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Community health workers navigating maternal and newborn health delivery in rural Somalia: a qualitative study of roles, barriers, and adaptive strategies

Year: 2026

Type: preprint

Abstract: Background Community health workers (CHW) are central to expanding access to maternal and newborn health (MNH) services in low- and middle-income countries (LMIC) and fragile settings. In rural Somalia, where MNH service access is limited, the International Rescue Committee (IRC) launched a program that mobilized female CHWs to deliver MNH services at home. This study explored the experiences of CHWs delivering MNH care as part of the Community-Based Maternal and Newborn Care (CBMNC) program in rural Somalia. Methods We conducted a qualitative descriptive study in eight rural Galmudug villages. Using stratified random sampling, we interviewed eight CHWs (one per village) and two supervisors (n = 10). Saturation was achieved through iterative assessment. Data were analyzed using deductive coding based on the Theoretical Framework of Acceptability alongside inductive coding to identify emergent themes beyond the framework. Results CHWs perceived their roles as extending beyond providing technical services to include social and cultural responsibilities. While CHWs’ social embeddedness enabled trust, it also led to informal pressures such as providing diiqista ( a traditional postpartum gift) and financial support. The key challenges included long travel distances, out-of-pocket expenses related to both logistics and cultural expectations, material aid expectations, and male gatekeeping, which restricted women’s access to care. CHWs used adaptive strategies, including mobile phone follow-ups, central meeting points, and engagement with male elders, to increase program acceptability. Conclusions CHWs are essential in delivering MNH services in low-resource settings. However, CHWs' effectiveness is shaped by geographic, financial and sociocultural challenges. Structural support and gender-sensitive community engagement are necessary to ensure equitable service delivery and to inform future program development and policy integration.

Source: Research Square

DOI: 10.21203/rs.3.rs-10766904/v1