Introduction
Reducing Maternal Mortality remains a top priority in the SDGs yet it remains a global issue more so in the sub Saharan Africa. Ante Natal Care (ANC) on the other hand is one of the key strategies for reducing maternal and perinatal mortality. ANC achieves this by providing appropriate medical and educational measures. In 2020, Machakos County’s Maternal and Perinatal Mortality was a major problem estimated at 13/1000 and 9.1/1000 respectively. This was attributed to low ANC Uptake (many women were not attending all the 4 recommended ANC clinics) and low skilled birth delivery. Further investigation proved that long waiting hours, unavailability of quality services and high burn out amongst MCH staff as major causes of dissatisfaction of mothers attending ANC clinics
Implementation of the practice (Solution Path):
Machakos County Health Department in collaboration with JPHIEGO designed a model-Predominant Model for Group Antenatal Care which entails putting ANC mothers of the same gestational age in groups of 8-30 mothers and taking the group through appropriate RMCH educational sessions. The Model required space, equipment, furniture, stationery, health workers and support staff to operate optimally. JPHIEGO supported Machakos County by providing the space (Tent) where the ANC groups meet, stationery (Flip charts, marker pens, biros) training modules, equipment (BP machines, weighing scales, screen) and furniture (chairs, examination beds) while the County provides refreshments for the mothers. The County rolled this approach in 13 facilities, four (4) high volume facilities and nine (9) low volume facilities. The ANC groups have two (2) sessions per week (Tuesdays and Thursdays) in High volume facilities due to other competing MCH roles and 5 sessions (Monday to Fridays) in low volume facilities. The following is the model’s different gestational groups and its respective RMCH educational modules;
Results of the practice (outputs and outcomes)-
The Predominant group ANC model has reduced the long waiting hours because mothers are served as a group. It has also reduced the MCH staff burn out leading to improved quality services. As a result, it increased the County’s RMCH Indicators (Number of four (4) ANC Visits, Family Planning Uptake, Skilled Birth Deliveries) and even immunization uptake. Increasing these RMCH indicators eventually reduced Maternal and Perinatal Mortality rates as summarized in the indicators table below.
The County intends to continue with this best practice even after JPHIEGOs project ends through the Linda Mama Program. The funds collected through Linda Mama (reimbursement) will be sufficient to support the Model and roll it out in the remaining facilities.
Lessons learnt:
The following are the lessons the County learned from the implementation the Predominant Group ANC Model
- The group model approach is time saving because it covers a wide knowledge area (Integrated Sexual Reproductive Health Services) in a short period of time.
- This approach is a solution for MCH Staff shortage, the staff spent only a maximum of 2 hours, then proceed to attend to other MCH roles.
There’s is no staff designated for running the model and hence MCH staff have to multitask amidst other competing roles more so for high volume facilities.
Recommendations:
- There’s need to designate specific staff for the Group ANC Model.
- There’s need to set a revolving Fund to run the Model efficiently.
- It is important to involve CHVs since they are the ones that refer mothers to facilities and inform them to attend the Group ANC.
- There’s need to continually train CHVs on Group ANC Basic Module in order to maximize its benefits.
There’s need to include the Group ANC Model in the Reproductive Health Policy.
