User and provider perspectives on emergency obstetric care in a Tanzanian rural setting: a qualitative analysis of the three delays model in a field study.

The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problems they were facing in the context of poverty. Local health professionals were aware of the poor quality of care at health facilities but were still blaming the community. The study describes the difficulties within the conceptual framework of the widely used "three delays model" to disentangle different perspectives and to identify a feasible strategy of action to improve access to timely and effective emergency obstetric care. There seems to be a need for a supplementary analytic model that more clearly has the health system as the central agent responsible for improving maternal health. A modified "actantial model is suggested for that purpose.