scholarly journals Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252182
Author(s):  
Mamothena Carol Mothupi ◽  
Jeroen De Man ◽  
Hanani Tabana ◽  
Lucia Knight
Keyword(s):  
South Africa ◽  
Maternal Health ◽  
Service Delivery ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Composite Index ◽  
Health Service Delivery ◽  
Continuum Of Care ◽  
Determinants Of Health ◽  
The Continuum

Introduction The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use. Materials and methods The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013–2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

scholarly journals Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa

2020 ◽  
Author(s):  
Mamothena Carol Mothupi ◽  
Jeroen De Man ◽  
Hanani Tabana ◽  
Lucia Knight
Keyword(s):  
South Africa ◽  
Maternal Health ◽  
Service Delivery ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Composite Index ◽  
Health Service Delivery ◽  
Continuum Of Care ◽  
Determinants Of Health ◽  
The Continuum

Abstract Introduction: The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in South Africa. Materials and Methods: The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index. Results: The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs=-0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r=0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health. Conclusions: This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.

scholarly journals Dynamics of Health Among Adults in South Africa

2020 ◽  
Author(s):  
Usengimana Shadrack Mutembereza
Keyword(s):  
South Africa ◽  
Social Determinants Of Health ◽  
Health Inequality ◽  
Social Determinants ◽  
National Income ◽  
Determinants Of Health ◽  
Health Campaigns ◽  
Health Selection ◽  
Policy Makers ◽  
The Poor

Abstract BackgroundThis paper estimates trend of health mobility in South Africa using National Income Dynamic Study (NIDS) and investigate whether the patterns of health mobility differs within socioeconomic groups created by income and gender. Health is measured by SRHS, which correlates with mortality and morbidity; thus, it is the best measure of health. MethodsUsing five waves of NIDS and various econometric models, this research estimates health mobility in the period between 2007 and 2017. This study will use transition matrix as descriptive analysis of health mobility and Conditional Maximum Likelihood Estimations to analyse health mobility, trend of health mobility and relationship between health mobility and health inequality within NIDS. ResultsThe study shows that, among poor males, health mobility neither follows a health selection or health constraint mobility trend; the high health mobility with ambiguous trends has not decreased health inequality. Among the poor females, a negative health mobility trend is observed; this research also found that health inequality has not creased. Among the non-poor males, it is found that health mobility follows a gradient constraint trend which has decreased health inequality. Among non-poor females, it is found that health mobility follows a health selection trend which has not decreased health inequality. The results suggest that policy makers should target both social determinants of health and health campaigns to deal with health inequality among the poor males. ConclusionsThe trend of health mobility among poor females suggest that policy makers should target the social determinants of health to combat health inequality. The trend of health mobility among the non-poor males suggests that health mobility will eliminate health inequality. Lastly, the trend of health mobility suggests that policymakers should target health campaigns to deal with health inequality.

scholarly journals Social Determinants of Health Composite Index

2018 ◽  
Vol 18 (s2) ◽  
pp. 230
Author(s):  
Eran Simhon ◽  
Michael Prokle ◽  
Amir Abdolahi ◽  
Cecilia Meijer ◽  
Reza Sharifi Sedeh
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Composite Index ◽  
Determinants Of Health

scholarly journals Social Determinants of Maternal Health in Afghanistan: A Review

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Said Ahmad Maisam Najafizada ◽  
Ivy Lynn Bourgeault ◽  
Ronald Labonté
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Local Economy ◽  
Determinants Of Health ◽  
Social Infrastructure ◽  
The Impact

Introduction: Afghanistan has a high maternal mortality rate of 400 per 100,000 live births. Although direct causes of maternal morbidity and mortality in Afghanistan include hemorrhage, obstructed labor, infection, high blood pressure, and unsafe abortion, the high burden of diseases responsible for maternal mortality arises in large part due to social determinants of health. The focus of this literature review is to examine the impact of various social determinants of health on maternal health in Afghanistan, filling an important gap in the existing literature.Methods: This narrative review was conducted using Arksey and O’Malley’s framework of (1) defining the question, (2) searching the literature, (3) assessing the studies, (4) synthesizing selected evidence in context, and (5) summarizing potential programmatic implication of the context. We searched Medline, CABI global health database, and Google Scholar for relevant publications. Results: A total of 38 articles/reports were included in this review. We found that social determinants such as maternal education, sociocultural practices, and social infrastructure have a significant impact on maternal health. Health care may be the immediate determinant, but it is influenced by other determinants that must be addressed in order to alleviate the burden on health care, as well as to achieve long-term reduction in maternal mortality. Conclusion: Because of the importance of social factors for maternal health outcomes, committed involvement of multiple government sectors (i.e. education, labor and social affairs, information and culture, transport and rural development among others, alongside health care) is the long-term solution to the maternal health problems in Afghanistan. National and international organizations’ long-term commitment to social investment such as education, local economy, cultural change, and social infrastructure is recommended for Afghanstan and globally.

Indicators and gaps for monitoring service provision along the continuum of care for maternal health in South Africa

2020 ◽  
Author(s):  
Mamothena Mothupi ◽  
Lucia Knight ◽  
Hanani Tabana
Keyword(s):  
South Africa ◽  
Quality Of Care ◽  
Maternal Health ◽  
Health System ◽  
Service Provision ◽  
Continuum Of Care ◽  
Care Utilization ◽  
District Health ◽  
The Continuum

Abstract Objective This study assesses indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the emerging construct of adequacy of the continuum of care to assess multi-dimensionality of available indicators. Using adequacy and the process of assessment in the study, the comprehensiveness of the continuum of care for improving maternal health outcomes can be assessed. Results We found indicators along the adequacy dimensions of care utilization and access, linkages of care, and quality of care in the routine district health information system. The General Household Survey contained indicators for the social determinants of health on the continuum of care framework. Indicator gaps include health promotion during and after pregnancy, maternal nutrition, empowerment and quality of care. At present, the available indicators measure about 74% of the interventions on the continuum of care framework. We make recommendations regarding improvements needed to better measure and monitor the continuum of care for maternal health. These involve actions within the health system and include integration of non-health system indicators.

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