Date of Award
January 2023
Document Type
Open Access Thesis
Degree Name
Master of Public Health (MPH)
Department
School of Public Health
First Advisor
Rafael R. Perez-Escamilla
Abstract
High maternal and neonatal mortality rates persist in Mozambique, with the issues of stillbirth remaining understudied. Most maternal and neonatal deaths in the country are due to preventable and treatable direct childbirth-related complications that often occur in low-resource settings. The World Health Organization (WHO) introduced the Safe Childbirth Checklist (SCC) in 2015 to reduce adverse birth outcomes. The SCC, a structured list of evidence-based practices, targets the main causes of maternal and neonatal deaths and stillbirths in healthcare facilities. Despite successful implementation in over 15 countries, the SCC has not been adopted in Mozambique. This study aimed to identify potential facilitators and barriers to SCC implementation from birth attendants’ and clinical administrators' perspectives, proposing future strategies.A qualitative study using focus group discussions (FGD) with birth attendants (n=23) and individual interviews with clinical administrators (n=6) was conducted. The Consolidated Framework for Implementation Research (CFIR) guided interview and FGD question creation and qualitative data analysis. A mixed inductive-deductive thematic analysis of Portuguese-to-English translated transcripts was performed. CFIR constructs were mapped to the High-Quality Health System Framework to synthesize findings and make recommendations. Three CFIR constructs were identified as facilitators (complexity, adaptability, and culture), while three other constructs and one emerging code were recognized as barriers (relative advantage, cost, available resources, and social recognition for birth attendants). Three CFIR constructs functioned as both facilitators and barriers (external policies and incentives, compatibility, knowledge, and beliefs about the intervention). In Mozambique, most barriers to the SCC implementation are due to the inadequacy of the health system, highlighting the need for health system strengthening and capacity building. Participants' dedication to improving childbirth practices and openness to SCC changes were identified as facilitators. To improve the feasibility of SCC implementation and increase compatibility with the current childbirth work routine for birth attendants, the SCC should also be adapted to context-specific needs.
Recommended Citation
He, Anqi, "Barriers And Facilitators For Implementing The Who Safe Childbirth Checklist In Mozambique: A Qualitative Study Using The Consolidated Framework For Implementation Research (cfir)" (2023). Public Health Theses. 2263.
https://elischolar.library.yale.edu/ysphtdl/2263

This Article is Open Access
Comments
This is an Open Access Thesis.