Doctoral Degrees (Health Systems and Public Health)

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Browsing Doctoral Degrees (Health Systems and Public Health) by Subject "Child health services -- South Africa"

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    Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilization in two South African Provinces : a realist evaluation
    (Stellenbosch : Stellenbosch University, 2023-03) Kabongo, Eveline Muika; Nicol, Edward; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Introduction: Improvement of maternal and child health is in the 2030 agenda of the 17 Sustainable Development Goals (SDGs) where health is centrally positioned with one comprehensive goal (SDG 3), of ensuring lives and promoting well-being for all at all ages. A mobile health programme called MomConnect programme was implemented in the nine provinces of South Africa to register pregnant women and mothers, providing them with health information and education on their health and that of their babies to improve the maternal and child health in the country. Some other studies have shown the efficacy of the MomConnect programme in improving health-seeking behaviours among pregnant women and mothers. Nonetheless, there is little understanding of the contextual factors and causal mechanisms that explained these intended outcomes. To this end, a theory-driven approach to evaluate the MomConnect intervention was proposed. Methodology: The realist evaluation approach was adopted to evaluate and describe not only the intervention and its outcomes but to understand how, why, for whom and under which health system conditions, the MomConnect programme improves the health-seeking behaviours of pregnant women and mothers of infants in antenatal (ANC) and post-natal care (PNC) services in Gauteng and Free State Provinces, South Africa. And to inform guidelines on how the MomConnect can be rolled out elsewhere. The study was conducted in three different phases. In Phase one/emergent phase, the initial programme theory (IPT) of the MomConnect programme was developed using the elicitation approach. In Phase two/construction phase, we applied a multi case explanatory theory-building approach and a confirmatory theory testing approach to test the initial programme theory in four healthcare facilities, in Free State and Gauteng provinces. A cross-case analysis/in-case theories comparison was done to obtain some more refined theories. In phase three/confirmatory phase, a discussion was done with MomConnect key informants to confirm and consolidate the refined theories. Retroduction logic of making inferences was applied to configure information obtained from different sources using the intervention-context-actor-mechanism-outcome (ICAMO) heuristic tool. Results: Our initial programme theory (IPT) revealed three plausible hypotheses. The first theory assumed that a good programme designer, and health system, allow for good implementation of the programme in HCPs and increase the uptake of health services among consumers. The second theory assumed that the national department of health (NDoH) support and influence of authorities and leaders motivate healthcare providers and managers to buy-in and engage with the programme to contribute to the success of the programme by improving their performance and delivering quality maternal and child health (MCH) services. The third theory suggested that women become encouraged, empowered, and motivated, through the MomConnect health information and education to change their health-seeking behaviours and improve their health and that of their babies. After testing the initial programme theory, four different theories were refined. The first showed that MomConnect works because of a good collaboration, political clout, healthcare providers (HCPs) and clinic managers’ buy-in and willingness to work and contribute to the success of the programme by improving their performance. The delivery of MCH services is assumed to improve the health-seeking behaviours. The second refined theory showed that the programme did not work in some facilities, due to a lack of training, lack of stewardship, lack of buy-in from HCPs and clinic managers, and lack of understanding of how the MomConnect Help Desk works. The third refined theory showed that when HCPs and clinic managers perceived the NDoH’s support through training on the programme they are empowered, leading to improvement in their self-efficacy, and they become motivated and nudged to improve their performance. In the fourth theory MomConnect encouraged, empowered, and motivated women to improve their health-seeking behaviours. Our refined theories confirmed the IPTs. Conclusion: The effective implementation, sustainability, and rollout of the MomConnect mobile health programme is contingent on some important health system conditions such as availability of funding, public awareness, HCPs, and clinic managers' buy-in and engagement, and facility readiness to provide care. HCPs' workload decreases if they feel that they can get assistance when women are educated on the MCH from the MomConnect platform and get all information needed on their mobile phones from home. This makes HCPs feel less pressured to conform to their work. Also, if HCPs are satisfied with the implementation of the MomConnect programme they will engage with the programme, and their positive attitude will encourage pregnant women and mothers to use healthcare facilities and change their health-seeking behaviours. In the context of the system failure or lack of updated mechanisms, caution must be taken when registering pregnant women by explaining to them how to switch to the baby messages once they give birth, to receive the baby messages and avoid the lack of system mechanism issues.