Challenges and Opportunities for Implementing Evidence-based Antenatal Care in Mozambique: a Qualitative Study


Background: Maternal mortality remains a daunting problem in Mozambique and many other low-resource countries. High quality antenatal care (ANC) services can improve maternal and newborn health outcomes and increase the likelihood that women will seek skilled delivery care. This study explores the factors influencing provider uptake of the recommended package of ANC interventions in Mozambique. Methods: This study used qualitative research methods including key informant interviews with stakeholders from the health sector and a total of five focus group discussions with women with experience with ANC or women from the community. Study participants were selected from three health centers located in Maputo city, Tete, and Cabo Delgado provinces in Mozambique. Staff responsible for the medicines/supply chain at national, provincial and district level were interviewed. A check list was implemented to confirm the availability of the supplies required for ANC. Deductive content analysis was conducted. Results: Three main groups of factors were identified that hinder the implementation of the ANC package in the study setting: a) system or organizational: include chronic supply chain deficiencies, failures in the continuing education system, lack of regular audits and supervision, absence of an efficient patient record system and poor environmental conditions at the health center; b) health care provider factors: such as limited awareness of current clinical guidelines and a resistant attitude to adopting new recommendations; and c) Users: challenges with accessing ANC, poor recognition amongst women about the purpose and importance of the specific interventions provided through ANC, and widespread perception of an unfriendly environment at the health center. Conclusions: The ANC package in Mozambique is not being fully implemented in the three study facilities, and a major barrier is poor functioning of the supply chain system. Recommendations for improving the implementation of antenatal interventions include ensuring clinical protocols based on the ANC model. Increasing the community understanding of the importance of ANC would improve demand for high quality ANC services. The supply chain functioning could be strengthened through the introduction of a kit system with all the necessary supplies for ANC and a simple monitoring system to track the stock levels is recommended.

Authors & affiliation: 
Biza A, Jille-Traas I, Colomar M, Belizan M, Requejo Harris J, Crahay B, Merialdi M, Nguyen MH, Althabe F, Aleman A, Berge E, Carbonell A, Chavane L, Delvaux T, Geelhoed D, Gülmezoglu M, Malapende CR, Melo A, Bique Osman N, Widmer M, Temmerman M, Betran AP. 2015. “Challenges and Opportunities for Implementing Evidence-based Antenatal Care in Mozambique: a Qualitative Study.” International Center for Reproductive Health (ICRH-Mozambique), Maputo, Mozambique. 2 Montevideo Clinical and Epidemiological Research Unit (UNICEM), Montevideo, Uruguay. 3 Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina. 4 Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 5 Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Avenue Appia 20, Geneva CH-1211, Switzerland. 6 Mozambique Country Office, World Health Organization, Maputo, Mozambique. 7 Mozambique Ministry of Health, Maputo, Mozambique. 8 Institute of Tropical Medicine, Antwerp, Belgium. 9 Central de Medicamentos e Artigos Médicos, Maputo, Mozambique.
Published In: 
Bmc Pregnancy and Childbirth 15.
Publication date: 
Monday, August 17, 2015