Research And Analysis | Health Systems Trust, South Africa
“A Nation thrives when mothers survive; we must strive to keep them alive’ Ellen Johnson Sir leaf
Background Introduction of Health Systems Trust, South Africa
Founded in 1992, we are a non-profit organisation with a mission of “To be a partner of choice in building comprehensive and equitable health systems” Health Systems Trust is consistently working to materialize its vision of health for all through strengthened healthcare systems. As our website proudly displays that the organisation is working passionately to provide health solutions to the department of health in South Africa and to the common people. Today we are the leading resource on health systems and primary healthcare in Southern Africa. Our core values of honesty and transparency, innovation and knowledge driven advancements, people-centric approach and responsive attitude have help us contribute effectively to achieve our mission and strengthen the National health policy for South Africa at the same time. For governance we have an independent board of trustees that collectively is an experienced group of experts in health care system policies and their implementation.
The health issue concerned is maternal mortality rate and primary healthcare in South Africa as a whole an especially in the underprivileged sections of the society. The severity of the situation is demonstrated by the MMR (Maternal Mortality Rate) of 138 deaths/100,000 live births against the target of achieving 38 deaths per 100,000 live births (Dr. Marjorie Jobson, 2015). There were 4452 maternal deaths as per the database collected in 2013-14 and these deaths are alrming. The top three causes for deaths were found to be non-pregnancy related infections, obstetric haemorrhage and hypertension and were together responsible for 65% of total avoidable maternal deaths. Most of the deaths ........
The health issue concerned is maternal mortality rate and primary healthcare in South Africa as a whole an especially in the underprivileged sections of the society. The severity of the situation is demonstrated by the MMR (Maternal Mortality Rate) of 138 deaths/100,000 live births against the target of achieving 38 deaths per 100,000 live births (Dr. Marjorie Jobson, 2015). There were 4452 maternal deaths as per the database collected in 2013-14 and these deaths are alrming. The top three causes for deaths were found to be non-pregnancy related infections, obstetric haemorrhage and hypertension and were together responsible for 65% of total avoidable maternal deaths. Most of the deaths were due non-pregnancy related infection such as HIV and accounted for 38.7% of the total. The reasons for such lapses in healthcare were found to be the Lack of appropriately trained doctors and nurses, ineffective primary healthcare facilities and negligence. In South Africa, on record in the cases of maternal mortality concerning anaesthesia, obstetric haemorrhage, pregnancy related sepsis and complications of hypertension 47%, 27% 24% and 19% badly trained doctors were responsible respectively. (Saving Mothers, 2011-2013)
The affected population
The affected section constitutes mostly the underprivileged women ageing from 15-49 years. The mortality rate relationship with income and wealth were complex, with highest values for middle income and middle wealth index. The effect of urbanization was small, and reversed in a multivariate analysis. Higher risks in provinces were not necessarily associated with lower income, lower education or higher proportions of home delivery, but correlated primarily with the prevalence of HIV/AIDS (Michel Garenne, Robert McCaa and Kourtoum Nacro, 2008). From the surveys and database study it is corroborated that the worst affected from the maternal mortality rates are the Sub Saharan Africa and these deaths are definitely avoidable as established by the disparities in maternal mortality rates among the rich and poor nations of the world. Hence, our organisation is working towards making better policies for healthcare in South Africa and generating awareness through various other flagship schemes to improve primary health care systems in the nation.
Urgency of the issue & impact on the affected population
The mortality rates affect the society in multiple ways. A child’s future without mother lies in uncertainty and the child’s education, employability and capacity are adversely affected by the incident. A mother-less child lives under the threats of poverty and poor education and hence weakens the future national resource for the nation building. With the incriminating cases of HIV infections now-a-days it is imperative to address the issue otherwise the cases may go up steeply and containing the deaths due to HIV and other non-pregnancy related infections combined may become impossible to curb. Therefore, to save the affected population from the grasp of the increasing maternal mortality rates we need comprehensive planning and time bound execution of the schemes. (Colleen M. Grogan, 2007)
Policy framework for improving MMR and Primary Healthcare
ABOUT THE POLICY:
The Ottawa charter framework for health promotion has been the basis of forming this policy for advocacy. The charter was introduced by W.H.O in Canada in order to solve health issues and promote health awareness. The framework directs towards identify the issue and collecting databases. Afterwards it helps to develop a plan of action for implementing innovative technique.(WHO, 2017)
To bring improvements in the current situation and statistical data of 138 deaths per one lac persons we need to prepare a comprehensive plan and step by step execution of the same with proper review at each step of the way.
