Stakeholders’ expectations and experiences of being involved with a global accreditation process for midwifery centres in LMICs: a rapid ethnography

Background

This study explored the expectations and experiences of stakeholders involved in the accreditation of midwifery centres (MCs) in low- and middle-income countries (LMICs). With increasing evidence that MCs provide safe, respectful, and evidence-based care that improves maternal and neonatal outcomes, accreditation may serve as a mechanism to bridge quality gaps in maternal health systems, particularly in regions with high maternal and neonatal mortality.

Methods

A rapid ethnographic approach, combining participant observation and semi-structured interviews, was conducted in partnership with the GoodBirth Network (GBN), which identified six pilot midwifery centres in Haiti, Uganda, and South Africa. Convenience sampling was applied, and qualitative data was thematically analyzed using NVivo software. Ethical approval was granted by City St. George’s, University of London.

Results

Findings suggest that the accreditation process fostered a culture of co-production and continuous quality improvement. Four key themes emerged: the value of accreditation, enablers and barriers of the process, and future expectations. The participatory approach was identified as a self-reflexive tool supporting an evolving culture of quality, an enabling environment and embedding the principles of continuous improvement. However, structural and cultural barriers varied across contexts, potentially influencing stakeholder engagement and implementation.

Conclusion

A participatory approach to accreditation may facilitate MC implementation, integration, and sustainability in LMICs, contributing to quality care and enabling environments for midwives. Further research is needed to explore the short- and long-term benefits of accreditation, as well as macro- and micro-level enablers and barriers to its adoption.