Table 2.

Summary of the quality of maternal care results

Domain	Subdomain	Positive result	Negative result
Element 1: access to maternal care services under the expanded FMP (equitable and timely)	Minimised access barriers (cultural, financial, geographic)	The expanded FMP enhanced maternal care access elements (geographical, financial or utilisation of services).	However, the facilities and HCWs were bearing the brunt of the burden of increased numbers of mothers seeking LM care (workload and burnout).
			There was an altered perception among women, leading to a preference for higher-level facilities.
	Additional maternal determinants of care and the timeliness of care	The distance to the hospital was perceived as normal (okay for the patients) and the preferred choice of transport to the facility was public transport.	There was a longer waiting time for the initial visit by the pregnant women due to the enhanced ANC package of the expanded FMP.
		All the three hospitals had a proper waiting area.
		There was a positive perception about the time to seek care and the waiting time.
	Provider availability		There were problems of struggling to employ specialists and other HCWs staffing challenges.
Element 2: provision of care (safe and effective)	Functional referral system		Fewer women were being referred, but they had a better perception of services received during referral.
			The facilities’ lack of equipment, theatre, NBU and blood were the main reasons for referrals.
	Safety	Because of the policy, the facilities were managing complications better.	HCWs were reducing the time they allocate per mother.
Element 3: management and organisation	Availability of essential physical resources	The policy has improved the availability and standards of equipment and supplies.	Despite progress, some infrastructure, commodities and supplies are still a challenge to some facilities.
		The facilities had improved infrastructure due to LM.
		Enhanced facility resources and facility characteristics.
	Competent and motivated staff	Mothers have a strong positive perception of healthcare delivery characteristics by the HCWs.	There were some causes of demotivation and dissatisfaction among HCWs.
		Nurses are multitasking and handling many roles among the challenge of human resources.
		HCWs are adequately motivated to work despite the challenges.
		HCWs’ source of motivation was more than just money.
	Monitoring and continuous quality improvement	Nurses monitor the quality of care provided through partographing and charting labour progress, though they face challenges.
Element 4: experience of care	Effective communication with the patients	Mothers perceived and experienced the positive interpersonal qualities of the HCWs.	Inadequate preparation for birth by the HCWs.
		Mothers were happy to have received information about emergency/procedures and training on breastfeeding, family planning and baby care.	The lack of proper education and communication on expectations.
	Respect and dignity		Food was perceived as inadequate in some hospitals.
			Overcrowding and bed-sharing led to a lack of privacy (congestion) and a lack of essential equipment and supplies, altering the QoC.
	Emotional support		Women were experiencing physical, verbal and emotional abuse.
			Some mothers experienced a lack of attention/care, negligence,and unhygienic practices from the HCWs and support staff.

ANC, antenatal care; FMP, free maternity policy; HCWs, healthcare workers; LM, Linda Mama; NBU, newborn unit; QoC, quality of care.