/sites/default/files/attachments/2022-04/banner2_1.jpg
STAR – Strengthening teamwork and respect

STAR – Strengthening teamwork and respect

STARRespectful maternal and newborn care is a priority, yet little evidence exists on what works to improve it. Strategies typically involve once-off didactic teaching which fails to encourage self-reflection or sustainable learning cultures. Our project has tackled this challenge through participatory learning processes, embedded in routine service delivery. A multi-disciplinary team developed the Strengthening Teamwork and Respect (STAR) intervention approach and toolkit which was implemented in nine rural hospitals in South Africa. A before-after mixed method evaluation was conducted to assess feasibility and impact of the intervention on person-centred maternity care and hospital organisational culture.

The midwife-led STAR intervention aimed to give control to health professionals to identify their own priorities for improving their working environment and ways of relating to women in their care. The findings will advance the evidence base for interventions to improve respectful care and cultures of teamwork and learning.

With approval of the KwaZulu-Natal Department of Health, the STAR project is a partnership of the South African Medical Research Council (SAMRC), the Centre for Rural Health at the University of KwaZulu-Natal, and the London School of Hygiene and Tropical Medicine.

Contact: tanya.doherty@mrc.ac.za

mrc-accordion
Journal articles
  1. Mapumulo S, Kinney M, Haskins L, Luthuli S, John VM, Penn-Kekana L, Filippi V, Horwood C, Doherty T. Voices from the neonatal unit: Mothers’ and healthcare workers’ perspectives on respectful and collaborative care for small and sick newborns in rural districts in KwaZulu Natal, South Africa, Global Public Health, 21:1, 2692100, DOI: 10.1080/17441692.2026.2692100
  2. Doherty T, Filippi V, John V et al. Impact of the Strengthening Teamwork and Respect (STAR) intervention on organisational learning culture and person-centred maternity care in rural South Africa: an uncontrolled before-and-after implementation study. The Lancet Regional Health – Africa, 2026; https://www.thelancet.com/journals/TLRHAFRICA/article/PIIS3050-5011(26)00051-9/fulltext
  3. Horwood, C., et al. (2025). "Reflection or correction? A qualitative study of health manager’s experience of clinical audit activities in rural maternity units in KwaZulu-Natal, South Africa." Global Public Health 20(1): 2597114. https://www.tandfonline.com/doi/full/10.1080/17441692.2025.2597114
  4. Luthuli, S., et al. (2025). "Women’s experiences of communication and supportive care during labour: a qualitative study in rural KwaZulu-Natal, South Africa." BMC Pregnancy Childbirth 25(1): 1157. https://link.springer.com/article/10.1186/s12884-025-08334-0
  5. Doherty T, Petrus R, Land S, Horwood C, Filippi V, Haskins L, et al. Strengthening teamwork and respect (STAR) in maternity units: developing a health system intervention in South Africa. Global Health Action 2025; 18(1). DOI: 10.1080/16549716.2024.2440982
  6. Doherty T, Horwood C, Mapumulo S, Haskins L, Manda S, Penn-Kekana L, et al. Case for improving respectful care: results from a cross-sectional survey of person-centred maternity care in rural South Africa. BMJ Public Health 2024; 2(2). https://bmjpublichealth.bmj.com/content/bmjph/2/2/e001086.full.pdf
  7. Horwood C, Haskins L, Filippi V, Penn-Kekana L, Manda S, Mapumulo S, et al. Organisational learning culture in maternity units: A mixed-method study in rural district hospitals in KwaZulu-Natal, South Africa. SSM - Health Systems. 2025. https://doi.org/10.1016/j.ssmhs.2025.100081
  8. Moxon SG, Graham W, Filippi V, Blencowe H, Doherty T, Kabakian-Khasholian T, Kumar MG, Oluoch D, Hinton L. Nothing About Us Without Us: Consolidating Experiences of Maternity Care to Advance Equity. BJOG, 24 July 2025. https://doi.org/10.1111/1471-0528.18300
Conference presentations

SOMSA conference August 2025

  • Makhosazana Buthelezi - Reducing absenteeism to enhance respectful maternity care.

43rd Conference on Priorities in Perinatal Care in Southern Africa – March 2025

  • Makhosazana Zulu – Reducing absenteeism to enhance respectful maternity care
  • Monica Mejeni – Improving respectful care for women who have suffered bereavement
  • Petronella Lunda – A conceptual framework to promote respectful perinatal care
  • Mfundo Magoso – Introducing birth companions: A strategy to enhance respectful maternity care
  • Zama Khosa – Experiences of implementing birth companions in a rural district hospital
  • John Vaughn, Tanya Doherty, Lyn Haskins, Neil Moran – Workshop – Strengthening Teamwork and Respect (STAR) in maternity units: Experiences from implementing a quality improvement intervention in rural KwaZulu-Natal

FIGO World Congress of Gynecology and Obstetrics Conference October 2025

  • Doherty T, Horwood C, Haskins L, Penn-Kekana L, John V, Petrus R, Land S, Mapumulo S, Luthuli S, Filippi V. A participatory learning and action intervention to improve respectful maternal and newborn care. P02.116. International Journal of Gynecology and Obstetrics 2025; 171: S2. Special Issue: Abstracts of the XXV FIGO World Congress of Gynecology and Obstetrics. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.70503
Media Outputs