Early Reflections on Mphatlalatsane, a Maternal and Neonatal Quality Improvement Initiative Implemented During COVID-19 in South Africa

  • Global Health Science and Practice, Volume 10, No. 5, Year 2022

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Study Justification:
– Despite progress, maternal and neonatal mortality rates remain high and COVID-19 has further disrupted healthcare services.
– The Mphatlalatsane initiative aims to reduce maternal and neonatal mortality rates by 50% between 2018 and 2022.
– The initiative utilizes a quality improvement (QI) approach and a multi-level intervention strategy.
– The study provides insights into the impact of COVID-19 on maternal and neonatal health services and the effectiveness of the Mphatlalatsane initiative.
Highlights:
– Mphatlalatsane is a multipartnered initiative implemented in South Africa before and during the COVID-19 pandemic.
– It focuses on improving maternal and neonatal health outcomes through QI and other interventions.
– The initiative initially addressed immediate needs of healthcare workers and the health system during the pandemic.
– It gradually refocused attention on the disruptions caused by COVID-19 to routine maternal and neonatal health services.
– Mphatlalatsane demonstrates the importance of agile and context-specific responses to crises to maintain and improve healthcare services.
Recommendations:
– Strengthen the implementation of the Mphatlalatsane initiative to achieve the desired reduction in maternal and neonatal mortality rates.
– Continue providing emotional support to healthcare workers and streamlining supply chain management for infection control and personal protection materials.
– Develop a risk matrix to identify specific risks to service provision and uptake and implement mitigating measures.
– Maintain a responsive design and implementation approach to adapt to future crises and maintain interventions to improve maternal and neonatal health services.
Key Role Players:
– Healthcare workers
– Health system managers
– Policy makers
– Community leaders
– Non-governmental organizations (NGOs)
– Research institutions
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare workers
– Procurement of necessary medical supplies and equipment
– Implementation of risk mitigation measures
– Monitoring and evaluation activities
– Communication and awareness campaigns
– Research and data analysis

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The abstract provides a detailed description of the Mphatlalatsane maternal and neonatal quality improvement initiative implemented in South Africa during COVID-19. It outlines the goals, design, and activities of the initiative, as well as its response to the challenges posed by the pandemic. However, the abstract does not provide specific data or results to support the effectiveness of the initiative in achieving its goals. To improve the strength of the evidence, the abstract could include quantitative or qualitative data on the impact of Mphatlalatsane on maternal and neonatal mortality rates, stillbirth rates, and access to MNH services. Additionally, including information on the methodology used to evaluate the initiative and any limitations or challenges encountered would further enhance the evidence.

Despite global progress in reducing maternal and neonatal mortality and stillbirths, much work remains to be done to achieve the Sustainable Development Goals. Reports indicate that coronavirus disease (COVID-19) disrupts the provision and uptake of routine maternal and neonatal health care (MNH) services and negatively impacts cumulative pre-COVID-19 achievements. We describe a multipartnered MNH quality improvement (QI) initiative called Mphatlalatsane, which was implemented in South Africa before and during the COVID-19 pandemic. The initiative aimed to reduce the maternal mortality ratio, neonatal mortality rate, and stillbirth rate by 50% between 2018 and 2022. The multifaceted design comprises QI and other intervention activities across micro-, meso-, and macrolevels, and its area-based approach facilitates patients’ access to MNH services. The initiative commenced 6 months pre-COVID-19, with subsequent adaptation necessitated by COVID-19. The initial focus on a plan-do-study-act QI model shifted toward meeting the immediate needs of health care workers (HCWs), the health system, and health care managers arising from COVID-19. Examples include providing emotional support to staff and streamlining supply chain management for infection control and personal protection materials. As these needs were addressed, Mphatlalatsane gradually refocused HCWs’ and managers’ attention to recognize the disruptions caused by COVID-19 to routine MNH services. This gradual reprioritization included the development of a risk matrix to help staff and managers identify specific risks to service provision and uptake and develop mitigating measures. Through this approach, Mphatlalatsane led to an optimization case using existing resources rather than requesting new resources to build an investment case, with a responsive design and implementation approach as the cornerstone of the initiative. Further, Mphatlalatsane demonstrates that agile and context-specific responses to crises such as the COVID-19 pandemic can mitigate such threats and maintain interventions to improve MNH services.

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

1. Telemedicine: Implementing telemedicine services can allow pregnant women to receive prenatal care and consultations remotely, reducing the need for in-person visits and improving access to healthcare, especially in rural or underserved areas.

