This post is part of our “Continuum of Care” blog series hosted by the Maternal Health Task Force
Our Adding Content to Contact (ACC) project is working to identify antenatal care (ANC) and postnatal care (PNC) delivery strategies across the world. In a recent blog post, we highlighted several ANC and PNC programs at both the regional and local levels. Now we present four country-level ANC and PNC delivery models. We’ve outlined their designs below and hope you’ll take a minute to explore lessons learned from these delivery models.
Health Extension Workers—Ethiopia
The Ethiopian government began its Health Extension Worker (HEW) Programme in 2003. By training young women with at least some schooling to provide basic health services to their communities, the Federal Ministry of Health hoped to improve access to quality primary health care in a country that is predominately rural.
By 2010, Ethiopia had trained 33,819 HEWs who were deployed in 89% of communities throughout the country. While HEWs do not focus exclusively on maternal and child health, they do provide WHO’s recommended Focused Antenatal Care (FANC), connect women to facilities for delivery, provide at least one PNC visit, and coordinate immunizations for newborns. Results have been largely promising, with the percentage of women receiving at least one ANC visit almost doubling from 2000 to 2011. However, linkages with higher-level health services need to be strengthened since the vast majority of women are still giving birth at home and without a skilled attendant.
Lady Health Workers—Pakistan
The Lady Health Worker (LHW) Programme began in 1994 to reduce poverty and improve health. With 110,000 LHWs across the country, Pakistan has one of the largest cadres of community health workers in the world. Each LHW has a catchment area of about 1,000 people and is responsible for providing education on reproductive health and nutrition, distributing family planning, immunizing children, and encouraging women to seek ANC–but LHWs do not provide ANC themselves. LHWs have built strong relationships with traditional birth attendants and midwives to ensure pregnant women and mothers receive adequate care. Women who are served by LHWs are more likely to use contraception and to receive early PNC. The program has also contributed to a reduction in maternal and infant mortality in recent years. In order to sustain LHWs and their impact, future attention should focus on ensuring manageable caseloads and adequately integrating LHWs with primary care facilities.
In recent years, Nepal has implemented a variety of programs to improve access to and quality of PNC in the country. While these programs have been implemented by a variety of agencies, most have been run in partnership with the Government of Nepal and have relied heavily on Female Community Health Volunteers (FCHVs) and other cadres of community health workers.
- The Community-Based Neonatal Care Package, for example, aimed to change health-related behaviors in the community and also provide three home visits in the week after delivery for mothers and newborns alike.
- The Nepal Family Health Programme II worked to increase access to family planning as well as basic health services, including postpartum care.
- The Birth Preparedness Package encouraged women and families to plan for their pregnancies as well as the postnatal period, including how to deal with emergency situations.
These programs have been quite successful in increasing uptake of PNC among women in their target areas. As many postnatal programs have been scaled up to a national level, crucial facilitators of success have been thorough, high-quality care guidelines; community buy-in; and an adequate number of appropriately-trained personnel.
Focused Antenatal Care—Tanzania
Tanzania adapted and implemented the WHO-recommended FANC model soon after the guidelines were released in 2002. FANC shifted the focus of ANC from a “risk approach,” which targeted women based on risk factors, to an individualized, targeted approach, which aims to detect complications as they arise.
Tanzania’s FANC model includes four ANC visits: one before 16 weeks, if possible; at 20-24 weeks; at 28-32 weeks; and at 36 weeks of gestation. When the model was implemented, the government hosted trainings on the new guidelines at the district, regional and national levels. Providers in Tanzania were trained on the importance of health promotion, individualized counseling, targeted assessments, and evidence-based interventions. While maternal mortality has declined in recent years and access to ANC has increased, more research is needed to establish the role the FANC model has played in these trends.
Follow the “Continuum of Care” series to learn more about these and other innovative models of ANC and PNC care.