Assessing the impact of COVID-19 on maternity services in Malawi: preliminary findings from a rapid qualitative study

Abstract

Background: The first case of COVID-19 in Malawi was reported on 2nd April 2020. This report details accounts of the early impacts of COVID-19 on women and healthcare professionals engaged in maternity services elicted by semi-structured interviews conducted 2nd to 14th July 2020. Views from healthcare providers looking after pregnant women on the changes that have been made in health service delivery and their working environment during the pandemic. (At that point) many healthcare providers reported not having received training in COVID- 19. Lack or shortages of PPE were reported. Changes in clinic operations (split teams, cap on daily client numbers, closures in waiting homes and stoppage of post-natal check-ups) were considered to be impacting negatively on access to services. Views on future practice: PPE provision needs to improve and should be carried forward into post-COVID practice. Hygiene and social distancing measures were positive developments that would have benefit post-COVID. The quota on patient numbers at clinic should end. Post-natal check- ups should resume to prevent avoidable post-natal complications. However, some nurses noted that reducing numbers at the clinic had in some instances enabled them to work more efficiently with their patients and in a more targeted manner. Views from currently or recently pregnant women about changes that have been made in their antenatal care, birth plans and health seeking behaviours during the pandemic. View on antenatal clinics: Some women were sent home without being seen. The journey was perceived as risky and tiring. Reduced service was reported e.g. limited testing, scanning and examination. Specialist advice was hard to access. Views on birth: In some facilities labour procedures were adapted, numbers of guardians and visitors were limited, the woman:midwife ratio was affected by quarantining staff and closure of other facilities due to COVID-19 cases. Views on future care: Women were keen to see an end to the practice of sending women back from clinic – proposal that clinics should expand their opening times. More washing facilities an mandatory mask wearing was requested. There was support for the continuation of the heightened hygiene measures. Some voiced support for the continuation of patient quotas attending clinic to enable better care. Summary: COVID-19 has been very disruptive to maternity services. Capacities have been limited. Services were re-configured in ways which unsettle both care providers and users. COVID-19 prevention measures have been put in place, but not always achieved. COVID-19 has brought significant anxiety to both women and staff. Staff want more training and PPE. Women want to be seen and not to be sent home. Increased hygiene practices praised by both staff and women. Further evaluation of the impact of the Malawi Ministry of Health COVID-19 guidelines for Maternal and Newborn Health Services introduced in June 2020 is needed.

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http://eprints.gla.ac.uk/236414/