ArticleBMC health services research2018
Understanding key drivers of performance in the provision of maternal health services in eastern cape, South Africa: a systems analysis using group model building.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Participatory systems mapping: a review of population health research practice.Health research policy and systems · 2026Pooled it
- Application of group model building in implementation research: A systematic review of the public health and healthcare literature.PloS one · 2023Pooled it
- Disrupting antimicrobial resistance in food systems from a One Health perspective: a complex systems analysis in Canada, Senegal and the Netherlands.BMC global and public health · 2026Article
- Interrelationship between subjective wellbeing and health.BMC public health · 2024Article
- Planning, implementing and governing systems-based co-creation: the DISCOVER framework.Health research policy and systems · 2024Article
- Methods and Measures to Assess Health Care Provider Behavior and Behavioral Determinants in Reproductive, Maternal, Newborn, and Child Health: A Rapid Review.Global health, science and practice · 2023Review
- Association between antenatal care facility readiness and provision of care at the client level and facility level in five low- and middle-income countries.BMC health services research · 2023Article
- Cultural adaptations and methodological innovations to group model building for the systems actions to reduce malnutrition in all its forms in Southeast Asian countries and China (SYSTAM CHINA-SEACS International Consortium) project.The international journal of behavioral nutrition and physical activity · 2023Article
- How to do (or not to do)…using causal loop diagrams for health system research in low and middle-income settings.Health policy and planning · 2022Article
- Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach.BMC health services research · 2021Article
- Health system determinants of tuberculosis mortality in South Africa: a causal loop model.BMC health services research · 2021Article
- Planning, implementing, and evaluating an online group-model-building workshop during the COVID-19 pandemic: celebrating successes and learning from shortcomings.System dynamics reviewArticle
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented understanding among stakeholders, a study was conducted in one of the chronically poorly performing districts.
methodsThe study used a systems analysis approach to understand the drivers and outcomes affecting maternal health in the district in order to identify key leverage points for addressing the situation. The approach included semi-structured interviews with a total of 24 individuals consisting health system managers at various levels, health facility staff and patients. This was followed by a participatory group model building exercise with 23 key stakeholders to analyze system factors and their interrelationships affecting maternal health in the district using rich pictures and interrelationship diagraphs (IRDs) and finally the development of causal loop diagrams (CLDs).
resultsThe stakeholders were able to unpack the complex ways in which factors were interrelated in contributing to poor maternal health performance and identified the feedback loops which resulted in the situation being intractable, suggesting strategies for sustainable improvement. Quality of leadership was shown to have a pervasive influence on overall system performance by linking to numerous factors and feedback loops, including staff motivation and capacity building. Staff motivation was linked to quality of care in turn influencing patient attendance and feeding back into staff motivation through its impact on workload. Without attention to workload, patient waiting times and satisfaction, the impact of improved leadership and staff support on staff competence and attitudes would be diminished.
conclusionUnderstanding the complex interrelationships of factors in the health system is key to identifying workable solutions especially in the context of chronic health systems challenges. Systems modelling using group model building methods can be an efficient means of supporting stakeholders to recognize valuable resources within the context of a dysfunctional system to strengthen systems performance.
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