Study title

Bangladesh, Bangladesh, Bangladesh

Individual

Organization

Mixed Methods - Qualitative:The sampling for the focus groups and interviews was purposeful. Midwives, doctors and nurses participated in focus groups; hospital managers were recruited for interviews. Focus groups and interviews provided the opportunity to discuss feelings and perceptions about improving the quality of clinical care. They also illuminated the experience of working with the new midwives, or being deployed as a new midwife, with the different groups of health care providers. The focus groups allowed for the development of understanding on the providers’ ideas, how they interacted on the different topics and their collective understanding. Interviews were largely used for the busy hospital managers and doctors who were less likely to be willing to participate in focus groups. The topics for the focus groups and interviews were similar, but managers were more open when they could share their perceptions and feelings alone. Quantitative:Convenience sampling was used for the quantitative component of this study. The three quantitative tools included 1) a facility readiness tool, 2) a clinical observation tool, and 3) a survey. The first two sought to answer the first research question concerning improved availability and quality of maternal and newborn care and the survey explored perceptions and experiences. The facility readiness tool consisted of direct observations and service utilization data logged in register books. Facility readiness, such as availability of life saving medicines and dedicated space for newborn resuscitation, aimed to detail readiness for managing emergencies and whether the needed space and equipment were in place. Service utilization data were only collected for normal deliveries and gave a sense of how busy the facilities were and if the numbers of births were increasing more in facilities with midwives and mentoring. The intention for collecting these data was to indicate if availability and or quality were affected by the midwives’ deployment, and the influence of mentoring, through increases in service utilization. The clinical observation tool aimed to collect information on which clinical interventions were being provided and allowed for the comparison of care provided with that guided by the World Health Organization (WHO). The survey enabled understanding of health care providers’ and managers’ perceived knowledge, attitudes, and reported use of clinical behaviours as related to quality maternity care. The survey helped to answer the second research question concerning the experiences of midwives and the maternity staff (doctors and nurses) and managers that they joined.