Abstract
M.Cur.
The study on ‘Sustainability of midwifery practice within the South African healthcare
system’ is stimulated by the lack of research that influences policy to support midwifery
practice in South Africa. The poor database and health information systems for midwives
result in the poor performance of maternal healthcare in the public sector (Parkhurst, Penn-
Kekana, Blaauw, Balabanova, Danishevski, Rahman, Onama, & Ssengooba 2005) in spite of
meeting the Safe Motherhood Initiative of the World Health Organisation’s criteria for
skilled attendance and facilities (Penn-Kekana & Blaauw 2004).
Generally, midwives remain the main provider of maternal healthcare, including South
Africa, where only 3 in 10 women in the public sector see a medical doctor once in
pregnancy (South African Demographic Health Survey 1998). The norms and standards
recommended by the Saving Mothers Reports 1998 – 2006 for staffing and resources to
improve outcomes of maternal deaths have not realised. The public sector needs help from
the private sector for improved care. The Nursing Strategy for South Africa 2008 endorses
Public-Private Partnerships (PPP) to support nursing and midwifery. There is no Public-
Private Partnership in South Africa to support or sustain midwifery practice.
The purpose of the study is to develop a model for a Public-Private Partnership for midwifery
practice sustainability in the South African healthcare system. This study follows adapted
explorative, descriptive, model generating research guidelines of Chinn and Jacobs (1983 &
1987), Chinn and Kramer (1991 to 2008) and Walker and Avant (1995). Analysis of the
South African maternal healthcare context uses the open-system theory for sustainability of
Olsen and a team of researchers (1998) and several frameworks for healthcare human
resources. The main concepts of the model are identified and analysed. The main concepts
are Public-Private Partnership, midwifery practice, sustainability and the related concepts
are governance, task environment and quality service.
The model for a Public-Private Partnership is synthesised through the relation of concepts.
The 45 statements of the context empirically ground the study. The model depicts the South
African healthcare context and all the factors that impact on midwifery and its context. The
model and its functions are explained within a constituted framework. The Global standards
for practice of the International Council for Nursing and Midwifery, the definition and core
competencies of midwives of the Confederation of Midwives, the Millennium Development
Goals for Sub-Sahara Africa 2020 and the newly formed World Health Organisation
Partnership for Africa for maternal, newborn and child care 2008 are factors of the global
(macro) context that influence the model. The South African healthcare system (meso
context) factors include economics, legal-ethical, professional, service delivery and civil
society dimensions that impact on policy for service delivery on micro level, where the PPP
formally exists. The PPP for maternal healthcare is developed within this framework. The
stakeholders of the formal PPP are the public sector, the private sector, the midwifery
profession and civil society. The PPP governs the task environment for midwifery through
the risk assessment strategies that include financial risk based on clinical risk and the
development of norms and standards for staff and resources as expressed in service level
agreements for quality service delivery. Governance implies policy standards and the
accountability of the PPP to the consumer for service delivery quality and performance. The
stakeholders of the PPP ensure sustainability in this model through collaboration and shared
responsibility, risk and decision-making between the institution, midwifery profession and
practice and civil society for a balance of interest.