Barriers and enablers to implementation of Botswana’s national maternal mortality reduction guidelines : a qualitative study

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Stellenbosch : Stellenbosch University
ENGLISH SUMMARY: Introduction: Like in many low-and-middle income countries, maternal mortality remains a challenge to Botswana. A number of initiatives such as maternal mortality audit with generation of recommendations, development of guidelines and occasional issuing of clinical directives have not resulted in the desired change. Factors such as staff attitude, lack of administrative or management commitment are often postulated as possible reasons, but these have not been well researched locally. The aim of this study was to explore the context specific attitudes and experiences of managers and health professionals towards the implementation of maternal mortality reduction guidelines in Botswana. Methods: Face to face interviews (Exploratory Qualitative Study) using pre-developed semi-structured questions was undertaken in 4 district hospitals in Botswana. A non-probability sampling technique was used to select both the study sites and the informants. Two facilities with no significant decrease in maternal mortality cases and two which have been recording fewer cases in the recent past were selected. Content data analysis was done with the help of Atlas.ti. Results: Effective change in the health system can broadly be divided into four areas; policy, administration, clinical practice and training. Some of the policy related issues noted were; shortage of staff and equipment, staff distribution and movement. Both study groups were equally affected by these issues, but facilities with lower maternal mortality seemed to have developed better coping mechanism. Administratively, long standing unresolved issues such as erratic stocking levels, weaker disciplinary procedures, limited services at some facilities etc. were reported. Generally, the staff morale was reported to below, mainly due to these unresolved administrative issues. Fewer administrative issues were reported at facilities with lower mortality. Regarding clinical practise, both clinicians and managers were well aware of the guidelines. Variable patient monitoring before, during and after delivery, poor team work, too much or repetitive documentation, were commonly reported. Under training; lack of concrete, consistent on-going learning among healthcare workers was more pronounced at facilities with higher maternal mortalities. Conclusion: Findings from this study revealed that unresolved administrative issues compounded by policy related issues were noted as the main barriers to implementation of the various guidelines. Furthermore, addressing staff welfare/concerns, negatives attitudes and investing on on-going learning were noted as areas which could enable effective guidelines’ implementation.
Thesis (MFamMed)--Stellenbosch University, 2017.
Newborn infants -- Mortality -- Botswana, Mothers -- Mortality -- Botswana, Maternal mortality -- Botswana, UCTD