Voices from the neonatal unit: Mothers’ and healthcare workers’ perspectives on respectful and collaborative care for small and sick newborns in rural districts in KwaZulu-Natal, South Africa

Neonatal care increasingly emphasizes improving the experience of care by engaging mothers as active partners alongside health workers providing clinical care for newborns. Guided by the World Health Organization's Standards for improving the quality of care for small and sick newborns, this study focuses on Standard 4, which promotes care that is respectful, responsive, and supportive of families' needs and preferences. We conducted a concurrent triangulation mixed-methods study among health workers and mothers of small and sick newborns admitted to neonatal units in two rural districts of KwaZulu-Natal, South Africa. Effective communication emerged as a foundational factor shaping mothers' experiences of care. Many mothers reported frustration due to inadequate, unfriendly communication and exclusion from clinical decision-making, resulting in limited collaboration and lack of informed consent. Health workers, in turn, described barriers to providing respectful, family-centred care, citing overcrowding, staff shortages, fatigue, and lack of space for mothers to participate. Findings reveal persistent gaps in the implementation of Standard 4 within rural neonatal units. Strengthening communication and integrating family-centered newborn care in rural settings requires investment in health workers' communication training, facility infrastructure that enables maternal presence, and policy adaptations that promote shared caregiving and decision-making.