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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Taylor & Francis
2020
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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. |
format | Online Article Text |
id | pubmed-7888043 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Taylor & Francis |
record_format | MEDLINE/PubMed |
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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