Age |
Gender |
Workplace |
Years of service |
70 |
M |
Hospital |
40 |
55 |
M |
Hospital |
30 |
38 |
F |
Hospital |
7 |
36 |
F |
Hospital |
8 |
62 |
M |
Clinic |
28 |
58 |
M |
Clinic |
20 |
65 |
M |
Health Center |
29 |
62 |
M |
Health Center |
25 |
40 |
M |
Health Center |
8 |
Table1 Characteristics of the participating physicians n=9
Mean age =54 ± 12.73 years
Years of service (mean) =21.6
Emerging topics |
Categories |
Codes |
Lack of adequate care procedures
Delays in the care processes
|
Each institution carries out procedures with the available resources
Limitations of the community model
Clinical barriers
Socio-cultural barriers
Administrative barriers |
Difficulty to comply with guidelines and manuals Processes are adapted according to existent resources Not everyone is familiar with the proceduresto treat the obstetric emergency It does not include midwives Lack of translators of Mayan The community doctor does not feel identified with the local people
Lack of good medical performance Oversaturation of services Lack of training in the management of obstetric emergencies Lack of medical decisions Bad attitude in terms of care
Communication difficulties regarding language Home-based birth care
Scarce budget Lack of transportation Lack of space for triage Lack of resources and equipment at the secondary level Lack of operative programs |
Table2 Data analytic framework
Type of strategy |
Objective |
Specific objective |
Participation
Education
Information dissemination
Infrastructure and resources |
To develop a participatory community model, includingmidwives, users, the health sector, and the education sector, focused more on prevention than on treatment
To train medical and non-medical staff 100%on obstetric emergencies at all levels
To give systematic training to
To give information on family planning after the obstetric event
To inform physicians and population of the negative impact of the medical claims on the doctor-patient relationship
To train community human resources to extend coverage
To provide peripheral clinics with infrastructure and basic resources for the management of obstetric emergencies |
To engage partners more so they are informed about family planning To empower women in terms of decision-making processes with permanent information on family planning To prevent pregnancies in women with chronic-degenerative diseases To have the university and the health sector develop an educational preconception proposal
To train physicians, psychologists, nurses, social workers, health aids, people in charge of transfer, drivers, midwives, etc. on the alarm signs of the pregnant woman with obstetric complication and the management of the obstetric complication To achieve the acceptance of a contraceptive method before hospital discharge To improve the quality of care of obstetric emergencies to reduce medical claims
To improve to access of remote communities to obstetric emergency care To reduce the risk of maternal death during the transfer of women to hospitals outside their communities |
Table3: Strategies proposed by the physicians regarding care for the pregnant woman