Exploring the role of district clinical specialist teams in maternal health outcomes in a South African district: A mixed method study from 2012 to 2020
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i11.2205Keywords:
DCST; Maternal health; district health services; outcomesAbstract
Background. High maternal and child mortality in South Africa (SA) necessitated the establishment of district clinical specialist teams (DCSTs) in all health districts in 2012, mandated to work in collaboration with district managers and health professionals to achieve joint goals of improved maternal and child health services and outcomes.
Objectives. Within the context of SA district health services, to explore the various obstetric intervention measures undertaken by a DCST over an 8-year period (July 2012 - February 2020), as aligned to the national DCST policy framework, and to document the knowledge and perceptions among managers and health professionals on the work done by the DCST in the district health service.
Methods. A review of DCST reports and documents was conducted along with in-person structured interviews among health professionals and district health managers in the Ekurhuleni Health District in SA. Health professionals who had a working relationship with the DCST and relevant managers of health, including CEOs, clinical managers, community health centre managers, maternal and child health co-ordinators and municipal managers were selected for the interview. Interviews were conducted by the interviewer using a data collection tool focused on the scope of work and acceptance of the DCST in improving maternal health services in a geographically defined district health system. Data collection tools were completed by the interviewer upon questioning the participants. Data were analysed by documenting the activities of the DCST, and thematic analysis was performed for the interviews.
Results. Analysis of DCST reports and documents revealed the broad range of activities, including clinical training and mentoring, clinical work, supervision, audit, research, monitoring and evaluation and clinical risk management. Thematic analysis extracted seven themes, namely clinical effectiveness, clinical risk management, professional development, accountability for maternal and child health, clinical work, monitoring and evaluation, and leadership and governance. All (n=20) participants acknowledged the positive impact of the DCST on the improvement in maternal health services.
Conclusion. The DCST was perceived by local peers as a successful strategy to improve maternal health services in a district health service. This success is likely rooted in its focused intervention measures, within a supportive environment of district managers and health professionals. Such district-based clinical teams are a potential strategy to improve maternal health services within primary healthcare services.
References
1. World Health Organization. Trends in maternal mortality 2000 to 2017: Estimates by WHO, UNICEF,
UNFPA, Geneva: World Bank Group and the United Nations Population Division, 2019. https://apps.
who.int/iris/handle/10665/327596 (accessed 5 October 2023).
2. World Health Organization. Maternal mortality. Geneva: WHO, 2020. https://www.who.int/newsroom/
fact- sheets/detail/maternal-mortality (accessed 5 October 2023).
3. Campaign on Accelerated Reduction of Maternal Mortality in Africa. Status report on maternal
newborn and child health. CARMMA, 2013. http://www.carmma.org/resource/2013-status-reportmaternal-
newborn-and-child-health-africa (accessed 5 October 2023).
4. United Nations. The Millennium Development Goals Report. New York: UN, 2009. https://www.
un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf (accessed 5 October 2023).
5. Republic of South Africa, 2010. Millennium Development Goals: Country Report 2010. Pretoria:
Government Press, 2010. http://www.statssa.gov.za/news_archive/Docs/MDGR_2010.pdf (accessed
5 October 2023).
6. United Nations. Open Working Group proposal for Sustainable Development Goals. New York: UN,
2015. https://sustainabledevelopment.un.org/sdgsproposal (accessed 5 October 2023).
7. World Health Organization. Sustainable Development Goal 3: Health. Geneva: WHO, 2020. https://
www.who.int/topics/sustainable-development-goals/targets/en (accessed 6 October 2023).
8. National Committee for the Confidential Enquiries into Maternal Deaths. Saving Mothers 2011 -
2013: Sixth report on confidential enquiries into maternal deaths in South Africa. Pretoria: National
Department of Health, 2014.9. Garenne M, McCaa R, Nacro K. Maternal mortality in South Africa: An update from the 2007
Community Survey. J Popul Res 2011;8(1):89-101. https://doi.org/10.1007/s12546-010-9037-y
10. South Africa. Constitution of the Republic of South Africa. Act No. 108 of 1996.
11. National Department of Health, South Africa. Decreasing maternal and child mortality: Negotiated
service delivery agreement: A long and healthy life for all South Africans. Pretoria: NDoH, 2010.
https://www.gov.za/news/media-statements/progress-towards-negotiated-service-deliveryagreement-
health-sector-15-feb (accessed 6 October 2023).
12. National Department of Health, South Africa. Policy document on primary health care re-engineering.
Pretoria: NDoH, 2011.
13. Human Rights Watch. South Africa: Stop making excuses: Accountability for maternal health care in
South Africa. New York: Human Rights Watch, 2011. https://www.hrw.org/sites/default/files/reports/
sawrd0811webwcover.pdf (accessed 6 October 2023).
14. National Committee for the Confidential Enquiries into Maternal Deaths. Third Report on Confidential
Enquiries into Maternal Deaths in South Africa: Pretoria: National Department of Health, 2006. https://
www.gov.za/sites/default/files/gcis_document/201409/maternaldeaths0.pdf (accessed 6 October 2023).
