Development of a Strategy to Facilitate the Implementation of Maternal Health care Guidelines in Limpopo Province, South Africa

Abstract

STRACT Background: The implementation of the World Health Organisation maternal health care guidelines in African countries has resulted in the reduction of maternal deaths by half since 1990. As a result, between 1990-2013, maternal mortality ratio declined by only 2.6% per year and this is far from the annual decline of 5.5% required to achieve the Sustainable Development Goals (SDGs). Ninety percent of women are dying from preventable maternal conditions and most of them are from the low and middle-income areas. The 2011-2013 Saving Mothers Report indicates that the Limpopo Province was ranked number three on the Maternal Mortality Rate in South Africa. Hence, this study sought to assess the implementation of maternal health care guidelines by professional nurses in Limpopo Province. Method: A convergent parallel mixed-methods design study was used. Phase 1 entailed parallel collection of qualitative and quantitative data. In this approach, self-administered questionnaires were used in the quantitative research method and an in-depth interview in qualitative research method. Data were collected from Maternal Health Care Managers, Professional Nurses and Operational Managers working in Primary Health Care Facilities of the Vhembe and Mopani Districts. Systematic methods to sample managers and midwives through the Slovan formula was used. Ethical clearance for the study was obtained from the University of Venda Research Ethics Committee and permission to conduct the study at the Primary Health Care facilities was obtained from the Limpopo Province Department of Health and Health District Offices. Data analyses were done separately using the Statistical Package for Social Sciences for quantitative data and Tesch’s open-coding methods for qualitative data. Validity, reliability and trustworthiness were ensured through a pilot study and by critical appraisal and peer review of the research instruments by experts in the field of maternal health.

Results: The study revealed that midwives experienced difficulty when providing care to women presenting with postpartum haemorrhage and pre-eclampsia or eclampsia. Difficulty in the management was confirmed by 36% of respondents. Some participants lacked knowledge on the management of women with postpartum haemorrhage, Pre-eclampsia and eclampsia and this was also indicated by 30% of respondents. Shortage of staff led to work overload, especially if one midwife was left alone to provide care to patients in the facility. Furthermore, midwives experienced delayed ambulance services when in need of referring women who required urgent attention to the next level. Delayed ambulance was indicated also by 80,4% of respondents ad this contributed to the midwives’ frustrations hence poor maternal outcomes. High risk women failed to return to the hospital and others hide their previous history of complications and hence experienced abrupt postpartum haemorrhage leading to poor implementation of maternal health guidelines. Phase 2 dealt with the development of the strategy to facilitate implementation of maternal health guidelines in Limpopo Province using the Strengths, Weaknesses, Opportunities and Threats analysis, identified from the collected data. Phase 3 comprised the validation of the strategy, which was conducted using a quantitative research design. Meetings were held with Maternal Health Care Managers, Midwives and Operational Managers working at Primary Health Care Facilities of Vhembe and Mopani districts. Self-administered questionnaires were distributed for respondents to complete and data were analysed using descriptive analysis. Almost all respondents (95%) agreed that the developed strategy was suitable and applicable for midwifery practice. Maternal Health Care Managers, Midwives and Operational Managers made suggestions that will enhance the developed strategy. Recommendations: Continuous education and in-service training must be done in order to capacitate midwives with knowledge of the management of women with postpartum haemorrhage, pre-eclampsia and eclampsia. The curriculum for Midwifery training must be strengthened and must include enrolled nurses. Health education to women must be strengthened and they must be encouraged to give the correct history in order to reduce maternal mortality rate.