Implementing antenatal care recommendations, South Africa
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Authors
Hlongwane, Tsakane MAG; Bozkurt, Burcu; Barreix, Maria C; Pattinson, Robert; Gülmezoglu, Metin; Vannevel, Valerie;Tunçalp, Özge
Issue Date
2021
Type
Journal / periodical articles
Language
Keywords
Policy and Practice;Antenatal care;Recommendations;South Africa
Alternative Title
Abstract
Description
Despite progress in reduction in maternal deaths in South Africa, deaths due to complications of hypertension in pregnancy
remain high at 26 deaths per 100 000 live births in 2016. The South African health ministry modified its existing four-visit antenatal care
model to align with the World Health Organization’s (WHO) 2016 recommendations for the number and content of antenatal care contacts.
Implementation of the eight-contact antenatal care recommendations began in April 2017, after adaptation to the national context and
nationwide trainings. In this article, we describe the stages of implementation and the monitoring of key indicators. We share lessons,
particularly from the important early stages of nationwide scale-up and an analysis of the early results. We analysed samples of maternity
case records in four catchment areas in the first year of the updated care model. The mean number of antenatal care contacts among five
monthly samples of 200 women increased steadily from 4.76 (standard deviation, SD: 2.0) in March 2017 to 5.90 (SD: 2.3) in February 2018.
The proportion of women with hypertension detected who received appropriate action (provision of medical treatment or referral) also
increased from 83.3% (20/24) to 100.0% (35/35) over the same period. South Africa’s experiences with implementation of the updated
antenatal care package shows that commitment from all stakeholders is essential for success. Training and readiness are key to identifying
and managing women with complications and developing an efficient antenatal care system accessible to all women.
Citation
Publisher
WHO