Early Reflections on Mphatlalatsane, a Maternal and Neonatal Quality Improvement Initiative Implemented During COVID-19 in South Africa

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FIGURE 1
Map of Implementation Districts for the Mphatlalatsane Maternal and Newborn Health Quality Improvement Initiative, South Africa
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FIGURE 2
Mphatlalatsane Theory of Change
Abbreviations: MMR, maternal mortality ratio; NMR, newborn mortality ratio.
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FIGURE 3
Mphatlalatsane Implementation Wedge in Eastern Cape, Limpopo, and Mpumalanga Provinces, South Africa
Abbreviation: PHC, primary health care.

TABLE 1.

Socioeconomic and Health Indicators of the South African Health Districts Served by Mphatlalatsane

Province	Eastern Cape		Limpopo	Mpumalanga
	District 1	District 2	District 3	District 4
Population estimates,^a No.	1,263,051⁴⁷	527,062⁴⁸	138,760⁴⁵	1,743,182⁴⁹
Unemployment rate,^a %	29⁵⁰	30⁴⁸	39⁴⁵	37⁵¹
Health facilities
Tertiary	2	0	0	1
Regional	1	0	1	2
District	1	10	6	8
CHC	9	3	8	15
PHC clinic	39⁵²	59⁵²	97⁵³	108⁴⁹
Institutional maternal mortality ratio (per 100,000 live births),^b 2018^c		107¹³	106¹³	111¹³
Live births in facility,^a No.	18,808⁵²	5,909⁵²	31,268⁴⁵	40,734
Neonatal mortality ratio (per 1,000 live births)^b		12.3⁵²	12.2¹³	10.8¹³

TABLE 2.

Mphatlalatsane Partnerships

Partner	Role and Responsibilities
South Africa National Department of Health	Custodian: provides strategic focus
Clinton Access Health Initiative	Implementation secretariat: coordinate and direct day-to-day activities; provides technical support through quality improvement advisors
University of Pretoria/South African Medical Research Council Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies	Content expert: provides input and support for maternal health care strengthening activities
University of Limpopo Trust Initiative for Newborn Care	Content expert: provides input and support for neonatal health care strengthening activities
Institute for Healthcare Improvement	Provides technical support to advisors and quality improvement training (short-term)
South African Medical Research Council and University of the Western Cape	Evaluation team

TABLE 3.

Mphatlalatsane Responsive Measures to Meet COVID-19 Challenges in South Africa

COVID-19 Challenges	Responsive Measures
MNH staff: distressed and overworked; redeployed	Shifted focus from QI work to management / HCWs’ immediate needs and offered pandemic response guidance Offered psychological support to HCWs Streamlined procurement of personal protective equipment Made new service delivery algorithms and frameworks available through an existing NDOH digital knowledge hub that addressed COVID-19 challenges
Delivery and uptake of routine MNH services disrupted	Risk matrix 1: offered practical recommendations to higher-level management to mitigate service disruption, e.g., used COVID-19 contact tracing to inform communities that MNH services are available Risk matrix 2: supported facility managers to develop risk mitigation measures within the facility, e.g., reconfigured workspaces to minimize contamination
Essential MNH equipment shortages	Facilitated the procurement and distribution of donated equipment through acceptable mechanisms and coordinated staff training to use it

Abbreviations: COVID-19, coronavirus disease; HCW, health care workers; MNH, maternal and neonatal health; NDOH, South Africa National Department of Health; QI, quality improvement.