Beyond Resources: Healthcare Workers’ Experiences of Systemic and Psychosocial Barriers to Maternal and Child Emergency Care in Kilimanjaro, Tanzania

Abstract

Background: Every day, more than 700 women worldwide die from preventable causes related to pregnancy and childbirth, with over 90% occurring in low- and middle-income countries (LMICs). Similarly, a majority (>80%) of pediatric deaths in children under 14 occur in LMICs. Although emergency care in LMICs has become a greater priority in research and policy in recent years, much of the existing literature focuses on general system-wide problems rather than specific gaps in maternal, child, and neonatal emergency care. This study examined barriers to effective emergency care for maternal and child health (MCH) patients in the Kilimanjaro region of Tanzania from the healthcare worker perspective.Methods: Semi-structured focus group discussions were conducted with 111 healthcare workers delivering obstetric, neonatal, and pediatric emergency care across 10 healthcare facilities in the Kilimanjaro region. Participants included nurses, physicians, and midwives, and facilities represented primary, secondary, and tertiary levels of care. Qualitative data were analyzed using thematic analysis with both inductive and deductive coding in Dedoose software, following the Attride-Stirling framework.Results: Six main themes were identified: 1) systemic barriers (equipment shortages, staffing gaps, infrastructure limitations, legal barriers, inadequate transportation, and financial barriers); 2) treatment systems (traditional medication use, treatment refusals, limited bereavement support, and limited support for patients); 3) healthcare worker experiences (emotional toll, blame, inadequate support, and debriefing inconsistencies); 4) communication challenges; 5) education and training needs, and 6) facility-level differences.Conclusions: MCH healthcare workers navigate resource limitations, system barriers, and psychosocial burdens. Addressing these challenges will require not only infrastructural improvements but also communication training, structured debriefing protocols, and comprehensive mental health support for healthcare workers to ensure workforce sustainability and quality of care.