15. National Department of Health, South Africa. Ministerial task team report. District clinical specialist
teams in South Africa. In: Ministerial Task Team Report to the Honourable Minister of Health, Dr
Aaron Motsoaledi. Pretoria: NDoH, 2001. https://www.hst.org.za/publications/South%20African%20
Health%20Reviews/5%20District%20Clinical%20Specialist%20Teams%20-%20SAHR2014.pdf
(accessed 6 October 2023).
16. National Department of Health, South Africa. Handbook for District Clinical Specialist Teams
(DCST). Pretoria: NDoH, 2014. http://www.health-e.org.za/wp-content/uploads/2015/06/Handbookfor-
DCSTs.pdf (accessed 6 October 2023).
17. Chopra M, Daviaud E, Pattinson R, Fonn S, Lawn JE. Saving the lives of South Africa’s mothers, babies,
and children: Can the health system deliver? Lancet 2009;374(9692)835-846. https://doi.org/10.1016/
S0140-6736(09)61123-5
18. Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. Health and health system of South Africa;
historical roots of current public health challenges. Lancet 2009;374(9692):817-834. https://doi.
org/10.1016/S0140-6736(09)60951-X
19. Moodley J, Fawcus F, Pattinson R. Improvements in maternal mortality in South Africa. S Afr Med J
2018;108(S1):S4-S8. https://doi.org/10.7196/SAMJ.2018.v108i3.12770
20. Damian DJ, Njau B, Lisasi E, Msuya Sia, Boulle A. Trends in maternal and neonatal mortality in South
Africa: A systematic review. Syst Rev 2019;8(1):76. https://doi.org/10.1186/s13643-019-0991-y
21. National Department of Health, South Africa. National launch and induction of the district
clinical specialists teams: Speech for the minister. Launch of the induction programme of the
clinical specialist teams. Pretoria: NDoH, 27 September 2012. http://www.info.gov.za/speech/
DynamicAction?pageid=461&sid=312 83&tid=86339 (accessed 9 October 2023).
22. Gauteng Department of Health. District Health Information System. Ekurhuleni Health District, 2023.
Routine Health Data: Gauteng Province, 2023.
23. Massyn N, Day C, Damboo M, Baron P, English R, Padarth A (eds). District Health Barometer
2012/13. Durban: Health Systems Trust, 2013.
24. National Department of Health, South Africa. Expanded terms of reference from the maternal, child
and women’s health committee. Pretoria: NDoH, 2014. https://www.gov.za/sites/default/files/gcis_
document/201409/childwomenhealth0.pdf (accessed 9 October 2023).
25. Ritchie J, Lewis J. Designing and selecting samples sampling strategies. In: Ritchie J, Lewis J, eds.
Qualitative Research Practice: A Guide for Social Science Students and Researchers. London: SAGE
Publications, 2003.
26. Frank K, Lombaard H, Pattinson RC. Does completion of the Essential Steps in Managing Obstetric
Emergencies training package improve knowledge and skills in managing obstetric emergencies? S Afr
J Obstet Gynaecol 2009;15(3):94-99.
27. Feucht U, Marshall C, Kauchali S, et al. Innovations in the clinical care of mothers and children in
South Africa: The contribution of district clinical specialist teams. S Afr Med J 2018;108(3a):S38-S43.
https://doi.org/10.7196/SAMJ.2017.v108i3b.12808
28. Rhoda NR, Velaphi S, Gebhardt GS, Kauchali S, Barron P. Reducing neonatal deaths in South Africa:
Progress and challenges. S Afr Med J 2018;108(3a):S9-S16. https://doi.org/10.7196/SAMJ.2017.
v108i3b.12804
29. Oosthuizen SJ, Bergh AM, Grimbeek J, Pattinson RC. CLEVER maternity care: A before-and-after
study of women’s experience of childbirth in Tshwane, South Africa. Afr J Prim Health Care Fam Med
2020;12(1):a2560. https://doi.org/10.4102/phcfm.v12i1.2560
30. Oyebanji OG, Mathole T, Jackson D. Promoting awareness of the role of the district clinical specialist
team in the Amathole district, South Africa: A valuable specialty in improving healthcare access and
quality. Trop Med Infect Dis 2022;7(12):436. https://doi.org/10.3390/tropicalmed7120436
31. Oboirien K, Goudge J, Harris B, Eyles J. Can institutional entrepreneurship strengthen clinical
governance and quality improvement: A case study of a district-based clinical specialist team in South
Africa. Health Policy Plan 2019;34(Supp 2):ii121-ii134. https://doi.org/10.1093/heapol/czz110
32. Oboirien K, Harris B, Eyles J, et al. Understanding roles, enablers and challenges of District Clinical
Specialist Teams in strengthening primary health care in South Africa. S Afr Health Rev 2014;1(1):45‑56.
https://api.semanticscholar.org/CorpusID:51731944 (accessed 9 October 2023).
33. Al-Abri R. Managing change in healthcare. Oman Med J 2007;22(3):9-10.
34. Choi M, Ruona WEA. Individual readiness for organisational change and its implications for
human resource and organisation development. Hum Resour Dev Rev 2011;10(1):46-73. https://doi.
org/10.1177/1534484310384957
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