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.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uj/uj:3497 |
| Date | 04 September 2012 |
| Creators | Dippenaar, Johanna Maria |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
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