Accepted for/Published in: JMIR Research Protocols
Date Submitted: Aug 19, 2022
Date Accepted: Mar 11, 2023
Date Submitted to PubMed: Mar 31, 2023
Intervention in mothers and newborns to reduce maternal and perinatal mortality in three provinces in South Africa using a quality improvement approach: Protocol for a Mixed Method Type 2 Hybrid Evaluation
ABSTRACT
Background:
The COVID-19 pandemic has undermined gains in reducing maternal and perinatal mortality in South Africa. The Mphatlalatsane Initiative is a health system intervention to reduce mortality and morbidity in women and newborns to desired levels through universal coverage of sustainable quality health systems and clinical care.
Objective:
Our evaluation aims to determine the effect of various exposures, including COVID-19 and a system-level, complex, patient-centred quality improvement (QI) intervention (Mphatlalatsane Initiative) on maternal and neonatal health services at 21 selected facilities in South Africa. The objectives are to determine whether Mphatlalatsane (i) reduces institutional maternal mortality ratio (iMMR), neonatal mortality rate and stillbirth rate (Objective 1); (ii) improves patients’ experiences (Objective 2) and quality of care (Objective 3). Objective 4 assesses the contextual and implementation process factors, including COVID-19, that shape Mphatlalatsane and uptake variation.
Methods:
This study is an implementation science type 2 hybrid effectiveness, controlled-before-after design with concurrent quantitative and qualitative components. The Mphatlalatsane intervention commenced at the end of 2019. For Objective 1, intervention and control facility-level data from the District Health Information System is compared for changes in institutional maternal and neonatal mortality and stillbirth rate and associations with QI, the COVID-19 pandemic and with both. For Objectives 2-3, data collectors’ abstract data from maternal and neonatal records, interview participants and conduct neonatal facility assessments. For Objective 4, interviews, programme documentation, surveys, and observations are used to assess how contextual factors at macro-, meso-, and micro-levels, explain variation in intervention uptake and outcome. The study is underway from 2020 to 2022.
Results:
This paper reports the protocol of the Mphatlalatsane evaluation.
Conclusions:
Few evaluations rigorously evaluated the effect of health systems interventions on improving health services and outcomes. Results will inform the scaling up of successful intervention components and strategies to mitigate the effect of COVID-19 or similar emerging epidemics on maternal and neonatal mortality.
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