Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.

<h4>Introduction</h4>The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on...

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Autores principales:	Mamothena Carol Mothupi, Jeroen De Man, Hanani Tabana, Lucia Knight
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cf9e12c36ce84ffd9d908a194bd04bcc
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spelling	oai:doaj.org-article:cf9e12c36ce84ffd9d908a194bd04bcc2021-12-02T20:05:32ZDevelopment and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.1932-620310.1371/journal.pone.0252182https://doaj.org/article/cf9e12c36ce84ffd9d908a194bd04bcc2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252182https://doaj.org/toc/1932-6203<h4>Introduction</h4>The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use.<h4>Materials and methods</h4>The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index.<h4>Results</h4>The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health.<h4>Conclusions</h4>This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.Mamothena Carol MothupiJeroen De ManHanani TabanaLucia KnightPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0252182 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mamothena Carol Mothupi Jeroen De Man Hanani Tabana Lucia Knight Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.
description	<h4>Introduction</h4>The continuum of care is a recommended framework for comprehensive health service delivery for maternal health, and it integrates health system and social determinants of health. There is a current lack of knowledge on a measurement approach to monitor performance on the framework. In this study we aim to develop and test a composite index for assessing the maternal health continuum in a province in South Africa with the possibility of nationwide use.<h4>Materials and methods</h4>The composite index was computed as a geometric mean of four dimensions of adequacy of the continuum of care. Data was sourced from the district health information system, household surveys and the census. The index formula was tested for robustness when alternative inputs for indicators and standardization methods were used. The index was used to assess performance in service delivery in the North West province of South Africa, as well as its four districts over a five-year period (2013-2017). The index was validated by assessing associations with maternal health and other outcomes. And factor analysis was used to assess the statistical dimensions of the index.<h4>Results</h4>The provincial level index score increased from 62.3 in 2013 to 74 in 2017, showing general improvement in service delivery over time. The district level scores also improved over time, and our analysis identified areas for performance improvement. These include social determinants of health in some districts, and access and linkages to care in others. The provincial index was correlated with institutional maternal mortality rates (rs = -0.90, 90% CI = (-1.00, -0.25)) and the Human Development Index (r = 0.97, 95% CI = (0.63, 0.99). It was robust to alternative approaches including z-score standardization of indicators. Factor analysis showed three groupings of indicators for the health system and social determinants of health.<h4>Conclusions</h4>This study demonstrated the development and testing of a composite index to monitor and assess service delivery on the continuum of care for maternal health. The index was shown to be robust and valid, and identified potential areas for service improvement. A contextualised version can be tested in other settings within and outside of South Africa.
format	article
author	Mamothena Carol Mothupi Jeroen De Man Hanani Tabana Lucia Knight
author_facet	Mamothena Carol Mothupi Jeroen De Man Hanani Tabana Lucia Knight
author_sort	Mamothena Carol Mothupi
title	Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.
title_short	Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.
title_full	Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.
title_fullStr	Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.
title_full_unstemmed	Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.
title_sort	development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in south africa.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/cf9e12c36ce84ffd9d908a194bd04bcc
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Development and testing of a composite index to monitor the continuum of maternal health service delivery at provincial and district level in South Africa.

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