African Journal of Public Health and Health Systems | 13 October 2016
A Theoretical Framework for Evaluating Midwife-Led Maternity Waiting Homes and Skilled Birth Attendance in Rural Oromia, 2016
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Abstract
Geographical and financial barriers in rural Ethiopia limit access to skilled birth attendance, contributing to high maternal mortality. While maternity waiting homes are a strategy to improve access, evidence on their effectiveness is variable. This article develops a theoretical framework to evaluate midwife-led maternity waiting homes in remote Oromia. The purpose is to construct a theoretical framework for evaluating the impact of midwife-led maternity waiting homes on skilled birth attendance rates in rural Oromia. The objective is to define and interrelate the key constructs required for a comprehensive assessment of the intervention. The framework was developed through a synthesis of established health behaviour and service utilisation theories, notably Andersen’s Behavioural Model of Health Services Use. Core concepts were adapted and structured to fit the specific context of the intervention and the rural Ethiopian setting. Key insights: As a theoretical article, it presents no empirical results. The central insight is the proposition that integrating a resident midwife into the maternity waiting home model is a critical mediating variable. The framework posits this integration influences utilisation by enhancing perceived service quality and trust, which may substantially increase skilled birth attendance. The proposed framework offers a structured, context-specific lens for investigating the relationship between midwife-led maternity waiting homes and skilled birth attendance. It delineates testable pathways and underscores the midwife’s role beyond providing accommodation. Researchers should apply this framework to design rigorous, mixed-methods evaluations of comparable interventions. Programme planners should consider its constructs—particularly enabling and need factors—when designing maternity waiting home services to maximise impact. maternity waiting homes, skilled birth attendance, theoretical framework, midwifery, maternal health, rural health services, Ethiopia This article contributes a novel theoretical framework that explicitly integrates the role of the midwife into the evaluation of maternity waiting homes, providing a structured basis for future empirical research and programme design in similar settings.