Innovative Approaches to Maternal Healthcare Delivery in Guinea-Bissau: A Community-Based Participatory Research Study

Maternal healthcare access in rural Sub-Saharan Africa remains a critical challenge. Guinea-Bissau faces significant barriers, including geographical isolation, limited infrastructure, and a shortage of skilled birth attendants, which contribute to high maternal mortality. This study aimed to develop and evaluate context-specific, community-led approaches to improve maternal healthcare delivery in rural Guinea-Bissau, focusing on antenatal care uptake and skilled birth attendance. A community-based participatory research design was employed in three rural regions. Data were collected through focus group discussions with women of reproductive age, in-depth interviews with traditional birth attendants and community health workers, and participatory workshops with local leaders. Thematic analysis was used to analyse the qualitative data. Key innovations co-developed included a community-managed mobile phone system for coordinating emergency transport and a pictorial antenatal care card for low-literacy populations. A central finding was the importance of integrating traditional birth attendants into the formal referral system. Preliminary implementation in one district was associated with an increase in reported skilled birth attendance. Community-based participatory research is an effective methodology for generating locally relevant innovations in maternal healthcare. Empowering communities to co-design solutions can address specific access barriers in low-resource settings. Health policy in Guinea-Bissau should formalise the role of traditional birth attendants as community liaisons. Scaling up the piloted communication and record-keeping innovations should be prioritised, supported by investment in community health worker training. Maternal health, community participation, healthcare delivery, Guinea-Bissau, Sub-Saharan Africa, qualitative research This research provides a practical framework for community-engaged maternal health intervention design in West Africa, offering transferable models for similar low-resource settings.