Table 5.
Barriers and facilitators to pilot implementation and nurturing care
| Theme | Quote | Respondent |
|---|---|---|
| Barriers | ||
| Limited staff availability | A challenge for some colleagues is they might know the information but maybe because of time limitation, they opt not to follow maybe when they look outside and see the long queue… We also have a lack of human resource in this area… There is only one nurse for pre-natal, maternity, family planning, all this, under the hands of a single nurse. Those with a good will undertake the work, however, the work could still be deficient. If there was a way if the personnel could be increased this would be very good. | Maternal and child health district lead, MoH |
| Reluctant attitudes by some providers | We are facing some situations that the integration of ECD is not progressing the way we would have liked it to be… If the health provider receives all this information but does not embrace it and does not really bother change his/her behavior to start implementing, then this will not function. There is an “I do not care attitude” by some health providers to understand the importance of incorporating such activities as a routine part of her/his work on a daily basis. | PATH district officer #1 |
| Far distance between communities and health facility | Distance [to health facility] is a major factor that makes it difficult for caregivers to complete proper follow-up for their children’s rehabilitation process. Most of the time caregivers do not return because of the distance from the community to the health facility. | Well-child consultation provider #1, health facility #3 |
| Lack of father involvement | Many men do not allocate time, and they think that this is the role of the woman only. However, the health of the child is important for both the mother and father and they should be both concerned. I think it is ugly. I think men should help their wives to take the child to the hospital. This is beautiful. They should dedicate some time. It is not good that the woman with two children – one on her hand or pregnant, and other baby on her back – going to the hospital. The husband should help. | Mother #2, community catchment area #1 |
| Facilitators | ||
| Strong government leadership | I think that the factors that enable our work to succeed in the district are involvement of the local leadership. I am referring to huge involvement of the district directorate of health with management of the services at the health facilities levels, such as the head doctor… The involvement of the health leaders, especially the local government, can sensitize the whole community, every political and decision-makers. | PATH district officer #1 |
| New materials/job aids received through pilot | In the past, I was just suspecting, seeing a thin child and I used to say that was because of nutrition, but now no. I have materials I can use to measure the children from 3 months to 5 years to see if the child is healthy and eating well or not. | APE #1, community catchment area #2 |
| Demonstrations during provider counseling | When the provider explains while at the same time showing you what they are talking about, it is easy to learn how to replicate. This very helpful for people like us who have a lot on our mind. | Mother #1, health facility #3 |
| Peer support | We are the 3 girls in this neighborhood that talk…We talk about family planning, we remind each other of the hospital visits and what we heard at the hospital. We give one another sweet potatoes, coconuts, and flour to make porridge for our children. | Mother #2, community catchment area #1 |