Feasibility of introducing a comprehensive package of antenatal care services in rural public clinics in South Africa

Abstract

To address and improve the quality of antenatal care provided in its clinics, the Maternal Child and Women's Health (MCWH) Unit of the KwaZulu-Natal (KZN) DOH decided to review and revise the way it provides antenatal care services. Informed by research conducted by WHO on focused antenatal care, this revised approach consists of five goal-directed ANC visits and two post-natal care visits. The MCWH Unit, in collaboration with the Population Council's FRONTIERS in Reproductive Health (FRONTIERS) Program,

Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries

“…None of these studies included information on enablers or barriers to integration of health services into ANC programmes. Thirteen relevant reports were identified from the websites of organisations involved in MCH issues and global health, and four additional reports were identified through citation tracking . In total, we thus identified 46 eligible reports (29 from peer‐reviewed and 17 from grey literature) for which we have here summarised the barriers and enablers to integration (Figure ).…”

“…The included reports cover programmes from Africa (Botswana, Cameroon, Cote d'Ivoire, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe and Sub‐Saharan Africa in general), Asia (China, Mongolia, Thailand), Europe (Ukraine) and the Pacific (Fiji). The majority of the emerging evidence relates to integration of HIV services, mainly prevention of mother‐to‐child transmission (PMTCT) of HIV, one study is on the integration of PMTCT and TB services, one on malaria, five on syphilis and two on integration of nutrition services . We also include guidance from the Global Fund to Fight AIDS, Tuberculosis and Malaria on how to integrate maternal, newborn and child health interventions with HIV, tuberculosis and malaria programmes…”

“…An adverse consequence of this internal workforce shift is that health workers who continue to work in ANC and MCH clinics are oftentimes underpaid and overworked. Increases in workload from new tasks, usually accompanied by training, combined with existing shortages and high turn‐over of staff have been highlighted as hurdles to scale‐up of integrated HIV, TB and syphilis services in, among others, Fiji, Uganda, Zambia, South Africa, Swaziland, Mozambique, Uganda and Kenya . A study from Tanzania on the impact of integrating and scaling‐up PMTCT on workload showed that integration could be done with existing staff, though this required adjustments in staff productivity and their distribution …”

“…Thirteen relevant reports were identified from the websites of organisations involved in MCH issues and global health [9][10][11][12][13][14][15][16][17][18][19][20][21] , and four additional reports were identified through citation tracking. [22][23][24][25] In total, we thus identified 46 eligible reports (29 from peerreviewed and 17 from grey literature) for which we have here summarised the barriers and enablers to integration ( Figure 1).…”

“…Increases in workload from new tasks, usually accompanied by training, combined with existing shortages and high turn-over of staff have been highlighted as hurdles to scale-up of integrated HIV, TB and syphilis services in, among others, Fiji, Uganda, Zambia, South Africa, Swaziland, Mozambique, Uganda and Kenya. 13,16,24,25,35,36,44,45,48 A study from Tanzania on the impact of integrating and scaling-up PMTCT on workload showed that integration could be done with existing staff, though this required adjustments in staff productivity and their distribution. 46 Reluctant to further increase the burden on frontline staff, some countries have sought new approaches to health workforce management, by shifting tasks and engaging new cadres of health workers from the community.…”