Postnatal clubs for integrated postnatal care in Johannesburg, South Africa: a qualitative assessment of implementation.

Autor: Makina-Zimalirana N; Anova Health Institute, Johannesburg, South Africa. makinan@anovahealth.co.za., Dunlop J; Anova Health Institute, Johannesburg, South Africa.; Division of Community Paediatrics, School of Public Health, University of Witwatersrand, Johannesburg, South Africa., Jiyane A; Anova Health Institute, Johannesburg, South Africa., Bartels SM; Department of Health Behaviour, University of North Carolina, Chapel Hill, USA., Struthers H; Anova Health Institute, Johannesburg, South Africa.; Department of Medicine, Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa., McIntyre J; Anova Health Institute, Johannesburg, South Africa.; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa., Rees K; Anova Health Institute, Johannesburg, South Africa.; Department of Community Health, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2022 Oct 25; Vol. 22 (1), pp. 1286. Date of Electronic Publication: 2022 Oct 25.
DOI: 10.1186/s12913-022-08684-x
Abstrakt: Background: South Africa has reported challenges in retaining women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs postnatally. Due to the success of PMTCT in the antenatal period, proportionally more infant transmissions now occur after delivery. The Médecins sans Frontières (MSF) Postnatal Club (PNC) model allows for integrated postnatal care and support. Anova Health Institute implemented the model in primary health facilities in Johannesburg as part of a planned national scale-up. We aimed to assess the implementation of these PNCs.
Methods: We used the RE-AIM (Reach, Adoption, Implementation, Maintenance) framework to assess implementation success and explore factors influencing implementation. In-depth interviews were conducted with 15 PNC staff, both clinicians and lay counsellors, using convenience sampling, from 12 facilities in Johannesburg. Data were analysed thematically using the RE-AIM framework.
Results: PNC were perceived to have many benefits for postnatal clients and their infants: providers reported reduced waiting times, reduced number of clinic visits and that PNC provided clients with a space to form cohesive group dynamics thereby contributing to retention and adherence to antiretroviral therapy. However, it was found that lacking resources (e.g., space, medical equipment, staff) negatively impacted reach, implementation and sustainability. At times the PNC model was altered to accommodate the availability of resources (e.g., counselling mothers individually). Additionally, providers expressed concerns about lack of stakeholder adoption and emphasized the importance of involving facility leadership for successful integration of the model into routine primary healthcare.
Conclusion: Our study found incomplete implementation of PNC in most of the participating facilities attributed to lack of resources and stakeholder buy-in. This underscores the need for increased support at management level to ensure sustainability. Effective collaboration between all stakeholders would allow better use of existing resources. Further studies are needed to evaluate whether all components of the model need to be implemented fully to ensure optimal outcomes, and to identify implementation strategies to facilitate scale-up.
(© 2022. The Author(s).)
Databáze: MEDLINE
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