Abstract
BackgroundThe potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed.MethodsCombining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision.ResultsThe delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy".ConclusionsEfforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker cadres with little pre-service training. Attention should be paid to the identification of informal practices resulting from individual coping strategies and "street-level bureaucracy" in order to tackle problems before they become part of the organizational culture.
Highlights
The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged
antenatal care (ANC) in practice The ANC clinics officially opened at 8am and closed at 3.30pm
This study was based on a small sample of four rural ANC clinics, and its results might not be applicable to other countries or even to other settings in Tanzania
Summary
The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. There are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. Potential implications for improving antenatal care provision in Tanzania are discussed. The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health has been widely acknowledged [4]. The antenatal period provides excellent opportunities to reach pregnant women with prophylactic medication, vaccinations, diagnosis and treatment of infectious diseases, as well as with health (FANC) model promoted by the WHO reflects this new understanding of the role of ANC [10]. The FANC model emphasizes goal-oriented and women-centred care by skilled providers [11]. One of the main goals of the new model is to strengthen the information component through individual health education and counselling [10,13]
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