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Table 4 Ten low-cost recommendations to imporve working life for maternity healthcare workers and quality of care for women

From: Learning from the experience of maternity healthcare workers in Malawi: a qualitative study leading to ten low-cost recommendations to improve working lives and quality of care

Recommendation Evidence from the data Studies with related findings
All Staff Should….
1: …show respect towards all colleagues regardless of their educational background and gender the qualifications also play some some role in um actually weakening the teams. Because people think ahh why should I be taking knowl, i mean ideas from you, why should I be taking decisions from him? I think I’m more superior in terms of qualification. Paul, Clinical officer Chimwaza 2014 [22]
2: …express appreciation to their colleagues of all cadres if he sees that you have done something great on the patient, he says you’ve managed patients very well. He used to say that…It makes me feel happy. You feel encouraged that I should do even more than this. Fanny, Clinical officer Mathauer 2006 [28]
3: …be available to perform clinical duties as per their job role I think its being selfish yea because sometimes when they are on call let’s say during the night, you phone them, they can’t even res respond to their phones. Rachel, Nurse Midwife technician Chodzaza 2010 [20]
4: …perform systematic clinical assessments when indicated maybe you want to examine the patient thoroughly but say ah am tired. Just take out your tongue I just want to see if you are pale or not. Ah she’s fine and you continue writing something instead of doing thorough examination Fanny, Clinical officer  
5: …communicate clearly about clinical issues to each other they don’t allow to go together to see patients so they just let you to go alone. Writing your plans in the files of patients. Then they just do it what you have written so come tomorrow the same thing, nothing has happened. So you again write may be take, check a full blood count. Come tomorrow, no sample taken so that’s what happens Aubrey, Clinical officer Bhattacharyya 2015 [30]
Leaders should
6: …take a supportive approach to all education and supervision with a focus on highlighting the positives and providing constructive criticism if the management would be flat out encouraging and if in like there’s this like with performance appraisals if you have done, done a good job you get appraised, not with money, but just maybe just somebody patting you at the back’ well done’ you continue. Or ok you have done better but what if you’d do it this way next time so you’ll be much more better than this. I think that kind of comment, of spirit is lacking in the management. Victor, Clinical officer Mathauer 2006 [28]
Bradley 2009 [21]
7: …lead by example They[leaders] are not supposed to be staying in the office the whole week, the whole month without going to the ward and seeing what’s happening there. Cynthia, Nursing officer Mathauer 2006 [28]
The system should
8:…have a transparent and fair process for selection to upgrade or attend training sessions/workshops/seminars/ when it’s saying that everyone, eve every nurse should be trained, we do. But it’s when they say we need only two nurses to be trained on this, then there is also favoritisms. Alile, Nurse midwife technician Songstad 2011 [31]
Manafa 2009 [24]
Mathauer 2006 [28]
Wurie 2016 [25]
Chimwanza 2014 [22]
9: …ensure that any training offered to staff is driven by the skills and knowledge staff need and desire, rather than attendance being motivated only by the incentives I was supposed to be to train people for tubal ligation and other family planning methods. And they were booked in a hotel they said everything is being paid for what they will be given back is their transport so the same day the people said we cannot just be staying here, this is like away from home its like we are having now two houses we have to manage our home there we are here so they said not giving you are not going to give us anything it will not be possible so the training was cancelled the same day everybody goes back. Natasha, Clinical officer, incharge Manafa 2009 [24]
Mathauer 2006 [28]
10: …carry out rotations or relocations of staff according to clinical need rather than any other agenda like currently the the labour ward has no HTC[HIV testing and counselling] provider and the all the nurses all of us that are working there we are not trained in doing HIV testing and counselling…yeah so, it’s always a challenge, there are some women which we are missing yeah…it’s almost a year now…they are usually a dispersed to other departments during the time they are doing the rotation Vincent, Nursing officer, incharge