Learning health systems: fostering participatory learning and action to equip rural health workers as change agents for maternal and newborn care.
Medical Research Council
South African Medical Research Council
Our study aims to create a culture of organizational learning within rural health facilities towards maternal and newborn health (MNH) care quality improvements. We will evaluate an innovative health system strengthening approach in rural KwaZulu-Natal, South Africa (SA) using participatory learning and action (PLA) groups. Evaluation sites are two rural districts, comprising 9 district hospitals and 2 community health centres. Districts were selected on the basis of low population density, long distances between levels of care, poor road infrastructure, lack of health resources, and poor MNH indicators. We will use implementation research methods to co-design and document intervention implementation via a mixed methods approach. A before-after evaluation design will assess the effect of PLA on organizational learning culture and person-centered MNH care. Pre-implementation, in-depth interviews with health personnel at all levels of participating districts exploring challenges of MNH care provision, and interviews with rural women as recipients of care, will inform the development of the intervention. Baseline and end-line cross-sectional surveys will measure facilities' performance as learning organisations, and womens' experiences of patient-centred MNH care. Two validated tools, 1) Dimensions of Learning Organisation questionnaire, will measure facilities' performance in terms of team learning, management support, and leadership, and 2) the Person-centred Maternity Care score (PCMC) will measure womens' MNH care experiences and their perceptions of newborn care in terms of dignity and respect, autonomy and supportive care. These will provide quantitative measures of change over the implementation period. A process evaluation using qualitative case study methodology will rigorously document the intervention implementation. An economic evaluation will determine budgetary implications of replicating this intervention routinely in rural districts in SA.
8.1 Organisation and delivery of services / Research Grant