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    "They do not see us as one of them": a qualitative exploration of mentor mothers' working relationships with healthcare workers in rural North-Central Nigeria

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    Author
    Sam-Agudu, N.A.
    Odiachi, A.
    Bathnna, M.J.
    Date
    2018
    Journal
    Human resources for health
    Publisher
    BioMed Central
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.1186/s12960-018-0313-9
    Abstract
    BACKGROUND: In HIV programs, mentor mothers (MMs) are women living with HIV who provide peer support for other women to navigate HIV care, especially in the prevention of mother-to-child transmission of HIV (PMTCT). Nigeria has significant PMTCT program gaps, and in this resource-constrained setting, lay health workers such as MMs serve as task shifting resources for formal healthcare workers and facility-community liaisons for their clients. However, challenging work conditions including tenuous working relationships with healthcare workers can reduce MMs' impact on PMTCT outcomes. This study explores the experiences and opinions of MMs with respect to their work conditions and relationships with healthcare workers. METHODS: This study was nested in the prospective two-arm Mother Mentor (MoMent) study, which evaluated structured peer support in PMTCT. Thirty-six out of the 38 MMs who were ever engaged in the MoMent study were interviewed in seven focus group discussions, which focused on MM workload and stipends, scope of work, and relationships with healthcare workers. English and English-translated Hausa-language transcripts were manually analyzed by theme and content in a grounded theory approach. RESULTS: Both intervention and control-arm MMs reported positive and negative relationships with healthcare workers, modulated by individual healthcare worker and structural factors. Issues with facility-level scope of work, workplace hierarchy, exclusivism and stigma/discrimination from healthcare workers were discussed. MMs identified clarification, formalization, and health system integration of their roles and services as potential mitigations to tenuous relationships with healthcare workers and challenging working conditions. CONCLUSIONS: MMs function in multiple roles, as task shifting resources, lay community health workers, and peer counselors. MMs need a more formalized, well-defined niche that is fully integrated into the health system and is responsive to their needs. Additionally, the definition and formalization of MM roles have to take healthcare worker orientation, sensitization, and acceptability into consideration.
    Sponsors
    The MoMent Nigeria study was funded by the WHO through an award for the INtegrating and Scaling up PMTCT through Implementation REsearch (INSPIRE) initiative from Global Affairs Canada.
    Keyword
    Expert mother
    HIV
    Human resources for health
    Mentor mother
    Nigeria
    Peer support
    PMTCT
    Task shifting
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85055623482&doi=10.1186%2fs12960-018-0313-9&partnerID=40&md5=7f5866e0877f0040742f16af4376a021; http://hdl.handle.net/10713/9216
    ae974a485f413a2113503eed53cd6c53
    10.1186/s12960-018-0313-9
    Scopus Count
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    UMB Open Access Articles 2018

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