Development of a framework for collaboration between midwives and traditional birth attendants at a selected province in South Africa

Abstract

English: BACKGROUND : The World health Organization (WHO) has identified collaboration between traditional health practitioners (Traditional birth attendants [TBAs]) and skilled birth attendants (midwives) as an essential strategy towards the reduction of maternal and neonatal mortality and morbidity rate (MNMR) especially in low- and middle-income countries (LMICS). In South Africa, the traditional birth attendants' care is often performed in a reticent manner. Nevertheless, the reality remains in South Africa, there is no collaboration existing between western health practitioners and traditional healthcare practitioners. AIM : The study aimed at developing a framework for collaboration between midwives and traditional birth attendants as part of the re-engineering of maternal Primary Health Care services in selected provinces in South Africa. METHODS : The study was conducted in two phases and was guided by the Structure-Process Outcome (SPO) Donabedian framework (1986). Phase 1 was a convergent parallel mixed methods design including concurrent data collection from quantitative and qualitative research design. The findings of phase 1 were analysed and merged to inform the next phase. Phase 2: a consensus method nominal group technique (NGT) held with various stakeholders was employed in the study. RESULTS AND FINDINGS : Subphase 1-Quantitative study. Overall Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants for maternal and neonatal healthcare. In terms of attitude, the midwives displayed a negative attitude towards collaboration for maternity care (mean=46.8, SD=2.1). Midwives (70.4%, n = 183) only agreed to collaborate for antenatal care. In addition, there was a significant relationship (p<0.05) between the level of education and attitude toward collaboration. However, on issues of collaborating for re-engineering of primary maternal healthcare services, the midwives displayed positive results (mean = 63,8, SD=2.4). Subphase 2, from empirical study findings eight themes emanated. In the nominal group technique, the stakeholders reached a consensus on the seven fundamental themes to be included in the framework for collaboration. CONCLUSION : The findings of the study indicate that both the Traditional birth attendant and midwives form the entry point to healthcare services for childbearing women. However, the traditional birth attendants facilitate access of women to maternity care services through a “non-organised and non-regulated framework” in most resource limited settings globally. Thus, the adoption and implementing the collaborative framework will strengthen provision of antenatal care services, prevention of complications including early identification of complications including referrals to modern health care services as recommended by WHO which in turn contributes to reduction on maternal morbidity and mortality through collaborative efforts between TBAs and midwives.