The Framework for mitigation the maternal mortality rate is depicted below.
- Identifying the lapses
The primary requirement of any solution is the identification of the problem. The maternal mortality ration is increasing and we need to keep track of the death rates to understand the urgency. Hence, Health Systems Trust maintains the record for all such cases of maternal mortality with proper analysis of the lapses in the particular case. The reasons for the deaths, the treatment practice applied in process and the infections responsible for the death of the mother. it categorises the infections into two types, one is pregnancy related and others are non-pregnancy related infections such as HIV or hypertension. It also investigates into the qualifications of the doctor who was appointed for the case and the treatment processes that he applied along with the proficiency and level of experience and training for the doctor and prepares a report for the improvements in the knowledge and expertise of the doctor and hospital staff that might help in avoiding such cases the future.(CAE, 2013)
- Health Research Dababase Management
The fundamental step for approaching any problem is planning and data retrieval, to ensure this, Health Systems Trust has developed the National Health Research Database (NHRD) in collaboration with the National Department of Health (NDoH), South Africa. It is web based tool to Monitor and track the health research being conducted in South Africa. Recently HST performed some database refinements concerning the provinces such as KwaZulu-Natal, Western Cape and Free State. This database is essential to keep the doctors and staff updated with the latest technology and train them in the advanced systems that employ innovative techniques to provide efficient solutions.
- Awareness Generation Programs and Medical History Records
Health System Trust employs policy which delves into the family history and infections related to the social environment of the patient or diseased. We believe that the awareness can avoid such incidents. If the doctor is fully aware and the patient has a family history chart to identify the diseases the family has been prone to, he can definitely treat the patient in a much informed environment and therefore reduce the chances of any fatalities due to negligence.( Antony Kaminju,2015) The patient also needs to understand the importance of maintaining the medical records of the family and himself so that quickly the doctor can scan through it and start the treatment with due consideration to the family disease history chart.
- Assessment of patient Background and economic status
The mortality rates are greatly affected by the income ratios. The research studies conducted in South Africa and other regions of the world shows the drastic changes due to the income levels of the sampled population. The high earning groups have better primary healthcare facilities and can afford more experienced and qualified doctors and hence have less MMR (Maternal Mortality Ratio) The countries which have high per capita incomes have low rates of maternal mortality. (Hoosen Coovadia, Rachel Jewkes, Peter Barron, David Sanders, Diane McIntyre,2014 ). Our trust policy is to categorise deaths on the basis of their economic and social background and study their cases in the light of social and economical disparities that exist in the society. We at Heath Systems Trust as part of our mission “To be a partner of choice in building comprehensive and equitable health systems” has started many projects to improve healthcare facilities for poor and underprivileged. Our social initiatives to provide free medicines and full body checkups have helped the poor population to understand their health requirements and better and made them aware of the complexities that might arise because of not addressing it timely. .( Mark Liebow,2011) Delivery might need sudden operation depending on the requirement and doctors discretion and matching blood group is a must sighting that we as a non profit organisation collect funds and organise charity events like blood donation caps to fulfil the need of blood banks in the hospitals. In the rural areas and among poor population, there is a grave problem of malnutrition. The mother at the time of pregnancy needs sufficient amount of proteins and fats to give birth to a healthy child but the poor and marginalised section of the society cannot afford the high priced supplements therefore the child is affected with underweight or malnutrition. (Prof Hoosen Coovadia, MD'Correspondence information about the author Prof Hoosen CoovadiaEmail the author Prof Hoosen Coovadia, Prof Rachel Jewkes, MD, Peter Barron, FFCH, Prof David Sanders, MRCP, Prof Diane McIntyre, PhD,2009) The mother also goes extremely week and therefore sometimes does not last long enough to even see the child. Hence our organisation helps the mothers through diet charts and routine checkups throughout the period of delivery as in each month the body requirement is different and responds erratically.
