Abstract:
Despite global progress in reducing maternal and neonatal mortality
and stillbirths, much work remains to be done to achieve the
Sustainable Development Goals. Reports indicate that coronavirus
disease (COVID-19) disrupts the provision and uptake of routine
maternal and neonatal health care (MNH) services and
negatively impacts cumulative pre-COVID-19 achievements. We
describe a multipartnered MNH quality improvement (QI) initiative
called Mphatlalatsane, which was implemented in South
Africa before and during the COVID-19 pandemic. The initiative
aimed to reduce the maternal mortality ratio, neonatal mortality
rate, and stillbirth rate by 50% between 2018 and 2022. The
multifaceted design comprises QI and other intervention activities
across micro-, meso-, and macrolevels, and its area-based approach
facilitates patients’ access to MNH services. The initiative
commenced 6 months pre-COVID-19, with subsequent adaptation
necessitated by COVID-19. The initial focus on a plan-dostudy-
act QI model shifted toward meeting the immediate needs
of health care workers (HCWs), the health system, and health
care managers arising from COVID-19. Examples include providing
emotional support to staff and streamlining supply chain management
for infection control and personal protection materials. As
these needs were addressed, Mphatlalatsane gradually refocused
HCWs’ and managers’ attention to recognize the disruptions caused
by COVID-19 to routine MNH services. This gradual reprioritization included the development of a risk matrix to help staff and managers
identify specific risks to service provision and uptake and develop
mitigating measures. Through this approach, Mphatlalatsane
led to an optimization case using existing resources rather than
requesting new resources to build an investment case, with a responsive
design and implementation approach as the cornerstone
of the initiative. Further, Mphatlalatsane demonstrates that agile
and context-specific responses to crises such as the COVID-19 pandemic
can mitigate such threats and maintain interventions to improve
MNH services.
