abstract: 'Objectives: to explore barriers experienced by community midwives (CMWs)

  when delivering services, from their own and their managers

  perspectives, at provincial and district level in the context of

  organisational factors, and to determine other factors linked with the

  poor performance of CMWs in the delivery of maternal, neonatal and child

  health (MNCH)-related services within their communities.

  Design: qualitative study design using in-depth interviews (IDIs) and

  focus group discussions (FGDs).

  Setting: two districts in Khyber Pakhtunkhwa and Punjab provinces in

  Pakistan.

  Participants.: 41 participants were interviewed in depth; they included

  CMWs, lady health supervisors and managerial staff of the MNCH

  programme.

  Measurements: participants were interviewed about administrative issues

  including Financial and policy areas, training and deployment in the

  community, functioning in the community, and supervision and referral

  for emergency cases.

  Findings: CMWs reported financial constraints, training needs and

  difficulty with building relationships in the community. They required

  support in terms of logistics, essential supplies, and mechanisms for

  referral of complicated cases to higher-level health facilities.

  Conclusions: CMWs working in developing countries face many challenges;

  starting from their training. deployment in the field and delivery of

  services in their respective communities. Facilitating their work and

  efforts through improved programming of the CMW''s services can overcome

  these challenges.

  Implications for practice: the MNCH programme, provincial government and

  other stakeholders need to take ownership of the CMW programme and

  implement it comprehensively. Long-term adequate resource allocation is

  needed to sustain the programme so that improvements in maternal and

  child health are visible. (C) 2014 Elsevier Ltd. All rights reserved.'
affiliation: 'Ahmed, J (Corresponding Author), B-54 Liaquat Town, Tandojam, Sindh,
  Pakistan.

  Ahmed, Jamil, Hlth Serv Acad, Islamabad, Pakistan.

  Ferdoos, Amber, Int Islamic Univ Islamabad, Islamabad, Pakistan.'
author: Rehman, Shafiq Ur and Ahmed, Jamil and Bahadur, Sher and Ferdoos, Amber and
  Shahab, Muhammad and Masud, Nazish
author-email: jamil.ahmed.dr@gmail.com
author_list:
- family: Rehman
  given: Shafiq Ur
- family: Ahmed
  given: Jamil
- family: Bahadur
  given: Sher
- family: Ferdoos
  given: Amber
- family: Shahab
  given: Muhammad
- family: Masud
  given: Nazish
da: '2023-09-28'
doi: 10.1016/j.midw.2014.08.006
eissn: 1532-3099
files: []
issn: 0266-6138
journal: MIDWIFERY
keywords: Community; Midwives; Maternal; Operational; Barriers; Qualitative
keywords-plus: 'MATERNAL MORTALITY; HEALTH-CARE; INTERVENTIONS; SURVIVAL; SALARIES;

  INCOMES'
language: English
month: JAN
number: '1'
number-of-cited-references: '36'
orcid-numbers: 'Ahmed, Jamil/0000-0002-3635-7912

  Masud, Nazish/0000-0003-2366-9770

  '
pages: 177-183
papis_id: 062674cef8e888605b284e8b9da833a4
ref: Rehman2015exploringoperational
researcherid-numbers: 'Shahab, Muhammad/F-9132-2015

  Ahmed, Jamil/GLS-0443-2022

  Masud, Nazish/AAB-6988-2020

  Ahmed, Jamil/T-1426-2019

  Masud, Nazish/ISA-4746-2023'
times-cited: '7'
title: 'Exploring operational barriers encountered by community midwives when delivering
  services in two provinces of Pakistan: A qualitative study'
type: article
unique-id: WOS:000346051500025
usage-count-last-180-days: '0'
usage-count-since-2013: '13'
volume: '31'
web-of-science-categories: Nursing
year: '2015'