Strengthening the system of Confidential Enquiry into Maternal Deaths (CEMD) in Lesotho - Ramaili-Letsie, Tlalane (University of the Free State, 2015)
The purpose of this study was to describe through Appreciative Inquiry (AI), the strengths, opportunities and aspirations of all stakeholders involved in the Confidential Enquiry into Maternal Deaths (CEMD) system in Lesotho. This was done with an intention of supporting and strengthening the work of this system. The study was conducted using a qualitative descriptive design and Appreciative Inquiry as a research technique. AI draws from the principle of positivism, where by strengths base, rather than problems are a point of focus to resolve problems. The researcher was seeking to appreciate the best of what the system is, by discovering its strengths. The participants used their strength base to envision the best of what the system could be. They also drew strategies that will enable them to attain the envisaged future CEMD in Lesotho. Data collection along with primary data analysis was conducted in a one day AI workshop. The participants for the study were selected using non-probability selection and comprised of representatives of all stakeholders of CEMD in Lesotho. The sample size was 20 participants comprising of four (4) members of QMMH maternal mortality review committee, ten (10) Maternal Mortality Assessors each representing one of the ten districts in Lesotho and six (6) members of the LCCEMD, two of which also represented the MOH. The results of the study reflected five main themes that portray the strengths of the CEMD system in Lesotho; namely government commitment to CEMD, an effective feedback mechanism, strong communication system, a strong support system following maternal death and Maternal Death Review (MDR) and lastly an effective training and monitoring system. The participants used these strengths as the base to map out an envisaged ideal system of CEMD in five years, which was reflected in a collage form. The dream phase depicted more government commitment where a revolution against maternal deaths was declared, urging government to commit more resources to CEMD. Interlinks and integration of the efforts of other disciplines in curbing maternal deaths was encouraged. Strengthening communication, Advocacy for MDR and dissemination of key messages about safe motherhood are seen as crucial in strengthening CEMD in Lesotho. Participants lobbied for support of the carers of the diseased mother as well as those involved in MDR. They recommended a system of trust with an element of debriefing and counseling to avert psychological impact of MDR. Training and monitoring need to be more decentralized for capacity building on both MDR processes and skills acquisition in caring for pregnant mothers. During the design phase participants realized that with only one year to 2015, the target of reducing maternal deaths by 75 % may not be realized. They however realized that it is possible to prevent primitive maternal deaths; those that are avoidable. They drew a bold affirmative statement “Lesotho amazes the world: Primitive Maternal deaths down to zero by 2015”. A plan to realize this included: strengthening information sharing, improving the infrastructure for Maternal and child health (MCH) services, ensuring availability of Human resources and commodities. The researcher concluded that with the positive attitude, the stakeholders of CEMD in Lesotho were able to realize the strengths of the system and used them as a platform of improving it. An improved system is likely to yield recommendations that will enable Lesotho to improve maternal health and curb maternal deaths. The study was concluded with recommendations for clinical practice, pre-service and in-service education, research, the LCCEMD, and regulatory bodies for health professions.

Die doel van hierdie studie was om deur Waarderende Ondersoek (WO) die sterktes, geleenthede en aspirasies van belanghebbendes wat in die Konfidensiële Ondersoeke na Moederlike sterftes (KOMS) sisteem van Lesotho (LKKOMS) betrokke is te beskryf. Hierdie proses is gevolg ten einde die werksaamhede van die sisteem te versterk en te ondersteun. Die studie is gedoen deur ‘n kwalitatiewe beskrywende ontwerp te gebruik en WO as navorsings tegniek. WO is geskoei op die beginsel van positivisme, waar ‘n sterktegebasseerde fokus eerder as problem-gebasseerde fokus gebruik word om probleme op te los. Die navorser het die beste in die stelsel waardeer deur die sterkpunte te ontdek. Die deelnemers het hul sterkpunte gebruik as basis om die beste van die sisteem te visualiseer. Hulle het ook strategieë uitgewerk wat hul in staat sal stel om die gevisualiseerde toekoms vir die KOMS in Lesotho te bereik. Data insameling en gepaardgaande primêre data analise is gedoen tydens ‘n een-dag WO werkswinkel. Die resultate van die studie het vyf hoof temas wat die sterk punte van die KOMS sisteem in Lesotho uitbeeld naamlik: regerings toewyding aan KOMS, ‘n effektiewe terugvoer meganisme, sterk kommunikasie sisteem, sterk ondersteunings sisteem na ‘n moederlike sterfte en die moederlike sterfte ondersoek (MSO) en laastens ‘n effektiewe opleidings- en moniterings sisteem. Die deelnemers het hierdie sterk punte gebruik om die gevisualiseerde ideale sisteem vir KOMS in vyf jaar voor te stel as ‘n collage. ‘n Nie-waarskynlikheidsteekproefneming met gerieflikheidsseleksie is gebruik. Die navorsing is gedoen met twintig (20) deelnemers bestaande uit ses (6) lede van die LKKOMS; vier (4) lede van die fasiliteits moederlike sterfte ondersoekspan van die Queen ‘Mamohato Memorial Hospitaal en tien (10) distrik moederlike sterfte assessors. Die droom fase het meer regerings toewyding uitgebeeld wat die vorm aangeneem het van ‘n verklaring van revolusie teen moederlike sterftes, ‘n bepleiting van die regering om meer hulpbronne aan KOMS te verskaf. Integrasie en skakeling met die pogings van ander dissiplines om moederlike sterftes in die vermindering van moederlike sterftes is aangemoedig. Versterking van kommunikasie, advokatuur vir MSO en verspreiding van sleutel boodskappe oor veilige moederskap is gesien as van kritiese belang vir die versterking van KOMS in Lesotho. Deelnemers het beding vir ondersteuning van diegene wat die oorlede moeder versorg het, asook diegene betrokke by die MSO. ‘n Sisteem van vertroue, met elemente van ontlading en berading is voorgestel om die negatiewe impak van MSO te verminder. Opleiding en monitering moet gedesentraliseer word om ook kapasiteit te ontwikkel beide in die MSO proses en vaardighede in die sorg van swanger moeders. Gedurende die ontwerp fase het deelnemers besef dat met slegs een jaar tot 2015, die doelwit van ‘n vermindering van moederlike sterftes met 75% nie haalbaar is nie. Hulle het egter besef dat voorkombare moederlike sterftes(primitiewe sterftes) wel voorkom kan word. Derhalwe is ‘n bevestigende stelling opgestel: ‘Lesotho verbaas die wêreld: primitiewe moederlike sterftes af na nul teen 2015.” ‘n Plan om hierdie doelwit te bereik sluit in deel van inligting, verbetering van infrastruktuur vir moederlike en kinder gesondheidsdienste, beskikbaarheid van menslike hulpbronne en kommoditeite. Die navorser het ten slotte bevind dat met die positiewe houding, die belanghebbers van die KOMS in Lesotho in staat was om hul sterk punte te identifiseer en dit te gebruik as platform vir die verbetering van die sisteem. ‘n Verbeterde sisteem kan aanbevelings doen wat Lesotho in staat sal stel om moederlik gesondheid te verbeter en moederlike sterftes te verminder. Die navorser het die studie afgesluit met ‘n evaluasie van die data wat die aanbevelings in die kliniese praktyk; vroedvrou opleiding; navorsing en die LKKOMS ingelig het.
Dissertation (M.Soc.Sc. (Nursing))--University of the Free State, 2014
Keywords: Confidential enquiries into maternal deaths; Maternal death review; Appreciative Inquiry; Mothers -- Mortality --Lesotho; Maternal health services -- Lesotho; Confidential communication