The preliminary findings of the maternity waiting home evaluation in Mozambique moved local stakeholders, spurring reflection and desire to drive change.

by Nazeem Muhajarine

February and March always prove to be eventful months for the Mozambique-Canada Maternal Health Project. This year was no different. Just like last year, Nazeem Muhajarine, the project’s principal investigator, and Nadege Sandrine Uwamahoro, the MWH realist research coordinator, were back in Inhambane, diving into the heart of the activities there. With most of the project activities scheduled to wrap up by March 31st, Nadege aimed to conclude data collection and to discuss preliminary findings with the working group.

Maternity Waiting Home Realist Evaluation Workshop attendees. Inhambane city, March 2024

Local stakeholder involvement in the evaluation was valued from the beginning and we made it happen through the establishment of a working group. It is bringing together staff representatives from each of the six health facilities in the evaluation, community support workers, and representatives from the Inhambane Provincial Health Directorate (DPSI). Working group members were familiarized with the methodology used, and we involved them actively in all stages of the evaluation process, including study design, participant recruitment, community access strategies, and in reflection and interpretation of preliminary findings.

Nadege facilitated a four-day workshop attended by working group members, project team members and data collectors. Characterized by a high level of engagement, the workshop provided adequate time for participants to reflect on and discuss collected evidence regarding each of the nine themes covered by the evaluation.

The evidence discussed was collected from women who used the MWHs, women who did not use the MWHs, male partners and mothers or mothers-in-law of both users and none-users, and some community leaders. During the workshop, working group members had a unique opportunity to gain insight into community perspectives regarding the quality of care provided by the MWHs and health facilities.

Particularly noteworthy were the interview excerpts shared about poor provider communication, attitudes, and neglect faced by MWH users, which prompted introspection and candid discussions about underlying individual and systemic causes as well as barriers to change.

Data collectors played a crucial role in bringing the evidence to life by sharing their field experiences and impressions. The reflections and discussions among participants not only enriched the evaluation process but also instilled a sense of agency among working group members to drive change in their respective health facilities. The workshop culminated in the formulation of actionable recommendations, which were later compiled into a comprehensive report.

Working group members identified their lack of decision-making power as a barrier to driving change, prompting them to stress the need to share the preliminary findings with the top leadership within DPSI and district health directors. With the support of the project team, a full-day workshop was organized to present and discuss preliminary findings, along with working group recommendations, with district health directors and select DPSI leaders. The second workshop also saw a high level of engagement and revealed additional insights into the systemic issues contributing to the poor quality of care and low utilization of MWHs in Inhambane.

The insights gathered from these workshops form part of the evidence base for the evaluation, which has moved to final analysis phase. Meanwhile, back in Denmark, Nadege is collaborating on the analysis with two realist researchers, Antoinette Davey, and Ola Abdelfatah. The team takes every opportunity to disseminate research findings and drive impact. That’s why we were thrilled to accept an invitation to present our preliminary findings at the Second Open Research Day organized by the DPSI in Inhambane on April 19th.