Experiences of midwives working in rural areas in Africa: a meta-aggregative review of qualitative studies on facilitators and barriers to effective healthcare delivery.

BACKGROUND: Midwives are essential providers of maternal and neonatal healthcare, particularly in sub-Saharan Africa, where they play a crucial role in managing obstetric complications and improving maternal and child health outcomes. Despite their significance, limited research has explored their lived experiences in rural healthcare settings, particularly the facilitators and barriers affecting their effectiveness. METHODS: This study employed a meta-aggregative approach guided by Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to synthesise qualitative research on midwifery in rural Africa. The main databases for the search included PubMed Central, PubMed, ScienceDirect, Ovid, and Taylor & Francis which identified eleven qualitative studies for inclusion. RESULTS: Key facilitators identified included motivation, social support, digital health innovations, access to training, and financial incentives. However, midwives face significant challenges, including psychological and emotional distress, lack of professional support, inadequate infrastructure, workforce shortages, financial constraints, and ineffective policies, which hinder their ability to provide quality maternal care. CONCLUSION: Midwives’ effectiveness in rural healthcare relies on adequate support, resources, and motivation but is limited by psychological distress, poor infrastructure, and staff shortages. Therefore, strengthening rural midwifery requires targeted policy reforms, better working conditions, investment in infrastructure and digital health, financial incentives, and stronger legal protections.