Rebuilding people-centred maternal health services in post-Ebola Liberia through participatory action research

ABSTRACT

During the March 2014–January 2016 Ebola crisis in Liberia, Redemption Hospital lost 12 staff and became a holding facility for suspected cases, prompting violent hostility from the surrounding New Kru Town community, in the capital city Monrovia. Inpatient services were closed for 6 months, leaving the population without maternity care. In January 2015, Redemption reopened, but utilization was low, especially for deliveries. A key barrier was community trust in health workers which worsened during the epidemic. The New Kru Town council, Redemption Hospital, the International Rescue Committee, and Training and Research Support Centre initiated participatory action research (PAR) in July 2015 to build communication between stakeholder groups, and to identify impacts of the epidemic and shared actions to improve the system. The PAR involved pregnant women, community-based trained traditional midwives (TTMs) and traditional birth attendants (TBAs), and community leaders, as well as health workers. Qualitative data and a pre-post survey of PAR participants and community members assessed changes in relationships and maternal health services. The results indicated that Ebola worsened community-hospital relations and pre-existing weaknesses in services, but also provided an opportunity to address these when rebuilding the system through shared action. Findings suggest that PAR generated evidence and improved communication and community and health worker interaction.

KEYWORDS:

• Ebola
• maternal health
• participatory action research
• Liberia
• people-centred

Acknowledgements

This work was spearheaded by members of New Kru Town, including the pregnant women, the traditional midwives and birth attendants, and the community leaders in partnership with the Redemption Hospital obstetric and antenatal department staff and the Ministry of Health and Social Welfare's District and County Reproductive Teams. Recognition is also given to the Redemption Hospital Senior Management Team. The PAR co-facilitator team included Priscilla Grey, Rosetta Brown, Gloria Togba, Thomas Snyder, Susie Saytue, Finda Halay, Roseline Broh and Lucretia Kokoi, and the additional PAR Committee members Nelson Sekeh, Sarah Wakai, Theresa Jayenneh, Don Musepe, Susan Kihuga and Maria Freeman. Gyanu Tamang provided invaluable support in designing part of the survey and analysing the results.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Office of US Disaster Assistance grant G0294.