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Table 4 Barriers to implementing the action plan in Morocco

From: Analyzing barriers and facilitators to the implementation of an action plan to strengthen the midwifery professional role: a Moroccan case study

  Mega codes Sub-codes Themes Illustrative quotations
Socio-cultural System Values/Law/Rules Structural characteristics Bureaucratic top-down and centralized organizational structure in Morocco “The activities are centralized at the training division that deals with implementation, …,we look after the execution phase, I mean we only take orders from the top and receive information regarding the activities to execute”
Methods Readiness for implementation/Available resources Insufficient financial resources “… We have 16 areas that need to be covered, few people were able to attend the sessions, not all the staff, because of budget problem
Actors Capacities/Attributes A truncated leadership to strengthen midwives “I think the other activities of the plan other than the training are not for the moment the priority of the policy makers, I mean they don’t have any interest or it is not yet official”
Attitudes Attitudes of resistance of physicians towards midwives “Physicians are not going to … provide a backup mainly as regards to the activities intended to obtain a council board and change the law, and to have a clear statute”
Targets N/A   
Educational System Values Culture/Philosophy of midwifery training and education A dominant technocratic approach to midwives education and training “The training model is primarily based on a task approach, we are not prepared for the role and trained to perform a global practice, this principle of training could be a problem, a difficulty to put in place any further intervention”
Methods Readiness for implementation/Available resources Limited availability of human, physical and technical resources for implementing the training activities “Computers made available to participants were not very helpful, without any protection against virus and software to download documents was not available. Thus, they [midwives] had great difficulty to have access to some references … and make presentation in plenary sessions”
    Deficient educational support for midwifery teachers “As I have mentioned a while ago, the lack of material resources …, the lack of human skills to support this change, we do not have till date competent midwives who are trained according to the competency-based approach to train the future midwives”
    Deficient access to information regarding the action plan “In general, when there is an action plan, few people are aware of the entire plan, it remains where it was developed at the top of the chain at the policy level …. I think, it’s the system here, it does not provide any information…”
   Networks and communications Inadequate mechanisms of coordination and collaboration within and across the educational institutes “We are all victims of the lack of coordination between our leaders and the educational institutes, we have done a crazy work during the first year …in September-October 2009, we asked for a feed-back, and we suggested a deadline for receiving feedback, comments were not submitted to the consultant, we even called for a meeting to get feedback, we have not received a response due to the issue of coordination”
  Actors Attributes/Capacities Difficulties in adapting teachers skills to the competency-based approach’s needs “If we teachers found it difficult… to understand, what would it be for students who fail in the first year to speak French, are not able to reason properly, students will not be able to understand the new concepts, they will face difficulties in assimilating the various "savoir, savoir-faire"
Attributes of students unfavorable to educational change
Targets N/A   
Professional System Values Culture Workplace culture resistant to innovations “The change is more difficult, it takes longer time, people's mentality is hard to change, they are not open to a new model of care primarily the medical community”
Methods Readiness for implementation/Professional support Lethargy of the midwifery association towards the profession “Their presence [Professional Association] is symbolic, we do not have a well-developed association, we are not part of it, in my opinion it no longer exists, no activities are done to strengthen the role of the midwife. At Rabat, there are no activities to strengthen the midwife’s role”
Deficient access to information as regards to the Action Plan “Here, at the maternity hospital, we did not receive any information from the Ministry of Health regarding the plan, and the ongoing training activities at the educational institutes”
Actors Attributes Lack of motivation of practicing midwives to embrace change “We are not motivated, so how do you want to set up a plan, we are like a simple tool for doing tasks, even for planning, for making decisions, for implementing a project, we are not considered nor consulted”
Targets N/A   
  1. N/A not applicable to data