Skip to main content

Table 3 Barriers and enablers to implementation of MWHs analysed using the SURE framework

From: Understanding the implementation of maternity waiting homes in low- and middle-income countries: a qualitative thematic synthesis

Level Barriers Article Enablers Article
Main Stakeholders from the Community-women & families Knowledge and Skills
Lack of knowledge of MWH - Mramba et al. 2010
- Ruiz et al. 2013
- Shrestha et al. 2007
Awareness of MWHs and services offered through community outreach and mobilization is high among women - Garcia Prado et al. 2012
- Gaym et al. 2012
- Kelly et al. 2010
- Poovan et al. 1990
- Schooley et al. 2009
- Wild et al. 2012
Women do not remember the date of their last period, so unsure about expected due date-point of entry into MWH and duration of stay uncertain and may be prolonged - Eckermann et al. 2008
- Spaans et al. 1998
  
Attitudes regarding programme acceptability, appropriateness and credibility
Traditional childbirth practices not accommodated - Eckermann et al. 2008
- Ruiz et al. 2013
Integration of cultural norms and expectations into the care provided at the MWH and associated health facility - Fraser 2008
- Lori et al. 2013b
- Ruiz et al. 2013
- Schooley et al. 2009
Family members (husbands and mothers in law) don’t allow women to use MWHs and no one left at home to do household chores or provide child care - Mramba et al. 2010
- Garcia Prado et al. 2012
- Lori et al. 2013b
- Ruiz et al. 2013
- Nhindiri et al. 1996
High awareness of benefits and acceptability of MWHs and facility birth among family and community members. Family and community actively involved through educational outreach and involved in decision-making. - Garcia Prado et al. 2012
- Gaym et al. 2012
- Kelly et al. 2010
- Lori et al. 2013a
- Ruiz et al. 2013
- Schooley et al. 2009
- Wild et al. 2012
   High acceptability of facility births and use of MWHs among women - Gaym et al. 2012
- Kelly et al. 2010
Health workers and users of MWH have different ethnicities which result in communication problems - Ruiz et al. 2013   
Companion not allowed or unable to accompany - Eckermann et al. 2008
- Gaym et al. 2012
- Ruiz et al. 2013
- Schooley et al. 2009
- Wild et al. 2012
  
Healthcare Providers Involved in Implementing MWH Knowledge and Skills
Without access to technologies, not possible for health workers to predict date of delivery so duration of stay is uncertain and prolonged stay at MWH might occur - Eckermann et al. 2008   
Attitudes regarding programme acceptability, appropriateness and credibility
Health workers and users of MWH have different ethnicities which result in communication problems - Ruiz et al. 2013   
Other Stakeholders Knowledge and Skills
   Training TBAs and integrating TBAs into the birthing process helped encourage women to use MWHs and deliver in facilities - Andemichael et al. 2009
- Lori et al. 2013a
- Lori et al. 2013b
- Poovan et al. 1990
- Schooley et al. 2009
Health Service Delivery Factors Accessibility of care
Geographical
- MWH is too far
- Schooley et al. 2009
- Shrestha et al. 2007
MWH located close to the hospital - Nhindiri et al. 1996
Cost
- MWH users incur costs for travel
- MWH users incur costs of staying at facility
- MWH use leads to costs of subsequent delivery in health facility
- Eckermann et al. 2008
- Garcia Prado et al. 2012
- Gaym et al. 2012
- Ruiz et al. 2013
- Schooley et al. 2009
- Spaans et al. 1998
- Wessel et al. 1990
- Wilson et al. 1997
Removal/reduction of costs associated with using the MWH and/or subsequent institutional delivery - Kelly et al. 2010
- Ruiz et al. 2013
- Spaans et al. 1998
- Wessel 1990
Health Service Delivery Factors Training
No regular visits by health workers or link to obstetric care are insufficient and unclear - Wilson et al. 1997
- Mramba et al. 2010
- Gaym et al. 2012
Daily visits to the MWH by midwives - Poovan et al. 1990
   Intensive training of health providers in MWH and facilities to provide good quality of care - Fraser 2008
- Gorry 2011
Communication
No clear communication of what to expect at the MWH while at the MWH - Mramba et al. 2010   
Health workers attitudes are not good - Garcia Prado et al. 2012
- Lori et al. 2013b
- Wilson et al. 1997
  
Information Systems
No registration and linkage of MWH records with health information system - Danel et al. 2003   
   Strong referral and communication systems between MWH and associated facilities, including transportation and communication equipment - Chandramohan et al. 1995
- Gaym et al. 2012
- van Lonkhuij-zen et al. 2003
Facilities
- Lack of privacy in MWH
- No space for relatives or companions to stay
- Poor toilet and bathing facilities
- Kitchen facilities are poor or inadequate
- Food not provided leading to differential access to food for MWH users. Women had to travel back to their homes to replenish supplies
- A lack of space for postpartum women
- Eckermann et al. 2008
- Gaym et al. 2012
- Kelly et al. 2010
- Lori et al. 2013b
- Mramba et al. 2010
- Nhindiri et al. 1996
- Ruiz et al. 2013- Schooley et al. 2009
- Shrestha et al. 2007
- Wild et al. 2012
- Wilson et al. 1997
MWH provides and maintains all needed facilities, including basic infrastructure such as electricity, kitchen/food facilities, and bathing and toilets. MWH also provided a space for companions and family members to stay with the pregnant woman. - Lori et al. 2013a
- Mramba et al. 2010
- Nhindiri et al. 1996
- Ruiz et al. 2013
Useful activities to occupy women’s time and provide knowledge and skills are not organised or insufficient (for example: entertainment, income generation skills, health education) - Eckermann et al. 2008
- Ruiz et al. 2013
- Mramba et al. 2012
- Lori et al. 2013b
Activities to occupy women’s time, including education and income generation activities, helped improve acceptability and use of MWH among women - Gorry 2011
- Ruiz et al. 2013
- Tumwine et al. 1996
- Wessel 1990
Intervention integrity
   Comprehensive provision of good quality care, across the continuum of care, in both the MWH and health facilities associated with the MWH - Gorry 2011
- Poovan et al. 1990
- Schooley et al. 2009
- Tumwine et al. 1996
Social and Political Factors Legislation or regulations
   Enabling policy environment, which included inclusion of supportive MWH policies in national and/or local legislation - Fraser 2008
- Gorry 2011
- Lori et al. 2013b
- Millard et al. 1991
Sustainability
Lack of community involvement in MWH set up, support and maintenance - Poovan et al. 1990
- Kelly et al. 2010
- Lori et al. 2013a
- Ruiz et al. 2013
- Shrestha et al. 2007
- Wilson et al. 1997
Involve community members and family in the design, development, and maintenance of the MWH - Lori et al. 2013b
- Poovan et al. 1990
- Schooley et al. 2009
   - MWH and facilities are able to adapt to changing health needs of women. For example, in Cuba, an economic crisis meant needing to focus and integrate nutrition improvement for pregnant women in the MWH - Gorry 2011
  1. Articles that are highlighted in bold are those that were included in the systematic review of effectiveness of MWHs