Repository logo
 

The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7193

Browse

Filters

2015 - 20172

Settings

Has files: YesSubject: search.filters.subject.Quality

Search Results

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Weighing the options for delivery care in rural Malawi: community actors' perceptions of the 2007 policy guidelines and redefined traditional birth attendants roles
    (Queen Margaret University, Edinburgh, 2017) Uny, Isabelle
    Despite significant recent improvements, maternal mortality remains high in Malawi. To address this, the Government prioritised strategies promoting skilled birth attendance. However, in a country where 80% of the population resides in rural areas, there are tremendous barriers to institutional deliveries. Historically rural women have been supported in childbirth by Traditional Birth Attendants (TBAs), and by skilled birth attendants (SBAs) at the health facility. In the past, TBAs were trained to help bridge the gaps in provision and accessibility of care but in the 1990's, the WHO recommended halting their training because it was perceived as ineffective for maternal mortality reduction. In 2007, the Government of Malawi issued Community Guidelines to promote skilled birth attendance and banned TBA utilization for routine deliveries. This grounded theory qualitative study used interviews and focus groups to explore community actors' perceptions of the 2007 Policy Guidelines and their implementation, and how the Policy affected the decisions and actions of rural women regarding their delivery care. Findings from this study indicate that although all actors may agree that delivering at facilities is safest when complications occur, this does not necessarily ensure their compliance. Women, men and TBAs particularly, perceived the Policy as prescriptive. Furthermore, the implementation of the policy aggravated some of the barriers women already faced. Issues of disrespectful and neglectful care at facilities also partly led women towards non-compliance. Furthermore, a view from the ground demonstrated that the Policy had led to a rupture of linkages between TBAs and SBAs, which have had a detrimental effect on the continuum of care. This study helps fill an important gap in research concerning maternal health policy implementation analysis in LICs, by focusing on the perceptions of those at the receiving end of policy change, and on their needs, and aspirations.
  • Thumbnail Image
    Item
    Crossing boundaries for maternal health: a qualitative investigation into the role of community health workers as frontline providers of maternal care in the Peruvian Andes
    (Queen Margaret University, Edinburgh, 2015) Vidal, Nicole L.
    Despite its status as a middle income country, Peru has one of the highest maternal mortality rates in the Americas. In the Andes region, poor, rural indigenous women are more likely to die from pregnancy related complications than their urban counterparts because they are denied the same level of maternal health services other women in the country receive. Barriers to care include geographic isolation, health staff members who do not speak indigenous languages, and cultural and ethnic discrimination. As a result, indigenous Andean women in need of maternal health services face a significant degree of social exclusion and institutionalized racism which hinders the accessibility, acceptability, and quality of maternal health services offered to them. One approach to improving access to health services has been through the use of Community Health Worker (CHW) programs. Although CHWs are recognized as an important frontline health source, there is a significant lack of literature concerning their role as community level providers of maternal health services. Using a combined grounded theory and case study methodology, this qualitative study investigates the experiences of CHWs working in Andean communities and their relationships with other community members and health and social service professionals. Findings from this study suggest that CHWs can be enabled to bring care directly to their communities in a way that community members can relate to and feel comfortable with while also forming part of the wider health system. Focusing on participants' reports of challenging cultural and ethnic boundaries through a process of ethnic bargaining and adopting professional affiliation, this study identifies CHWs as a potentially vital link between rural community members and other providers of these services. If the right factors are met, such as finding ways to navigate the tensions between traditional and biomedical health care models, CHWs can be considered critical community level health providers who can communicate the value of both models, thereby improving the accessibility, acceptability and quality of maternal health services. However, the root causes leading to social, structural and institutional boundaries to care still need to be addressed. As such, this study aims to fill a significant gap in current research on the role of CHWs in Peru, specifically in the ways they are enabled to negotiate ethnic discrimination within the health system.