Provider-perceived benefits and constraints of complete adherence to antenatal care guideline among public health facilities, Ethiopia: A qualitative study

Abstract

Background In Ethiopia, health care providers’ level of adherence to the national Antenatal Care (ANC) guideline is relatively low. The reasons why they do not follow the guidelines are not well known. Therefore, this study aimed to explore the provider-perceived benefits and constraints associated with using the guideline for ANC in public health facilities in Gondar town. Methods A qualitative study was conducted using a semi-structured interview guide. The interview was conducted among a purposive sample of nine health care providers working in four public health facilities in Gondar town. After the interviews were transcribed and coded, a content analysis was done using Atlas ti version 7.5 software packages. Result Decreasing provider’s workload and maximizing performance, improving safe motherhood, and improving the process of service delivery were reported as the perceived benefits of following ANC guideline. Organizational problems, care providers’ existing knowledge, attitude, and skills and availability of training and mentorship were the three main identified groups of factors that hinder complete providers’ adherence to ANC guideline. Conclusion Although providers acknowledged the benefits of following ANC guideline, the guideline is not fully implemented. Refresher training should be given at the start of the updated eight-contact ANC guideline and continuing education and supervision throughout the implementation process. Health care providers call for profound and urgent revisions of the supply chain system for supplies and equipment.

The effect of national antenatal care guidelines and provider training on obstetric danger sign counselling: a propensity score matching analysis of the 2014 Ethiopia service provision assessment plus survey

“…ANC guidelines are also essential to reduce the time that the providers would typically spend thinking about the types of prenatal healthcare that should be provided to the expectant mother. As a result, this maximises the probability of counselling on each obstetric danger sign [ 41 – 43 , 67 ].…”

“…Appropriate and acceptable care tailored to the pregnant woman’s socio-cultural context requires providers to be clinically competent, motivated and available [ 74 , 75 ]. Training, mentoring, and supportive supervision are among the strategies that make the ANC provider capable and motivated [ 67 , 76 ]. Provider training includes pre-service training and in-service training.…”

“…Provider training includes pre-service training and in-service training. In-service training is a low-cost option to refresh provider knowledge and skills [ 77 , 78 ], ensuring their competencies are up-to-date [ 38 , 67 ]. Moreover, in-service ANC-related training is vital to address the emerging healthcare needs of pregnant women and to take their socio-cultural context into account [ 79 ].…”

Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia

“…19 20 Poor providers competency, lack of in-service training and unavailability of ANC guidelines were the main reasons for providers not following the ANC guideline. 21 Studies in Ethiopia have assessed on the effectiveness of ANC in reducing maternal and neonatal complications. [22][23][24] However, these measures often focus on service contacts as opposed to the interventions delivered during those contacts.…”

“… 19 20 Poor providers competency, lack of in-service training and unavailability of ANC guidelines were the main reasons for providers not following the ANC guideline. 21 …”