scholarly journals What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda

2018 ◽  
Vol 23 (1) ◽  
pp. 46-59 ◽  
Author(s):  
Louise Ackers ◽  
Hannah Webster ◽  
Richard Mugahi ◽  
Rachel Namiiro
Keyword(s):  
Public Health ◽  
Low Income ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Health Facilities ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Private Care ◽  
Willingness To Disclose ◽  
Respectful Care

Purpose The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.

Exploration of Mothers’ Expectations of Care during Childbirth in Public Health Facilities in Kumasi, Ghana

2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Veronica Dzomeku ◽  
Brian Van Wyk ◽  
Lucia Knight ◽  
Jody R. Lori
Keyword(s):  
Public Health ◽  
Clinical Care ◽  
Health Facilities ◽  
Individual Interviews ◽  
Midwifery Education ◽  
Health Centres ◽  
Adequate Communication ◽  
Safe Care ◽  
Respectful Care ◽  
Childbirth Care

It is well established that clients’ past healthcare experiences influence their further use of that particular service, as well as their recommendations of that service. This also applies to the use of facility-based childbirth services which contribute to reducing maternal and infant mortality rates. This paper explores what mothers’ want from care in public health centres during childbirth. Knowing mothers’ expectations will contribute to improving their future childbirth care experiences. In this explorative qualitative study, 56 women were recruited from four public health centres. In-depth individual interviews were digitally recorded and transcribed in full, and subjected to content analysis. Themes emerged, revealing participants’ desire for both “respectful care” and “safe care”. From our findings, we posit that respectful care should be characterised by adequate communication between the healthcare provider and patient, and involvement of the patient in care decisions. Participants expected safe care, which results from health facilities with adequate resources. Health services generally concentrate on clinical care which aligns with mothers’ expectations of respectful and safe care. However, soft skills need much attention in nursing and midwifery education. There is also a need to orient midwives to a patient-centred approach to care that meets mothers’ expectations for childbirth care.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Do institutions matter?

2019 ◽  
Vol 13 (3) ◽  
pp. 319-332
Author(s):  
Habiba Ibrahim
Keyword(s):  
Social Networks ◽  
Low Income ◽  
Qualitative Interviews ◽  
Community Support ◽  
Institutional Perspective ◽  
Content Type ◽  
Credit Line ◽  
Institutional Determinants ◽  
The Usa ◽  
Nationally Representative

Purpose Guided by the institutional theory of savings, the purpose of this study is to assess the institutional elements of rotating, savings and credit associations (ROSCAs) that enable participants to save. Design/methodology/approach The study used data from in-depth qualitative interviews (N = 10) conducted among the ROSCA group leaders from African immigrant communities in the USA. Findings The primary goal for joining the ROSCA group among participants is to achieve economic stability. The results of the study postulate that, through institutional mechanisms and social networks, ROSCAs create an environment for families to save and invest. The emphasis on the concept of “you cannot save alone” underscores the importance of supportive structures to enable low-income households to save. Although “alternative savings programs” such as ROSCAs are imagined as something that less well-to-do persons use, the findings from this study demonstrate that such strategies also appeal to some people with higher socioeconomic status. This appeal and utility speaks to the importance of ROSCAs as an institutional response, rather than just an informal arrangement among persons known to each other. Research limitations/implications It is prudent to bear in mind that the study sample is not nationally representative, and therefore, the results presented cannot be generalized to immigrants across the country. However, as one of the few ROSCA studies in the USA, the findings from this study make generous contributions to the immigrants’ savings and ROSCA practices literature. Practical implications ROSCAs could be used as a bridge to the formal financial institutions. Non-profit agencies working with these communities could work with these groups to report ROSCA payments to the major credit bureaus, to help them build a credit line in their new country. Originality/value Previous studies of ROSCAs have assessed ROSCAs as community support systems and social networks. The current study has analyzed ROSCAs from an institutional perspective by examining the institutional characteristics of ROSCAs comparable to the institutional determinants of savings that enable savings among the participants.

