Table 4 Example quotes illustrating how in-depth interview respondents discussed the main benefits of maternity waiting homes on the health center staff workforce and maternal health service delivery at intervention and control sites

4a. “Those women that are in the MWH are examined regularly so complications are detected early and referred in good time.” (Health staff, intervention site)

4b. “Complications are detected early and therefore referrals are made in good time. Before we had an MWH, complications were detected late and therefore, the prognosis and the outcomes of the deliveries were not good.” (Health staff, intervention site)

4c. “We are able to recognize the complications after delivery and able to refer to the hospital in time, unlike in the past (before the MWH).” (Health staff, intervention site)

4d. “The mothers have been coming earlier than when the labor starts. They are able to come in good time. Unlike in the past, where they would come maybe 30 minutes before the delivery time.” (Health staff, intervention site)

4i. “In terms of postnatal, at least we are able to see mothers for 48 hours. Before [the MWH], we discharged after they delivered, we were just able to observe them for six hours and then discharged them due to lack of space. But now, we are able to keep them. We take them to the MWH.” (Health staff, intervention site)

4j. “If they deliver today we keep the women for two days because we have the space there in the MWH. We do the postnatal at 48 hours then we discharge them. So even if we miss them at six days, we’ll have checked them at 48 hours, seeing the mother was okay and the child was okay.” (Health staff, intervention site)

4k. “The new MWH, with a capacity of four beds for postnatal mothers, is helping us to reduce on the congestion after delivery. We always have space.” (Health staff, intervention site)

4o. “The MWH is everything to the health facility staff. It brings a lot of easiness in going about our responsibilities. On one hand, workload has increased but on the other hand you get satisfaction and ensure that your obligations are fulfilled. We are doing our best to ensure balance.” (Health staff, intervention site)

4p. “The MWH has helped us as staff in providing the best service possible because we are able to make a quick decision on a problem as early as possible. We can only help someone properly if that person comes in at the right time to the clinic.” (Health staff, intervention site)

4q. “Each time when there are mothers there [at the MWH], we are always psychologically prepared to wake up at night. Compared to the way before [the MWH] when you go to sleep, and then after 10 minutes, someone comes saying, they have brought someone in labor.” (Health staff, intervention site)

4r. “In terms of work load, the MWH has actually made work easy for us, because we are able to identify the challenge ahead.” (Health staff, intervention site)

4s. “The MWH has actually made our work a bit lighter because we are able to do the correct things at the correct times.” (Health staff, intervention site)

4e. “Our mothers will be near us as early as possible, so we will identify their problems early and then take a step. Those that we can’t handle, we’ll refer them early to the hospital.” (Health staff, control site)

4f. “It’s quite a lot of work. But then we are also looking at the wellbeing of a mother and the child. Some of them come from very far, they’ve got an opportunity to wait, and as they wait here we can also assess if they’ve got any danger signs. And even those who deliver, as least if a problem arises we are able to monitor it.” (Health staff, control site)

4l. “We can’t even see them at 48 hours because we have nowhere to keep them. After delivery, we’re supposed to keep a mother for 48 hours but we don’t have enough space. So for someone to come back from home after 48 hours, it’s not possible.” (Health staff, control site)

No themes emerged

District health officers

4g. “For cases where our staff are able to monitor the patient who is in the MWH, it gives ample time for staff to actually make a decision. If it is an issue they know they are not able to handle, they are able to call for an ambulance way in advance. They are able to refer to the hospital.” (District health staff)

4h. “The facility staff are in contact with these mothers much earlier and they examine them, and those complications are being referred much earlier. There is an improvement in that assistance is given to the mothers early.” (District health staff)

4m. “There are about four bed spaces [in the intervention MWH sites] that once she delivers, the mother can wait there and do their first postnatal visit. We are already seeing those changes and we are seeing more mothers being able to access the first postnatal visit.” (District health staff)

4n. “In the past we didn’t have the capacity to keep a mother for 48 hours. The delivery room was small, the postnatal ward was small, and even the antenatal ward was small, so we couldn’t keep a mother after delivery, we were discharging after six hours, but this time we keep mothers up to 48 hours [at intervention MWH sites].” (District health staff)

No themes emerged