Training the Doctors and Filling vacant posts
In South Africa, on record in the cases of maternal mortality concerning anaesthesia, obstetric haemorrhage, pregnancy related sepsis and complications of hypertension 47%, 27% 24% and 19% badly trained doctors were responsible respectively. Hence this is alarming and needs to be addressed immediately. The doctors need to be sympathetic and qualified. Experienced and well trained doctors should oversee the treatment process to ensure a well guided approach to the disease and delivery operation. A well trained doctor can understand the needs and judge the necessary precautions by the family history of the patient and therefore employ methods to avoid complexities that might arise due to the patient being prone to a particular disease.( R Picken and The Lancet, 1930)
Objective of the policy for Advocacy
The main objective of the policy for advocacy is based on the understanding of the objective of the Ottawa framework. The policy has to serve the purpose of the seriousness of the issue of maternal mortality and generate awareness in the community to take precautions and avoid negligence. There have been many cases which had been ignored. The happening of such cases are increasing the MMR at a higher rate. In order to drop it down the policy serve the purpose of identifying the solutions available to vacant the cause of the problem.The framework of the policy also serves an important role. The policy does also outline the policy framework for containing the issue and discuss innovative methods in healthcare to keep maternal mortality rates under control. The Ottawa framework is related with identifying issue and then designing innovative framework to solve the issue.(WHO, 2017)
For any policy to work there is a need of government co-operation. The Ottawa policy framework thus suggests to recommend to the Government the steps those need to be taken to improve the primary healthcare services and bring down the MMR through effective policy making.In order to reduce the number of deaths due to non-pregnancy related infections such as HIV and hypertension must be well informed to the people. The policy must include publicity mediums for mass communication. Also the final purpose is to know about the factors affecting the environment. In order to make a effective impact it is necessary togenerate an environment where the mother and child receive proper attention without any social economical or racial biases.
Recommendations to the Government
The government can do some changes in its structural and functional system so as to make this policy more impactful on the people as well as on the economy of the country. Firstly it could employ comprehensive methods to create maternal mortality database with proper reasons on a case to case basis. Maintain a record for the lapses that resulted into the death. This would help to create more balance in the rate of mortality and this will lead to reduction of the MMR. Other than this, the government can recruit qualified doctors in order to give a proper health care system to the people. The government can fill up the vacant positions for qualified doctors and staff and give them state of the art training on advanced methods and techniques that can help in avoiding the deaths during pregnancy in both pregnancy related and non-pregnancy related infections.
There is a need for proper database system in the government. The data entry would help to identify the need and cause of the problem. Prepare the list of affected patients on the basis of social and economical backgrounds and understand the disparities due to class divide and poor-rich ditch. Also it can issue subsidised food and nutrition products for the expectant mothers so that they can take care of their health and give birth to a healthy and optimal weight child. This will help the mothers to gain proper nutrition. On the other hand, it can improve primary healthcare facilities especially for pregnant women and ensure that they receive free routine checkups and medicines.(Health Policy, 1986)
The government in order to co-operate with the framework of policy can also maintain database for family history of each citizen so that the treatment can be delivered quick and effective. It also must take care of the quick aid facility. The policies of the government try to provide all help and recourses to provide medicines and nutrition products according to the body requirements of the expected mothers. It also needs to provide subsidised health products and nutrition foods for taking care of the pregnant ladies. And also the government should conduct surveys to identify the marginal sections who cannot afford these supplements at the time of pregnancy and should provide assistance for purchasing the products and availing the healthcare facilities especially during pregnancy for the better of the mother and the child. (Benatar,2016)
The government can conducts its own research and shares the finding to enhance the knowledge of doctors, organises training camps and lab research sessions to develop deeper understanding of the procedures. The data of the case studies with the help the research and team of expert doctors will help to aware all the doctors and their staff to use innovative techniques and state of the art equipments in order to avoid any issues which might result into casualties and become a statistics in maternal mortality rate in South Africa.’(Charlene Downing1 and Marie Hastings Tolsma2,2016)
In the view of increasing HIV cases the government should take measures to aware the people of early stage identification of such complexities and deal with it in a more informed environment and train the doctors with the knowledge and tools to carry out treatment more efficiently.
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