Table 3 Barriers identified in focus group and ratings from consensus meeting

Lack of access to medications (e.g., oxytocin).

9.00

0

(9 – 9)

Lack of integration of healthcare resources (e.g., medications, equipment, healthcare personnel) across the system.

8.95

0.05

(8 – 9)

Lack of healthcare/clinical data (e.g., for medication use, hospital diagnoses, complications).

8.81

0.15

(8 – 9)

Lack of ability to monitor implementation of guidelines.

8.76

0.18

(8 – 9)

Lack of ability to document and monitor current practice.

8.66

0.32

(7 – 9)

Lack of communication between professional associations and the Ministry of Health around guideline development.

8.63

0.23

(7 – 9)

Lack of integration of clinical care across the system.

8.60

0.34

(7 – 9)

Lack of accountability for guideline implementation.

8.57

0.35

(7 – 9)

Lack of communication between professional associations and the Ministry of Health around guideline dissemination and implementation.

8.43

0.35

(7 – 9)

Lack of agreement between professional associations and the Ministry of Health around data required for monitoring guideline implementation.

8.37

0.63

(6 – 9)

Lack of agreement with recommendations from guidelines.

8.32

2.42

(2 – 9)

Lack of communication across healthcare provider groups (e.g., physicians, nurses, midwives).

8.26

2.89

(2 – 9)

Lack of process for identifying local opinion leaders/champions.

8.19

0.63

(7 – 9)

Lack of continuing education/continuing professional development on guideline use and implementation (capacity building).

8.10

0.89

(5 – 9)

Lack of a process for prioritising guidelines and recommendations for implementation.

8.09

0.56

(7 – 9)

Lack of undergraduate training (for medical and midwifery students) on guideline use and implementation.

7.85

0.93

(6 – 9)

Lack of clarity about who is responsible for implementing guidelines (e.g., Ministry of Health and/or professional associations).

7.84

2.17

(5 – 9)

Lack of awareness of the protocols/recommendations from the guidelines.

7.70

5.31

(1 – 9)

Lack of awareness of the significance of the clinical problem.

7.21

3.43

(2 – 9)