Strengthening accountability for improved maternal and newborn health: A mapping of studies in Sub‐Saharan Africa

Hilber, Adriane Martin; Blake, Carolyn; Bohle, Leah F.; Bandali, Sarah; Agbon, Esther; Hulton, Louise

doi:10.1016/j.ijgo.2016.09.008

Cited by 49 publications

(72 citation statements)

References 55 publications

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“…Both facilities reportedly made use of perinatal meetings to discuss adverse cases, monitor and account for poor outcomes, but there was limited use of lessons learnt in Tinyade as compared to Chisomo, and the latter monitored implementation through meeting records. A recent literature review illustrated how accountability mechanisms, such as perinatal and maternal death surveillance reviews, have failed to make health care providers and managers account for the quality of services as implementation rates of recommendations from reviews were low ( Hilber et al 2016 ).…”

Section: Discussionmentioning

confidence: 99%

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

Mathole

Lembani

Jackson

et al. 2018

Health Policy and Planning

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Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. In ongoing research, leadership emerged as one of the key health systems factors affecting the performance of maternal health services at facility level. This article reports on a subsequent case study undertaken to examine leadership practices and the functioning of maternal health services in two resource-limited hospitals with disparate maternal health outcomes. An exploratory mixed-methods case study was undertaken with the two rural district hospitals as the units of analysis. The hospitals were purposively selected based on their maternal health outcomes: one reported good maternal health outcomes (pseudonym: Chisomo) and the other had poor outcomes (pseudonym: Tinyade). Comparative data were collected through a facility survey, non-participant observation of management and perinatal meetings, record reviews and interviews with hospital leadership, staff and patients to elicit information about leadership practices including supervision, communication and teamwork. Descriptive and thematic data analysis was undertaken. The two hospitals had similar infrastructure and equipment. Hospital managers at Chisomo used their innovation and entrepreneurial skills to improve quality of care, and leadership style was described as supportive, friendly, approachable but ‘firm’. They also undertook frequent and supportive supervisory meetings. Each department at Chisomo developed its own action plan and used data to monitor their actions. Good performers were acknowledged in group meetings. Staff in this facility were motivated and patients were happy about the quality of services. The situation was different at Tinyade hospital. Participants described the leadership style of their senior managers as authoritarian. Managers were rarely available in the office and did not hold regular meetings, leading to poor communication across teams and poor coordination to address resource constraints. This demotivated the staff. The differences in leadership style, structures, processes and work culture affected teamwork, managerial supervision and support. The study demonstrates how leadership styles and practices influence maternal health care services in resource limited hospitals. Supportive leadership manifested itself in the form of focused efforts to build teamwork, enhance entrepreneurship and in management systems that are geared to improving maternal care.

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Section: Discussionmentioning

confidence: 99%

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

Mathole

Lembani

Jackson

et al. 2018

Health Policy and Planning

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“…A good accountability mechanism fosters an environment of learning and improvement (as opposed to an environment of blaming and shaming) [34], and this is the central philosophy of the ICM MEAP.…”

Section: Discussionmentioning

confidence: 99%

“…A strong accountability mechanism includes a recourse mechanism, i.e. a process that can be triggered if the entity being held to account does not take the necessary remedial action identified during the monitoring and review phases [34]. In the case of the ICM MEAP, this recourse mechanism is the withholding of accreditation or reaccreditation.…”

Section: Discussionmentioning

confidence: 99%

The development of a global Midwifery Education Accreditation Programme

Nove

Pairman

Bohle

et al. 2018

Global Health Action

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Background: Many countries are responding to the global shortage of midwives by increasing the student intake to their midwifery schools. At the same time, attention must be paid to the quality of education being provided, so that quality of midwifery care can be assured. Methods of assuring quality of education include accreditation schemes, but capacity to implement such schemes is weak in many countries. Objective: This paper describes the process of developing and pilot testing the International Confederation of Midwives’ Midwifery Education Accreditation Programme (ICM MEAP), based on global standards for midwifery education, and discusses the potential contribution it can make to building capacity and improving quality of care for mothers and their newborns. Methods: A review of relevant global, regional and national standards and tools informed the development of a set of assessment criteria (which was validated during an international consultation exercise) and a process for applying these criteria to midwifery schools. The process was pilot tested in two countries: Comoros and Trinidad and Tobago. Results: The assessment criteria and accreditation process were found to be appropriate in both country contexts, but both were refined after the pilot to make them more user-friendly. Conclusion: The ICM MEAP has the potential to contribute to improving health outcomes for women and newborns by building institutional capacity for the provision of high-quality midwifery education and thus improved quality of midwifery care, via improved accountability for the quality of midwifery education.

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“…A growing number of studies have investigated the implementation of M/PDSR in selected countries, and some reviews have explored implementation factors for maternal death reviews or perinatal death audits, separately. For example, a structured literature review of accountability mechanisms for maternal and newborn health in sub-Saharan Africa found MDSR the most common mechanism for performance accountability 17. A systematic review of facility-based perinatal mortality audit in LMIC in 2009 identified 10 low-quality evaluations with mortality outcome data 10.…”

Section: Introductionmentioning

confidence: 99%

“…While there are valuable contributions to the literature, these previous reviews did not consider implementation theory to assess implementation of M/PDSR nor of the full range of types of maternal and/or perinatal death reviews 9 17 18. Implementation theory allows for more complex interventions to be unpacked and examined 19–24.…”

Section: Introductionmentioning

confidence: 99%

Implementation of maternal and perinatal death reviews: a scoping review protocol

et al. 2019

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IntroductionMaternal and perinatal death surveillance and response (MPDSR), or any related form of audit, is a systematic process used to prevent future maternal and perinatal deaths. While the existence of MPDSR policies is routinely measured, measurement and understanding of policy implementation has lagged behind. In this paper, we present a theory-based conceptual framework for understanding MPDSR implementation as well as a scoping review protocol to understand factors influencing MPDSR implementation in low/ middle-income countries (LMIC).Methods and analysisThe Consolidated Framework for Implementation Research will inform the development of a theory-based conceptual framework for MPDSR implementation. The methodology for the scoping review will be guided by an adapted Arksey and O’Malley approach. Documents will include published and grey literature sourced from electronic databases (PubMed, CINAHL, SCOPUS, Web of Science, JSTOR, LILACS), the WHO Library, Maternal Death Surveillance and Response Action Network, Google, the reference lists of key studies and key experts. Two reviewers will independently screen titles, abstracts and full studies for inclusion. All discrepancies will be resolved by an independent third party. We will include studies published in English from 2004 to July 2018 that present results on factors influencing implementation of MPDSR, or any related form. Qualitative content and thematic analysis will be applied to extracted data according to the theory-based conceptual framework. Stakeholders will be consulted at various stages of the process.Ethics and disseminationThe scoping review will synthesise implementation factors relating to MPDSR in LMIC as described in the literature. This review will contribute to the work of the Countdown to 2030 Drivers Group, which seeks to explore key contextual drivers for equitable and effective coverage of maternal and child health interventions. Ethics approval is not required. The results will be disseminated through various channels, including a peer-reviewed publication.

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Strengthening accountability for improved maternal and newborn health: A mapping of studies in Sub‐Saharan Africa

Cited by 49 publications

References 55 publications

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

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

The development of a global Midwifery Education Accreditation Programme

Implementation of maternal and perinatal death reviews: a scoping review protocol

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