Midwives’ descriptions of policies on access to maternity health services in North West Province, South Africa

Authors

DOI:

https://doi.org/10.20525/ijrbs.v13i5.3503

Keywords:

Access to healthcare, Maternity health services, maternal mortality, Neonatal mortality, Quality healthcare

Abstract

The study sought to explore and describe the various policies regarding access to Maternity health care services in the North West Province, South Africa, through the lens of midwives.  Legal and ethical frameworks guide maternity healthcare services to ensure such a service's quality, safety, and standardization. A qualitative, descriptive, explorative research design was followed. Nine purposefully sampled midwives participated in a one-on-one in-depth interview. Data were analyzed using Collaizi's descriptive method based on the emerging themes and categories. One overarching theme with six categories emerged from the data. From the overarching perspective, it was evident that midwives were dissatisfied with the ambiguity of various policies guiding patients' access to Maternity healthcare services. To a certain extent, the admission policy was inconsistent with the patient's rights and constitution of the land on access to health. The ambiguity of admission position led to uncontrolled movements of self-referred patients to clinical facilities. The ambiguity of the transfer policy contributed to challenges during interfacility transfers of referred patients from lower levels of care facilities and vice versa. In addition, the policy on escorts of patients was unspecific about the healthcare personnel required to escort complicated patients in transit, which caused care interruptions. The study findings highlight the Midwives' concerns regarding various policies of access to maternity health services, and the marked ineffectiveness of controlling patients' movement into facilities could be the reason for overcrowding, inadvertently causing a decline in the quality of maternity healthcare services. The study findings may alert policymakers to be cautious and ensure that policies are succinct and consistent with other related laws.

Downloads

Download data is not yet available.

References

Abalos, E.E., Rivera, R.Y., Locsin, R.C., & Schoenhofer, S.O. (2016). Husserlian phenomenology and Collaizi’s Method of data analysis: Exemplar in qualitative nursing. Nursing Inquiry using nursing as caring theory. International Journal for Human Caring, 20(1):19-23. DOI: https://doi.org/10.20467/1091-5710-20.1.19

Ala, S.H., Husain, Samia and Husain, Saba (2021) ‘Reasons for presenting to antenatal care clinics in a sample of Pakistani women and their knowledge of WHO antenatal care package’, European journal of midwifery, 5, p. 43. https://doi.org/10.18332/ejm/140794. DOI: https://doi.org/10.18332/ejm/140794

Ashokcoomar, P. and Bhagwan, R. (2022).The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa’, Health SA = SA Gesondheid, 27, p. 1617. https://doi.org/10.4102/hsag.v27i0.1617. DOI: https://doi.org/10.4102/hsag.v27i0.1617

Babalola, T.K., Ojugbele, H.O., Shahwan, M. & Moodley, I.(2022). Analysis of factors influencing technical efficiency of public district hospitals in KwaZulu-Natal province, South Africa’, Human Resources for Health, 20(1). DOI: https://doi.org/10.1186/s12960-022-00777-2

Busse, R., Klazinga, N., Panteli, D. & Quentin, W (2019) ‘Improving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies’. live&scope=site (Accessed: 30 May 2023).

Becker, J, Becker, C, Oprescu, F, Wu, C-J, Moir, J, Shimwela, M, Gray, M & Wu, C-JJ (2022). Silent voices of the midwives: factors that influence midwives’ achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry’, BMC Pregnancy & Childbirth, 22(1), pp. 1–13. https://doi.org/10.1186/s12884-021-04339-7. DOI: https://doi.org/10.1186/s12884-021-04339-7

Belay Tolu, L., Yigezu, E., Urgie, T., & Feyissa, G. T. (2020). Maternal and perinatal outcome of preeclampsia without severe feature among pregnant women managed at a tertiary referral hospital in urban Ethiopia. PloS one, 15(4), e0230638. DOI: https://doi.org/10.1371/journal.pone.0230638

Burger, R., & Christian, C. (2020). Access to health care in post-apartheid South Africa: availability, affordability, acceptability. Health Economics, Policy and Law, 15(1), 43-55. DOI: https://doi.org/10.1017/S1744133118000300

Callander, E. J., Fenwick, J., Donnellan-Fernandez, R., Toohill, J., Creedy, D. K., Gamble, J., Fox, H., & Ellwood, D. (2019). Cost of maternity care to public hospitals: a first 1000-days perspective from Queensland’, Australian Health Review, 43(5), pp. 556–564. https://doi.org/10.1071/AH18209. DOI: https://doi.org/10.1071/AH18209

