Abstract
BackgroundShortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Despite the government of Malawi’s efforts to increase the number of human resources for health, maternal mortality rates remain persistently high. Health workers’ perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition, while the resulting sub-standard care and poor attitudes towards women dissuade women from facility-based delivery. Understanding the situation from the health worker perspective can inform policy options that may contribute to a better working environment for staff and improved quality of care for Malawi’s women.MethodsA qualitative research design, using critical incident interviews, was used to generate a deep and textured understanding of participants’ experiences. Eligible participants had performed at least one of the emergency obstetric care signal functions a in the previous three months and had experienced a demotivating critical incident within the same timeframe. Data were analysed using NVivo software.ResultsEighty-four interviews were conducted. Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The main themes emerging were: too few staff, too many patients; lack of clinical officers/doctors; inadequate obstetric skills; undermining performance and professionalism; and physical and psychological consequences for staff. Underlying factors were inflexible scheduling and staff allocations that made it impossible to deliver quality care.ConclusionThis study revealed the difficult circumstances under which maternity staff are operating and the professional and emotional toll this exacts. Systems failures and inadequate human resource management are key contributors to the gaps in provision of obstetric care and need to be addressed. Thoughtful strategies that match supply to demand, coupled with targeted efforts to support health workers, are necessary to mitigate the effects of working in this context and to improve the quality of obstetric care for women in Malawi.
Highlights
Shortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented
Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The findings from both these groups are reported in this paper, as they demonstrate the pervasive negative impact of the human resources for health crisis on staff
This study investigated the negative consequences of staff shortages and workload for maternal health staff in Malawi
Summary
Shortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Shortages of staff have a significant and negative impact on maternal outcomes [1] and decrease the ability of health systems to maintain a state of ‘readiness’, where sufficient skilled staff, furnished with the supplies, equipment and resources that they need, are available and ready to respond to women 24 hours a day, 7 days a week [2] Without these personnel, countries face an uphill battle to meet their Millennium Development Goal (MDG) 5 target to reduce the maternal mortality ratio (MMR) by two-thirds and increase the proportion of births attended by skilled health workers [3]. These factors combine to severely compromise health workers’ abilities to deliver adequate quality care and have been implicated as drivers of disrespectful intrapartum care [10]
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