1. 5 DECEMBER 2012 PRESENTER: AS SESING MCWH MANAGER(FSDOH)

2. Maternity services are essential components of the health system at all levels of care.  Services are managed according to specific policies, protocols and guidelines.  Despite having systems in place, South Africa is facing challenges with maternity services in terms of poor management of the services and systems not functioning well.  In the National District Hospital (NDH) the bed occupancy is very low but nurses complain that there is high number of day patients that are captured in the information system.  Also anecdotal evidence that unit had poor performance The aim of this study was to evaluate the performance of the maternity unit at the National District Hospital.

4. NDH is one of the four district hospitals in Motheo District in the Free State province  The hospital renders a package of services to 500 000 population in the catchment area which is constantly growing  The hospital is located in Bloemfontein which is the most urban area of Motheo district  The city is the trade and administrative hub of the province and has a university, technicon and tertiary colleges  NDH renders 24hours Maternity, Emergency and Radiographic services and 8hours Theatre services

5. The study was conducted in the maternity unit at NDH  Period 2006 – 2008  A cross sectional study design was used comprising retrospective review of various records  Data was collected on various variables that are relevant to the performance of maternity services  Ethical approval and permission from authorities to do study was obtained  Confidentiality was strictly maintained  Data was entered onto Excel spreadsheets, cleaned and imported into EpiInfo for analysis  Descriptive statistics were first done ◦ To test for difference across the years, ◦ tests for association were used. ◦ A p – value of 0.05 was considered to be significant

7. Patient profile  There is a slight change in the profile recently with significant more White and married patients being admitted in 2008 Length of stay  Length of stay was very short with 50% of patients being discharged in a day

8. HIV Investigation 2006 (n=30)2007 (n=30)2008 (n=30) Pre counseling Yes No Not recorded Card missing 14 9 1 6 11 6 9 4 17 0 10 3 Testing Yes No Not recorded Card missing 16 3 4 1 10 5 11 4 9 2 16 3 Result status Yes No Not recorded Card missing 4 15 4 1 10 15 4 5 18 3 Post counseling Yes No Not recorded Card missing 14 3 6 1 10 7 9 4 13 0 14 3

11. indicators200620072008 Bed occupancy rate60%56.6%62.9% Caesarean section rate6.88%8.9%6.86% Monthly PNR meetings9 months11 months9 months Adverse events/Complaints 433

12.  Gaps in the management of the patients care rendered in the maternity unit which indicated substandard quality of care  Support system not considered  Non adherence to guidelines and protocols  Poor record keeping  Data collection mismanagement  Unit supervision not up to the required standard

13.  Study based on record review only  No interviews were done  Information on patients records and registers were a problem  Records of referred patients were excluded  The study did not investigate resource allocation and its utilization

14.  Need to benchmark good and best practices  Have a family oriented care – support system  Train and retrain service providers  Need to improve the patients’ registry  Improve supervision of the unit  Improve information management system – Perinatal review meetings

15.  Continuity of care use of H10  Importance of initial assessment on admission  Involvement of support system  Use of partogram for patients in labour  Improving Perinatal review meetings for compliance

16.  World Health Organization.2005.Reducing Maternal Death: The Challenge of the New Millennium in the African Region.Geneva.WHO.  National Department of Health. 2007. Guidelines for Maternity Care and District Hospitals. Pretoria. Department of Health.

17.  My supervisor Dr. R Jina  Wits Medical School  The National District Hospital  Free State Department of Health