Oosthuizen, Sarie J.Bergh, Anne-MarieSilver, AntonellaMalatji, RefilweMfolo, VivianBotha, Tanita2023-02-152023-02-152022-03-30Oosthuizen, S.J., Bergh, A.-M., Silver, A., Malatji, R.E., Mfolo, V. & Botha, T. The COVID-19 pandemic and disruptions in a district quality improvement initiative: Experiences from the CLEVER Maternity Care programme. South African Family Practice 2022;64(1), a5359. https://DOI.org/10.4102/safp.v64i1.5359.2078-6190 (print)2078-6204 (online)10.4102/safp.v64i1.5359https://repository.up.ac.za/handle/2263/89522BACKGROUND : Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs. METHODS : This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers. RESULTS : Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers’ response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging. CONCLUSION : Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication.en© 2022. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.Health-systems readinessMaternity servicesQualityCLEVER maternity careWorking environmentCommunicationCOVID-19 pandemicCoronavirus disease 2019 (COVID-19)Midwife-led obstetric units (MOUs)Article