Sepedi: Tshedimošo ya mathomong: Mokgatlo wa Lefase wa maphelo (WHO) o lemogile tirišano magareng ga ditsebi tša maphelo tša setšo (Bahlokomedi ba pelego ba setšo [di-TBA]) le bahlokomedi ba pelego bao ba nago le bokgoni (babelegiši) bjalo ka leano le bohlokwa go ya go phokotšo ya mahu a bomma le masea ao a sa tšwago go belegwa le tekanyo ya malwetši (MNMR) kudukudu dinageng tša letseno la fase le la magareng (LMICS). Afrika Borwa, tlhokomelo ya setšo ya bahlokomedi ba pelego gantši e dirwa ka mokgwa wa go se loke. Le ge go le bjalo, nnete e sa le gona mo Afrika Borwa, ga go na tirišano ye e lego gona magareng ga bašomi ba maphelo ba bodikela le bašomi ba tlhokomelo ya maphelo ba setšo. Maikemišetšo: Thuto ye e be e ikemišeditše go hlama tlhako ya tirišano magareng ga babelegiši le bahlokomedi ba pelego ba setšo bjalo ka karolo ya boentšeneere leswa bja ditirelo tša Tlhokomelo ya Maphelo ya Mathomo ya bomma ka diprofenseng tše di kgethilwego ka Afrika Borwa. Mekgwa: Dinyakišišo di dirilwe ka dikgato tše pedi gomme e hlahlwa ke tlhako ya Donabedian ya Structure- ProcessOutcome (SPO) (1986). Kgato ya 1 e be e le tlhamo ya mekgwa ye e hlakantšwego ya go bapelana ye e kopanago go akaretšwa kgoboketšo ya datha ya nako e tee go tšwa go tlhamo ya nyakišišo ya boleng le ya boleng. Dikutollo tša kgato ya 1 di ile tša sekaseka gomme tša kopanywa go tsebiša kgato ye e latelago. Kgato ya 2: mokgwa wa kwano ya thekniki ya sehlopha sa leina (NGT) yeo e swerwego le bakgathatema ba go fapafapana e šomišitšwe mo nyakišišong ye. Dipoelo le dikhwetšo: Kgato ya ka fasana ya 1-Thuto ya boleng. Ka kakaretšo Babelegiši ka Afrika Borwa ba bontšhitše maemo a fase a tsebo (mean = 41.8, SD=1.7) ka ga tema le mekgwa ya bahlokomedi ba pelego ba setšo bakeng sa tlhokomelo ya maphelo ya bomme le masea a sa tšwago go belegwa. Mabapi le maikutlo, babelegiši ba bontšhitše maikutlo a mabe ka ga tirišano bakeng sa tlhokomelo ya pelego (mean=46.8, SD=2.1). Babelegiši (70.4%, n = 183) ba ile ba dumela feela go dirišana bakeng sa tlhokomelo ya pele ga pelego. Go tlaleletša, go bile le kamano ye bohlokwa (p <0.05) magareng ga maemo a thuto le maikutlo a tirišano. Le ge go le bjalo, ditabeng tša go šomišana bakeng sa boentšeneare leswa bja ditirelo tša mathomo tša tlhokomelo ya maphelo ya bomma, babelegiši ba bontšhitše dipoelo tše dibotse (mean = 63,8, SD = 2.4). Kgato ya ka fasana ya 2, go tšwa go dikhwetšo tša nyakišišo ya diphihlelelo go tšweletše merero ye seswai. Ka thekniki ya sehlopha sa leina, bakgathatema ba fihleletše kwano ka ga merero ye šupa ya motheo yeo e swanetšego go akaretšwa ka gare ga tlhako ya tirišano. Taba ya ka pele v Sephetho: Dikutollo tša nyakišišo di laetša gore bobedi mohlokomedi wa pelego wa Setšo le babelegiši ba bopa lefelo la go tsena ditirelong tša tlhokomelo ya maphelo tša basadi bao ba belegago bana. Le ge go le bjalo, bahlokomedi ba pelego ba setšo ba nolofatša phihlelelo ya basadi go ditirelo tša tlhokomelo ya pelego ka "tlhako ye e sa rulaganywago le yeo e sa laolwego" ka bontši bja mafelo ao a lekanyeditšwego methopo lefaseng ka bophara. Ka go realo, go amogelwa le go tsenya tirišong tlhako ya tirišano go tla maatlafatša kabo ya ditirelo tša tlhokomelo ya pele ga pelego, thibelo ya mathata go akaretšwa go hlaolwa ga mathata ka pela go akaretšwa go romelwa ditirelong tša sebjalebjale tša tlhokomelo ya maphelo bjalo ka ge go šišinywa ke WHO yeo ka morago e tsenyago letsogo go phokotšo ya malwetši le mahu a bomma ka maitapišo a tirišano magareng ga di-TBA le babelegiši. Mantšu a bohlokwa: Tirišano, Tlhako, Babelegiši, Bahlokomedi ba pelego ba setšo, Boentšenere leswa bja tlhokomelo ya maphelo ya mathomo, tlhokomelo ya maphelo ya bomma le masea a sa tšwago go belegwa

