/10.1080/26410397.2020.1854153
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author Asefa, Anteneh
McPake, Barbara
Langer, Ana
Bohren, Meghan A.
Morgan, Alison
author_facet Asefa, Anteneh
McPake, Barbara
Langer, Ana
Bohren, Meghan A.
Morgan, Alison
author_sort Asefa, Anteneh
collection PubMed
description Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system “hardware” and “software” factors influencing the promotion of RMC were identified, and their interaction was complex. The “hardware” factors included bed availability, infrastructure and supplies, financing, and health workforce. “Software” factors encompassed service providers’ mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC.
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spelling pubmed-78880432021-03-30 Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care Asefa, Anteneh McPake, Barbara Langer, Ana Bohren, Meghan A. Morgan, Alison Sex Reprod Health Matters Research Articles Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system “hardware” and “software” factors influencing the promotion of RMC were identified, and their interaction was complex. The “hardware” factors included bed availability, infrastructure and supplies, financing, and health workforce. “Software” factors encompassed service providers’ mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC. Taylor & Francis 2020-12-14 /pmc/articles/PMC7888043/ /pubmed/33308051 http://dx.doi.org/10.1080/26410397.2020.1854153 Text en © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Asefa, Anteneh
McPake, Barbara
Langer, Ana
Bohren, Meghan A.
Morgan, Alison
Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
title Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
title_full Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
title_fullStr Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
title_full_unstemmed Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
title_short Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
title_sort imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888043/
https://www.ncbi.nlm.nih.gov/pubmed/33308051
http://dx.doi.org/10.1080/26410397.2020.1854153
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