Browsing by Author "Mianda, Solange"
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Item District and sub-district stewardship of quality and health outcomes: roles, systems and strategies(University of the Western Cape, 2022) Schneider, Helen; Mianda, SolangeSub-district and district health systems – generically referred to as the meso-level – are key to enhancing quality of care and improving health outcomes. Facility (micro) level improvement strategies are less likely to succeed or be sustained if they are not supported and enabled by the meso-level. In this briefing document, we explore district and sub-district stewardship of quality of care and health outcomes, based on insights and experiences of a national initiative referred to as Mphatlalatsane. This initiative seeks to improve maternal and neonatal health in selected districts of three provinces (Mpumalanga, Limpopo and Eastern Cape). As part of the wider evaluation of Mphatlalatsane, we conducted serial interviews with project partners over the course of 2020 and 2021, specifically probing views on the meso-level in relation to maternal and neonatal health (MNH) quality and outcomes. Drawing on these interviews and programme documentation, we seek to characterize both the ‘what’ and ‘the how’ of meso-level stewardship of quality and outcomes, including roles/capabilities, enabling systems and change strategies. We believe the insights generated offer guidance on system functioning that can complement clinical guidelines and standards, and feed into debates on the design of district and sub-district health systems in South Africa. To achieve better quality and health outcomes (whether for MNH or other programmes), the meso-level needs to be able to: drive implementation of provincial and national strategy, while simultaneously advocating for bottom-up service delivery needs; authorise and support innovation by frontline providers, drawing on improvement methodologies; coordinate health programmes and players across levels of the health system; and ensure appropriate accountabilities. These roles imply a high degree of agency and responsiveness on the part of the meso-level, proactively connecting elements of the system, problemsolving, learning, allocating resources and exploiting efficiencies.Item Facilitating factors and barriers to kangaroo mother care utilisation in low- and middle-income countries: A scoping review(AOSIS, 2021) Mathias, Christina T.; Mianda, Solange; Ohdihambo, Julius N.Kangaroo mother care (KMC) has been widely adopted in low-and middleincome countries (LMICs) to minimise low birthweight infants’ (LBWIs) adverse outcomes. However, the burden of neonatal and child mortality remains disproportionately high in LMICs. Thus, this scoping review sought to map evidence on the barriers, challenges and facilitators of KMC utilisation by parents of LBWIs (parent of low birthweight infant [PLBWI]) in LMICs. We searched for studies conducted in LMICs and published in English between January 1990 and August 2020 from SciELO, Google Scholar, JSTOR, LILACS, Academic search complete, PubMed, CINAHL with full text, and Medline databases. We adopted Arksey and O’Malley’s framework for conducting scoping reviews.Item Intervention in mothers and newborns to reduce maternal and perinatal mortality in 3 provinces in South Africa using a quality improvement approach: Protocol for a mixed method type 2 hybrid evaluation(JMIR Publications, 2023) Chetty, Terusha; Singh, Yages; Mianda, SolangeThe COVID-19 pandemic 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. Our evaluation aims to determine the effect of various exposures, including the COVID-19 pandemic, and a system-level, complex, patient-centered quality improvement (QI) intervention (the Mphatlalatsane Initiative) on maternal and neonatal health services at 21 selected South African facilities. The objectives are to determine whether Mphatlalatsane reduces the institutional maternal mortality ratio, neonatal mortality rate, and stillbirth rate (objective 1) and improves patients’ experiences (objective 2) and quality of care (objective 3). Objective 4 assesses the contextual and implementation process factors, including the COVID-19 pandemic, that shape Mphatlalatsane uptake and variation.