Model to strengthen maternal healthcare service delivery in Gauteng Province, South Africa

Abstract

Maternal healthcare service delivery influences the obstetric outcomes of the women in their perinatal period, including six weeks after childbirth. It is in that regard that the purpose of this study was to determine the nature and extent of maternal healthcare service delivery in Gauteng Province, South Africa. The research study adopted a three-phased sequential exploratory mixed-methods research (MMR) design approach, involving qualitative and quantitative data collection, and convergent data analysis respectively. The study population comprised midwives working at the four selected public hospitals in Gauteng Province, as well as the perinatal women accessing their maternal health at the self-same public hospitals. Due to the multiple data collection instruments applied, the study concomitantly adopted different sampling strategies involving purposive, maximum variation, stratified random, and convenience sampling. Finally, a sample size of 392 was obtained, consisting of 105 midwives and 287 perinatal women. Qualitative data collection was implemented through focus group discussions (FGDs), in-depth interviews and documentary analysis. The quantitative data collection was facilitated through checklists and structured questionnaires. Both thematic and content data analysis were applied in the study’s qualitative phase. For quantitative data analysis, the Statistical Package for Social Sciences (SPSS), Version 27 and STATA 16 computer programs were utilised. The study findings revealed diverse assumptions, statements and beliefs that urge for a reconfiguration of current domination and authority practices over women and other vulnerable groups. Furthermore, the study found that five dominant literature-based themes were still observable in the practical environment of midwives and their patients in the maternity wards. These are: individual factors, interpersonal relations, organisational challenges; as well as community and policy and government factors. The researcher’s developed model was based on the actual findings in the current study and was subsequently evaluated by the midwifery experts. The purpose of the model was to contribute towards improvements in maternal healthcare service delivery for the reduction of maternal mortality.

Thebolelo ya ditirelo tsa pelegi e na le tlhotlheletso e kgolo mo dipholong tsa pelegi mo basading ka nako ya boimane le botsetse jwa bone go fitlha dikgwedi di le thataro. Mo ntlheng eno, maitlhomo a thuto e, ke go batlisisa gore ditirelo tsa pholo mo basading ba porofense ya Gauteng – Aferika Borwa ke tsa mofuta ofe le go leba kamano ya tsone Dipatlisiso tsa thuto e, di di dirisitse magato a le mararo a sequential exploratory mixed method, a akaretsang mekgwa ya kokoantsha tshedimosetso ka qualitative, le quantitative le go kopantsha tshedimosetso ka go latelana jalo. Tshedimosetso e tswa mo setlhopheng sa baoki ba ba katiseditsweng pelegi e bile ba dira, le basadi ba ba leng mo nakong ya pelegi ba tlhoka tlhokomelo mo dipataleng tsa puso tse nne (04) mo porofenseng ya Gauteng. Ka ntlha ya methale e e fapaneng ya go kokoanya tshedimosetso, mmatlisisi o ne a dirisa purposive, maximum variation, stratified random, le convenience sampling. Ka jalo, o ne a feleletsa ka palo ya bannaleseabe ba le 392, e e akaretsang ba belegisi ba le 105 and basadi ba le 287. Kokoantsha tshedimosetso ya qualitative e ne ya dirisa dipuisano tsa ditlhopha le tsa bongwe le go le tlhatlhoba ditokumente. Mme, lenaane and foromo ya dipotso tsone di ne tsa dirisiwa mo tshobokanyo ya tshedimosetso ya quantitative. Go sekaseka ga di teng tsa qualitative go direlwe ka setshwantsho sa thematic le content, fa Statistical Package ya Social Sciences (SPSS), kgaolo ya 27 le STATA 16 porokeramo ya khomphuta di dirisitswe mo quantitative. Dipholo tsa thuto di bontsha thulaganyo ya maatla a ditumelo tse di faroganeng mo ntlheng ya dipegelo tsa basadi. Go bonagala ditheme di le tlhano (05) go tswa mo dibukeng le mo dipuisanong le babelegisi le basadi mo dipateleng tsa bone. Ditheme tse, di bontsha mabaka a a latelang: mabaka a motho ka esi, tirisano mmogo, thulaganyo ya tsamaiso mo tirong, tsabosetshaba, taolo le tsamaiso. Kwa bofelong, mmatlisisi o ne a tlhoma sekao se se tshegetsang babelegising le basadi mo leetong la pelegi, e bile sekao se se ne sa tlhotlhwafatswa ke baitsaanape mo lefapheng la tsa boimana. Leano la sekao se, ke matlafatsa ditirelo tsa basadi le pelegi ka maitlhomo a fokotsa dintsho tse di amanang le pelegi.