Background
Research utilisation in policy making
Systematic review 1[9] |
Systematic review 2[12] |
This study
|
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Interaction (or the lack of interaction) and trust between policy makers and researchers | Interaction between policy makers and researchers Trust in the research and the researcher | An interactive relationship between policy makers and researchers in which the researchers are able to receive the evidence and interpret it for members of the bureaucracy |
The timeliness, relevance and quality of the research | The quality, timing and timeliness of the research; and the perceived relevance of the research | The evidence being regarded as being of good quality and therefore trustworthy Appropriate evidence available at the right time, in this case when a solution to the problem of the high maternal mortality rate was being sought |
The inclusion of effectiveness data | - | - |
The political environment including political (in)stability and community pressure | - | A political environment that is conducive to policy making |
The extent to which research confirmed existing policies | - | - |
Bureaucratic processes including power and budget struggles | Political and bureaucratic conflict | A bureaucracy that is open to change rather than obstructive |
The availability of research summaries with clear recommendations | Publishing findings in a manner that is accessible beyond a scientific audience | - |
- | The importance of management support | - |
- | The skill and attitude of those receiving the research | - |
- | The existence of policy networks | A functioning policy network that includes researchers, policy makers and bureaucrats |
- | - | The evidence being received in the context of a positive attitude towards research utilisation, particularly with regard to evidence from randomised controlled trials and systematic reviews. |
The maternal health policy context in South Africa
The problem of eclampsia and pre-eclampsia in South Africa
Effective treatment for eclampsia and pre-eclampsia: The evidence
Aim
Theoretical and analytical approaches
Methods
Data collection
Policy Review
Timeline
Interviews
Analysis
Ethical issues
Findings
Research utilisation in contemporary maternal health policies and guidelines: a document review
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Guidelines for Maternity Care in South Africa: A manual for clinics, community health centres and district hospitals, (2000 & 2002)[53]
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Saving Mothers: Policy and Management Guidelines for Common Causes of Maternal Deaths, (2001) [54]
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Saving Mothers: Second Report on Confidential Enquiries into Maternal Deaths in South Africa, 1999–2001, (2002)[18]
Policy making for maternal care in South Africa
• Filling a policy vacuum and standardising national care
• A change in direction for national maternal health care
Date | Key Events in The evolution of policy and guidelines for the treatment of eclampsia and pre-eclampsia in South Africa |
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1955 | First Pritchard case series published, showing effectiveness of MgSO4. Updated every 10 years until 1984 |
1968 | British physicians in Hong Kong suggest use of diazepam |
1970's | MgSO4 introduced into obstetric care at key medical faculties in South Africa |
1979 | Obstetrics criticised by Archie Cochrane as being least evidence based medical speciality |
1980's | Use of MgSO4 spreads through teaching and inter-institutional contact between academics. International divisions on the choice of anti-convulsant are reflected in the country |
1980's-90's | South African researchers become increasingly connected to the international obstetric research community and simultaneously the local research output increases Although provinces and institutions have their own policies there are no national policies or guidelines |
By early 1990's | MgSO4 in widespread use in SA for treating eclampsia |
1990 | Randomised controlled trial, of MgSO4 vs phenytoin for eclampsia conducted in South Africa published in British Journal of Obstetrics and Gynaecology 1990 Feb; 97 (2): 104–9. |
1992 | Pregnancy and Childbirth Group, first Cochrane Review Group to be registered |
1993–95 | South African researchers collaborate in Eclampsia Trial at local trial sites |
1994 | Change of government promotes new focus on maternal health and openness to academic involvement in policy making |
1995
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Collaborative Eclampsia Trial published
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1995 | Senior obstetricians in South Africa publish editorial on implications of Collaborative Eclampsia Trial |
1996 | Maternal health organised into a separate directorate within national DoH Academic advocacy for maternal mortality monitoring followed by the appointment of the first National Committee for Confidential Enquiry into Maternal Deaths (NCCEMD) |
1999 | First NCCEMD report published. Eclampsia accounts for highest percentage of the deaths due to hypertensive disorders of pregnancy, which is the second largest cause of maternal deaths. National policy and guidelines recommended. |
2000
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First national "Guidelines Maternity Care" published. Evidence is referred to but not referenced
|
2001
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NCCEMD publishes policy and management guidelines for common causes of maternal deaths. MgSO4 recommended and use of evidence made explicit. South African researchers collaborate in Magpie Trial at local sites. South Africa is the regional trial co-ordinating centre. |
2002
|
Magpie Trial published
|
2003 | Following on from trial, MgSO4 is recommended for women with moderate to severe pre-eclampsia, where it can be administered safely, in South African Medical Journal. |