Assessment of the Implementation of Focused Antenatal Care in Public Health Centers in Addis Ababa, Ethiopia
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Date
2014-06
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Addis Abeba University
Abstract
Background- Antenatal care (ANC) is a widely used strategy to improve the health of pregnant women and to
encourage skilled care during childbirth. In 2007, the Ministry of Health of Ethiopia developed a national
adaptation plan based on the new model (Focused Antenatal care) of the World Health Organization (WHO).
Although antenatal services are well utilized in Addis Ababa (100% first visit coverage), there are gaps in full
implementation of all components of Focused antenatal care. Currently, there are limited studies on the
implementation of Focused antenatal care in Ethiopia including in the study area.
Objective-To assess the implementation of Focused Antenatal Care in public health centers of Addis Ababa.
Methodology- Facility based cross sectional study using quantitative supplemented with qualitative data
collection methods were conducted from July to August 2013. Eight hundred Sixteen sessions of Antenatal
care were observed in ten health centers. Simple random and purposive sampling techniques were used for
quantitative and qualitative components of the study respectively. A pretested semi structured interview guide
and structured checklist was used to collect data. Data were entered with EPI-info version 3.5.1 and cleaned
with, analyzed by SPSS version 20. Data was analyzed using descriptive and bivariate statistics and thematic
analysis for in-depth interview.
Results- The study revealed that the health care providers’ performance by five FANC components was as
follows, on average comprehensive history taking had the highest performance (92%) and lowest performance
was in clinical examination (54%). There was statistically significant difference (p<0.05) on the performance
of health care providers where health officer and diploma midwives total average percentage performance
scores were 79% and 75% respectively, while nurses scored 67%. Practice compared by visit and time spent
showed that health care provider perform better in visit one (78%) and worse in visit three (62%). The
average duration was 19 minutes for visit one and the time reduced during subsequent visits and was lower
than WHO/National protocol.
The qualitative data analysis revealed that there is variation among health care providers experience in
implementing FANC and this may depend on their knowledge on FANC and work collaboration from their
colleagues. Besides, Health care providers performed most of the procedures but also omitted certain
procedures developed in the WHO / National protocol in all assessed health centers. Most of the assessed
health centers have basic equipment’s and supplies while the National protocol on selected obstetrics topic
including FANC was not found in all health centers and some procedures were not included in ANC card.
Conclusion and recommendations- Health care providers did not spend adequate time as per the
WHO/National protocol for each visit and their practice was not uniform. This affects the implementation of
all components of Focused ANC and the desired outcome, it is especially prone to shallow health information
and counseling which is at the center of Focused ANC. There were adequate equipment and supply to provide
FANC in most of the assessed health center except few gaps. Implementation of Focused ANC may require
assigning adequate staff and providing training, updating and disseminating the 2010 National Management
Protocol on Selected Obstetric Guidelines for Antenatal Care to be in line with the new PMTCT guideline
then revise FANC card accordingly.
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Keywords
Focused antenatal care, health care provider, health center, implementation