Maternal and newborn health is one of the main indicators of a good health system. The
study wished to develop a strategy to improve the referral system for maternal and
newborn care. To identify issues for improvement, the researcher explored the
appropriateness of referrals, referral pathways and challenges, and provider costs for
maternal and newborn care at health centres and hospitals levels. The researcher
selected a sequential explanatory mixed method research design. Two primary
hospitals and six health centres were purposively selected for participation.
The first phase collected quantitative data by reviewing the health facilities’ medical
records for services provided and health service costing, respectively. Data collection
covered one Ethiopian fiscal year (8 July 2017 to 7 July 2018). Based on the existing
human resource arrangement and care needs, the health service costing found that a
single midwife at health centre level spent half of the expected time for delivery care.
The cost estimates of various types of care delivery care indicated that delivery care at
health centre and hospital levels cost $27.5 to $30.2, and $34.7 to $37.8, respectively.
The primary hospitals incurred four times the cost for newborn intensive care units and
Caesarean sections compared to normal delivery care.
In the second phase, the researcher collected qualitative data from 26 purposively
selected key informants in interviews. The findings indicated that the selected hospitals
and health centres had a referral system, but several factors impeded its effective
implementation. Knowledge of referral pathways determined the referral practices at the
lower level of the system. The number of inappropriate referrals to primary hospitals
indicated a need to mobilize and educate the community on the services available and protocols of care. In general, most referrals could have been managed at health centre
level.
Emergency medical transportation is a critical component of the referral system; delays
in transportation determine the outcome of care at hospital level. Ambulance
management was generally poor, lacked a tracking system, and was negatively affected
by confusion and lack of coordination between facilities. The available ambulances were
not well equipped or well-staffed for emergency management. Moreover, there were
frequent breakdowns due to limited budget for maintenance and running costs.
The quality of maternal care depends on the quality of the labour monitoring. However,
partograph utilization was not consistently practised. Admitted cases were not properly
monitored because of the high caseload and limited supervision support. In many
cases, healthcare professionals tended to “treat charts” rather than promote evidencebased practice while providing care. The quality of practice was challenged by insecurity
in the working environment but strengthened by good teamwork and available
consultation support. The implementation of the existing referral system depended on
the people involved; the use of performance indicators; follow up by management, and
an accountability framework.
The findings of the two phases of the study and review of other countries’ experiences
on the identified problems, led to the development of draft strategy and then a
consultation with relevant experts produced the final strategy. The strategy includes
interventions to improve the practices at the sending and receiving facilities as well as
suggestions to improve the communication, transportation and overall governance
system. Then, taking into consideration all the phases of the study, the researcher
makes recommendations for practice and further research. / Health Studies / D. Litt. et Phil. (Healht Studies)
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:unisa/oai:uir.unisa.ac.za:10500/26695 |
| Date | 11 1900 |
| Creators | Desta, Binyam Fekadu |
| Contributors | Dolamo, B. L. |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 1 online resource (xi, 198 leaves) : illustrations (some color), graphs (chiefly color), application/pdf |
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