Table 2 Additional illustrative quotes for structural themes and sub-themes
From: Structural barriers to maternity care in Cameroon: a qualitative study
Theme | Sub-theme | Quote |
|---|---|---|
1. Persistent Civil Unrest | 1A. Threats to Personal Security | The common complications especially where I work is previous CS (Caesarean section) and then since such cases cannot be handled in a place where there is no theatre, so the only option is to go to the district hospital… one of the things they fear so much is that the district hospital is also close to the military camp… -Maternity provider, 44, Female |
1B. Unsafe Transportation | …and also, one of the most important things that needs to be done is to bring the current crisis in the region to an end …because there are some women who have delivered in the house not because they did not have money… but there was no way to get to the hospital -Administrator, 30, Male | |
1C. Disruption of Medical Transport System | It becomes very difficult… when they have premature labor… and you have to transport it now to the hospital and the road is not accessible…, at times you take the baby and then they resend back maybe because of the nature of the crisis -Maternity provider, 36, Female | |
2. Inadequate Health System | 2A. Lack of Maternity Care Providers | It is very strenuous and difficult because working there as a mid-wife alone, you will do everything alone because you do not have somebody that you will provide task… you do everything and if there is a labor you need to work from start to delivery -Maternity provider, 36, Female |
2B. Lack of Specialists | I was with a midwife… they can only manage to give me antibiotics until the day the doctor will come and do the work or the surgery -Previously pregnant woman, 32, Female | |
2C. Lack of Commitment to Evidence-based Practices | We could also want to encourage regular refresher courses for maternal health care providers… because at times you may have the equipment you may have the maternal (providers) but without (committed) personnel you will not be able to do it effectively -Maternity provider, 28, Male | |
2D. Critical Shortage of Medical Equipment | …when the children came out all was alive, but I see that they did not have enough machine (incubator)… to sustain my children, so they passed away… if (only) they had machines… my children might still be alive today -Previously pregnant woman, 29, Female | |
2E. Poor Communication System between Health Units | I had this woman who was referred from a health center due to severe preeclampsia… she came in unstable… and we were unable to auscultate the fetal heart rate. …out of sudden the woman just arrested, We struggle pushing to theatre while doing CPR …all efforts proved abortive, so we ended up with a maternal death… if they had called me 2 days earlier, maybe it would have been different -Maternity provider, 49, Female | |
2F. Lack of Incentives to Provide Quality Care | …because there is little budget for health care… the UNO (United Nations Organization) expect that each country should budget at least 1% of their GDP for health but I think in Cameroon, we do not even budget up to 0.5. The budget is usually so small that hardly is enough… -Administrator, 49, Male | |
2G. Inadequate Data Collection Systems / Processes | …documentation is poor because all documentation is manual, and it takes time… you can imagine, if a patient comes in to register for antenatal care when they are going to [register anew]… when they register, they are going to the laboratory you register anew, they are going to pay, you register anew [again] …everything is done anew so that takes a lot of staff time. Whereas if we had an electronic system where once a client is registered, the name is already in the system and you need to add any information, you just add -Administrator 410, age 49, Male | |
3. Insufficient Physical Infrastructure | 3A. Inadequate Facilities Lead to Logistical Challenges | …usually in very remote communities… people will prepare something in form of a ladder …a local stretcher and carry the woman on. …growing up, I witnessed a situation wherein we had this wheelbarrow. They pushed women in the wheelbarrow to the health center -Administrator, 30, Male |
3B. Power Outages | We have epileptic power supply, unstable network and if we don’t have electricity the phones will not be charged -Maternity provider, 28, Male |