Providers’ Perceived Benefits and Implementation Challenges of Midwife-Led Continuity of Care at Primary Health Facilities in Rivers State, Nigeria

Vollständiger Abstract

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Midwife-led continuity of care (MLCC) is globally recognized for improving maternal and neonatal health outcomes through continuous and personalized care. This study examined the perceived benefits and implementation challenges of MLCC among healthcare providers in selected health facilities in Rivers State, Nigeria. A parallel convergent mixed-methods design was employed. The study was conducted in four primary healthcare centres: Orogbum, Ozuoba, Aluu, and Omoku. For the qualitative component, 16 key healthcare providers were purposively selected until data saturation was reached. For the quantitative component, a census of 22 midwives participated in the study. A structured interview guide was used for face-to-face qualitative interviews, while a structured self-administered questionnaire was used for the quantitative data collection. Qualitative data were analysed thematically using NVivo, while quantitative data were analysed using descriptive statistics with SPSS version 25. Results from the qualitative phase revealed three emerging themes on the benefits of MLCC, which included relational continuity, improved maternal outcomes, and perceived transformative potential. It indicated that MLCC improves trust, enhances therapeutic relationships, promotes early detection of complications, and strengthens decision-making in maternity care. Conversely, four emerging themes were identified regarding implementation challenges, namely human resource constraints, organisational and infrastructural barriers, geographical inequities, and capacity-building gaps. It demonstrated that implementation was hindered by inadequate staffing, high workload, insufficient funding, weak policy support, poor collaboration, and infrastructural constraints. Quantitative findings revealed that midwives generally agreed that insufficient funding, high workload, inadequate collaboration, lack of clear policies, poor infrastructure, and inadequate training were major barriers to MLCC implementation. In conclusion, MLCC is perceived as beneficial but remains poorly implemented due to systemic health system challenges. It is recommended that health authorities strengthen staffing levels, improve funding, enhance training, and develop clear policy frameworks to support sustainable implementation of MLCC in primary healthcare settings.