Three themes emerged from the qualitative results from the survey and focus groups: poor quality of health care services, need for future training, and improving women’s experiences.
Poor quality of health care services
It became clear to the health care providers after attending the workshops, that the quality of health care services they offered was lacking. Multiple participants commented that their attitudes towards their women clients were problematic:
“Women don’t come to health facility because our bad language towards them.” (Focus Group Participant, Kowak Hospital).
“I am very happy about this workshop, because it reminds us about the ethics that we have forgotten and are not following.” (Survey Response, Masonga Health Centre).
“This [workshop] has really changed my behaviour, I thought we were doing the right thing, seriously we were very wrong.” (Focus Group Participant, Kogaja Dispensary).
In addition to their attitudes being a barrier for women attending health facilities, the health care providers also noted the quality of care for women who did attend the health facility was lacking due to insufficient supplies and sometimes limitations of the health care provider’s service:
“Sometimes we have a shortage of supplies so we don’t give satisfactory care.” (Focus Group Participant, Kowak Hospital).
“We also give shallow advice to women and forget some important issues.” (Focus Group Participant, Kowak Hospital).
The workshops provided an opportunity for the health care providers to identify where the weaknesses in quality of service originated. Amongst this group of health care providers serving the rural population of Rorya District, it was clear that their negative attitudes were a major barrier for women, in addition to lack of supplies and appropriate levels of service at the health facility. The health care providers were aware that some women would therefore seek their maternity care elsewhere, particularly with the traditional birth attendants.
Need for future training
The health care provider participants in the workshops were pleased to have the opportunity to address their negative attitudes, to improve their services. They felt the workshops made a significant impact on their ongoing care, and they could influence others to improve as well. They also requested more time for the seminars in the future.
“I appreciate the seminars. I was able to learn a lot and make changes as needed. I realized the mistakes I was making in giving services to the mothers. I will teach my colleagues so they will also be aware.” (Survey Response, Shirati Hospital).
“I suggest there should be more time for the workshops so that we can learn more about what to tell mothers when they come to health facilities. I would also like the mothers to know that they are learning this, to encourage the mothers who do not want to come.” (Survey Response, Shirati Hospital).
The participants had several suggestions for improving the workshops. In particular, they requested that more of their colleagues have the opportunity to participate in the workshops. For this pilot study, only a fraction of the health care providers working with women and children were chosen to attend, however, for greater impact, they recommended that other health care providers working with pregnant women and children, and those on other services be invited to participate in the workshops.
“The seminar is good, all nurses should participate, not only those working with mothers and children.” (Focus Group Participant, Kowak Hospital).
Some participants also suggested we include management staff, and even women and their partners to widen the impact of the workshops.
“It is good to be with mothers in the seminar so that nurses could hear directly the mother’s opinion.” (Focus Group Participant, Masonga Health Centre).
“I advise that this seminar should have included the employers so they would understand the problems that we face in our work, especially the lack of supplies at the right time. They would see the importance of improving in this area. Also we need to educate the community, especially the men, so they understand the rights of women in society through role play as was demonstrated in the seminar.” (Survey Response, Shirati Hospital).
Many participants insisted that one series of workshops was insufficient to sustain change. They requested that we repeat the workshops for greater impact.
“These workshops should be done again in the future as they give us a chance to improve on giving services to our clients.” (Survey Response, Utegi Health Centre).
“I would like to urge you if it is possible to keep this program going, it is beneficial to us whenever we get this training. It is challenging us to improve services to our clients.” (Survey Response, Rao Hospital).
“I am thankful for the training I got. I realized that I did not know a lot of things that were taught. Now I understand more and I will provide better service to the mothers and children to my ability. I would request more workshops like this in the future.” (Survey Response, Shirati Hospital).
Improving Women’s experiences
The health care providers participating in the workshops had several suggestions for improving women’s experiences. They emphasized that the continuation of health education about the importance of family planning and safe deliveries was key. Providing financial incentives to community health workers for bringing women for care was also a creative suggestion:
“Establish a system that community health worker can be paid according to the number of pregnant mothers he/she brings or registers.” (Focus Group Participant, Utegi Health Centre).
Another suggestion from several health care providers was to assist women with the cost of transportation to reach the health facility, as this was perceived as a significant barrier for some women. Infrastructure issues such as sufficient, functional equipment, and the provision of health care facilities in convenient locations for women were also mentioned as strategies for improving care. Motivating women to come for care by provision of free baby clothes was proposed by one of the participants. Finally, involving the village leaders to encourage women to attend the health facilities was another suggestion, as the leaders had the benefit of familiarity with the women and would therefore be trusted.
“The village authority should be involved to help mothers to go to health facility because they know them well.” (Focus Group Participant, Shirati Hospital).