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.

scholarly journals Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

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

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the 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 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 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.

scholarly journals Review of health and non-health sector indicators for monitoring service provision along the continuum of care for maternal health

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

Abstract Objective : This study uses health and non-health sector data sources to select and assess available indicators for service provision along the continuum of care for maternal health at subnational levels in South Africa. It applies the adequacy approach established in another study to assess the 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 27 indicators of care utilization and access, linkages of care, and quality of care from the routine district health information system. The General Household Survey contained 11 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.

scholarly journals Assessing Contact, Coverage, and Quality of continuum of care in Uttar Pradesh, India

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Gupta ◽  
K S ◽  
K Yonzon ◽  
P Kumar ◽  
V Choudhry
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Neonatal Mortality ◽  
Service Provision ◽  
Clinical Care ◽  
Uttar Pradesh ◽  
Continuum Of Care ◽  
Multilevel Regression ◽  
The Continuum

Abstract Background Given the high neonatal mortality in LMIC, strategies suggest a continuum of care (COC) as an effective framework to ensure timely and appropriate service provision throughout the MNCH continuum. However, the measurement approaches traditionally focus on assessing continuum of care from the lenses of time-based coverage and missing out on the quality of coverage and service delivery. This paper aims to assess the continuum of care based on these three parameters and the factors affecting its achievement. Methods Multistage sampling design identified live births and stillbirths in the last calendar year (March 2018-February 2019) across the 50 districts of Uttar Pradesh(n = 16646).COC was assessed on three measurements 1) Contact: Any contact with the health system across the continuum, 2)Coverage: Adequate contacts of the health system through outreach services and clinical care, and 3)Quality: receiving adequate services along with these contacts. Further, a multilevel regression model was used to estimate the factors associated with the continuum of care. Results 64% (60.04-67.65) of the women and child received health system contact across the continuum while only 2.1% (1.57-2.78) and 2.8% (2.33-3.44) women and children achieved coverage and quality based COC, respectively. Achievement of COC coverage and COC quality is highly affected by the service delivery platform, with women at outreach platform being more likely to achieve adequate coverage while women at facilities are more likely to achieve quality services across ANC, delivery, and PNC. Conclusions Achievement of both coverage and quality based COC remains low in Uttar Pradesh, India. Even those who achieve contact(s) failed to receive quality services along with these contacts with health systems. Efforts should be focused on building quality service at the outreach and non-outreach platforms across the continuum of care for reducing the risk of neonatal mortality. Key messages Owing to the lack of an integrated approach for service delivery across outreach, clinical care and community care, continuum of care remains broken for most of the mothers and children. For targeting coverage and quality of COC, focus should be on improving the quality of service provision across the outreach platforms which are already in reach of the women.

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 The perceptions of nurses in a district health system in KwaZulu-Natal of their supervision, self-esteem and job satisfaction

Curationis ◽  
2004 ◽  
Vol 27 (2) ◽  
Author(s):  
L.R. Uys ◽  
A. Minnaar ◽  
S. Reid ◽  
J.R. Naidoo
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health System ◽  
Self Esteem ◽  
District Health ◽  
District Health System ◽  
Health Care Settings ◽  
Kwazulu Natal ◽  
Health Districts

Supervision has been identified as a major issue in quality of care. Although increasing attention is being given to supervision in the District Health System, there have been no studies describing the current situation. This article describes a survey done in two health districts in KwaZulu-Natal involving 319 nurses from all types of government health care settings.

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.

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