Chiu, W.-K., & Fong, B. Y. F. (2023). Sustainable Development Goal 3 in Healthcare. In Environmental, social and governance and sustainable development in healthcare (pp. 33-45). Springer. DOI: https://doi.org/10.1007/978-981-99-1564-4_3

Dahab, R., & Sakellariou, D. (2020). Barriers to accessing maternal care in low income countries in Africa: a systematic review. International journal of environmental research and public health, 17(12), 4292. DOI: https://doi.org/10.3390/ijerph17124292

Daniels, A. A., & Abuosi, A. (2020). Improving emergency obstetric referral systems in low and middle income countries: a qualitative study in a tertiary health facility in Ghana. BMC health services research, 20, 1-10. DOI: https://doi.org/10.1186/s12913-020-4886-3

Edmonds, J. K., Ivanof, J., & Kafulafula, U. (2020). Midwife led units: transforming maternity care globally. Annals of global health, 86(1). DOI: https://doi.org/10.5334/aogh.2794

Edoka, I. P., & Stacey, N. K. (2020). Estimating a cost-effectiveness threshold for health care decision-making in South Africa. Health Policy and Planning, 35(5), 546-555. DOI: https://doi.org/10.1093/heapol/czz152

Fuzy, E., Clow, S.E. and Fouché, N. (2020) ‘’Please treat me like a person’—respectful care during adolescent childbirth’, British Journal of Midwifery, 28(6), pp. 360–369. https://doi.org/10.12968/bjom.2020.28.6.360. DOI: https://doi.org/10.12968/bjom.2020.28.6.360

Goemaes, R, Beeckman, D, Verhaeghe, S & Van Hecke, A .(2020). Sustaining the quality of midwifery practice in Belgium: Challenges and opportunities for advanced midwife practitioners’, Midwifery, 89, p. N.PAG. https://doi.org/10.1016/j.midw.2020.102792. DOI: https://doi.org/10.1016/j.midw.2020.102792

Gordon, T., Booysen, F., & Mbonigaba, J. (2020). Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa. BMC Public Health, 20, 1-13. DOI: https://doi.org/10.1186/s12889-020-8368-7

Gray,J.R. & Grove, S.K.(2019).Burns & Grove’s: The Practice of Nursing Research: Appraisal, Synthesis and Generation of Evidence. 9thedition. Missouri: Elsevier ‘Hospital overcrowding: 192 instead of 51 in maternity ward’ (2019) Medical Brief,

(0259).

International Citizens Insurance.(2023).Understanding South Africa’s Healthcare System Available at: https://www.internationalinsurance.com/health/systems/south-africa.php (Accessed 19 April 2023)

Ireland,B. (2018, March 20). 5 things you need to know to prepare for your government hospital birth Accreditation. Available at: https://www.news24.com/life/archive/5-things-you-need-to-know-to-prepare-for-your-government-hospital-birth-20180320(Accessed: 27 April 2023).

Jean-Baptiste, M. C., Millien, C., Sainterant, O., Dameus, K. J. R., Julmisse, M., Julmiste, T. M., Fanfan, J. G., & Raymonville, M. (2023). Quality improvement initiative reduces overcrowding on labour and delivery unit in a university hospital in Haiti. BMJ Open Quality, 12(1), e001879. DOI: https://doi.org/10.1136/bmjoq-2022-001879

Jooste, K. (2017).Leadership in health services management.3RD Edition. Lansdowne, Cape Town: Juta,

Lavin, T. and Pattinson, R. (2018). Does antenatal care timing influence stillbirth risk in the third trimester? A secondary analysis of perinatal death audit data in South Africa. BJOG: An International Journal of Obstetrics and Gynaecology, 125(2), pp. 140–147. DOI: https://doi.org/10.1111/1471-0528.14645

Lord, M. G., Calderon, J. A., Ahmadzia, H. K., & Pacheco, L. D. (2023). Emerging technology for early detection and management of postpartum hemorrhage to prevent morbidity’, American journal of obstetrics & gynecology MFM, 5(2S), p. 100742. https://doi.org/10.1016/j.ajogmf.2022.100742. DOI: https://doi.org/10.1016/j.ajogmf.2022.100742

Mahmood, F. J., & Tayib, A. Y. (2021). Healing environment correlated with patients’ psychological comfort: Post-occupancy evaluation of general hospitals. Indoor and Built Environment, 30(2), 180-194. DOI: https://doi.org/10.1177/1420326X19888005

Malakoane, B., Heunis, J., Chikobvu, P., Kigozi, N., & Kruger, W. (2020). Public health system challenges in the Free State, South Africa: A situation appraisal to inform health system strengthening. BMC health services research, 20, 1-14. DOI: https://doi.org/10.1186/s12913-019-4862-y

Mattison, C. A., Lavis, J. N., Wilson, M. G., Hutton, E. K., & Dion, M. L. (2020). A critical interpretive synthesis of the roles of midwives in health systems. Health Research Policy and Systems, 18, 1-16. DOI: https://doi.org/10.1186/s12961-020-00590-0

Mndebele, S. (2021). Nurse Escorts’ Perceptions of Their Ability to Manage Patient Clinical Deterioration During Nurse-Led Inter-Hospital Ambulance Transfer in the Wheatbelt Region of Western Australia: A Mixed Methods Study.

