Browsing by Author "Ray, Sunanda"

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    Changes in attitudes, behaviour and practices following an educational intervention for midwives using reflective writing journals
    (Stellenbosch : Stellenbosch University, 2019-12) Ray, Sunanda; Jacobs, Cecilia; Van Schalkwyk, Susan; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education.
    ENGLISH SUMMARY: Introduction: Inclusion of transformative learning techniques into the education of midwives and other health professionals, creates opportunities for improving health outcomes. Women in public and private sector health facilities in Southern Africa have experienced abusive behaviour and neglect from midwives. Negative birth experiences may deter women from seeking institutional care during labour, and lead to poor obstetric outcomes such as delayed progress in labour, higher risk of instrumental and surgical interventions and postnatal depression. Complex relationships between midwives and women in labour give rise to dissonance between the midwives’ sense of identity and pride as professionals, and their apparently disrespectful behaviour in their workplace, leading to possible negative outcomes. The aim of the research study was to explore from the midwives’ perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, as evidenced by entries in their reflective writing journals augmented by facilitated group dialogue. Methods: The qualitative research study comprised two facets: firstly, a document analysis of eighteen reflective journals written by the midwives and secondly, member-checking of the thematic analysis of the journal entries during follow-up discussions and a one-day participative workshop held a year later. Data were analysed using a phenomenology approach, which looks at how individuals make sense of social phenomena in their lived experiences. Transformative learning theory was used as a conceptual framework to explore the learning journey of the midwives. The a priori analysis identified patterns of changes within the pre-determined domains of attitudes, behaviours and practices. The comments and insights of the midwives during the member-checking process contributed further data for analysis. Findings: Overall the midwives reported gains in professional pride and stronger identification as patient advocates. Their stories in their reflective writing journals gave several examples of treating women in labour with empathy and compassion. Categories were constructed within the three domains of attitudes, behaviours and practices. Some of these categories aligned directly with the ten phases of transformative learning theory, such as self-examination of prior experience, building of competence and self-confidence into new roles and relationships. Other categories related to improving communications and teamwork, providing role-models of good behaviour and demonstrating competence in management of complex cases. Changes in practices were specific to this context and relate to changes in practices related to involvement of birth companions and encouragement to use different positions in labour and delivery. Discussion: This study demonstrated that participatory approaches to training on respectful maternity care may lead to changed attitudes, behaviour and practices in this context. The beneficiaries of these changes will be the midwives, as well as the women they look after in maternal health, their colleagues and the health system at large. The midwives have shown that even in adverse circumstances, they are able to share a common vision for the quality of service they want to provide and to progress with improving health outcomes. Sustainability and reproducibility to achieve the same results depends on continued investment in the participatory methodology to train midwives in respectful maternity care, with skilled facilitation of the reflective writing and dialogic approach. Pre-service and in-service training for midwives and medical students in maternal health could benefit from these new approaches, using reflective writing journals and dialogue as part of their educational methods and curricula. Conclusion: Promoting Respectful Maternity Care as part of the educational process opens the door to more empathy and compassion in healthcare, with better health outcomes and more rewarding relationships with their patients. This study shows that innovative educational initiatives have the potential to significantly change the way midwives work together, how they can continue to learn from reflecting on their experiences and to develop life-long learning skills.
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    Community-orientated primary care : a scoping review of different models, and their effectiveness and feasibility in sub-Saharan Africa
    (BMJ, 2019) Mash, Bob; Ray, Sunanda; Essuman, Akye; Burgueno, Edu
    Introduction: Community-orientated primary care (COPC) is an approach to primary healthcare (PHC) that originated in South Africa and contributed to the formulation of the Declaration of Alma-Ata 40 years ago. Despite this, PHC remains poorly developed in sub-Saharan African countries. There has been a resurgence of interest in strengthening PHC systems in the last few years and identifying key knowledge gaps. COPC has been an effective strategy elsewhere, most notably Brazil. This scoping review investigated COPC in the sub-Saharan African context and looked for evidence of different models, effectiveness and feasibility. Methods: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Studies were grouped into five categories: historical analysis, models, implementation, educational studies and effectiveness. Results: A total of 1997 publications were identified and 39 included in the review. Most publications were from the last 5 years (n = 32), research (n = 27), from South Africa (n = 27), focused on implementation (n = 25) and involving case studies (n = 9), programme evaluation (n = 6) or qualitative methods (n = 10). Nine principles of COPC were identified from different models. Factors related to the implementation of COPC were identified in terms of governance, finances, community health workers, primary care facilities, community participation, health information and training. There was very little evidence of effectiveness of COPC. Conclusions: There is a need for further research to describe models of COPC in Africa, investigate the appropriate skills mix to integrate public health and primary care in these models, evaluate the effectiveness of COPC and whether it is included in training of healthcare workers and government policy.
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    Curriculum and training needs of mid-level health workers in Africa : a situational review from Kenya, Nigeria, South Africa and Uganda
    (BioMed Central, 2018-07-16) Couper, Ian; Ray, Sunanda; Blaauw, Duane; Ng’wena, Gideon; Muchiri, Lucy; Oyungu, Eren; Omigbodun, Akinyinka; Morhason-Bello, Imran; Ibingira, Charles; Tumwine, James; Conco, Daphney; Fonn, Sharon
    Background: Africa’s health systems rely on services provided by mid-level health workers (MLWs). Investment in their training is worthwhile since they are more likely to be retained in underserved areas, require shorter training courses and are less dependent on technology and investigations in their clinical practice than physicians. Their training programs and curricula need up-dating to be relevant to their practice and to reflect advances in health professional education. This study was conducted to review the training and curricula of MLWs in Kenya, Nigeria, South Africa and Uganda, to ascertain areas for improvement. Methods: Key informants from professional associations, regulatory bodies, training institutions, labour organisations and government ministries were interviewed in each country. Policy documents and training curricula were reviewed for relevant content. Feedback was provided through stakeholder and participant meetings and comments recorded. 421 District managers and 975 MLWs from urban and rural government district health facilities completed self-administered questionnaires regarding MLW training and performance. Results: Qualitative data indicated commonalities in scope of practice and in training programs across the four countries, with a focus on basic diagnosis and medical treatment. Older programs tended to be more didactic in their training approach and were often lacking in resources. Significant concerns regarding skills gaps and quality of training were raised. Nevertheless, quantitative data showed that most MLWs felt their basic training was adequate for the work they do. MLWs and district managers indicated that training methods needed updating with additional skills offered. MLWs wanted their training to include more problem-solving approaches and practical procedures that could be life-saving. Conclusions: MLWs are essential frontline workers in health services, not just a stop-gap. In Kenya, Nigeria and Uganda, their important role is appreciated by health service managers. At the same time, significant deficiencies in training program content and educational methodologies exist in these countries, whereas programs in South Africa appear to have benefited from their more recent origin. Improvements to training and curricula, based on international educational developments as well as the local burden of disease, will enable them to function with greater effectiveness and contribute to better quality care and outcomes.