Table 2 Example quotes illustrating how health facility and district-level in-depth interview respondents discussed the challenges of understaffing and overwork at intervention and control sites

Intervention sites

2a. “We are already understaffed at this facility.…One person cannot do it all. Sometimes you find that maybe you delay here at the facility and the women at the MWH will say 'you have ignored us.'” (Health staff, intervention)

2b. “We are understaffed but we manage. So far there has never been a time when there is no one completely to attend to the mothers.” (Health staff, intervention site)

2c. “From the time the MWH was built, we ended up feeling that the number of staff that were there [at the health facility] was not enough, so we aired it out and the district officers started giving us more staff because sometimes we are encountering challenges of attending to people.” (Health staff, intervention site)

Control sites

2d. “Though we are understaffed we have to carry out these duties. I am the only midwife who has to run the labor ward as well as the maternal child health department, but we help our other colleagues. We do manage.” (Health staff, control site)

2e. “It’s always been a challenge in terms of workload.” (Health staff, control site)

2f. “Workload comes in because you have to see the people in the MWH, you have to see people in the maternal child health department, you have to see people at the outpatient department. We can’t leave the people alone in the MWH, they came here and they are in our hands.” (Health staff, control site)

District health officers

2g. “The only bad aspect is we may need people to be full time with these mothers. Staffing is bringing a strain because if you have a mother in the ward, you are expecting to be checked and you find some facilities only have two staff to have a continuous check.” (District health staff)