Abstract
BackgroundAs part of a national strategy for reaching Millennium Development Goals 4 and 5 in Morocco, an action plan covering three systems (sociocultural, educational and professional) was developed to strengthen midwives’ professional role in order to contribute to high quality maternity care. This study aimed to understand the implementation process by identifying the characteristics of this intervention and the dimensions of the three-systems which could act as barriers to/facilitators of the implementation process. We used a conceptual framework that builds on Hatem-Asmar’s model that describes change in a health professional role; and on the Consolidated Framework for Implementation Research for our analysis.MethodsAn embedded case study with three levels of analysis was conducted during June and July 2010. Data were collected through 11 semi-structured interviews, 20 focus groups, training session observations and documents. A purposive sample of 106 multi-stakeholders from two Moroccan regions (health professionals, academic staff, students, medical administrative officers and health programmers) and one international consultant were recruited. A thematic analysis was conducted using QDA Miner.ResultsData showed a failure to carry out the plan as intended. Seventeen barriers and seven facilitators were identified. Misalignment of the values, methods, actors and targets of the sociocultural system with the values, methods and actors of the educational and professional systems, on one hand, and with the intervention, on the other hand, were likely the greatest impediments to implementing the plan. The bureaucratic structure and lack of readiness of the sociocultural system were among the most influential barriers to: dissemination of information, involvement of key actors in the process and readiness of the educational system. The main facilitators were the values promoted related to human rights, and the national and international policies to strengthen midwifery and reduce maternal mortality. The plan was perceived as beneficial, but complex and externally driven.ConclusionsThe findings suggest that successful implementation requires redesigning the implementation strategy to adapt to the factors identified in our study. The results would be very useful to health planners seeking the expansion of such an intervention to other developing countries looking to strengthen midwives’ role and to improve maternity health care services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1037-3) contains supplementary material, which is available to authorized users.
Highlights
IntroductionAs part of a national strategy for reaching Millennium Development Goals 4 and 5 in Morocco, an action plan covering three systems (sociocultural, educational and professional) was developed to strengthen midwives’ professional role in order to contribute to high quality maternity care
As part of a national strategy for reaching Millennium Development Goals 4 and 5 in Morocco, an action plan covering three systems was developed to strengthen midwives’ professional role in order to contribute to high quality maternity care
Participants were recruited in two stages: 1) we sent invitations to participate via email along with informational letters to potential key informants pertaining to the above mentioned systems using address lists provided by the training division of the Ministry of Health (MOH); posters were used to recruit midwifery students; and, 2) site visits were conducted by the first author in collaboration with the project coordinator to select key informants for focus groups
Summary
As part of a national strategy for reaching Millennium Development Goals 4 and 5 in Morocco, an action plan covering three systems (sociocultural, educational and professional) was developed to strengthen midwives’ professional role in order to contribute to high quality maternity care. Role strengthening is one of the main interventions being considered to provide high-quality care through expanding human resources’ skills, tasks and responsibilities beyond their traditional scope of practice [5] It has been conceptualized as a whole systems change implicating essential actions in many systems, including the sociocultural, and educational systems as well as the system pertaining to the profession itself1 [6], through which a health professional role (namely the midwife’s role) evolves. Further research is needed in this area to inform policy makers’ decisions and to tailor interventions to the factors that have been identified in the context under investigation [12] To address this need, this paper presents findings from an implementation analysis of an action plan (AP) to strengthen midwives’ professional role in Morocco with the aim of reducing the scientific knowledge gap on role strengthening interventions. The objectives of this study are to: 1) assess the extent to which the intervention was delivered; and 2) understand how the possible barriers and facilitators influenced the AP’s implementation in Morocco
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
