Peripartum care provision in a resource-constrained setting – a qualitative study from Guinea-Bissau

The European Journal of Public Health · 5 authors, 7 centres

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TL;DR

This qualitative study explored peripartum care in rural Guinea-Bissau during a transition in external support, finding that disruptions in donor supplies led to severely compromised care quality due to material, staffing, and space constraints.

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Thematic network analysis, informed by social practice theory and the WHO quality framework, was applied. The analysis revealed that care was provided under severe resource constraints, including a lack of essential drugs, consumables, equipment, space, and staff. Providers reported feeling overburdened and attributed material shortages to discontinued donor supplies. To cope, they used tactics like delegating tasks to birth companions, prescribing materials for purchase, omitting tests, and rationing supplies. These adaptations had negative consequences, such as diffusion of responsibilities, financial barriers, delays, unsanitary conditions, and compromised safety.

STUDY TYPE

other

SPECIALTY

obstetrics and gynecology

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ORIGINAL PAPER

PMC10596711

Peripartum care provision in a resource-constrained setting – a qualitative study from Guinea-Bissau

The European Journal of Public Health

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ABSTRACT

Abstract Background Guinea-Bissau has among the world's highest maternal-perinatal mortality. Here, the European Union financed a national health system strengthening initiative to improve access to quality peripartum care from 2013-21. Thereafter, the initiative was supported by the World Bank. We conducted a situational analysis to explore factors shaping the provision of timely and quality peripartum care amid this transition in rural Guinea-Bissau. Methods We conducted in-depth interviews with eight peripartum care providers in four rural regions, and participant observations (192 hours) at the regional hospital and a health center in one region in 2021-22. Interviews and observation notes were analyzed using thematic network analysis aided by theories of social practice and the WHO framework for quality maternal and newborn health care. Results Peripartum services were provided under severely resource-constrained conditions. Care providers especially experienced a lack of materials (e.g., essential drugs, consumables, appropriate equipment), space and staffing, and commonly voiced feeling overburdened. Material constraints were explained by discontinued donor supplies. To navigate this context, providers used several tactics, including: delegating monitoring and support tasks to birth companions; prescriptions of materials for purchase; omitting tests; and using materials thrifty, e.g., by shifting tasks requiring gloves to the staff member wearing them or rationing disinfectants. These tactics had several consequences: diffusion of health worker responsibilities; financial barriers to care; delays; unsanitary conditions; and compromised occupational and patient safety. Conclusions With provision of quality peripartum care being highly dependent on external support amid scarce domestic resources, support disruptions led to severely compromised care. This highlights the need to strengthen donor-coordination warranting continuity and quality of essential health services. Key messages • Disruptions in donor support led to severely compromised peripartum care in rural Guinea-Bissau. • This underscores the need for strengthened donor-coordination warranting continuity of service quality.

CITATION EXPORT

S M Damerow, H V Adrian, B Indjai et al.. Peripartum care provision in a resource-constrained setting – a qualitative study from Guinea-Bissau. The European Journal of Public Health. (2023). https://doi.org/10.1093/eurpub/ckad160.710

AUTHORS

5 · 7 CENTRES

S M Damerow, H V Adrian, B Indjai, A B Fisker, J B Sørensen

1 Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
2 Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Copenhagen, Denmark
3 Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
4 National Institute for Studies and Research, INEP, Bissau, Guinea-Bissau
5 Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
6 Bandim Health Project, Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Copenhagen, Denmark
7 Department of Public Health, University of Copenhagen, Copenhagen, Denmark