Sustainability of midwifery practice within the South African healthcare system
- Authors: Dippenaar, Johanna Maria
- Date: 2012-09-04
- Subjects: Midwifery , Medical care , Public-private sector cooperation
- Type: Thesis
- Identifier: uj:3497 , http://hdl.handle.net/10210/6887
- Description: 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.
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The reasons for choosing a private practising midwife as birth attendant
- Authors: De Maayer, Ivy Lucy
- Date: 2011-11-24
- Subjects: Midwives , Midwifery , Prenatal care , Postnatal care , Childbirth at home
- Type: Thesis
- Identifier: uj:1740 , http://hdl.handle.net/10210/4089
- Description: M.Cur. , Few South African studies have been done with regard to private midwives and their clients. The practices of these midwives are overloaded, indicating a growing need for their services. An exploratory, contextual and descriptive study was undertaken to investigate some of the issues relating to the practice of the private midwife. This was done from the perspective ofthe women attending these practices. The aims of this study were to explore and describe how women experience the care they receive from their private midwives in Gauteng during antenatal visits, labour and postnatal contacts; to explore and describe the reasons for clients of private midwives in Gauteng to choose an independent midwife as birth attendant and to explore how these clients get to hear about their midwives. Eight women, attending a total of two different midwifery practices, were interviewed. The main categories that emerged from analysing the women's experience of private midwifery care were that the midwives were caring, family orientated, informative, knowledgeable, guiding and unintrusive. Time was both respected and given by the midwives. The midwives saw childbirth as a normal and natural process. The midwives empowered the women and left them in control oftheir childbirth. A mutual, intimate relationship was formed between the women and their midwives, which was based on trust and continuity of care. The women felt they were treated as unique individuals. One woman related some negative aspects ofthe care she received. A variety of reasons were given for choosing a private midwife as birth attendant. Some had specific wishes for their birth, such as a homebirth and knew that private midwives would grant them Other reasons included cost effectiveness, control over childbirth, one on one care, shorter waiting periods, longer consulting times and wanting an experienced birth attendant. Previous negative experience with staff at government hospitals and private gynaecologists; and hearing about positive experiences with private midwives also contributed to women opting for independent midwives. The women got to hear about their private midwives through their general practitioner, obstetrician, antenatal class instructor, friends, family members or health professional that delivered a previous baby. These research findings were supported by existing literature and recommendations were made to midwifery practice, education and research.
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