Afrikaans: Agtergrond: Die Wêreldgesondheidsorganisasie (WGO) het samewerking tussen tradisionele gesondheidspraktisyns (TGP's) en geskoolde geboorteassistente (vroedvroue) geïdentifiseer as 'n noodsaaklike strategie vir die vermindering van moeder- en neonatale sterftes en morbiditeitsyfers (MNSMS), veral in lae- en middelinkomstelande (LMIL'e). In Suid-Afrika word sorg deur tradisionele geboorteassistente dikwels op 'n terughoudende wyse uitgevoer. Desondanks bly die werklikheid in Suid-Afrika dat daar geen samewerking tussen Westerse gesondheidspraktisyns en tradisionele gesondheidsorgpraktisyns is nie. Doel: Die studie het ten doel gehad om 'n raamwerk vir samewerking tussen vroedvroue en tradisionele geboortebegeleiers te ontwikkel as deel van die herontwerp van primêregesondheidsorgdienste vir moeders in geselekteerde provinsies van Suid-Afrika. Metodes: Die studie is in twee fases uitgevoer en is gerig deur Donabedian se struktuur-proses-uitkoms- (SPU) raamwerk (1986). Fase 1 het 'n konvergente parallelle gemengdemetode-ontwerp gehad wat gelyktydige data-insameling vanuit kwantitatiewe en kwalitatiewe navorsingsontwerp ingesluit het. Die bevindinge van Fase 1 is ontleed en saamgevoeg om die volgende fase te beïnvloed. In Fase 2 het die studie 'n konsensusmetode- nominale groepstegniek (NGT) met verskeie belanghebbendes gebruik. Resultate en bevindinge: Subfase 1 - Kwantitatiewe studie. Regdeur Suid-Afrika het vroedvroue ’n lae kennispeil (gemiddeld = 41,8, SD=1,7) getoon omtrent die rol en praktyke van tradisionele geboortebegeleiers vir moeder- en neonatale gesondheidsorg. Wat houding betref, het die vroedvroue 'n negatiewe houding oor samewerking in kraamsorg getoon (gemiddeld=46,8, SD=2,1). Vroedvroue (70.4%, n = 183) het slegs daartoe ingestem om saam te werk rakende voorgeboortelike sorg. Daar was boonop 'n beduidende verband (p<0,05) tussen die peil van onderwys en die houding jeens samewerking. Maar oor die kwessie van samewerking om primêre moedergesondheidsorgdienste te herontwerp was die vroedvroue se resultate positief (gemiddeld = 63,8, SD = 2,4). In Subfase 2 het agt temas uit die empiriese studiebevindinge na vore gekom. In die nominale groeptegniek het die belanghebbendes 'n konsensus bereik oor die sewe fundamentele temas wat in die raamwerk vir samewerking ingesluit moet word. Voorwerk v. gevolgtrekking: Die bevindinge van die studie dui daarop dat beide die tradisionele geboortebegeleier en vroedvroue die toegangspunt tot gesondheidsorgdienste vir vrugbare vroue vorm. Die tradisionele geboortebegeleiders bevorder egter vir vroue toegang tot kraamsorgdienste by wyse van 'n "niegeorganiseerde en niegereguleerde raamwerk" in die meeste omgewings met beperkte hulpbronne wêreldwyd. Dus sal die aanvaarding en implementering van die samewerkingsraamwerk versterkend werk in die voorsiening van voorgeboortelikesorgdienste, die voorkoming van komplikasies, insluitend vroeë identifisering van komplikasies, insluitend verwysings na moderne gesondheidsorgdienste soos aanbeveel deur die WGO, wat weer bydra tot die vermindering van moederlike morbiditeit en mortaliteit deur samewerking tussen tradisionele geboortebegeleiders en vroedvroue. Sleutelwoorde: samewerking, raamwerk, vroedvroue, tradisionele geboortebegeleiers, herontwerp van primêregesondheidsorg, moeder- en neonatale gesondheidsorg

