COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

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5. DISCUSSION: TRIANGULATION AND SUMMARY OF RESULTS In triangulating the results across the various sources of data in this study, many consistent themes emerged. Since within each section above, discussion and conclusions specific to that section were already included, this section provides a short summary of the primary themes that were observed in this analysis: • Transport and Distance to Health Facilities is the biggest problem facing women trying to access health services This study shows that the major barriers to accessing health facilities for both ANC and maternity services are lack of transport and the distances that have to be covered. • Communication with Families was very poor Communication by health workers with families was shown to be inadequate leading to a decreased belief in the health services. • Health Seeking Behaviour was good In spite of often poor treatment and lack of communication by the health services, the study showed that most people first seek help from the clinic or hospital and only when failed by the Western health system did they access traditional healers. In a few people who started off by using traditional healers, they turned to Western health services as soon as a serious complication arose. Women and families appear to only delay or not access Western health services when they cannot get there (see transport above) not because the do not want to access services, or do not feel the services are valuable. • Treatment by health providers and quality of care was mixed This study also shows that women had mixed perceptions on the ‘care’ provided by hospital and clinic health workers and the quality of care they received. However, it is clear that quality of care issues are a factor impacting on the health of women and infants. Therefore, improved health structures and systems, quality of care and treatment of women and infants by health workers are needed. • HIV and AIDS is a major issue - but cannot overlook basic maternity and neonatal service quality HIV and AIDS is a huge issue affecting every aspect of health care service. However care must be taken to ensure that the quality of basic maternity and neonatal services is not overshadowed. • Families and Community are an untapped resource This research showed that the families and communities are crucial in determining the health seeking behaviour of pregnant women and mothers of young children. This valuable resource must be exploited to minimise maternal and infant morbidity and mortality. Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 36
6. RECOMMENDATIONS: 24-hour emergency transport services must be available within each community for emergency obstetric and paediatric care. This is critical in both rural areas (where other forms of public transport are often not available and where many people do not have access to private vehicles) and in urban areas where ones safety is compromised if travelling alone. Women interviewed mentioned that communities could be more helpful at crisis time like going into labour, e.g. pay later for transport accessed. They also wanted more ambulances and quicker time to reach patients. Also the women mentioned mobile clinics as a way of bringing services closer to them, thus increasing both antenatal and postpartum clinic attendance. This is a complicated problem that should be a priority for the Department of Health. However, any long term solution will probably also require extensive collaboration and community partnerships (see below). Community education about maternal and infant health and danger signs is imperative. Families should be educated (by both CHWs and health facility staff) on the maternal and infant health and danger signs and they should also know that prompt medical attention can save lives. While women and their families had some knowledge on danger signs, this was incomplete. It must be recognised that women trust most the information from health facility based health providers. Therefore, it is imperative that health providers are active participants in health education and health promotion. It is also important that health education and promotion be comprehensive to include common symptoms of pregnancy, recognising risk factors that need urgent treatment, other issues such as maternal nutrition (including micronutrients) and genetics, family planning, HIV and other sexually transmitted infections, as well as infant feeding and infant care. The Health Promoting Settings Model coordinates individual, group and community health promotion both within the health facilities and in partnership with communities. This model should be considered for all health facilities providing primary health care in South Africa. Finally, for broad community based education through the public media, the radio appears to be the preferred channel of communication of health information for the majority of women. Hospital protocols for assessment and treatment of women and infants must be reviewed and current standards must be implemented. Even in this small study, evidence of inappropriate treatment and patient discharge were evident. Implementation of national initiatives and treatment guidelines such as those promoted by the Saving Mothers and Saving Babies Programmes and the Integrated Management of Childhood Illness (IMCI) need to be assured at all levels of care. Particular attention to rural and poorly resourced areas is needed. For example there is not a single IMCI trained health provider in the entire Umzimkulu sub-district where Rietvlei Hospital is located. All facilities must be adequately supplied with the essential medicines and other supplies to promote maternal and infant health. The current mechanisms used to ensure that stock-outs do not happen at any clinic or hospital must be reviewed and strategies should be developed to better respond to identified needs. Sensitivity training for hospital staff working with mothers and infants should be explored and communication with families needs to be enhanced. All families in South Africa have the right to be treated with respect when they present at a health facility, and all deserve to have full knowledge of the diagnosis and treatment for themselves and their infants. This also includes a discussion of cause of death with the family for both women and infants. While confidentiality concerns are important, it is clear that families are primary care givers for Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 37
Page 1 and 2: COMMUNITY BASED SITUATIONAL ANALYSI
Page 3 and 4: Table of Contents ABSTRACT ........
Page 7 and 8: Executive Summary COMMUNITY BASED S
Page 9 and 10: It was not possible to identify par
Page 11 and 12: With regard to knowledge of risk fa
Page 13 and 14: Themes that emerged from the qualit
Page 17 and 18: 3. METHODS Description of Research
Page 19 and 20: Data Collection The study utilised
Page 21 and 22: inclusion criteria required women t
Page 23 and 24: Table 2: Demographic Data Average a
Page 25 and 26: Graph 2: Comparing Average Travel T
Page 27 and 28: household members gave to women's h
Page 29 and 30: a source of information. CHWs were
Page 31 and 32: Provincial governments to improve h
Page 33 and 34: NO ANC ATTENDANCE The most commonly
Page 35 and 36: Attitude of nurses: Only one woman
Page 37 and 38: SECTION 2: MATERNAL DEATH REVIEW Me
Page 39 and 40: There was no delay from the time of
Page 41 and 42: women from Umlazi (33%) and neither
Page 43 and 44: SECTION 3: INFANT DEATH REVIEW Meth
Page 45 and 46: Maternal and infant HIV status for
Page 47 and 48: The role of traditional healers: In
Page 49: programme. This was all clearly doc
Page 53 and 54: transport will likely not be succes
Page 55 and 56: APPENDIX A: RESULTS* *Notes to Tabl
Page 57 and 58: Appendix A2: Distribution of Select
Page 59 and 60: Appendix A5: Barriers to accessing
Page 61 and 62: OBJECTIVE 2: To determine the level
Page 63 and 64: Appendix A15: What Are Some Dangero
Page 65 and 66: Appendix A17: Household Member: Wha
Page 67 and 68: Appendix A20: Quality of Care by HI
Page 69 and 70: Appendix A22: Family Involvement in
Page 71 and 72: Appendix A25: Family Involvement af
Page 73 and 74: APPENDIX B1: MATERNAL VERBAL AUTOPS
Page 75 and 76: APPENDIX B2: INFANT VERBAL AUTOPSY
Page 77 and 78: areas covered during the interview
Page 79 and 80: way home after having been admitted
Page 81 and 82: APPENDIX B3: FACILITY SUB-STUDY REP
Page 83 and 84: Staff at all facilities felt that t
Page 85 and 86: 8. HUMAN RESOURCES The District HIV
Page 87 and 88: DATA FROM PMTCT REGISTER Page Numbe
Page 89 and 90: counseling and not ongoing support
Page 91 and 92: year. It has not been possible to l
Page 93 and 94: 8. HUMAN RESOURCES When the PMTCT p
Page 95 and 96: Each clinic had a register in which
Page 97 and 98: APPENDIX B5: FACILITY SUB-STUDY REP
Page 99 and 100: THEMES PAARL RIETVLEI attached by t

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