Development of an approach for measurement and monitoring of the continuum of care for maternal health in the South African health system
Year: 2021
Type: article
Abstract: Background: The continuum of care is a public health framework for improving maternal health outcomes by providing comprehensive health services, at different levels of the health system and across the lifecycle.The framework emphasizes the importance of interventions to address the social determinants of health as well, alongside healthcare services.Although the framework is useful for visualizing service organization, it has not been adequately integrated into policy and practice in South Africa.In addition, there is currently no comprehensive approach to monitor and evaluate service provision along the continuum of care.The current approach is fragmented across programs and sectors and focuses on only a handful of indicators.This research explores an approach for measurement and monitoring of a comprehensive continuum of care for maternal health in South Africa, with implications for application in other low-and middle-income countries (LMICs).Methods: A sequential exploratory mixed methods study was conducted.It consisted of a systematic review and critical interpretive synthesis of evidence across LMICs; a review of potential indicators across multiple data sources in South Africa; key informant interviews with experts in relevant sectors; and development and testing of a composite index for tracking performance, using indicator data from the North West province and its four districts in the period 2013-2017.The composite index was termed the comprehensive continuum of care for maternal health index, or C3MH index.The qualitative and quantitative findings were integrated through a triangulation protocol and an analytical framework for measurement and monitoring of the continuum of care for maternal health in South Africa and LMICs was proposed.The proposed approach was explained using concepts from complex adaptive systems and critical realist theory.Results: The adequacy model for the continuum of care was proposed, which guided holistic measurement of aspects of service provision and multidimensional quality of care in maternal health.Adequacy also informed the four-dimensional C3MH index, which encompasses indicators of i) health service access and utilization, ii) quality of care, iii) linkages of care and iv) the social determinants of health.The study identified 39 potential indicators from health and non-health sector sources that can be used to monitor interventions along the continuum of care.These indicators were used for comprehensive performance assessment and to make service provision and measurement recommendations for the health system in the North West http://etd.uwc.ac.za/Dedication This work is dedicated to my late father, Tona David Mothupi (1955 -2001), for the ever-lasting impression he has made on me to always reach for my fullest potential.We did it, Papa.Equally, this work is dedicated to
Author: Mothupi, Mamothena Carol
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G686600162, G8117433718
OpenAlex ID: W6981038110