Development of Woman-Centred Midwife-led Model of Care through Participatory Methods for the Uasin Gishu County Hospital, Kenya

ABSTRACT Background: The concept woman-centred care is gaining currency in maternity care and is increasingly being used to guide provision of quality care. The midwifery philosophy supports woman-centred care and is associated with positive pregnancy and birth outcomes. Development of a woman-centred midwife-led model of care requires involvement of the users (women), service providers (midwives), and health administrators to ensure representativeness of the model. Purpose: The purpose of this study was to explore, through participatory methods, the views of women midwives and health service managers on current maternity care, and describe desired maternity care and develop a woman-centred maternity care model for Uasin Gishu County, Kenya. Methodology: Appreciative Inquiry 4-D cycle was used in the study. The Human Scale Development framework guided the study. Thirty two midwives, 85 women attending maternity and well-baby services at the facility, and four facility and three county health service managers participated in the study. Focus group discussions and interviews were carried out from May 2015 to April 2016 using the four phases of the Appreciative Inquiry cycle. Phase one “discovered” what best maternity care looks like, phase two “dreamt” what best maternity care would look like, phase three “designed” the model, and phase four “destiny” was used for development of implementation strategies. Data was analysed using thematic analysis augmented by thematic networks analysis and NVIVO 11 software. Ethical approval was obtained from the University of Cape Town and the Moi University and Moi Teaching and Referral Hospital Research Ethics Committees. Individual’s participation was voluntary, informed consent was obtained and confidentiality maintained. There was no compensation for participation. IV Findings: After the first three cycles of Appreciative Inquiry, analysis culminated in the design of the UPENDO-S wheel – an acronym for: User-friendliness, Person-focused care, Excellence in evidence based care, Networking, Dedicated supported midwives, Organization of care and Supportive leadership. UPENDO is a Swahili word for love. Phase four of the study resulted in development of strategies for implementation of the model. Recommendations and Conclusions: The UPENDO-S Wheel provides a novel approach to delivery of maternity care in Uasin Gishu County Hospital and contributes to existing body of knowledge in Midwifery for Kenya a low-middle income country.