Evaluation of integrated antenatal care implementation in primary health care

Abstract

PurposeThis study was aimed to evaluate the implementation of an integrated antenatal care (ANC) scheme through a retrospective document study using a checklist for measuring the adequacy of the cohort ANC register documented by midwives in an urban area and to describe the barriers for the midwives during the ANC record process.Design/methodology/approachAn exploratory descriptive study using a sequential mixed method was utilised where a quantitative method was employed by collecting secondary data of 150 entries of the cohort ANC register and followed by in-depth interviews among midwives and community health workers.FindingsThe results show that the cohort registry indicators for integrated care such as laboratory and management were poorly recorded. Several barriers were found and categorised during the implementation of the integrated ANC, namely (1) governance and strategy, (2) process of care, (3) organisation and management support.Research limitations/implicationsThe contribution of this present research is that it provides empirical data of the integrated ANC implementation in primary health care (PHC) which has the responsibility to deliver an integrated level of care for ANC using a cohort registry for pregnancy registration monitoring which facilitates the continuity and quality of care.Practical implicationsPractical implication of the finding is that functional integration such as the clinical information system to facilitate an efficient and effective approach during the implementation of integrated ANC in primary care should be considered to support the clinical, professional, organisational, system and normative integration.Originality/valueSince only limited studies have been conducted to assess the quality of the cohort ANC registry and to investigate the barriers against integrated ANC implementation in Indonesia, the research findings are valuable information for the national and local governments to improve the ANC service in Indonesia.

Neonatal Death Incidence in Healthcare Facility in Indonesia: Does Antenatal Care Matter?

“…It is necessary to strengthen the early identification of obstetric complications and urgent intervention to prevent neonatal mortality 24 . The results of this analysis again to confirm the importance of quality ANC during pregnancy 17 .…”

“…Complete ANC visits (≥4 times) according to government recommendations, at least 4 visits during pregnancy, helping pregnant women to monitor and control risks during pregnancy 15 . ANC provides routine monitoring of height and weight gain, identification of maternal or fetal medical problems, counseling on tobacco or substance use, providing psychosocial support, nutritional advice, and early intervention that can reduce adverse pregnancy output, including the occurrence of neonatal death 16,17 . This finding is in line with previous findings conducted in urban areas in Indonesia 18 .…”

The Determinants of Four or More Antenatal Care Visits Among Working Women in Indonesia

“…10,15,16 Better education might help working women understand their needs and demands and make them confident about making independent decisions. 17,18 Education is closely related to power in sexual relationships, especially in a paternalistic social system. Women with better education might have more freedom to decide what is beneficial for their health.…”

A population-based study of neonatal deaths in Indonesia based on the Indonesian demographic health survey: what determinants play an essential role?

“…Based on a report by Suharmiati et al, this low utilisation of antenatal care visits in the remote and border islands with extreme topography was affected by the low availability of healthcare services and facilities, non-optimised health infrastructure and inappropriate reward for healthcare providers (19). Furthermore, in urban areas of Indonesia, the constraints of actualising e cient antenatal care services are made worse by several factors, including poor laboratory and management records during antenatal care services, inadequate monitoring documentation and the fact that less than 5% of women receive all the routine measurements, consisting of urine tests, blood screening tests, iron supplementation, tetanus vaccination and information on pregnancy complications (20). Meta-analyses conducted in African countries have also implied that the bene ts of antenatal care visits facilitated by skilled providers can reduce the incidence of neonatal deaths (21,22).…”