Managers’ support on implementation of maternal guidelines, Limpopo province, South Africa

  • Curationis, Volume 43, No. 1, Year 2020

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Study Justification:
– The study aimed to determine the support offered by managers to midwives during the implementation of maternal health guidelines.
– This study was conducted because despite the availability of national maternal health guidelines, a significant number of maternal deaths in the Limpopo province of South Africa were caused by preventable and avoidable factors.
– The study aimed to identify the factors contributing to substandard implementation of maternal guidelines and highlight the importance of manager support in promoting the utilization of these guidelines.
Study Highlights:
– The study revealed that a shortage of staff and material resources contributed to substandard implementation of maternal guidelines.
– Managers indicated difficulties in supervision and monitoring of the implementation of maternal guidelines, with a significant number of respondents indicating a lack of supervision.
– Limited support in terms of monitoring and supervision by managers was strongly indicated as having a negative effect on the implementation of maternal guidelines.
– Capacity building was offered, but the shortage of resources led to poor implementation of maternal guidelines by midwives.
Study Recommendations:
– Increase the number of staff available to attend to pregnant women in order to address the shortage of staff.
– Allocate sufficient material resources to ensure the proper implementation of maternal guidelines.
– Improve supervision and monitoring of the implementation of maternal guidelines by managers.
– Provide additional support and resources to managers to enhance their ability to effectively support midwives in implementing maternal guidelines.
– Strengthen capacity building efforts to ensure midwives are adequately trained and equipped to implement maternal guidelines.
Key Role Players:
– Operational Managers (OMNs)
– Maternal Healthcare Managers (MHCMs)
– Director of Maternal Health Care
– University of Venda Research Ethics Committee
– Limpopo Provincial Department of Health
– District Executive Managers
Cost Items for Planning Recommendations:
– Staff recruitment and training
– Provision of material resources
– Capacity building programs
– Supervision and monitoring systems
– Research and data analysis
– Ethical clearance and permissions
– Publication and dissemination of study findings

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is clearly described, and data collection methods are explained. However, the abstract lacks specific details about the sample size, response rate, and statistical analysis methods used. To improve the evidence, the abstract could include these missing details and provide more information about the validity and reliability of the research instrument. Additionally, the abstract could mention any limitations of the study and suggest potential areas for future research.

BACKGROUND: The report of Saving Mothers indicated a decline of maternal mortality from 12.8% to 12.5% last triennium of 2017. This shows that regardless of availability of national maternal health guidelines, midwives and managers, 25% of maternal deaths were caused by preventable and avoidable factors. As such, support provided by managers is vital in promoting the utilisation of maternal guidelines. OBJECTIVES: The objective was to determine the support offered by managers to midwives during the implementation of maternal health guidelines. METHOD: The study design was cross-sectional descriptive in a quantitative domain. Simple random sampling was used to select 58 operational managers and two maternal managers. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences version 23. Descriptive statistics provided by Microsoft Excel in the form of charts was used to describe data. Pearson’s correlation test was used to describe relationships amongst variables. RESULTS: The results revealed that 83.3% respondents indicated a shortage of staff to attend pregnant women. Fifty-six per cent of managers indicated that shortage of material resources contributed to substandard implementation of maternal guidelines. Supervision and monitoring of implementation of maternal guidelines was difficult as indicated by 53.3%, and 63.3% indicated lack of supervision. CONCLUSION: Limited support in terms of monitoring and supervision by managers was strongly indicated as having a negative effect on implementation of maternal guidelines. Capacity building was offered; however, shortage of resources led to poor implementation of maternal guidelines by midwives.

The study employed a quantitative descriptive design, in which a cross-sectional survey was conducted in order to determine the support offered by managers to midwives. The study was conducted from four selected municipalities of two districts in Limpopo province. The four municipalities consist of 114 PHC facilities and each is supervised by one operational manager, one assistant manager per local area, one sub-district manager per municipality and one MHCM per district. For the purpose of this study, OMNs were considered because their supervisory role is directly linked to midwives on a daily basis and MHCMs were considered as they are responsible for maternal healthcare services. The two districts had a comparatively high MMR of 242.9/100 000 live births (DoH 2017). As a result, the researcher assessed managers to determine the support they are providing to midwives during the implementation of maternal health guidelines in order to reduce MMR. The study population comprised MHCMs and OMNs from the selected PHC facilities within the two districts. The total population was 114 and a simple random sampling was used to sample 58 OMNs and two maternal managers. The fishbowl method was used where equal numbers of small papers were folded (with either YES or NO written on them), placed in a container and mixed, and all those who chose YES were included in the study. In this study, 67 respondents chose YES; however, during data collection only 60 completed the questionnaires. A self-administered questionnaire was used for data collection. The questionnaire contained closed-ended items. The questionnaire was divided into two sections: demographic characteristics and the support offered by managers to midwives during the implementation of maternal healthcare guidelines when rendering maternal healthcare services. The research team distributed questionnaires in various selected PHC facilities. Respondents completed self-administered questionnaires at their respective work place during lunch break, which took about 30 min. Data were collected from March to June 2017 because OMNs were not always available in their workplace. Data were analysed using the Statistical Package for Social Sciences version 23 and Microsoft Excel was used to present data in the form of charts. Descriptive statistics was used to describe data and Pearson’s correlation test was used to describe the relationship amongst variables. Validity and reliability were ensured before data collection of the main study. The research instrument was given to experts like the Director of Maternal Health Care who supervise and monitor the implementation of the guidelines in order to check for face and content validity. Reliability was ensured by pre-testing the instrument through five OMNs who did not form part of the main study; two questions were slightly rephrased for clarity and the Cronbach’s alpha test yielded a significant level of p < 0.06. Ethical clearance to conduct the study was obtained from the University of Venda Research Ethics Committee (SHS/16/ PBC/34/1910). The Limpopo Provincial Department of Health (Ref 4/2/2) and district executive managers granted permission to access the facilities. The voluntary nature of participation in this study and the time it took to complete a questionnaire were explained to the respondents. Respondents were assured that they can withdraw from the study at any time during data collection without being penalised. The purpose and significance of the study were explained. To ensure anonymity and confidentiality, each questionnaire had a participant code assigned by the researcher and no names or contact numbers of the respondents were written in the questionnaires. Respondents were informed that the information collected from them might be published but the individual’s identity would not be revealed. To ensure justice and fairness, respondents who met the characteristics required for this study were randomly selected. Respondents had to sign an informed consent form before completing the questionnaires.

