Making Systems Work: The Hard Part of Improving Maternal Health Services in South Africa

Thomas, Leena Susan; Jina, Ruxana; Tint, Khin San; Fonn, Sharon

doi:10.1016/s0968-8080(07)30314-5

Cited by 16 publications

(14 citation statements)

References 3 publications

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“…Poorly functioning health systems have compromised efforts to improve health in sub-Saharan Africa, [17] even in those betterresourced middle-income countries such as SA and Botswana. This case review shows how maternal deaths highlight opportunities for key institutions -particularly Ministries of Health, but also training and professional bodies -to address underlying deficiencies in the health system.…”

Section: Discussionmentioning

confidence: 99%

Review of causes of maternal deaths in Botswana in 2010

Madzimbamuto

Ramagola-Masire

et al. 2013

S Afr Med J

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Background. In Botswana the maternal mortality ratio in 2010 was 163 per 100 000 live births. It is a priority to reduce this ratio to meet Millennium Development Goal 5 target of 21 per 100 000 live births. Objective. To investigate the underlying circumstances of maternal deaths in Botswana. Method. Fifty-six case notes from the 80 reported maternal deaths in 2010 were reviewed. Five clinicians reviewed each case independently and then together to achieve a consensus on diagnosis and underlying cause(s) of death. Results. Sixty-six percent of deaths occurred in Botswana's two referral hospitals. Cases in which death had direct obstetric causes were fewer than cases in which cause of death was indirect. The main direct causes were haemorrhage (39%), hypertension (22%), and pregnancy-related sepsis (13%). Thirty-six (64%) deaths were in HIV-positive women, of whom 21 (58%) were receiving antiretroviral (ARV) therapy. Nineteen (34%) deaths were attributable to HIV, including 4 from complications of ARVs. Twenty-nine (52%) deaths were in the postnatal period, 19 (66%) of these in the first week. Case-note review revealed several opportunities for improved quality of care: better teamwork, communication and supportive supervision of health professionals; earlier recognition of the seriousness of complication(s) with more aggressive case-management; joint management between HIV and obstetric clinicians; screening for, and treatment of, opportunistic infections throughout the antenatal to postnatal periods; and better supply management of medications, fluids, blood for transfusion and laboratory tests. Conclusion. Integrating HIV management into maternal healthcare is essential to reduce maternal deaths in the region, alongside greater efforts to improve quality of care to avoid direct and indirect causes of death.

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Section: Discussionmentioning

confidence: 99%

Review of causes of maternal deaths in Botswana in 2010

Madzimbamuto

Ramagola-Masire

et al. 2013

S Afr Med J

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“…March 2011. [42][43][44][45][46][47][48][49][50][51][52][53][54][55] and relatively easy to implement -either because they are not labour-intensive (or require a large number of staff but over a very short period of time). They usually consist of standardised interventions and are logistics-intensive, such as measles vaccination to reduce child mortality.…”

Section: 1652mentioning

confidence: 99%

“…They are also managerial (especially human resources management) and involve governance and accountability issues at multiple levels. 46,56 The involvement of civil society and a focus on vulnerable groups are important to ensure equitable access. Innovative solutions have to be found, taking into account the particular context.…”

Section: Health Systems Strengthening: a Window Of Opportunitymentioning

confidence: 99%

“…These assumptions may be far from the reality in countries where there is a lack of skilled health professionals, wages are very low, and where strikes by civil servants against the decline in purchasing power are increasing. 45,46 Similarly, policies that exempt certain patients (e.g. those who are indigent) from paying are very difficult to achieve unless the exemption criteria are clear [42][43][44][45][46][47][48][49][50][51][52][53][54][55] and applied correctly.…”

mentioning

confidence: 99%

“…45,46 Similarly, policies that exempt certain patients (e.g. those who are indigent) from paying are very difficult to achieve unless the exemption criteria are clear [42][43][44][45][46][47][48][49][50][51][52][53][54][55] and applied correctly. Both sorts of policies need good coordination between the Ministry and local health authorities, since funds need to be transferred to ensure costs are covered in a timely manner.…”

mentioning

confidence: 99%

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