The Potential Impact of the We Care Solar Suitcase on the Quality of Care Health Workers Deliver in The Gambia

Abstract

Background: In The Gambia, a woman has a 1/24 lifetime chance of dying during childbirth and there are approximately 706 deaths per every 100,000 births, one of the highest rates of maternal mortality in the world. These high rates of maternal mortality are due to a series of factors including a delay in reaching a health facility. A low quality of care provided at a facility during an institutional delivery can contribute to these high rates as well. A factor in low quality of care is having inadequate resources, such as electricity, in health facilities. More specifically, not having a reliable source of light might impact the quality of care that health workers are able to provide during the night. Along with the greater structural issues and correlations between energy access and wellbeing, energy poverty can have an impact on health facilities and perpetuate poor health outcomes.The We Care Solar Suitcase strives to bridge this gap by providing a reliable source of light in labor wards of health facilities, with the aim of decreasing maternal and infant mortality. This study was conducted in The Gambia, one of the countries where We Care Solar has deployed Solar Suitcases. The study had three aims: 1) to assess the user experience of the We Care Solar Suitcase and its impact on the quality of care delivered by midwives, nurses and traditional birth attendants; 2) to explore the perceived impact of the We Care Solar Suitcase on infant and maternal mortality in rural communities through qualitative methods; and 3) to explore the continuing barriers to providing high quality care that health workers face in The Gambia face during institutional and facility level deliveries. Methods: In depth interviews, focus group discussions and unstructured observations were used as qualitative data collection methods. Participant groups were health workers (including community health workers, nurses and midwives), women who had given birth, key informants and traditional birth attendants. 28 in depth interviews with health workers, 9 in depth interviews with key informants, 2 focus group discussions with women who had given birth, and 1 focus group discussion with traditional birth attendants occurred. The interviews and focus group discussions with health workers sought to gain insight into the quality of care health workers felt they could deliver to women as they were laboring and delivering in the middle of the night with the addition of the Solar Suitcase in their facility. Observations, which occurred at 8 facilties, sought to gain insight into what birth looks like with the light of the Solar Suitcase. At the end of the study period, all data was transcribed. Close reading of the transcripts occurred, followed by memoing, the iterative creation of a codebook, coding and thematic analysis in NVivo 12. Results: Health workers felt that they were able to provide a higher quality of care to women when they are in labor or giving birth with a reliable source of light. The Solar Suitcase was seen to be a mechanism of providing a reliable source of light. Health workers felt they could deliver higher quality of care by having 1) Increases sanitation in facilities; 2) Ability to manage complications more easily; 3) Less referrals to other health centers and 4) Self efficacy and autonomy in their work. In addition, the suitcase was seen as being a motivating factor for women to deliver at a health facility. Continuing barriers to care still exist in facility-level births in The Gambia, but the Solar Suitcase addresses the issue of lack of light. Conclusion: While energy access continues to be a challenge in low resource settings, innovations such as the We Care Solar Suitcase help in bridging the gap between larger infrastructural development and barriers to providing care and therefore facilitate a higher quality of care in institutional deliveries.