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Original Research
The COVID-19 pandemic and disruptions in a district quality improvement initiative: Experiences from the CLEVER Maternity Care programme
Submitted: 05 July 2021 | Published: 30 March 2022
About the author(s)
Sarie J. Oosthuizen, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, SAMRC Research Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South AfricaAnne-Marie Bergh, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, SAMRC Research Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Antonella Silver, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, SAMRC Research Unit for Maternal and Infant Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Refilwe E. Malatji, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, District Clinical Specialist Team, Tshwane District Health Services, Tshwane, South Africa
Vivian Mfolo, Research Centre for Maternal, Fetal, Newborns and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, South Africa
Tanita Botha, Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
Abstract
Background: Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs.
Methods: This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers.
Results: Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers’ response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging.
Conclusion: Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication.
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