Managing liminality: professional care during organizational change

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Eileen Mary Willis ◽  
Deidre D. Morgan ◽  
Kate Sweet
Keyword(s):  
Lived Experience ◽  
Health Professionals ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Occupational Therapists ◽  
Theoretical Construct ◽  
Content Type ◽  
Provide Quality Care ◽  
Dying At Home ◽  
Ritual Process

PurposeThe purpose of this study is to examine the way in which the theoretical construct of liminality contributes to understanding the process of dying of cancer from the perspective of patients, carers and professionals in a state-run organization undergoing privatization.Design/methodology/approachQualitative interviews were held with 13 patients and their carers and two focus groups with eight physiotherapists and occupational therapists. Data were analysed from the perspective of liminality for all three actors: patients, carers and health professionals.FindingsThe theoretical construct of liminality was useful for understanding the lived experience of patients and their carers. However, a major finding of this study reveals that health professionals operated in a dual space as both managers of the ritual process and individuals undergoing a liminal journey as their organization underwent transformation or restructure. Clients and carers had little knowledge of these tensions.Research limitations/implicationsThe findings are limited by the fact that the interviews did not directly ask questions about the restructure of the organization.Social implicationsIt would appear that professionals provide quality care despite their own struggles in moving from one organizational form to anotherOriginality/valueFew studies have explored the liminal rituals of dying at home that outline how professionals, as managers of the process, deal with their own liminal issues.

scholarly journals Return to Treatment in the Formal Health Care Sector: Evidence from Tanzania

2015 ◽  
Vol 7 (3) ◽  
pp. 29-57 ◽  
Author(s):  
Achyuta Adhvaryu ◽  
Anant Nyshadham
Keyword(s):  
Public Health ◽  
Health Care ◽  
Low Income ◽  
Health Care Sector ◽  
Health Facilities ◽  
Low Income Countries ◽  
Formal Sector ◽  
Health Goal ◽  
Public Health Goal ◽  
Formal Health Care

Improving access to the formal health care sector is a primary public health goal in many low-income countries. But the returns to this access are unclear, given that the quality of care at public health facilities is often considered inadequate. We exploit temporal and geographic variation in the cost of traveling to formal sector health facilities to show that treatment at these facilities improves short-term health outcomes for acutely ill children in Tanzania. Our results suggest that these improvements are driven in part by more timely receipt of and better adherence to antimalarial treatment. (JEL I11, I12, I15, I18, J13, O15)

scholarly journals Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation

BJGP Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. bjgpopen18X101632 ◽  
Author(s):  
Muhammad Amir Khan ◽  
Muhammad Ahmar Khan ◽  
John D Walley ◽  
Nida Khan ◽  
Faisal Imtiaz Sheikh ◽  
...  
Keyword(s):  
Public Health ◽  
Integrated Care ◽  
Low Income ◽  
Service Providers ◽  
Health Facilities ◽  
Public Healthcare ◽  
Care Providers ◽  
Asthma Care ◽  
Public Health Facilities ◽  
Clinical Records

BackgroundIn Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities.AimTo understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.Design & settingThe mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.MethodThe care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data.ResultsUtilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking.ConclusionThe integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.

scholarly journals Assessing capacity of health facilities to provide routine maternal and newborn care in low-income settings: what proportions are ready to provide good-quality care, and what proportions of women receive it?

2019 ◽  
Author(s):  
Keith Tomlin ◽  
Della Berhanu ◽  
Meenakshi Gautham ◽  
Nasir Umar ◽  
Joanna Schellenberg ◽  
...  
Keyword(s):  
Low Income ◽  
Quality Care ◽  
Newborn Care ◽  
Uttar Pradesh ◽  
Routine Care ◽  
Health Facilities ◽  
Signal Functions ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn

Abstract Background Good quality maternal and newborn care at primary health facilities is essential for both mothers and infants, but in settings with high maternal and newborn mortality the evidence for the protective effect of facility delivery is inconsistent. We surveyed samples of health facilities in three settings with high maternal mortality, to assess the quality of routine maternal and newborn care and the proportion of women delivering in facilities with a good standard of care. Surveys were conducted in 2012 and 2015 to assess changes in the quality of care over time. Methods Surveys were conducted in Ethiopia, the Indian state of Uttar Pradesh and Gombe State in North-Eastern Nigeria. 166 and 305 primary care facilities were sampled in 2012 and 2015 respectively. In each year we assessed whether each facility could provide four “signal” functions of routine maternal and newborn care. From facility registers we counted the number of deliveries in the previous six months and calculated the proportion of women giving birth in facilities which could offer good quality routine care. Results In Ethiopia the proportion of deliveries in facilities which provided all four signal functions rose from 40% (95% CI 26-57) in 2012 to 43% (95% CI 31-56) in 2015. In Uttar Pradesh in 2012 an estimated 4% (95% CI 1-24) of facility deliveries occurred in facilities which provided all four signal functions, rising to 39% (95% CI 25-55) in 2015. In Nigeria these estimates were 25% (95% CI 6-66) and zero for 2012 and 2015 respectively. Improvements in signal functions in Ethiopia and Uttar Pradesh were led by improved supplies of commodities while Nigeria experienced declines in supplies of commodities and the number of Skilled Birth Attendants employed. Conclusions This study quantifies how health facilities can provide sub-optimal maternal and newborn care, and may help explain inconsistent outcomes of health facility care in some settings. Signal function methodology can provide a rapid and inexpensive measure of the capacity of facilities to provide such care. Incorporating data on facility deliveries and repeating the analyses highlights the adjustments that could have greatest impact upon maternal and newborn care.

