Integrating services for impact and sustainability: a proof-of-concept project in KwaZulu-Natal, South Africa

Abstract

Background: Integration of services in primary health care settings can provide mother/baby pairs with all required services at one visit. This study aimed to evaluate a proof of concept, quality improvement (QI) intervention to strengthen well-child service provision and integration with maternal health services in five rural clinics in KwaZulu-Natal, South Africa.

Methods: Quantitative cross-sectional surveys were conducted among mothers bringing their child for well-child services, before and after implementation of the intervention. Exit interviews and reviews of the child’s Road to Health Booklet (RTHB) were conducted to determine services provided at the visit, and the time spent in the clinic was observed and recorded.

Results: A total of 413 exit interviews and record reviews were conducted (123 at baseline and 290 at follow-up). At follow-up, significantly more mothers were tested for HIV during the well-child visit (9.2% vs. 22.6%; p = 0.045) and significantly more mothers received ART (3.7% vs. 35.5%; p = 0.010). However, coverage of growth-monitoring services remained low and there was no difference in infant feeding advice provided to mothers at baseline and follow-up (49.5% vs. 49.7%; p = 0.996). More mothers interacted with a registered nurse at follow-up than at baseline (35.8% vs. 80.7%; p = 0.032).

Conclusions: Over the implementation period of the QI intervention, improvement was shown in coverage and quality of some maternal health and HIV services, but there was no improvement in growth monitoring. This suggests that QI has the potential to improve integration of service delivery, but this was a small study and further research is recommended.

Keywords::

• child growth
• child health
• growth monitoring
• HIV/AIDS
• integrated care
• maternal health
• nutrition
• quality improvement
• South Africa

Acknowledgements

The authors gratefully acknowledge the financial support for this study from UNICEF and RMCH.

They would also like to acknowledge the KZN Department of Health, in particular the district manager and the district clinical specialist for primary health care, for their support. In addition, the authors would like to thank the operational managers of the clinics, all the registered nurses, enrolled nurses, HIV counsellors, nutrition advisers and community caregivers for participating in the intervention and evaluation. Finally, they would like to thank all the mothers who participated in the study.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

J Lyn Haskins http://orcid.org/0000-0003-3636-5370

Christiane M Horwood http://orcid.org/0000-0003-4395-1423