2. Mobile health (mHealth) applications: Developing mobile applications that provide educational resources, appointment reminders, and personalized health information can empower pregnant women to take an active role in their own maternal health and improve access to important information.

3. Community health workers: Expanding the role of community health workers can help bridge the gap between healthcare facilities and pregnant women in remote or marginalized communities. These workers can provide essential prenatal care, education, and support, improving access to maternal health services.

4. Transportation solutions: Addressing transportation barriers by providing reliable and affordable transportation options for pregnant women can ensure they can reach healthcare facilities in a timely manner, particularly in areas with limited transportation infrastructure.

5. Health facility infrastructure improvements: Investing in the improvement of healthcare facilities, including upgrading equipment, ensuring a clean and safe environment, and enhancing the capacity to handle emergencies, can enhance access to quality maternal health services.

6. Public-private partnerships: Collaborating with private sector organizations can help leverage their resources and expertise to improve access to maternal health services. This can include partnerships for funding, technology solutions, and capacity-building initiatives.

7. Maternal health awareness campaigns: Conducting targeted awareness campaigns to educate communities about the importance of maternal health, the available services, and the benefits of seeking care can help reduce stigma, increase demand for services, and improve access to maternal health.

It’s important to note that the specific context and needs of the community should be considered when implementing these innovations to ensure their effectiveness and sustainability.
AI Innovations Description
Based on the description provided, the recommendation to develop into an innovation to improve access to maternal health is to implement a multifaceted quality improvement (QI) initiative similar to Mphatlalatsane in South Africa. This initiative should have a focus on reducing maternal mortality, neonatal mortality, and stillbirth rates.

The innovation should include intervention activities at micro-, meso-, and macro-levels to address various aspects of maternal and neonatal health care. It should also adopt an area-based approach to facilitate patients’ access to services.

Given the challenges posed by the COVID-19 pandemic, the innovation should be adaptable and responsive to the immediate needs of healthcare workers, the health system, and healthcare managers. This may involve providing emotional support to staff, streamlining supply chain management for infection control and personal protection materials, and developing risk mitigation measures.

The innovation should optimize the use of existing resources rather than relying on new resources, building an investment case based on resource efficiency. It should also prioritize agile and context-specific responses to crises to ensure the continuity of interventions to improve maternal and neonatal health services.

By implementing such an innovation, it is possible to improve access to maternal health and mitigate the disruptions caused by crises like the COVID-19 pandemic.
AI Innovations Methodology
In order to improve access to maternal health, here are some potential recommendations:

1. Telemedicine and Mobile Health: Implementing telemedicine and mobile health solutions can help overcome geographical barriers and provide remote access to maternal health services. This can include virtual consultations, remote monitoring of vital signs, and educational resources delivered through mobile apps.

2. Community Health Workers: Training and deploying community health workers can improve access to maternal health services, especially in rural and underserved areas. These workers can provide basic antenatal care, education, and referrals to healthcare facilities.

3. Transportation Support: Providing transportation support, such as ambulances or vouchers for transportation services, can help pregnant women reach healthcare facilities in a timely manner, particularly in areas with limited transportation infrastructure.

4. Maternal Health Hotlines: Establishing hotlines staffed by healthcare professionals can provide pregnant women with information, advice, and guidance on maternal health concerns. This can help address common questions and provide reassurance, reducing unnecessary visits to healthcare facilities.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data Collection: Gather data on the current state of maternal health access, including factors such as distance to healthcare facilities, availability of transportation, and utilization rates of maternal health services.

2. Modeling: Develop a simulation model that incorporates the potential recommendations and their expected impact on access to maternal health. This could involve estimating the number of additional women who would be able to access care, reduction in travel time, or increase in utilization rates.

3. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the model and explore the potential variations in outcomes based on different assumptions or scenarios. This can help identify key factors that influence the impact of the recommendations.

4. Evaluation: Compare the simulated outcomes with the baseline data to evaluate the potential impact of the recommendations on improving access to maternal health. This can provide insights into the effectiveness and feasibility of implementing these innovations.

5. Refinement and Implementation: Based on the evaluation results, refine the recommendations and the simulation model as needed. Develop an implementation plan that takes into account the resources, infrastructure, and contextual factors specific to the target population and healthcare system.

By following this methodology, stakeholders can gain insights into the potential benefits and challenges of implementing innovations to improve access to maternal health and make informed decisions on how to prioritize and allocate resources effectively.


Identifiers:
DOI: 10.9745/GHSP-D-22-00022
Research Areas:
Community Interventions, COVID, Health System and Policy, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
South Africa
Study Design:
randomised-control-trial
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