170 Chapter 6 (continued) Macro-level challenges Theory Context Mechanism Proximal outcome Supporting references Resource Response Increasing pressure on healthcare systems Healthcare systems are under increasing pressure to optimise resource allocation and reduce healthcare expenditures while maintaining or improving the quality of services. Maternity care organisations face challenges in recruiting and retaining sufficient numbers of professionals. MLCC emphasises personalised, relational continuity over standardisation, centralisation and efficiency. Stakeholders supporting centralisation, may view centralised models as the best way to address staff shortages, ensure access to specialised care, and manage high-risk pregnancies. Competing priorities may lead to polarisation among stakeholders, hindering collaboration. Both groups may act from the conviction that they want to provide the best possible care, but differ in beliefs and perspectives on wat constitutes the best care. 1 2 9 11 13-21 Stakeholders supporting MLCC, may view relational continuity as the best way to reduce healthcare expenditure and retain maternity staff, by reducing unnecessary interventions, increasing job satisfaction, and promoting a positive experience for women. Financial dependency In many countries, hospitals are reimbursed for each service, treatment or procedure, also called a feefor-service model. Provision of MLCC leads to a reduction of interventions, like induction of labour, assisted vaginal birth, caesarean section, and the use of analgesia. Care for uncomplicated pregnancies and childbirth are no moneymakers for hospitals, what makes it a target for hospital executives looking to cut costs. Stop the provision of MLCC, or close down an in-hospital birthing center which provides MLCC. 1 11 20 21
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