Barriers to high-quality primary reproductive health services in an urban area of Iran: views of public health providers

Sakineh Mohammad-Alizadeh C, Rolf Wahlström, Rezagoli Vahidi, Alireza Nikniaz, Lena Marions, Annika Johansson
Midwifery 2009, 25 (6): 721-30

OBJECTIVE: to explore public primary reproductive health providers' views on their own roles and tasks in their present organisation, and the perceived barriers to providing high-quality services.

DESIGN: a qualitative approach using semi-structured, audio-taped focus group discussions (FGDs). The discussions were held in Farsi or Turkish, transcribed verbatim, translated into English and analysed using content analysis.

SETTING: family health units of public health facilities, Tabriz, Iran.

PARTICIPANTS: two FGDs with 12 midwives and two FGDs with eight other family health providers working at the facilities.

FINDINGS: the providers identified the most satisfying part of their duties as working with clients. A dominant theme in all FGDs was the providers' frustration about a number of factors, most of which were beyond their control. The identified system and organisational barriers were grouped into five categories: multiplicity of tasks and incompatibility with the providers' own basic training; suboptimal supervision and management; too little time for clients; lack of privacy and appropriate materials for education and counselling; and inadequate opportunities for continuing education.

KEY CONCLUSIONS: this study highlighted the providers' satisfaction in working with clients, and their dissatisfaction with not being used to the best of their capabilities due to a number of systemic and organisational barriers.

IMPLICATIONS FOR PRACTICE: based on these findings, multifaceted interventions seem to be necessary to improve staff productivity and service quality. The interventions should include needs-based pre-service education, supportive supervision and management, provision of educational materials, simplifying record management, and appointing more staff in socio-economically deprived areas. Research is needed to identify the best way to integrate the services, as well as basic and continuing educational needs of staff.

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