Journal Article

Maternity waiting homes in Liberia: Results of a countrywide multi-sector scale-up

Perosky, Joseph E., Munro-Kramer, Michelle L., James, Katherine H., Kofa, Alphonso, Cole, G. Gorma, Liu, Haiyin, Cooper, Faith, Rominski, Sarah, Lori, Jody R., Coley, Katrina, Moyer, Cheryl A., Nyanplu, Aloysius

2020

Overview

Descriptions of maternity waiting homes (MWHs) as an intervention to increase facility delivery for women living in remote geographic areas dates back to the 1950s, yet there is limited information on the scale-up and sustainability of MWHs. The objective of this study was to describe the evolutionary scale-up of MWHs as a component of health system strengthening efforts and document the successes, challenges, and barriers to sustainability in Liberia. Data were collected from a national sample of 119 MWHs in Liberia established between 2010-2018. The study used a mixed method design that included focus group discussions, individual interviews, logbook reviews, and geographic information systems. Qualitative data were grouped into themes using Glaser's constant comparative method. Quantitative data were analyzed using negative binomial regression to measure the differences in the counts of monthly stays at facilities with different funding sources and presence of advisory committee. Additionally, each MWH was geo-located for purposes of geo-visualization. In the years since the original construction of five MWHs, an additional 114 MWHs were constructed in 14 of the 15 counties in Liberia. Monthly stays at facilities funded by community were 2·5 times those funded by NGOs (IRR, 2·46, 95% CI 1·33-4·54). Attributes of sustainability included strong local leadership/active community engagement and community ownership and governance. Success factors for scale-up and sustainability included strong government support through development of public policy, local and county leadership, early and sustained engagement with communities, and self-governance. A multi-pronged approach with strong community engagement is key to the scale-up and sustainability of MWHs as an intervention to increase facility delivery for women living the farthest from a healthcare facility.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Attended births / Biology and Life Sciences / Births / Community / Community involvement / Community participation / Focus groups / Geographic information systems / Health care facilities / Health care reform / Health facilities / Health sciences / Leadership / Maternal & child health / Maternal health services / Maternal mortality / Medically underserved areas / Medicine and Health Sciences / Methods / Midwifery / Nursing schools / Obstetrics / People and Places / Pregnancy / Public policy / Qualitative analysis / Regression analysis / Remote sensing / Social aspects / Studies / Sustainability / Sustainable development / Womens health