Leadership and the functioning of maternal health services in two rural district hospitals in South Africa

137

Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, aims to improve health services and pre-empt future maternal and perinatal deaths. With expansion of MPDSR across low- and middle-income countries (LMIC), we conducted a scoping review to identify and describe implementation factors and their interactions. The review adapted an implementation framework with four domains (intervention, individual, inner and outer settings) and three cross-cutting health systems lenses (service delivery, societal and systems). Literature was sourced from six electronic databases, online searches and key experts. Selection criteria included studies from LMIC published in English from 2004 to July 2018 detailing factors influencing implementation of MPDSR, or any related form of MPDSR. After a systematic screening process, data for identified records were extracted and analysed through content and thematic analysis. Of 1027 studies screened, the review focuses on 58 studies from 24 countries, primarily in Africa, that are mainly qualitative or mixed methods. The literature mostly examines implementation factors related to MPDSR as an intervention, and to its inner and outer setting, with less attention to the individuals involved. From a health systems perspective, almost half the literature focuses on the tangible inputs addressed by the service delivery lens, though these are often measured inadequately or through incomparable ways. Though less studied, the societal and health system factors show that people and their relationships, motivations, implementation climate and ability to communicate influence implementation processes; yet their subjective experiences and relationships are inadequately explored. MPDSR implementation contributes to accountability and benefits from a culture of learning, continuous improvement and accountability, but few have studied the complex interplay and change dynamics involved. Better understanding MPDSR will require more research using health policy and systems approaches, including the use of implementation frameworks.

“…Often described as the most influential factor in shaping organizational culture, effective leadership is critical at all levels ( Mathole et al. 2018 ).…”

Section: Discussionmentioning

confidence: 99%

“…For successful MPDSR implementation, more needs to be understood on what motivates these leaders, what skills are needed, how to grow new champions. There is a wealth of knowledge already about leadership in health ( Gilson 2016 ; Mathole et al. 2018 ), which may be applicable to MPDSR.…”

Section: Discussionmentioning

confidence: 99%

Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors

Kinney

Walugembe

Wanduru

et al. 2021

137

“…Collaborative learning initiatives based on mutual trust, inclusion and respect connected to higher levels of the system and community stakeholders may help to address disconnects between policy and implementation offering solutions to local health priorities. Within and outside South Africa, research increasingly suggests that enhancing organizational and workplace cultures with more attention to how care is delivered can yield advances (Braithwaite, 2018; Cleary et al , 2018a; Mathole et al , 2018). As stated by Allwood et al (2018): ‘the front line can see clearly every day what needs to change’ and ‘change is accepted when people are involved in the decisions and activities that affect them, but they resist when change is imposed by others’.…”

Section: Discussionmentioning

confidence: 99%

Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa

D’Ambruoso

Merwe

Wariri

et al. 2019

Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating ‘in the dark’ in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.

“…Three papers presenting evidence on the role of, and influences over, leadership and management within public hospitals are drawn from three different countries. A South African analysis of two rural case study hospitals ( Mathole et al , 2018 ) shows how leadership style and practices can make a difference in terms of hospital performance. In contrast, the Ghanaian and Kenyan studies presented here illuminate quite negative pictures of public hospital leadership and management.…”

Section: What Do the Papers Presented Here Consider?mentioning

confidence: 99%

Strengthening health system leadership for better governance: what does it take?

Gilson

Agyepong

2018

This editorial provides an overview of the six papers included in this special supplement on health leadership in Africa. Together the papers provide evidence of leadership in public hospital settings and of initiatives to strengthen leadership development. On the one hand, they demonstrate both that current leadership practices often impact negatively on staff motivation and patient care, and that contextual factors underpin poor leadership. On the other hand, they provide some evidence of the positive potential of new forms of participatory leadership, together with ideas about what forms of leadership development intervention can nurture new forms of leadership. Finally, the papers prompt reflection on the research needed to support the implementation of such interventions.