Abstract
Despite decades of training health workers in communication, complaints from clients and communities about poor health worker attitudes abound. This was found to be so in Zambia where the More Mobilizing Access to Maternal Health Services in Zambia (MORE MAMaZ) program was trying to ensure the inclusion of under-supported women in a community-based maternal and newborn health program in five intervention districts. Under-supported women suffer a disproportionate burden of child mortality and are poor users of health services. An exploratory small-scale qualitative survey involving nurses from training schools and health facilities found that nurses knew how to communicate well, but were selective with whom and in what circumstances they did this. In general, those who received the worst communication were under-supported and had low confidence—the very people who needed the best communication. An experiential training program was started to help health workers reflect on the reasons for their poor communication. The training was evaluated after 14 months using semi-structured interviews and focus group discussions with staff at participating health facilities. The results showed improved inclusion of under-supported women but also increased attendance generally for ante-natal clinics, deliveries and under-five clinics. Another outcome was improved communication between, and a sense of job satisfaction among, the health workers themselves. The program demonstrated an effective way to improve the inclusion and involvement of the least-supported women and girls. There are important lessons for other health programs that aim to operationalize the goals of the Global Strategy for Women’s, Children’s and Adolescent’s Health, which include an emphasis on reaching every woman.
Highlights
Concerns about poor health worker communication are reflected in the recent call for respectful maternity care as part of the bid to improve maternal health [1,2]
The evaluation found that the communication training intervention was perceived to be successful in all but one health facility in relation to the improvement of communication in terms of: staff–staff relationships in health centers; communication between staff and their clients in general; a stronger, more nuanced and supportive focus on under-supported women in clinics; and improved linkages between health center staff, volunteers, community workers and communities
The impact of the MORE MAMaZ communications training intervention could be seen through improved clinic attendance; improved relevance of clinical diagnosis, treatment, support and referral of under-supported women; improved morale of staff and fewer complaints about staff; and a decrease in intimate partner violence, with a concomitant improvement in the participation and voice of women affected by violence
Summary
Concerns about poor health worker communication are reflected in the recent call for respectful maternity care as part of the bid to improve maternal health [1,2]. It is widely understood that women who feel they are not respected or supported by their families or communities are less likely to care for themselves or their children—partly as a result of the lack of support, and because of associated depression, anxiety and frustration [4,5,6,7,8]. They are less likely to communicate well, and to remain silent or unquestioning when confronted with people who they perceive to be more powerful. A recent study in northern Nigeria was pivotal in exposing the relationship between the burden of mortality and women’s lack of social support and voice, with important implications for health programs that are concerned with targeting resources to where they are needed the most [9]
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