Strengthening health system promotion of maternal and child health through medical travel

This 12 month grant focuses on strengthening health system promotion of maternal and child health through medical travel. It concentrates on South Africa and the effect on resident population of patients traveling to South Africa for treatment from neighbouring countries. It is a collaboration between the University of Cape Town and the London School of Hygiene and Tropical Medicine.

The main objective is to identify how to assess and influence the effect of medical travel on the health system and maternal and child health in South Africa. There are three linked specific objectives.
1) To understand how inbound medical travel affects the maternal and child health of the resident South African population.
2) To identify and analyse current agreements between South Africa and neighbouring countries which govern and affect patients traveling.
3) To establish and review what kind of indicators and data are available at national and sub-national level to monitor health systems impact of medical travel on MCH.

Research employs quantitative and qualitative methods. To assess effects on resident South African MCH, it examines indicators and experiences of health workers, patients and other actors in areas where health facilities are seeing a large number of medical travellers coming in and compare these with areas and facilities who do not. These will be identified through initial key informant interviews. Interviews will be in five communities/facilities where large numbers of medical travellers are received and five where there are not. Quantitative work will evaluate usefulness of core indicators for MCH and health systems access which are publicly accessible. Research will include the analysis of agreements governing medical travel between South Africa and neighbouring countries to identify policy recommendations on how such governance arrangements can best support health systems' promotion of maternal and child health.

Findings, including reflection on methods, will inform a larger comparative research proposal with researchers in India and Thailand.

This 12 month grant focuses on strengthening health system promotion of maternal and child health through medical travel. It concentrates on South Africa and the effect on resident population of patients traveling to South Africa for treatment from neighbouring countries. It is a collaboration between the University of Cape Town and the London School of Hygiene and Tropical Medicine.
The main objective is to identify how to assess and influence the effect of medical travel on the health system and maternal and child health in South Africa. There are three linked specific objectives.
1) To understand how inbound medical travel affects the maternal and child health of the resident South African population.
2) To identify and analyse current agreements between South Africa and neighbouring countries which govern and affect patients traveling.
3) To establish and review what kind of indicators and data are available at national and sub-national level to monitor health systems impact of medical travel on MCH.
Research employs quantitative and qualitative methods. To assess effect on resident South African MCH, it examines indicators and experiences of health workers, patients and other actors in areas where health facilities are seeing a large number of medical travellers coming in and compare these with areas and facilities who do not. These will be identified through initial key informant interviews. Interviews will in five communities/facilities where large numbers of medical travellers are received and five where there are not. Quantitative work will evaluate usefulness of core indicators for MCH and health systems access which are publicly accessible. Research will include the analysis of agreements governing medical travel between South Africa and neighbouring countries to identify policy recommendations on how such governance arrangements can best support health systems' promotion of maternal and child health.
Findings will inform a comparative res

Ultimate impact will be on women and children in South Africa, as findings will result in better health systems' promotion of maternal and child health. As the South African health system responds better, incidental benefits to the general population using the public health system in areas receiving a large number of medical travelers, can be expected through more targeted use of resources.
Policymakers in South Africa working on health systems, maternal and child health, and migration will benefit from new knowledge on how medical travel influences health systems promotion of maternal and child health. Findings from research will document impact and health systems responses, which will assist in the design of policies. It will allow policymakers to manage the influence of medical travel to the maximum benefit of maternal and child health. This includes health planners and implementers within the areas receiving medical travelers in South Africa. Review and testing of available data to assess suitability to monitor impact of medical travel will provide national and sub-national policymakers in South Africa with a methodology to monitor impact of medical travel on health systems promotion of maternal and child health.
Findings will be of additional benefit to those policymakers working on migration in South Africa. Inward migration is a highly sensitive issue, as evident during the 2008 riots against migrants from neighbouring countries. While the need to respond to human mobility is a key theme in South African politics, its impact including on the health system is little understood. Research findings will provide information to enable better planning and more informed policy responses in the field of health. Insights generated by this research will help civil society organizations working on the issue of migration to better inform services and advocacy.
Findings on how health systems adapt, will also hold valuable lessons for policymakers in other low and middle -income countries receiving medical travelers. Lessons learnt will be shared through a policy briefing, the project website, academic articles and presentations by researchers. New knowledge on how to influence the effects of medical travel on health systems promotion of maternal and child health will thus impact the population in low and middle -income countries more generally. Such knowledge will also be of benefit to policymakers globally working on these issues, such as the Partnership Maternal and Child Health at WHO, by providing evidence for better informed policies.
Analysis of agreements between South Africa and its neighbours pertaining to medical travel will assist policymakers within the region to ensure that as these are reviewed and revised they maximize the potential to promote maternal and child health. Moreover, insights from this study will provide lessons for policymakers in other countries working on trade in health services and governance arrangements relating to patient mobility. This includes policymakers in Ministries of Trade and Foreign Affairs, WHO and WTO, as well as pressure groups working on these issues.
Researchers in the fields, of health systems in low and middle income countries, in maternal and child health, medical travel and in migration will benefit from addition to empirical evidence. They will derive additional benefit from the development and testing of methods, and the review of data to monitor impact of medical travel on maternal and child health specifically, and health outcomes more generally.
Two South African researchers recruited will benefit from mentorship of study investigators as well as exposure and training through conducting the research. Investigators themselves will gain further insight. They will benefit and learn from the interaction with patients, health care workers, policymakers and each other, as well as the opportunity to develop a larger research proposal on this issue.