Planning for Maternity Waiting Home Bed Capacity: Lessons from Rural Zambia

Ann Glob Health. 2022 May 24;88(1):37. doi: 10.5334/aogh.3691. eCollection 2022.

Abstract

Background: Maternity waiting homes (MWH) allow pregnant women to stay in a residential facility close to a health center while awaiting delivery. This approach can improve health outcomes for women and children. Health planners need to consider many factors in deciding the number of beds needed for an MWH.

Objective: The objective of the study is to review experience in Zambia in planning and implementing MWHs, and consider lessons learned in determining optimal capacity.

Methods: We conducted a study of 10 newly built MWH in Zambia over 12 months. For this case study analysis, data on beds, service volume, and catchment area population were examined, including women staying at the homes, bed occupancy, and average length of stay. We analyzed bed occupancy by location and health facility catchment area size, and categorized occupancy by month from very low to very high.

Findings: Most study sites were rural, with 3 of the 10 study sites rural-remote. Four sites served small catchment areas (<9 000), 3 had medium (9 000-11 000), and 3 had large (>11 000) size populations. Annual occupancy was variable among the sites, ranging from 13% (a medium rural site) to 151% (a large rural-remote site). Occupancy higher than 100% was accommodated by repurposing the MWH postnatal beds and using extra mattresses. Most sites had between 26-69% annual occupancy, but monthly occupancy was highly variable for reasons that seem unrelated to catchment area size, rural or rural-remote location.

Conclusion: Planning for MWH capacity is difficult due to high variability. Our analysis suggests planners should try to gather actual recent monthly birth data and estimate capacity using the highest expected utilization months, anticipating that facility-based deliveries may increase with introduction of a MWH. Further research is needed to document and share data on MWH operations, including utilization statistics like number of beds, mattresses, occupancy rates and average length of stay.

Keywords: average length of stay; facility delivery; health system strengthening; maternal health; mothers’ shelters; occupancy rate.

Publication types

  • Review

MeSH terms

  • Child
  • Female
  • Health Facilities
  • Health Services Accessibility
  • Humans
  • Maternal Health Services*
  • Pregnancy
  • Rural Population
  • Zambia

Grants and funding

This program was developed and implemented in collaboration with Merck for Mothers, Merck’s 10-year, $500 million initiative to help create a world where no woman dies giving life. Merck for Mothers is known as MSD for Mothers outside the United States and Canada (MRK 1846–06500.COL). The development of this article was additionally supported in part by the Bill & Melinda Gates Foundation (OPP1130329) https://www.gatesfoundation.org/How-We-Work/Quick-Links/Grants-Database/Grants/2015/07/OPP1130329 and The ELMA Foundation (ELMA-15-F0017) http://www.elmaphilanthropies.org/the-elma-foundation/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily reflect positions or policies of Merck, the Bill & Melinda Gates Foundation, or The ELMA Foundation.