Moeti, T., Mokhele, T., Weir-Smith, G., Dlamini, S., & Tesfamicheal, S. (2023). Factors Affecting Access to Public Healthcare Facilities in the City of Tshwane, South Africa. International journal of environmental research and public health, 20(4), 3651. https://doi.org/10.3390/ijerph20043651 DOI: https://doi.org/10.3390/ijerph20043651

Moudi, A., Iravani, M., Najafian, M., Zareiyan, A., Forouzan, A., & Mirghafourvand, M. (2022). The development and validation of an obstetric triage acuity index: a mixed-method study’, Journal of Maternal-Fetal & Neonatal Medicine, 35(9), pp. 1719–1729. https://doi.org/10.1080/14767058.2020.1768239. DOI: https://doi.org/10.1080/14767058.2020.1768239

Mthethwa E, Peu MD, de Waal M, Yazbek M.(2019). Recommendations to Improve Antenatal Care Uptake through Community Participation and Local Accountability’, Africa Journal of Nursing & Midwifery, 21(2), pp. 1–13. https://doi.org/10.25159/2520-5293/6214. DOI: https://doi.org/10.25159/2520-5293/6214

Nkosi, V., Haman, T., Naicker, N. & Mathee, A.( 2019). Overcrowding and health in two impoverished suburbs of Johannesburg, South Africa’, BMC public health, 19(1), p. 1358. https://doi.org/10.1186/s12889-019-7665-5. DOI: https://doi.org/10.1186/s12889-019-7665-5

Oladapo, O.T., Tunçalp, Ö., Bonet, M., Lawrie, T.A., Portela, A., Downe, S. & Gülmezoglu, A.M.(2018). WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing’, BJOG: An International Journal of Obstetrics & Gynaecology, 125(8), pp. 918–922. https://doi.org/10.1111/1471-0528.15237. DOI: https://doi.org/10.1111/1471-0528.15237

Penwell, V. (2022) .The Role of the Midwife in the First 1000 Days’, Midwifery Today, (141), pp. 46–49.

Ravitch, Sharon, M. and Nicole Mittenfelner Carl. Qualitative Research: Bridging the Conceptual, Theoretical, and Methodological. Available from: VitalSource Bookshelf, (2nd Edition). SAGE Publications, Inc. (US), 2019

Rogers, J. M., & Warwick, K. A. (2022). Stronger together: Interprofessional collaboration and sustainability of maternity services in a small northern Ontario hospital. Canadian Journal of Rural Medicine, 27(3), 99-103. DOI: https://doi.org/10.4103/cjrm.cjrm_30_21

Savioli, G., Ceresa, I. F., Gri, N., Bavestrello Piccini, G., Longhitano, Y., Zanza, C., ... & Bressan, M. A. (2022). Emergency department overcrowding: understanding the factors to find corresponding solutions. Journal of personalized medicine, 12(2), 279. DOI: https://doi.org/10.3390/jpm12020279

Sibiya, M. N., Ngxongo, T. S. P., Reddy, P., Ghuman, S., Borg, D., Connor, L.O., Haffejee, F., & Govender, N. (2018). Timing of first antenatal care attendance and associated factors among pregnant women in an obstetric health facility in eThekwini district, KwaZulu-Natal Province, South Africa’, African Journal for Physical, Health Education, Recreation and Dance, 24(2), pp. 181–192.

Senekal, A.C.G., 2021. Experiences of Gauteng-Based Emergency Care Providers Involved in

Critical-Care Transfers. Master’s dissertation, University of Johannesburg, Johannesburg (South Africa). Viewed at https://hdl.handle.net/10210/476126

South Africa. Department of Statistics South Africa.(2022). Rustenburg Local Municipality.

South Africa. Department of Health. (2016). Guidelines for maternity care in South Africa.

Pretoria: Department Of Health. Available at: https://knowledgehub.health.gov.za/elibrary/guidelines-maternity-care-south-africa-2016 (Accessed: 27 April 2024).

South Africa(2018).National Department of Health: Patients’ rights charter. Available at: https://www.idealhealthfacility.org.za/App/Document/Download/150 (Accessed: 27 April 2024).

