https://orcid.org/0000-0003-2424-0992
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ABSTRACT
Background
The World Health Organization recommends the implementation of maternity waiting homes (MWH) to reduce delays in access to obstetric care, particularly for high-risk pregnancies and mothers living far from health facilities, and as a result, several countries have rolled out MWHs. However, Rwanda has not implemented this recommendation on a large scale. There is only one MWH in the country, hence a gap in knowledge regarding the potential utilisation and benefits of MWHs.
Objective
To explore providers’ and clients’ perspectives on facilitators and barriers to the use of MWH in rural Rwanda.
Methods
We conducted a qualitative study to explore health providers’ and clients’ perspectives on facilitators and barriers to the use of MWH in Rwanda, between December 2020 and January 2021. We used key informant interviews and focus group discussions to collect data. Data were analysed using NVivo qualitative analysis software version 11.
Results
Facilitators included perceptions that the MWH offered either a peaceful and home-like environment, good-quality services, or timely obstetric services, and was associated with good maternal and neonatal outcomes. Barriers included limited awareness of the MWH among pregnant women, fear of health providers to operate the MWH at full capacity, women’s lack of autonomy, uncertainty over funding for the MWH, and perceived high user fees.
Conclusion
The Ruli MWH offers a peaceful environment for pregnant women while providing quality and timely obstetric care, resulting in positive maternal and neonatal outcomes for women. However, its existence and benefits are not widely known, and its use is limited due to inadequate resources. There is a need for increased awareness of the MWH among healthcare providers and the community, and lessons from this MWH could inform the scale up of MWHs in Rwanda.
Responsible Editor Maria Emmelin
Responsible Editor Maria Emmelin
Acknowledgments
We acknowledge the contribution of all the study participants and data collectors.
Author contributions
ET, RK, and SMG conceptualised the study. ET and RK collaborated on study design and data collection. SMG analysed the data. ET and SMG drafted the manuscript. RK, YMK, JvD, and JS reviewed and provided substantial contributions. All authors reviewed and approved the manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethics and consent
The Rwanda National Ethical Committee approved the study. All participants provided written consent and voluntarily participated in the study. Personal identifiers were not included in the transcripts.
Paper context
The World Health Organization recommends the implementation of MWH to reduce delays in access to obstetric care for high-risk pregnancies. This recommendation has not been implemented in Rwanda, and there is a gap in knowledge regarding MWHs. Using data collected from the only MWH in the country, we explored health provider and beneficiary perspectives on facilitators and barriers to the use of MWH. Our findings provide critical information for the scale-up of MWHs.