Abstract:
BACKGROUND : Many health systems were poorly prepared for the coronavirus disease 2019
(COVID-19) pandemic and found it difficult to protect maternity and reproductive health
services. The aim of the study was to explore the influence of the COVID-19 pandemic on the
ability of maternity healthcare providers to maintain the positive practices introduced by the
CLEVER Maternity Care programme and to elicit information on their support needs.
METHODS : This multimethod study was conducted in midwife-led obstetric units (MOUs) and
district hospitals in Tshwane District, South Africa and included a survey questionnaire and
qualitative reports and reflections by the CLEVER implementation team. Two five-point
Likert-scale items were supplemented by open-ended questions to provide suggestions on
improving health systems and supporting healthcare workers.
RESULTS : Most of the 114 respondents were advanced midwives or registered nurses (86%).
Participants from MOUs rated the maintenance of quality care practices significantly higher
than those from district hospitals (p = 0.0130). There was a significant difference in perceptions
of support from the district management between designations (p = 0.0037), with managers
having the most positive perception compared with advanced midwives (p = 0.0018) and
registered nurses (p = 0.0115). The interpretation framework had three main themes: working
environment and health-system readiness; quality of patient care and service provision; and
healthcare workers’ response to the pandemic. Health-facility readiness is described as
proactive, reactive or lagging.
CONCLUSION : Lessons learned from this pandemic should be used to build responsive health
systems that will enable primary healthcare workers to maintain quality patient care, services
and communication.
