5 DECEMBER 2012
PRESENTER: AS SESING
MCWH MANAGER(FSDOH)
Maternity services are essential components of the health
system at all levels of care.
 Services are managed according to specific policies, protocols
and guidelines.
 Despite having systems in place, South Africa is facing
challenges with maternity services in terms of poor
management of the services and systems not functioning
well.
 In the National District Hospital (NDH) the bed occupancy is
very low but nurses complain that there is high number of
day patients that are captured in the information system.
 Also anecdotal evidence that unit had poor performance
The aim of this study was to evaluate the performance of the
maternity unit at the National District Hospital.
NDH is one of the four district hospitals in Motheo District in
the Free State province
 The hospital renders a package of services to 500 000
population in the catchment area which is constantly growing
 The hospital is located in Bloemfontein which is the most
urban area of Motheo district
 The city is the trade and administrative hub of the province
and has a university, technicon and tertiary colleges
 NDH renders 24hours Maternity, Emergency and Radiographic
services and 8hours Theatre services
The study was conducted in the maternity unit at NDH
 Period 2006 – 2008
 A cross sectional study design was used comprising
retrospective review of various records
 Data was collected on various variables that are relevant to the
performance of maternity services
 Ethical approval and permission from authorities to do study was
obtained
 Confidentiality was strictly maintained
 Data was entered onto Excel spreadsheets, cleaned and imported
into EpiInfo for analysis
 Descriptive statistics were first done
◦ To test for difference across the years,
◦ tests for association were used.
◦ A p – value of 0.05 was considered to be significant
Patient profile

There is a slight change in the profile recently with
significant more White and married patients being
admitted in 2008
Length of stay

Length of stay was very short with 50% of patients
being discharged in a day
HIV
Investigation
2006 (n=30)
2007 (n=30)
2008 (n=30)
Pre counseling
Yes
No
Not recorded
Card missing
14
9
1
6
11
6
9
4
17
0
10
3
Testing
Yes
No
Not recorded
Card missing
16
3
4
1
10
5
11
4
9
2
16
3
Result status
Yes
No
Not recorded
Card missing
4
15
4
1
1
10
15
4
4
5
18
3
Post counseling
Yes
No
Not recorded
Card missing
14
3
6
1
10
7
9
4
13
0
14
3
indicators
2006
2007
2008
Bed occupancy rate
60%
56.6%
62.9%
Caesarean section rate
6.88%
8.9%
6.86%
Monthly PNR meetings
9 months
11 months
9 months
Adverse
events/Complaints
4
3
3
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Gaps in the management of the patients care
rendered in the maternity unit which
indicated substandard quality of care
Support system not considered
Non adherence to guidelines and protocols
Poor record keeping
Data collection mismanagement
Unit supervision not up to the required
standard
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Study based on record review only
No interviews were done
Information on patients records and registers
were a problem
Records of referred patients were excluded
The study did not investigate resource
allocation and its utilization
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Need to benchmark good and best practices
Have a family oriented care – support system
Train and retrain service providers
Need to improve the patients’ registry
Improve supervision of the unit
Improve information management system –
Perinatal review meetings
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Continuity of care use of H10
Importance of initial assessment on
admission
Involvement of support system
Use of partogram for patients in labour
Improving Perinatal review meetings for
compliance


World Health Organization.2005.Reducing
Maternal Death: The Challenge of the New
Millennium in the African
Region.Geneva.WHO.
National Department of Health. 2007.
Guidelines for Maternity Care and District
Hospitals. Pretoria. Department of Health.
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My supervisor Dr. R Jina
Wits Medical School
The National District Hospital
Free State Department of Health