Unlocking the path to quality maternity care: a qualitative study on work environment dynamics, providers' responsiveness, and professionalism in central region, Malawi.

Background: Responsiveness and professionalism are essential components of high-quality maternity care. Responsiveness involves effective communication, respectful interactions, and consideration of the emotional, physical, and cultural needs of women, while professionalism encompasses clinical competence, ethical adherence, and respectful engagement with patients and colleagues. However, various workplace factors, including managerial structures, resource constraints, and institutional culture, influence the extent to which maternity care providers uphold these principles. This study aims to explore how organizational culture, management styles, and resource availability influence responsiveness and professionalism in Malawian maternity care settings, with the goal of identifying strategies to enhance provider motivation and improve maternal healthcare delivery.

Methods: A qualitative study was conducted in two maternity care units in Malawi. Data were collected using Twelve semi-structured interviews, two focus group discussions and sixteen observations with maternity care providers in one faith-based hospital and one government-owned hospital, sampled purposively. Transcripts were imported into NVIVO 14 software, and a reflexive thematic analysis was conducted.

Findings: The study found that limited physical space, resource shortages, and heavy workloads constrained providers' ability to deliver responsive care. Rigid managerial structures, lack of professional recognition, and restricted autonomy contributed to low morale and reluctance to take initiative. Hierarchical power dynamics and inadequate institutional support further discouraged collaboration and accountability. Despite these challenges, providers highlighted the importance of teamwork, mutual support, and a positive work environment in fostering professionalism and responsiveness. Unpredictable work schedules and poor work-life balance also emerged as key concerns, impacting provider well-being and engagement.

Conclusion: The study provides insights into the complex interplay of systemic, managerial, and interpersonal factors affecting responsiveness and professionalism in maternity care. Addressing these challenges requires targeted interventions that can strengthen resource allocation, supportive leadership, and policies that promote provider well-being and motivation which can in turn enhance maternal and newborn outcomes.