Factors affecting provision of high-quality maternal and newborn healthcare in Zanzibar - A qualitative study

In Tanzania and Zanzibar, the maternal mortality ratio remains high, hence, this study explored factors affecting the provision of high-quality maternal and newborn healthcare in Zanzibar.

A qualitative research design was used, with data collected through five focus group discussions (FGDs) with healthcare providers. The discussions, held in Swahili, included midwives, nurses, and medical doctors (n = 27) working at five childbirth clinics in Zanzibar. A semi-structured FGD guide was used. All discussions were audio-recorded, transcribed, and translated into English. Content analysis was performed.

Three generic categories describe the factors affecting the provision of high-quality maternal and newborn healthcare: i) a shortage of essential resources, including medical equipment, medication, and an emergency transport system; ii) an inadequate working environment, characterized by understaffing, low salaries, limited involvement of and protection for healthcare providers, and a lack of clinical guidelines; and iii) healthcare perception and cultural dynamics encompassing mistrust of healthcare providers, as well as cultural beliefs and practices.

The study highlights critical barriers to the provision of high-quality maternal and newborn care in Zanzibar, including resource shortages, inadequate working environments, and cultural perceptions of healthcare. These findings suggest that addressing systemic challenges, such as improving resource allocation and enhancing healthcare infrastructure, is essential for advancing maternal and newborn health outcomes. Additionally, efforts to align healthcare practices with local cultural dynamics are crucial to improving service utilization. These findings underscore the need for targeted interventions to strengthen healthcare delivery and reduce maternal and newborn mortality in Zanzibar and similar settings.