Abstract
BackgroundLack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines.MethodsA cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment.ResultsEleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8–54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities.ConclusionAlthough antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.
Highlights
Lack of resources has been identified as a reason for non-adherence to clinical guidelines
Focused antenatal care requires that a pregnant woman receives individualized care for a minimum of four ANC visits, with all services provided at the ANC unit
Some examples of modifications were that each client was seen by a midwife for history taking and examination, but some services like medication and laboratory testing were referred to another health worker outside the cubicle where the woman received consultation, or in some cases outside the maternity unit
Summary
Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. Health workers have subsequently been trained to use this protocol in their daily work [9] It is, known that there are varying levels of adherence to guidelines [9,10,11], and in Ghana the extent to which evidence based guidelines are used by frontline providers in care decision making is uncertain [9]. In a study in Ghana to understand why and how caregivers make clinical decisions for clients, health system resource constraints such as availability of staff, medicines, supplies and equipment were listed as key in influencing decisions made in service delivery [9]. Routine medication for a pregnant woman needs to be available in the pharmacy for the provider who wants to prescribe them as the protocol may require
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