Challenges experienced by midwives working in rural communities in the Upper East Region of Ghana: a qualitative study
Tóm tắt
In 2017, a total of 295,000 women lost their lives due to pregnancy and childbirth across the globe, with sub-Saharan Africa and South Asia accounting for approximately 86 % of all maternal deaths. The maternal mortality ratio in Ghana is exceptionally high, with approximately 308 deaths/100,000 live births in 2017. Most of these maternal deaths occur in rural areas than in urban areas. Thus, we aimed to explore and gain insights into midwives’ experiences of working and providing women-centred care in rural northern Ghana. A qualitative descriptive exploratory design was used to explore the challenges midwives face in delivering women-centred midwifery care in low-resource, rural areas. A total of 30 midwives practicing in the Upper East Region of Ghana were purposefully selected. Data were collected using individual semistructured interviews and analysed through qualitative content analysis. Five main themes emerged from the data analysis. These themes included were: inadequate infrastructure (lack of bed and physical space), shortage of midwifery staff, logistical challenges, lack of motivation, and limited in-service training opportunities. Midwives experience myriad challenges in providing sufficient women-centred care in rural Ghana. To overcome these challenges, measures such as providing adequate beds and physical space, making more equipment available, and increasing midwifery staff strength to reduce individual workload, coupled with motivation from facility managers, are needed.
Tài liệu tham khảo
World Health Organization. World health statistics 2020: monitoring health for the SDGs sustainable development goals. World Health Organization; 2020. Available from; https://apps.who.int/iris/bitstream/handle/10665/332070/9789240005105-eng.pdf.
World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO. UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization. 2019. Available from; https://apps.who.int/iris/handle/10665/327595.
Apanga PA, Awoonor-Williams JK. Maternal death in rural Ghana: a case study in the Upper East Region of Ghana. Frontiers in public health. 2018;6:101.
Filby A, McConville F, Portela A. What prevents quality midwifery care? A systematic mapping of barriers in low and middle-income countries from the provider perspective. PloS one. 2016;11(5):e0153391.
Pan American Health Organization. Toolkit for strengthening professional midwifery in the Americas. 3rd edition. Montevideo: 2014.
Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, van Lerberghe W. Lancet Maternal Survival Series steering group. Going to scale with professional skilled care. The Lancet. 2006;368(9544):1377–86.
International Confederation of Midwives. Core document: international definition of a midwife. The Hague: ICM. 2017.https://internationalmidwives.org/assets/files/definitions-files/2018/06/eng-definition_of_the_midwife-2017.pdf.
Stanton C, Blanc AK, Croft T, Choi Y. Skilled Care At Birth In The Developing World: Progress To Date And Strategi Es For Expanding Coverage. J Biosoc Sci. 2007;39(1):109.
World Health Organisation. Midwives voices, midwives realities. Findings from a global consultation on providing quality midwifery care. Geneva. WHO; 2016.
Ghana Health Service (GHS). “Reproductive and Child Health Unit (Public Health Division) Annual Report”, 2016. Accra: GHS; 2016.
United State. Agency for International Development (USAID). The Emerging Midwifery Crisis in Ghana: Mapping of Midwives and Service Availability Highlights Gaps in Maternal Care. USAID, 2006.
Bogren M, Erlandsson K, Byrskog U. What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students. BMC Health Services Research. 2018;18(1):639.
Bogren M, Grahn M, Kaboru BB, Berg M. Midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo—an interview study. Human resources for health. 2020;18(1):1–0.
Bremnes HS, Wiig ÅK, Abeid M, Darj E. Challenges in day-to-day midwifery practice; a qualitative study from a regional referral hospital in Dar es Salaam. Tanzania Global health action. 2018;11(1):1453333.
Adatara P, Strumpher J, Ricks E. A qualitative study on rural women’s experiences relating to the utilisation of birth care provided by skilled birth attendants in the rural areas of Bongo District in the Upper East Region of Ghana. BMC Pregnancy Childbirth. 2019;19(1):195.
Afaya A, Dzomeku VM, Baku EA, Afaya RA, Ofori M, Agyeibi S, Boateng F, Gamor RO, Gyasi-Kwofie E, Nyaledzigbor PP. Women’s experiences of midwifery care immediately before and after caesarean section deliveries at a public Hospital in the Western Region of Ghana. BMC Pregnancy Childbirth. 2020;20(1):1–9.
Adatara P, Afaya A, Baku EA, Salia SM, Asempah A. Perspective of traditional birth attendants on their experiences and roles in maternal health care in rural areas of northern ghana. International journal of reproductive medicine. 2018.
