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Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care
Sexual and Reproductive Health Matters ( IF 5.732 ) Pub Date : 2020-12-14 , DOI: 10.1080/26410397.2020.1854153
Anteneh Asefa 1 , Barbara McPake 2 , Ana Langer 3 , Meghan A Bohren 4 , Alison Morgan 5
Affiliation  

Abstract

Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system “hardware” and “software” factors influencing the promotion of RMC were identified, and their interaction was complex. The “hardware” factors included bed availability, infrastructure and supplies, financing, and health workforce. “Software” factors encompassed service providers’ mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC.



中文翻译:

将产科护理想象成一个复杂的适应系统:了解卫生系统对促进尊重产科护理的限制

摘要

在埃塞俄比亚和全球范围内,卫生系统在促进尊重产妇保健 (RMC) 方面面临挑战的证据有限。本研究调查了埃塞俄比亚南部三所医院对 RMC 的卫生系统限制。我们在实施 RMC 干预之前和之后进行了一项定性研究(与 RMC 的提供者进行了 7 次焦点小组讨论 (FGD),并与焦点人员和管理人员进行了 12 次深入访谈)。我们将分娩服务定位在卫生系统中,并应用复杂适应系统理论来分析促进 RMC 的机会和限制。确定了影响 RMC 推广的系统“硬件”和“软件”因素,它们的相互作用是复杂的。“硬件”因素包括床位可用性、基础设施和供应、融资和卫生人力。“软件”因素包括服务提供商的心态、员工积极性和 RMC 意识。这些因素之间的相互作用包括在分娩室接纳助产士时妇女的隐私泄露。在引入产科服务费用豁免后延迟报销导致收入减少、供应短缺,并最终导致提供者之间的不尊重行为。其他财务限制,包括资金发放不足和延迟发放,也导致与员工积极性以及劳动力和物资供应情况的复杂互动,导致未能遵守 RMC 的指导。仅旨在改善行为成分的干预措施不足以减轻对妇女的虐待。

更新日期:2021-01-12
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