Development of intervention strategies to enhance implementation of maternal and neonatal referral system guidelines in Mopani district in the Limpopo Province

Abstract

Introduction: South Africa is experiencing maternal and neonatal mortality challenges due to pregnancy related conditions such as hypertension, obstetric haemorrhage and HIV in pregnancy. There are gaps when it comes to referral of obstetric emergencies, despite the availability of maternal and neonatal referral system guidelines. Therefore, appropriate measures need to be put in place to enhance the implementation of the maternal and neonatal referral system guidelines to assist the country in overcoming these challenges. Aim: To develop intervention strategies to enhance the implementation of maternal and neonatal referral system guidelines in the Mopani District of the Limpopo Province, to facilitate prompt referral of obstetric emergencies, to minimise obstetric complications and improve maternal and neonatal outcomes. This study was conducted in two (2) phases, namely, phase 1: Empirical phase and phase 2: Development phase) Research design and methods: Descriptive phenomenological research design methods were used in phase one of this study. The population were three groups of participants, eleven (11) postnatal mothers, ten (10) registered midwives and four (4) supervisors/managers. Purposive sampling was used. Data collection in-depth individual face-to-face interviews. Data analysis, Colaizzi’s seven (7) procedural steps. A modified Delphi technique was employed in phase two, to validate the drafted intervention strategies. Population were a panel of twenty (20) experts in maternal and neonatal health fields. Purposive and snowballing sampling were used. Data collection and analysis were done in three rounds on a 4-point Likert scale questionnaire. Findings: Phase one findings revealed six (6) essential meanings and thirty-four (34) constituents derived from those essential meanings. Four (4) essential meanings and fourteen (14) constituents emerged from the interviews with the postnatal mothers. Those essential meanings were: postnatal mothers’ positive experiences, postnatal mothers' challenging experiences, consequences of challenges and the essential meaning of experiences. Two essential meanings and twenty (20) constituents emerged from the interviews with the registered midwives and the supervisors/managers. Those essential meanings were: the essence of experiences and the essence of recommendations. From the findings, the researcher identified statements, constructs and words related to the relevant intervention strategies and formulated a framework to draft the eight (8) intervention strategies. During phase two of this study, the researcher consolidated feedback, suggestions and comments to refine the intervention strategies. The most reliable agreement was obtained in all three (3) rounds of validation. From the eight (8) developed intervention strategies, various intervention activities, sub-interventions and the rationale thereof were drawn, inter alia, provision of effective maternal healthcare and health education by effectively managing low-risk maternal conditions, provision of accessible maternal and neonatal healthcare services. 24/7 through 24-hour unrestricted access to promote improved operational functioning, Identification of the mothers’ obstetrical, medical, social, physical and psychological well-being. The health care providers listen and attend to the mothers' and relatives’ concerns, demands and needs to build mutual trust and empower them. Measures of trustworthiness: To ensure trustworthiness the researcher adhered to the principles of credibility, dependability, confirmability, transferability, authenticity, bracketing, prolonged engagement and persistent observation, reflexivity, triangulation and member checking. Ethical considerations: Ethical clearance was obtained from the University of Pretoria, Faculty of Health Sciences Research Ethics Committee (Ethics Reference No: 236/2021). Permission to access the research setting was obtained from the Limpopo Provincial Department of Health and Mopani District Health Department. From a maternity unit of a selected district hospital permission was obtained from the Chief Executive Officer (CEO) of the selected district hospital while at the selected primary healthcare facility permission was obtained from the Operational Manager of the selected primary healthcare facility. Conclusion of the study or significance of the study: The study findings in phase one of this study highlighted referral system gaps which informed development of the eight (08) intervention strategies in phase two of this study to enhance implementation of the maternal and neonatal referral system guidelines in Mopani District, Limpopo Province. The eight (08) developed intervention strategies are aimed to be utilized in primary health care facilities and district hospitals in Mopani District, Limpopo Province to facilitate prompt referral of obstetric emergencies. In so doing obstetric complications may be minimized and maternal and neonatal outcome may be optimized. Key terms: expert; referral; referral system; maternal care; neonatal care