Health workers' disrespectful and abusive behaviour towards women during labour and delivery: A qualitative study in Durban, South Africa

Strategies to Reduce Maternal Death Rate and Improve the Provision of Quality Healthcare Services in Selected Hospitals of Vhembe District Limpopo Province

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in the maternal mortality rate was reported between 2020 and 2021, with Limpopo ranking fourth highest out of nine provinces. The Vhembe district maintained its position as the third-ranked area with a notably elevated maternal mortality rate. This study aimed to explore the strategies used to reduce the maternal death rate and improve the provision of quality maternal healthcare services based on participant experiences in selected hospitals of the Vhembe district, Limpopo Province. One hospital was purposively sampled from every four municipalities. A qualitative approach using a phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data, complemented by the use of an audio recorder, continuing until data saturation was reached. Data saturation was reached at the 20th participant; however, the researcher continued until 28 sampled participants were interviewed. An interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). The results indicate that, despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as the lack of material resources, shortage of staff, incompetent staff and poor infection control, affect the quality of maternal health services in the Vhembe district. The Limpopo Department of Health and hospital management should ensure that hospitals have all the necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

Evaluation of community-based participatory governance interventions to improve access to health-related public entitlements in India

Purpose

As the investment in social and health protection remained poor in India, the most vulnerable citizens lack access to existing health related government initiatives with transformational benefits due mostly to the lack of “accurate information”. The purpose of this paper is to explore and demonstrate the impact of participation of the community through a structured intervention that promotes awareness, enables the community to ensure entitlements, and enhances the utilization of government initiatives.

Design/methodology/approach

Through a baseline–endline study using a quasi-experimental design, this research provides empirical evidence of such intervention on awareness and utilization of health, nutrition and developmental initiatives. It involved survey of 400 households from the four study locations before and after the interventions. The pre-post estimation in the “proportion of respondents who were fully aware” was analyzed to measure changes in knowledge. Mc-Nemar test was applied to measure the statistical significance of these changes.

Findings

The results indicate that the intervention of “empowerment centers” has increased knowledge and utilization of the various government schemes, services and facilities that are routine and offer benefits all household members, in general, and women as well as children, in particular. The intervention was found to be successful in improving the local governance systems; empowering communities, linking communities and local level government systems across all sectors, as well as bringing in inter-sectoral linkages across governments systems.

Research limitations/implications

Although there have been many interventions of community participation for reducing inequities across the globe, there is a dearth of documentation and evidence generation. More efforts are required to evaluate such interventions, identify which interventions work and how they can be adapted to different contexts. This also requires exploration of the social processes and contextual realities underlying these interventions.

Originality/value

To the best knowledge of the authors, this research is one-of-its-kind that assessed an intervention targeting cross-cutting schemes and services, beyond just health interventions. The evidence points to the success of grassroots level inter-sectoral community actions, in the form of empowerment centers, to improve awareness and utilization of government interventions through participatory governance, and points to the expanding scope of learning and adapting such interventions to different contexts and scopes.