Afaya A, Yakong VN, Afaya RA, Salia SM, Adatara P, Kuug AK, Nyande FK. A qualitative study on Women’s experiences of Intrapartum nursing Care at Tamale Teaching Hospital (TTH), Ghana. Journal of Caring Sciences. 2017;6(4):303.
Padgett DK. Qualitative and mixed methods in public health. USA: SAGE publications; 2011.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care. 2007;19(6):349–57.
Sarfraz M, Hamid S. Challenges in delivery of skilled maternal care–experiences of community midwives in Pakistan. BMC Pregnancy Childbirth. 2014;14(1):59.
Dalinjong PA, Wang AY, Homer CS. Are health facilities well equipped to provide basic quality childbirth services under the free maternal health policy? Findings from rural Northern Ghana. BMC Health Serv Res. 2018;18(1):959.
Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, Aguiar C, Coneglian FS, Diniz AL, Tunçalp Ö, Javadi D. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12(6):e1001847.
Banchani E, Tenkorang EY. Implementation challenges of maternal health care in Ghana: the case of health care providers in the Tamale Metropolis. BMC Health Serv Res. 2014;14(1):7.
Kafulafula UK, Hami M, Chodzaza E. The challenges facing nurse-midwives in working towards Safe Motherhood in Malawi. Malawi Medical Journal. 2005;17(4):125–7.
Rahmani Z, Brekke M. Antenatal and obstetric care in Afghanistan -a qualitative study among health care receivers and health care providers. BMC Health Services Research. 2013;13:166–75.
Kwast BE, Bentley J. Introducing confident midwives: midwifery education—action for safe motherhood. Midwifery. 1991;7(1):8–19.
Floyd L. Helping midwives in Ghana to reduce maternal mortality. African Journal of Midwifery Women’s Health. 2013;7(1):34–8.
Pettersson KO. Major challenges of midwifery in Africa. British Journal of Midwifery. 2007;15(8):470–4.
Bream KDW, Gennaro S, Kafulafula U, Mbweza E, Hehir D. Barriers to and facilitators for newborn resuscitation in Malawi, Africa. Journal of Midwifery Women’s Health. 2005;50(4):329–34.
World Health Organization. The world health report 2006: working together for health. World Health Organization; 2006.
Ghana Health Service. Human resource annual report – 2018. Accra: Ghana Health Service; 2019.
Asamani JA, Amertil NP, Ismaila H, Francis AA, Chebere MM, Nabyonga-Orem J. Nurses and midwives demographic shift in Ghana—the policy implications of a looming crisis. Human resources for health. 2019;17(1):32.
Asamani JA, Amertil NP, Ismaila H, Akugri FA, Nabyonga-Orem J. The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives’ unemployment crisis in Ghana. Human Resources for Health. 2020;18(1):1–6.
Uduma O, Galligan M, Mollel H, Masanja H, Bradley S, McAuliffe E. The impact of a human resource management intervention on the capacity of supervisors to support and supervise their staff at health facility level. Human resources for health. 2017;15(1):57.
World Health Organization. The world health report 2000: Health systems: improving performance. Geneva: World Health Organization; 2000.
Franco LM, Bennett S, Kanfer R, Stubblebine P. Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia. Soc Sci Med. 2004;58(2):343–55.
Tibandebage P, Kida T, Mackintosh M, Ikingura J. Can managers empower nurse-midwives to improve maternal health care? A comparison of two resource‐poor hospitals in Tanzania. Int J Health Plan Manag. 2016;31(4):379–95.
WHO. Standards for improving quality of maternal and newborn care in health facilities. Geneva: World Health Organization; 2016.
Turan JM, Bukusi EA, Cohen CR, Sande J, Miller S. Effects of HIV/AIDS on Maternity Care Providers in Kenya. Journal of Obstetric Gynecologic Neonatal Nursing. 2008;37(5):588–95.
Taylor LC, Fair CD, Nikodem C. Working conditions and perspectives among South African health workers. African Journal of Midwifery Women’s Health. 2011;5(4):176–80.
Hussein J, Phoya A, Ansong Tornui J, Okiwelu T. Midwifery practice in Ghana and Malawi: influences of the health system. In: Reid L, editor. Freedom to practise: An international exploration of midwifery practice. London: Churchill Livingstone Elsevier; 2007. pp. 75–99.
Walker D, Lannen B, Rossie D. Midwifery practice and education: Current challenges and opportunities. OJIN: The Online Journal of Issues in Nursing. 2014;19(2):4.