Minimum package of antenatal care services defined
There is documented evidence of a national policy and/or Ministry of Health (MOH) guidelines for a recommended minimum package of services to be provided by antenatal care (ANC) facilities. Variations exist among recommended essential and minimum care packages, and can be attributed to the types of health risks prevalent in different settings (e.g., areas of endemic malaria or generalized HIV epidemic). For women whose pregnancies are progressing normally, WHO recommends a minimum of four ANC visits, ideally at 16 weeks, 24-28 weeks, 32 weeks and 36 weeks (USAID/Population council, 2006).
Each visit should include care that is appropriate to the overall condition and stage of pregnancy and should include four main categories of care (with specific examples provided for each category):
- Identification of pre-existing health conditions (e.g., check for weight and nutrition status, anemia, hypertension, syphilis, HIV status)
- Early detection of complications arising during pregnancy (e.g., check for pre-eclampsia, gestational diabetes)
- Health promotion and disease prevention (e.g., tetanus vaccine, prevention and treatment of malaria, nutrition counseling, micronutrient supplements, family planning counseling)
- Birth preparedness and complication planning (e.g., birth and emergency plan, breastfeeding counseling, antiretrovirals for HIV positive women and reducing mother-to- child transmission [MTCT] of HIV)
This indicator is measured as yes/no based on whether all the minimum recommended services are included in national policy and/or MOH guidelines.
Written national policies and/or MOH documentation of recommendations or guidelines for a minimum package of ANC are needed to provide evidence for this indicator. The documents should reflect the range of recommended essential ANC services under the WHO four categories of care listed above and reflect specific needs for country and regional settings, such as malaria treatment in endemic areas.
National policy documents and/or MOH written guidelines for ANC; interviews with key informants.
This indicator measures the level of national commitment provision of quality ANC services through the health system. Quality ANC is associated with a better overall pregnancy outcome for both mother and infant. Many health problems experienced by pregnant women can be prevented, detected and treated during ANC visits with trained health workers. ANC can foster a rapport between the mother and the father and the health care provider, provide preventive care and health education, identify and treat illness, encourage skilled attendance at birth and prepare the mother, other family members, and birth attendants for possible emergencies (WHO, 2006). Good ANC can help prevent factors associated with newborn mortality such as low birth weight and complications from infectious diseases, including reducing MTCT. Male partner participation in antenatal health care can encourage male partner support and involvement in pregnancy and delivery (WHO, 2006). Overall, women’s access to quality ANC is central to achieving the Millennium Development Goals #5. improve maternal health and #4. reduce child mortality.
Evaluators may have difficulty obtaining evidence that the full range of recommended minimum ANC services have been incorporated into government policy or MOH guidance. This indicator does not measure if the recommendations are being distributed throughout the ANC health system and if the minimum package guidelines are being followed or monitored at the facility level. Evaluators would need to follow-up to verify if and to what extent these recommendations are being operationalized.
policy, quality, safe motherhood (SM)
Mailman School of Public Health, 2007, Package of Care to be provided according to type of Health facility, New York City: Columbia University/Mailman SPH Website. http://cumc.columbia.edu/dept/icap/resources/pmtct/PMTCTpackagecare092507.pdf
USAID/Population Council, 2006, Acceptability and Sustainability of the WHO Focused Antenatal Care package in Kenya, Washington DC: USAID. http://www.popcouncil.org/pdfs/frontiers/FR_FinalReports/Kenya_ANC.pdf
USAID/Core Group, 2004, Maternal and Newborn Standards and Indicators Compendium, Washington DC: USAID/CORE Group. http://www.coregroup.org/storage/documents/Workingpapers/safe_motherhood_checklists-1.pdf
USAID, 2009, Child Survival and Health Grants Program (CSHGP), Technical Reference Materials: Maternal and Newborn Care, Washington, DC: USAID. http://www.usaid.gov/our_work/global_health/home/Funding/cs_grants/cs_index.html
WHO, 2002, Antenatal Care Randomized Trial: Manual for the Implementation of the New Model, Geneva: WHO. http://whqlibdoc.who.int/hq/2001/WHO_RHR_01.30.pdf
WHO, 2006, Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Care. Geneva: WHO. http://whqlibdoc.who.int/publications/2006/924159084X_eng.pdf