Collective coping work among healthcare providers navigating the precarities of an overburdened maternity facility in Dar es Salaam, Tanzania

Abstract

This study examines collective coping among birth attendants, managers, and pregnant women in an overburdened urban maternity facility in Dar es Salaam, Tanzania. Drawing on three months of ethnographic research (from April to July 2021), including participant observations and interviews with purposively selected participants, we explore how birth attendants navigate systemic challenges in a low-resource setting. Using thematic network analysis, we found that collective coping involved modifying care practices, reconfiguring spaces, and fostering collaboration with managers, pregnant women, and nearby health facilities. It centered on interdependence, flexible care roles, and mutual support, with teamwork and interfacility coordination crucial in emergencies. Birth attendants also relied on women to engage actively in their care. We argue that collective coping, rather than individual strategies, emerges in response to systemic constraints and cultural values of collectivism and solidarity. This study contributes to understanding clinical practice in urban maternity facilities and offers insights for contextualizing health interventions in low-resource settings.