A Charles Darwin University researcher is working with Timor-Leste’s Ministry of Health to better understand the factors that influence access to maternal health services in remote areas of the country.
Dr Kayli Wild, who was awarded a PhD from CDU at its recent May graduation ceremony, used maternity waiting homes as a case study to examine the factors that influenced the development of maternal health policy and the use of maternity services in Timor-Leste.
Dr Wild said that an analysis of the policy process revealed complex power relationships that favoured the role of national elites when setting the policy agenda.
“Providing equitable maternity care services for poorer women in rural and remote areas is an ongoing challenge,” she said.
“Despite strong national leadership promoting one model of maternity waiting home, these were transformed during implementation indicating ‘street level bureaucrats’ such as health managers and midwives had more control over implementation than expected.”
Drawing on the anthropology of policy in her research, Dr Wild conducted 124 interviews with policy-makers, health workers, women and families in 2006 and 2007.
She has suggested an alternative model of policy, one which framed implementation as a process of adaptation.
“This model illustrates the importance of considering women’s needs and health system capacity when developing interventions. It advocates for the participation of these ‘street level bureaucrats’ and rural women in setting a rural health policy agenda.”
Dr Wild said it was imperative that women who were having difficulties attending maternity establishments had access to transport and outreach birthing services.