Midwife-led birthing centres in four countries: a case study.

Area of Science:

• Global Health
• Maternal and Child Health
• Health Systems Strengthening

Background:

• Midwives are vital for primary healthcare, particularly in improving sexual, reproductive, maternal, newborn, and adolescent health.
• Midwife-led birth centres (MLBCs) show significant potential in low- and middle-income countries (LMICs), where most maternal and newborn deaths occur.
• Existing evidence on MLBCs predominantly comes from high-income countries.

Purpose of the Study:

• To explore the factors essential for establishing and sustaining successful midwife-led birth centres (MLBCs) in four low- and middle-income countries.
• To understand the specific needs and enablers for effective MLBC implementation in diverse LMIC settings.

Main Methods:

• A descriptive case study design was utilized across four countries: Bangladesh, Pakistan, South Africa, and Uganda.
• Data were collected through key informant interviews with 77 MLBC clients and 33 health service leaders/policymakers.
• Focus group discussions with 100 midwives and MLBC staff provided additional insights, informed by an Appreciative Inquiry approach and a network of care framework.

Main Results:

• Key enablers for successful MLBCs include effective financing models and community recognition of quality midwifery care.
• Interdisciplinary and interfacility collaboration, including functional referral systems, are critical for operational success.
• Supportive and enabling leadership and governance at all levels are essential for the sustainability of MLBCs.

Conclusions:

• Findings offer significant implications for enhancing maternal and neonatal health outcomes and strengthening healthcare systems in LMICs.
• Understanding success factors can inform policy, decision-making, and the design of tailored maternal and newborn health programs.
• This research contributes to shaping international guidelines and strengthening the midwifery profession globally.