Disability-Friendly Healthcare at Public Health Facilities in Bangladesh: A Mixed-Method Study To Explore the Existing Situation

2021 ◽  
Author(s):  
Nawshin Torsha ◽  
Farah Naz Rahman ◽  
Shafkat Hossain ◽  
Hasina Akhter Chowdhury ◽  
Minjoon Kim ◽  
...  
Keyword(s):  
Public Health ◽  
Mixed Method ◽  
Qualitative Interviews ◽  
People With Disabilities ◽  
Health Facilities ◽  
Mixed Method Study ◽  
Healthcare Facilities ◽  
Public Health Facilities ◽  
Healthcare Needs ◽  
Information And Communication

Abstract Background Several strategies and policies are being implemented in Bangladesh to address the healthcare needs of people with disabilities, who comprise about 10% of the country’s total population. However, these measures are not adequate to provide accessible or friendly healthcare to the people with disabilities. This study aimed to explore the disability-friendliness of healthcare facilities, and the challenges of people with disabilities in terms of access to 1) information and communication, 2) access to infrastructure, and 3) providers’ capacity in Bangladesh. Methods A mixed-method study was conducted, including a cross-sectional survey of healthcare facilities, followed by structured-interview with people with disabilities and healthcare managers, and qualitative interviews among people with disabilities or their caregivers, healthcare providers (HCPs), policymakers, and community leaders. Data were collected from 150 public healthcare (primary-to-tertiary) facilities and from 300 people with disabilities in 16 districts across Bangladesh between January-December 2019. An observational checklist and structured questionnaires were used to assess the situation of healthcare facilities, and literature-guided guidelines were used for qualitative interviews. During analysis, the disability-friendliness of healthcare facilities were quantified through a scoring system, and thematic analysis of qualitative data was performed to identify the challenges of implementing disability-friendly healthcare (DFHC). Results The score for providing DFHC was low across all the four objectives in the healthcare facilities. The highest score (mean percentage) was observed in the infrastructure domain: 29.3±20.5, followed by communication: 18.2±4.8, and information: 14.6±6.22, and the lowest (0.93±7.1) score was for capacity of the HCPs to provide DFHC. Mean percentage scores for access to 13 infrastructure points were low, and extremely low scores were found in areas such as access to elevators (5.6±5.0), ticket counters (7.3±17.7) and toilets (10.6±9.3). Furthermore, about 59.1% of people with disabilities expressed dissatisfaction regarding access to information and communication. The majority (98.2%) recommended that training of HCPs can improve the situation. Conclusion This study revealed that most of the public health facilities in Bangladesh were not disability-friendly. Findings can inform development of a national disability-friendly policy with implementation guidelines.

scholarly journals Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania

2021 ◽  
Vol 6 (4) ◽  
pp. e004725
Author(s):  
Tina Lavender ◽  
Carol Bedwell ◽  
Chowa Tembo Kasengele ◽  
Debora Kimaro ◽  
Flora Kuzenza ◽  
...  
Keyword(s):  
Grounded Theory ◽  
Low Income ◽  
Quality Care ◽  
Healthcare Providers ◽  
Newborn Care ◽  
Health Providers ◽  
Training Programmes ◽  
Vantage Points ◽  
Respectful Care

BackgroundQuality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points.MethodsWe used Strauss and Corbin’s grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia. In-depth interviews were conducted with 98 participants (48 women, 18 partners, 21 health-providers and 11 key stakeholders), resulting in data saturation. Analysis involved constant comparison, comprising three stages of coding: open, axial and selective. The process involved application of memos, reflexivity and positionality.ResultsFindings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman’s benefit, and were often caring against the odds, in challenging environments. Emergent categories were related to the core category: respectful care, an added extra, which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive.ConclusionBoth quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women’s and health-provider voices are pivotal to the development of such interventions.

Sign in / Sign up

Export Citation Format

Share Document