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Table 3 Example quotes illustrating how in-depth interview respondents perceived the primary responsibilities of rural health center staff toward maternity waiting homes in intervention and control sites

From: The effects of maternity waiting homes on the health workforce and maternal health service delivery in rural Zambia: a qualitative analysis

 

Primary responsibilities of health center staff toward the MWH

(1) Monitor waiting women

(2) Attend deliveries

(3) Educate waiting women

(4) Clean and manage MWH

Health center staff respondents

Intervention sites

3a. “I think there is close monitoring of the mothers before they deliver. Mothers are being palpated twice in a week to detect if maybe there is a complication, which is then attended to in due time before anything happens.” (Health staff, intervention site)

3b. “All those women that are in the MWH are reviewed regularly and examined regularly to detect if there’s any problem with the women.” (Health staff, intervention site)

3f. “We have seen an increase in deliveries. Last month the MWH was very full, we had a lot of deliveries. Most of them were coming from the MWH to deliver.” (Health staff, intervention site)

3g. “People will come here two weeks or even a month before the expected date of delivery. So as a result, we don’t have home deliveries but health facility deliveries, and the numbers are increasing.” (Health staff, intervention site)

3h. To even double that number [of facility deliveries] to have just one midwife working was a challenge, because the midwife will be called every night and still need to work during the day.” (Health staff, intervention site)

3l. “When you look at the MWH, it is part of us as a facility, but we always find time to go and give health education to the mothers there.” (Health staff, intervention site)

3n. “We’re receiving a lot of mothers and then we have to make sure they’re well-kept and they are safe. It is our duty to see that everything is in order.” (Health staff, intervention site)

3o. “The health facility staff are responsible to ensure that the mothers who are at the MWH are safe and there are no conflicts. In the event where conflicts are reported, as a center, we have the responsibility to ensure that we resolve the conflicts amicably.” (Health staff, intervention site)

 Control sites

3c. “Although there’s a lot of work overload, it’s very important that at least we monitor, we observe our mothers and the babies. It’s about their wellbeing.” (Health staff, control site)

3d. “It is good to have mothers waiting at the facility. We do check vitals twice a day. If we come across any problem then we refer there and then, unlike if they are at home, then it’s difficult.” (Health staff, control site)

3i. “It is a lot of pressure for the staff now because a lot of people are delivering at the facility, so the midwife tends to be overwhelmed.” (Health staff, control site)

3j. “The impact is that we have more women to deliver here hence there is a lot of work to do when the staffing still remains the same.” (Health staff, control site)

3m. “We also give health education on various topics like signs of labor, family planning, postnatal...Even for mothers who have delivered, we give health education on personal hygiene, family planning, the importance of breastfeeding and coming back for PNC.” (Health staff, control site)

3p. “In fact, we are the ones taking care of the structure. We make sure it is in good shape, it is well maintained. In terms of cleanliness, we need to make sure the surroundings are clean.” (Health staff, control site)

3q. “Some of our staff that clean the health facility, we do actually oblige them to also clean the MWH. Even sweeping around the place, it is done by staff.” (Health staff, control site)

District health staff respondents

 District health officers

3e. “We need to make sure that those mothers that make it to the MWH get the best attention - on a daily basis in terms of health facility staff checking on their baby, checking for danger signs, examining them.” (District health staff)

3k. “The positive impact is that a lot of women are now delivering at the health institution, but the challenge now is on the staff, because you find that the staff are overwhelmed. There is a lack of trained midwives at the facilities.” (District health staff )

No themes emerged

3r. “The role of the health center in-charge in terms of overall management of the MWHs is mitigated by the presence of those independent structures [community-derived committees], which are all linked to the general management of the health center, at least they are able to supervise and also to make sure some organizational arrangement is assured in the MWH.” (District health staff)