BACKGROUND The continuum of care is a key strategy for ensuring comprehensive service delivery for maternal health, while acknowledging the role of the social determinants of health. However, there is little research on the operationalisation of the framework by decision-makers and implementers to address maternal health challenges. The framework should be measurable and feasible for implementation in low- and middle-income country contexts. In this study, we explore experts' perspective on monitoring indicators for continuum of care and key issues related to their use in the South African context. METHODS We conducted key informant interviews with a range of experts in decision-making and programme implementation roles in the health system and relevant sectors. Key informants provided their perspectives on systematically selected, nationally representative monitoring indicators in terms of validity, relevance and feasibility. We interviewed 13 key informants and conducted a thematic analysis of their responses using multi-stage coding techniques in Atlas.ti 8.4. RESULTS Experts believed that the continuum of care framework and monitoring indicators offer a multisectoral perspective for maternal health intervention missing in current programmes. To improve validity of monitoring indicators, experts suggested reflection on the use of proxy indicators and improvement of data to allow for equity analysis. In terms of relevance and feasibility, experts believe there was potential to foster co-accountability using continuum of care indicators. However, as experts stated, new indicators should be integrated that directly measure intersectoral collaboration for maternal health. In addition, experts recommended that the framework and indicators should evolve over time to reflect evolving policy priorities and public health challenges. CONCLUSION Experts, as decision-makers and implementers, helped identify key issues in the application of the continuum of care framework and its indicators. The use of local indicators can bring the continuum of care framework from an under-utilised strategy to a useful tool for action and decision-making in maternal health. Our findings point to measurement issues and systematic changes needed to improve comprehensive monitoring of maternal health interventions in South Africa. Our methods can be applied to other low- and middle-income countries using the continuum of care framework and locally available indicators.

中文翻译：

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提高南非孕产妇保健连续护理框架的有效性、相关性和可行性：专家观点的专题分析。


背景 持续护理是确保为孕产妇健康提供全面服务的一项关键战略，同时承认健康的社会决定因素的作用。然而，关于决策者和实施者如何运用该框架来应对孕产妇健康挑战的研究却很少。该框架应该是可衡量的，并且对于在低收入和中等收入国家实施来说是可行的。在这项研究中，我们探讨了专家对连续护理监测指标的看法以及与其在南非使用相关的关键问题。方法 我们对卫生系统和相关部门中担任决策和计划实施角色的一系列专家进行了关键知情人访谈。主要知情人就系统选择的、具有全国代表性的监测指标的有效性、相关性和可行性发表了自己的看法。我们采访了 13 位关键信息提供者，并使用 Atlas.ti 8.4 中的多阶段编码技术对他们的回答进行了主题分析。结果 专家们认为，连续护理框架和监测指标为当前计划中缺失的孕产妇保健干预措施提供了多部门视角。为了提高监测指标的有效性，专家建议反思代理指标的使用和改进数据以进行公平性分析。就相关性和可行性而言，专家认为使用连续护理指标有可能促进共同问责。然而，正如专家指出的那样，应该纳入新的指标来直接衡量孕产妇健康的部门间合作。 此外，专家建议框架和指标应随着时间的推移而不断发展，以反映不断变化的政策优先事项和公共卫生挑战。结论 专家作为决策者和实施者，帮助确定了连续护理框架及其指标应用中的关键问题。使用当地指标可以将连续护理框架从未充分利用的战略转变为孕产妇保健行动和决策的有用工具。我们的研究结果指出了改善南非孕产妇健康干预措施综合监测所需的测量问题和系统性变革。我们的方法可以使用连续护理框架和当地可用的指标应用于其他低收入和中等收入国家。