Learning from the experience of maternity healthcare workers in Malawi: a qualitative study leading to ten low-cost recommendations to improve working lives and quality of care

Abi Merriel, Julia Hussein, Address Malata, Arri Coomarasamy, Michael Larkin

Research output: Contribution to journalArticlepeer-review


Background: In Malawi there are too few maternity healthcare workers to enable delivery of high quality care to
women. These staff are often overworked and have low job satisfaction. Skilled maternity healthcare workers are
essential to improve outcomes for mothers and babies. This study focuses on understanding the working life
experience of maternity staff at district hospitals in Malawi with the aim of developing relevant low-cost solutions
to improve working life.
Methods: A qualitative study using semi-structured interviews was undertaken in three district hospitals around
Malawi’s Capital city. Thirty-one staff formed a convenience sample, purposively selected to cover each cadre.
Interviews were recorded, transcribed and then analysed using Interpretative Phenomenological Analysis
complemented by Template Analysis to elicit the experience of maternity staff.
Results: Staff describe a system where respect, praise and support is lacking. Many want to develop their skills,
however, there are barriers to advancement. Despite this, staff are motivated; they are passionate, committed
professionals who endeavor to treat patients well, despite having few resources. Their ‘superdiverse’ background
and experience helps them build resilience and strive to provide ‘total care’.
Conclusions: Improving working lives can improve the care women receive. However, this requires appropriate
health policy and investment of resources. There are some inter-relational aspects that can be improved with little
cost, which form the ten recommendations of this paper. These improvements in working life center around individual
staff (respecting each other, appreciating each other, being available when needed, performing systematic clinical
assessments and communicating clearly), leadership (supportive supervision and leading by example) and the system
(transparent training selection, training being need driven, clinical skills being considered in rotation of staff).
To improve working lives in this way will require commitment to change throughout the health system. Thus, it
could help address preventable maternal and newborn deaths.
Original languageEnglish
Article number336
JournalBMC pregnancy and childbirth
Issue number1
Publication statusPublished - 17 Aug 2018

Bibliographical note

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


Dive into the research topics of 'Learning from the experience of maternity healthcare workers in Malawi: a qualitative study leading to ten low-cost recommendations to improve working lives and quality of care'. Together they form a unique fingerprint.

Cite this