IsiZulu: Ngemuva: I-World Health Organization (WHO) ihlonze ukusebenzisana phakathi kwabelaphi bendabuko (abanakekeli bendabuko ngokuphathelene nokubelethisa [TBAs]) kanye nabanakekeli bendabuko abanamakhono (ababelethisi) njengecebo elibalulekile lokunciphisa izinga lokushona komama kanye nabantwana abasanda kuzalwa kanye nezinga lokushona kwabantu (MNMR) ikakhulukazi emazweni anamaholo aphansi kanye naphakathi nendawo (LMICS). ENingizimu Afrika, ukunakekela kwababelethisi bendabuko kuvame ukwenziwa ngendlela engakhombisi imizwa yothile. Noma kunjalo, okusalokhu kuyiqiniso eNingizimu Afrika ukuthi, akukho ukusebenzisana okukhona phakathi kwabasebenzi bezempilo kanye nabanakekeli bezempilo bendabuko. Inhloso: Ucwaningo luhlose ukusungula uhlaka lokusebenzisana phakathi kwababelethisi kanye nababelethisi bendabuko njengengxenye yokwakhiwa kabusha kwezinsiza zokunakekelw kwempilo eyisisekelo yomama ezifundazweni ezikhethiwe eNingizimu Afrika. Izindlela zokwenza: Ucwaningo lwenziwe ngezigaba ezimbili futhi lwaluqondiswa uhlaka lwe-Structure-ProcessOutcome (SPO) Donabedian (1986). Isigaba 1 kwakuwumklamo wezindlela ezixubile ezihambisanayo ezihlanganisa ukuqoqwa kwedatha ngesikhathi esifanayo kusuka ekwakhiweni kocwaningo ngokuphathelene nokuhlaziya ngokwezibalo kanye nokuthola ukuthi kwenzeke kanjani futhi ngobani. Okutholakele esigabeni 1 kwahlaziywa futhi kwahlanganiswa ukuze kwaziswe isigaba esilandelayo. Isigaba 2: kulolu cwaningo kwasetshenziswa indlela yeqembu lababamba iqhaza ngokulingana kuze kufinyelelwe esivumelwaneni (NGT) okwenziwa nababambiqhaza abahlukahlukene. Imiphumela kanye nokutholakele: Ucwaningo olungaphansi kwesigaba 1-Ucwaningo oluhlaziya ngokwezibalo. Sekukonke Ababelethisi eNingizimu Afrika babonise izinga eliphansi lolwazi (isilinganiso = 41.8, i-SD =1.7) ngendima nemikhuba yababelethisi bendabuko ngokuphathelene nokunakekelwa komama kanye nabantwana abasanda kuzalwa. Ngokwesimo sengqondo, ababelethisi babonisa isimo sengqondo esingesihle ngokubambisana kokunakekelwa ngokuphathelene nokubeletha (isilinganiso = 46.8, SD=2.1). Ababelethisi (70.4%, n = 183) bavumile kuphela ngokuphathelene nokubambisana ekunakekelweni kwangaphambi kokubeletha. Ngaphezu kwalokho, bekunobudlelwano obuphawulekayo (p<0.05) phakathi kwezinga lemfundo kanye nesimo sokubuka ukubambisana. Nokho, ezindabeni zokusebenzisana ekwakhiweni kabusha izinsiza zezempilo eziyinhloko zokunakekela omama abakhulelwe, ababelethisi babonisa imiphumela emihle (isilinganiso = 63,8, SD=2.4). Ucwaningo olungaphansi kwesigaba 2, esivela kokutholakele ocwaningweni oluvamile kukhishwe izihloko eziyisishiyagalombili. Enkambisweni yeqembu lababamba iqhaza ngokulingana kuze kufinyelelwe esivumelwaneni, ababambiqhaza bafinyelele ekuvumelaneni ngezihloko eziyisikhombisa eziyisisekelo ezizofakwa ohlakeni lokubambisana. Indaba yangaphambili uma kuqhaniswa Nesiphetho: Okutholakele ocwaningweni kukhombisa ukuthi kokubili umbelethisi Wendabuko kanye nababelethisi bakha indawo yokungena ezinsizeni zokunakekela kwezempilo zabesifazane ababelethayo. Kodwa-ke, ababelethisi bendabuko benza abesifazane bafinyelele ezinsizeni zokunakekela ngokuphathelene nokubeletha "ngohlaka olungahlelekile kanye nendlela engahlelekile" ezimweni eziningi ezinezinsiza ezilinganiselwe emhlabeni jikelele. Ngakho, ukwemukelwa nokusebenzisa uhlaka lokubambisana kuzoqinisa ukuhlinzekwa kwezinsiza zokunakekelwa kwangaphambi kokubeletha, ukuvimbela izinkinga ezihlanganisa ngokuhlonza kusenesikhathi izinkinga ezihlanganisa ukudluliselwa ezinsizeni zokunakekela kwezempilo kwesimanje manje njengoba kunconywa yi-WHO ezinomthelela ekunciphiseni ukugula kanye nokushona komama ngenxa yemizamo yokubambisana phakathi kwama-TBA kanye nababelethisi. Amagama abalulekile: Ukubambisana, Uhlaka, Ababelethisi, Ababelethisi bendabuko, Ukwakhiwa kabusha kokunakekela kwezempilo okuyinhloko, ukunakekela kwezempilo komama kanye nabantwana abasanda kuzalwa