New study demonstrates how a participatory teamwork approach can improve childbirth experiences in rural hospitals
Cape Town, South Africa | Respectful maternity care is a cornerstone of high-quality maternal and newborn health services, yet many women report poor experiences during childbirth. These experiences can delay care-seeking and contribute to avoidable complications. A new study published in Lancet Regional Health–Africa shows that a participatory intervention strengthening teamwork and organisational culture can improve care experiences in resource-constrained settings.
The study, led by the South African Medical Research Council (SAMRC) and University of KwaZulu-Natal, evaluated the Strengthening Teamwork and Respect (STAR) intervention across nine district hospitals in KwaZulu-Natal.
The STAR intervention brought together maternity teams through facilitated learning sessions where healthcare workers reflected on their work environment and interactions with women. These sessions enabled teams to identify challenges and implement practical changes within existing resources. Surveys with postpartum women and maternity staff before and after the intervention assessed changes in care experiences and organisational learning culture within maternity units.
The study found improvements in key aspects of care, particularly in communication, autonomy, and supportive care experienced during childbirth. Importantly, the largest gains were observed among those women from poorer households and those who had attended fewer antenatal visits, who may be more vulnerable. It also improved organisational learning culture and health worker teams, indicating stronger teamwork, reflection, and systems for continuous learning within facilities.
These findings highlight that improving respectful maternity care requires more than changes in individual provider behaviour with organisational culture and systems playing a critical role. Prof Tanya Doherty, project lead and Chief Specialist Scientist at the SAMRC, said that the study provides important new insights into how a bottom-up, health worker-led process can improve respectful maternity care. “This is the first study to assess an intervention that addresses both organisational learning culture and women’s experience of care,” she said. “No midwife, nurse or doctor goes to work intending to cause harm to women in labour. However, the systems they work in can make it difficult to provide respectful, supportive care.’’
Dr Christiane Horwood, co-investigator on the study, emphasised the importance of addressing the systems in which care is delivered: “Our findings highlight how creating space for collective reflection, learning, and locally led action can strengthen both teamwork and accountability, ultimately improving women’s experiences of care,” she said.
Dr Neil Moran, Head of Obstetrics and Gynaecology for the KwaZulu-Natal Department of Health reported that “Ensuring that women are treated respectfully when they come to our health facilities to give birth is a priority for the province. For this to happen, health workers of different categories and seniority must also support each other and treat each other with respect, so that they work well as a team with a common goal to provide a positive experience for their patients. The STAR project introduced an innovative approach to improving quality of care for women by bringing together the different members of the team to reflect on how their patients might perceive the care they receive and what they could immediately do, within available resources, to make that experience better. The project put the initiative in the hands of the health worker teams on the ground, while at the same time, involving and getting buy-in from facility, district and provincial management, to provide positive reinforcement and enable successful implementation”. He continued “The results of the project provide evidence which suggests that with managerial support and encouragement, women’s experience of care during childbirth can be positively impacted by promoting teamwork and allowing front-line health professionals to identify and implement locally driven change. This in turn makes a positive impact on the organisational culture in the maternity unit, making the work experience more fulfilling for the health worker.”
The research paper can be downloaded at: https://www.thelancet.com/journals/TLRHAFRICA/article/PIIS3050-5011(26)00051-9/fulltext
Contact Information
Prof Tanya Doherty
Tanya.Doherty@mrc.ac.za