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Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can provide remote access to healthcare professionals, allowing pregnant women in remote or underserved areas to receive prenatal care and consultations without having to travel long distances.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information, reminders, and guidance on prenatal care, nutrition, and maternal health can empower pregnant women to take control of their own health and access important resources.

3. Training and capacity building: Investing in training programs for midwives and managers can improve their knowledge and skills in implementing maternal health guidelines. This can lead to better adherence to guidelines and ultimately improve maternal health outcomes.

4. Strengthening supply chains: Addressing the shortage of material resources mentioned in the study can be achieved by improving supply chains for essential maternal health supplies, ensuring that facilities have an adequate and consistent supply of necessary resources.

5. Enhanced supervision and monitoring: Implementing systems for regular supervision and monitoring of maternal health services can help identify gaps and challenges in the implementation of guidelines. This can enable managers to provide timely support and guidance to midwives, ultimately improving the quality of care.

6. Collaboration and coordination: Establishing partnerships and collaborations between different stakeholders, such as government agencies, healthcare providers, and community organizations, can help streamline efforts and resources, leading to more effective and efficient maternal health services.

These are just a few potential innovations that could be considered to improve access to maternal health based on the information provided. It is important to conduct further research and analysis to determine the feasibility and effectiveness of these innovations in the specific context of Limpopo province, South Africa.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health would be to enhance the support provided by managers to midwives during the implementation of maternal health guidelines. This can be achieved through the following actions:

1. Increase staffing levels: Address the shortage of staff by recruiting and training more midwives to ensure adequate coverage and care for pregnant women.

2. Allocate sufficient material resources: Address the shortage of material resources by providing the necessary equipment, supplies, and medications needed for the implementation of maternal guidelines.

3. Improve supervision and monitoring: Enhance the supervision and monitoring of the implementation of maternal guidelines by managers. This can be done through regular site visits, performance evaluations, and feedback sessions to ensure compliance and quality of care.

4. Provide capacity building opportunities: Offer training and capacity building programs for midwives to enhance their knowledge and skills in implementing maternal health guidelines effectively.

5. Address resource constraints: Allocate sufficient resources to overcome the challenges faced in implementing maternal guidelines. This may include securing funding for equipment, supplies, and infrastructure improvements.

By implementing these recommendations, the support provided by managers to midwives can be strengthened, leading to improved access to maternal health services and ultimately reducing maternal mortality rates.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase staffing levels: Address the shortage of staff by recruiting and training more midwives and healthcare professionals to ensure adequate coverage and care for pregnant women.

2. Improve availability of material resources: Allocate sufficient resources such as medical equipment, medications, and supplies to healthcare facilities to support the implementation of maternal health guidelines.

3. Enhance supervision and monitoring: Implement regular and effective supervision and monitoring systems to ensure compliance with maternal health guidelines and identify areas for improvement.

4. Provide capacity building opportunities: Offer training and professional development programs for midwives and managers to enhance their knowledge and skills in maternal healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of pregnant women receiving prenatal care, the percentage of births attended by skilled healthcare professionals, and the maternal mortality rate.

2. Collect baseline data: Gather data on the current status of these indicators before implementing the recommendations. This can be done through surveys, interviews, and analysis of existing data sources.

3. Implement the recommendations: Put the recommendations into action, ensuring that the necessary resources and support are provided to healthcare facilities and professionals.

4. Monitor and evaluate: Continuously monitor the implementation of the recommendations and collect data on the selected indicators. This can be done through regular reporting, data collection tools, and site visits.

5. Analyze the data: Use statistical analysis techniques to examine the collected data and determine the impact of the recommendations on the selected indicators. This can involve comparing the baseline data with the data collected after the implementation of the recommendations.

6. Draw conclusions and make recommendations: Based on the analysis, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any gaps or areas for further improvement and make recommendations for future actions.

7. Repeat the process: Continuously repeat the monitoring and evaluation process to assess the ongoing impact of the recommendations and make necessary adjustments to further improve access to maternal health.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further interventions.

Statistics:
Citations: 1
Authors: 5
Identifiers:
DOI: 10.4102/curationis.v43i1.1949
Research Areas:
Health System and Policy, Maternal and Child Health, Quality of Care, Workforce
Study Countries:
South Africa
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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