South Africa.(2021)National Health Act: Regulations: Standards for emergency medical services. Reguation no 94 0f 2021. Pretoria . Available from: https://www.gov.za/sites/default/files/gcis_document/202102/44161gon94.pdf (Accessed 13 April 2024).

South Africa. (1996). Constitution of the Republic Of South Africa1996. Available at: https://www.gov.za/documents/constitution-republic-south-africa-1996 (Accessed: 27 April 2024).

The World Counts (2023). World Population. Available at: https://www.theworldcounts.com/populations/world/births (accessed 19 April 2024)

South Africa. Department Of Health(2018). Ideal Health Facility. Available at: https://www.idealhealthfacility.org.za/App/Document/Download/150 (Accessed 16/10/2024)

South African Private Hospitals. (2016).Childbirth Delivery Costs in South Africa. Available from https://www.saprivatehospitals.com/hospital-care/childbirth-delivery-costs-in-south-africa/ Accessed 16 October 2024

South Africa.Department of Health South Africa.(2003) The National Health Act, 2003 (Act No. 61 Of 2003). Regulations Relating Standards For Emergency Medical Services. Available from; https://www.gov.za/sites/default/files/gcis_document/202102/44161gon94.pdf Accessed 16 October 2024

Sustainable Developmental Goals (SDG).2016.Transforming our World: The 2030 Agenda for Sustainable Development. Available at 21252030 Agenda for Sustainable Development web.pdf

Tukisi, K.P., Temane, A. & Nolte, A., 2022, ‘The midwives’ experiences of the use of obstetric triage and obstetric triage tool during labour in Bojanala district’, Health SA Gesondheid 27(0), a1758. https://doi.org/ 10.4102/hsag.v27i0.1758 DOI: https://doi.org/10.4102/hsag.v27i0.1758

Vallely, L.M., Smith, R., Bolnga, J.W., Babona, D., Riddell, M.A., Mengi, A., Au, L., Polomon, C., Vogel, J.P., Pomat, W.S., Vallely., A.J. & Homer, C.S.E. (2021). Perinatal death audit and classification of stillbirths in two provinces in Papua New Guinea: A retrospective analysis’, International Journal of Gynecology and Obstetrics. 153(1), pp. 160–168. Available at: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=eoah&AN=55492502&site=ehost-live&scope=site (Accessed: 27 April 2024). DOI: https://doi.org/10.1002/ijgo.13431

Wallace, J., Hoehn-Velasco, L., Tilden, E., Dowd, B. E., Calvin, S., Jolles, D. R., Wright, J., & Stapleton, S. (2023). An alternative model of maternity care for low-risk birth: Maternal and neonatal outcomes utilizing the midwifery-based birth center model. Health services research [Preprint]. https://doi.org/10.1111/1475-6773.14222. DOI: https://doi.org/10.1111/1475-6773.14222

Vogus, T. J., McClelland, L. E., Lee, Y. S., McFadden, K. L., & Hu, X. (2021). Creating a compassion system to achieve efficiency and quality in health care delivery. Journal of Service Management, 32(4), 560-580. DOI: https://doi.org/10.1108/JOSM-05-2019-0132

Wasik, M. A. (2020). The role of the nurse in improving the quality of healthcare. Journal of Education, Health and Sport, 10(4), 68-74. DOI: https://doi.org/10.12775/JEHS.2020.10.04.008

Weiss, D., Nelson, A., Vargas-Ruiz, C., Gligori?, K., Bavadekar, S., Gabrilovich, E., Bertozzi- Villa, A., Rozier, J., Gibson, H., & Shekel, T. (2020). Global maps of travel time to healthcare facilities. Nature medicine, 26(12), 1835-1838. DOI: https://doi.org/10.1038/s41591-020-1059-1

WHO Recommendations. (2016).Antenatal Care for a Positive Pregnancy Experience: Summary Highlights and Key Messages from the World Health Organization’s 2016 Global Recommendations for Routine Antenatal Care. Available at: https://apps.who.int/iris/bitstream/handle/10665/259947/WHO-RHR-18.02-eng.pdf (Accessed: 27 April 2024).

WHO recommendations Intrapartum care for a positive childbirth experience Transforming care of women and babies for improved health and well-being https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf

Downloads

Published

2024-08-20

How to Cite

Tukisi, K. P. (2024). Midwives’ descriptions of policies on access to maternity health services in North West Province, South Africa. International Journal of Research in Business and Social Science (2147- 4478), 13(5), 960–971. https://doi.org/10.20525/ijrbs.v13i5.3503

Issue

Section

Related Topics in Social Science