Ginger Golub1, May Sudhinaraset2, Katie Giessler3, Kendall Dunlop-Korsness4, Allison Stone5. 1. Senior research and business development manager, Innovations for Poverty Action, Nairobi, Kenya, ggolub@poverty-action.org. 2. Assistant professor, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, USA. 3. Senior research analyst, University of California, San Francisco Institute for Global Health Sciences, San Francisco, CA, USA. 4. Senior engagement specialist, American Red Cross, Los Angeles, CA, USA. 5. Deputy country director, Innovations for Poverty Action, Nairobi, Kenya.
Abstract
CONTEXT: A growing body of evidence indicates that nonclinical health care facility staff provide support beyond their traditional roles, particularly in low- and middle-income countries. It is important to examine the role of health facility cleaners in Kenya-from their perspective-to better understand their actual and perceived responsibilities in maternity care. METHODS: In-depth, face-to-face interviews using a semistructured guide were conducted with 14 cleaners working at three public health facilities in Nairobi and Kiambu Counties, Kenya, in August and September 2016. Results were coded and categorized using a thematic content analysis approach. RESULTS: Cleaners reported performing a range of services beyond typical maintenance responsibilities, including providing emotional, informational and instrumental support to maternity patients. They described feeling disrespected when patients were untidy or experienced bleeding; however, such examples revealed cleaners' need to better understand labor and childbirth processes. Cleaners also indicated a desire for training on interpersonal skills to improve their interactions with patients. CONCLUSION: Cleaners' direct involvement in maternity patients' care is an alarming symptom of overburdened health facilities, insufficient staffing and inadequate training. This key yet overlooked cadre of health care staff deserves appropriate support and further research to understand and alleviate health system shortcomings, and to improve the quality of maternity health care provision.
CONTEXT: A growing body of evidence indicates that nonclinical health care facility staff provide support beyond their traditional roles, particularly in low- and middle-income countries. It is important to examine the role of health facility cleaners in Kenya-from their perspective-to better understand their actual and perceived responsibilities in maternity care. METHODS: In-depth, face-to-face interviews using a semistructured guide were conducted with 14 cleaners working at three public health facilities in Nairobi and Kiambu Counties, Kenya, in August and September 2016. Results were coded and categorized using a thematic content analysis approach. RESULTS: Cleaners reported performing a range of services beyond typical maintenance responsibilities, including providing emotional, informational and instrumental support to maternity patients. They described feeling disrespected when patients were untidy or experienced bleeding; however, such examples revealed cleaners' need to better understand labor and childbirth processes. Cleaners also indicated a desire for training on interpersonal skills to improve their interactions with patients. CONCLUSION: Cleaners' direct involvement in maternity patients' care is an alarming symptom of overburdened health facilities, insufficient staffing and inadequate training. This key yet overlooked cadre of health care staff deserves appropriate support and further research to understand and alleviate health system shortcomings, and to improve the quality of maternity health care provision.
Authors: Patience A Afulani; Laura Buback; Ann Marie Kelly; Leah Kirumbi; Craig R Cohen; Audrey Lyndon Journal: Reprod Health Date: 2020-06-03 Impact factor: 3.223