MAMOTHENA CAROL MOTHUPI Tell us about the background of your research. My research focuses on determinants of maternal health outcomes. I specifically wanted to measure health systems performance and its relationship with outcomes such as maternal mortality while taking into consideration the social determinants of health. Despite investments, quality improvement programs and the continued commitment, maternal mortality rates in South Africa are still high when compared to similar countries. The reasons for high mortality rates are varied, and exist at the individual, community and health facility level. They include high infection rates for HIV, hypertension, and obstetric haemorrhage. These outcomes, on the other hand, can be related to the social determinants like drivers of HIV infection in South Africa, the rise of obesity and NCDs, poor quality of antenatal care, the efficiency and effectiveness of referrals and emergency obstetric services, and poor access to care due to constraints such as costs and transport, education/care-seeking etc. So, one can look at the clinical causes of death and/ or underlying systemic factors t h a t
make those risk factors and outcomes more likely. I used a framework called the continuum of care to help me focus on this broad public health perspective. That framework considers interventions at different stages of the pregnancy journey and even before conception, and captures the environments people live in (through water, sanitation, housing for instance) and even nutrition factors. My challenge was to develop a way to analyse these multiple factors together in a new measure of health system performance as related to maternal health. The conception of health system in this instance is of course broad, as it includes the performance of other sectors related to health, which the health system has a mandate to collaborate with through multisectoral decision making platforms. What were the motivations for carrying out this research? I wanted to engage with a comprehensive way of understanding public health problems, and devise new ways to measure performance that enhance the co-accountability of multiple sectors for health outcomes. I have always been interested in women’s health and maternal health, and due to some of my background studying epidemiology I also gravitated towards measurement related research problems. Through this research I also got to engage more with qualitative research by interviewing experts and decision makers in maternal health and related areas in South Africa and LMICs in general. So, I was privileged to be able to integrate their voices into my own approach because I believe in creating solutions that are likely to resonate with stakeholders making the policies and plans in maternal health and public health. Research can be a long and tough journey, what kept you going during this process? Different things at different
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DVC: RESEARCH & INNOVATION MAGAZINE
