From the Editor

Implementation of strategies to improve programme effectiveness lead to an improvement in maternal and child health outcomes in South Africa

S Bhardwaj, R Pattinson, S Kauchali, N Dlamini, C Marshall, M Van der Merwe, P Barron


Over the last few years, the South African (SA) National Department of Health has led the design, implementation and monitoring of key strategies to improve maternal, newborn, and child health outcomes. The strategies have resulted in the reduction of maternal, under-5 and infant mortality rates in SA. Here, we examine the strategies using a framework to understand the determinants and actions that influence the quality of care, coverage and resultant programme effectiveness in saving the lives of mothers and children. Three case studies from the field, namely, the Essential Steps In Managing Obstetric Emergencies, undernutrition in young children and breastfeeding are illustrated through applying the framework and demonstrating how improved quality of care and coverage achieved better health outcomes for pregnant women and children under 5 years of age. These case studies highlight different aspects of the framework, including improving healthcare workers’ skills, ensuring implementation of standard protocols and strengthening management accountability within facilities and across the districts. We also highlight how these aspects collectively improved the overall programme impact. The paper concludes that the framework would be strengthened through addition of critical cross-cutting aspects related to targeting and sustainability of actions.

Authors' affiliations

S Bhardwaj, United Nations Children’s Fund (UNICEF), Pretoria, South Africa

R Pattinson, South African Medical Research Council and University of Pretoria, Pretoria, South Africa

S Kauchali, National Department of Health, Pretoria, South Africa; Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa

N Dlamini, National Department of Health, Pretoria, South Africa

C Marshall, National Department of Health, Pretoria, South Africa

M Van der Merwe, Mpumalanga Department of Health, Nelspruit, South Africa

P Barron, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

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Cite this article

South African Medical Journal 2018;108(3a):s44-s49. DOI:10.7196/SAMJ.2017.v108i3b.12812

Article History

Date submitted: 2018-03-02
Date published: 2018-03-02

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