New 2016 ANC Model Applicability in Ethiopia (ppt): Natnael Dechasa Gemeda, Seminar Presentation at Dire Dawa University.pdf

DIRE DAWA UNIVESITY
COLLEGE OF MEDICINE AND HEALTH
SCIENCES.
1/20/2023 Prepared By Natnael .D(MSc.) 1
Seminar topic
Implementation of WHO’s new ANC model in our health setup
and scholarly recommendations to tackle possible barriers.
BY - Natnael Dechasa(MSc ,In Clinical Midwifery)

Welcome!
And Thanks for joining me!
Listen up, because I'm about to provide you with a current hot
topic that demands academic debate and discussion.

Major contents of the presentation.
A way forward
What is the WHO's new 2016 ANC model?
Why new guideline is needed ?
What are key principles of the new ANC standard ?
What are barriers to the attainment of this new standard in our country?
How can we address and tackle possible barriers .

Objectives of this seminar
1. Introducing the model and describing a scholarly overview regarding
the service.
2. Creating an academic dialogue regarding its implementation barriers
and applicability in our context.

Ante Natal Care Is interventions that a pregnant woman and adolescent girl
receives in order to ensure the best health conditions for both mother and
baby during pregnancy .(WHO,2018).
WHO replaced focused ANC model with four visit with PPE Model wich have
eights contact starting from 2016.
New 2016 WHO ANC guideline for a positive pregnancy experience includes 49
recommendations.
Introduction

• Recent evidence suggests that FANC model is associated with more perinatal
deaths than recent PPE models that comprise at least eight visits.
• The new guideline focuses on core practices in ANC (assessment, prevention,
and treatment), and is complemented by lifestyle modifications.(WHO,
2016)
• As a result, the EFMH adopted this new 2016 (PPE) model & replaced FANC
model beginning in 2020.
Why new guideline?

Contact Vs Visit.
Under the new recommendations, a routine ANC visit is considered a
contact.
 It implies an active connection between a pregnant woman and a
health-care provider that is not implicit with the word “visit”.
“In terms of the operationalization of this recommendation, „contact‟ can
take place at the facility or community level .
Introduction

 In the new ANC model, several doable
recommendations addressing .
1. Preconception care,
2. Pregnant-woman centered care,
3. Maternal and fetal health assessment,
4. Preventive and therapeutic interventions,
5. Counseling and health promotion, and
6. Health system strengthening for quality ANC.
*are included..
Introduction

Primary clinical and public health outcomes of
interest of this new guideline/standard/

A.Maternal outcomes of interesest..
 Increasing maternal and family satisfaction with the ANC services provided.
 Preventing or correcting pregnancy related nutritional problems
 Early detecting and treating common pregnancy related conditions
 Counseling to have safe and successful pregnancy outcome.
 Counseling on postpartum family planning.
 Are maternal outcomes of interest of this new guideline/standard/
Prepared By Natnael .D(MSc.) 10
Introduction
Primary clinical and public health outcomes…..

B. Fetal and neonatal outcomes of interest..
 Preventing early pregnancy losses and its complications.
 Preventing or early detecting & managing pregnancy with congenital
anomaly.
 Timely detecting Jeopardized fetuses and delivering in a setting where
neonatal care is optimal.
 Reducing premature deliveries due to preventable causes, thereby
reducing perinatal mortality.
 Reducing of MTCT of HIV, syphilis, and HBV during pregnancy, delivery and
lactation.
 Are fetal & neonatal outcomes of interest of this new guideline/standard/
Introduction

C - Health system outcomes: of interest ..
 Improving quality of ANC.
 Maintaining ANC attendants in the continuum of care through
preconception care, ANC, delivery, postnatal care and linking to other RH
services.
 Increasing ANC coverage,skilled birth attendance, postpartum care, and
decreasing ANC dropout.
Introduction

1. Implementing the new ANC model of eight contact schedule
2. Providing be person-centered care
3. Providing de-medicalized care: minimum set of interventions necessary.
4. Providing efficient and timely care to all pregnant women
5. Providing evidence based, multidisciplinary care.
6. Respecting privacy, dignity and confidentiality of women
KEY PRINCIPLES OF ANTENATAL CARE

ANC SCHEDULE …
*The reason for increasing the number of contacts in the third trimester is considering the
increased risk of complications to the mother and the fetus during this period of gestation

• History and physical examination
Maternal and fetal assessment at first ANC contact
Pregnancy risk identification

1/20/2023
Prepared By Natnael .D(MSc.)
16
Pregnancy risk identification
N.B.
• Those classified under basic care needs a minimum of eight contacts while
• Those having pre-existing or newly developed problems will be followed in a specialized
care setting.

Focus areas of assessment and interventions in
subsequent ANC contacts

Indicators for ANC monitoring and evaluation (M & E).
Proportion of pregnant women having at least 1/2/4 ANC contact in a health
facility.
Percentage of pregnant women with an ultrasound scan before 24 weeks
Proportion of pregnant women who received HIV/syphilis/HBV testing.
Proportion of pregnant women whose husband or partner received triple
testing (HIV, syphilis, and HBV).
Proportion of pregnant women who is diagnosed to have HIV and received
ART.
Proportion of pregnant women who received Td-1 dose/ Td-2 dose/
Proportion of pregnant women who received iron-folate at least for 90 days.

Barriers!!!
…to attain this new standard /eight contact/
in our country….

 Barriers/ Health system /
 These include lack of resource
 Equipment/ health personnel /
 Healthcare staffing shortages.
 Lack of staff training /trained staff/.
 Lack of good leadership
 Undermining the effort of staffs
 Resistance to change and lack of data
systems and analytics infrastructure.
 Postponement and service delayance.
 Longer client's wait time.
 Demand for payment at some facilities.
Barriers/ Care Provider /
 Non respectful care for women
 Women treated poorly so do not return.
 Poor providers’ attitude,and unequal client's
treatment.
 Ineffective communication skills.
 Poor counseling skills.
 Lack of keeping privacy and confidentiality of
clients.
Barriers!!!
(Gulema and Berhane, 2017,Phommachanh et al., 2019, Tekelab et al., 2019)

Barriers/socio & economic/.
 Long distance & lack of means of/cost for/ transportation to health facilities.
 Burden of domestic chores/duties/.
 Misperceptions about the benefits of ANC.
 Low perceived risk of pregnancy-related complications.
 The negative influence of reluctant husbands to allow their wives to attend ANC.
 Most women need partners’ approval and support to stick to ANC service.
• These are the barriers /challenges/ to fully implementing the WHO's new ANC
standard (with eight contacts) in our context.
Barriers!!!
(Tekelab et al., 2019,Gulema and Berhane, 2017, Wolde et al., 2019).

We have all these barriers.
…..so how can we attain/manage/ this new standard of
"eight contacts"in our country?.....

Prepared By Natnael .D(MSc.) 24
WHO’S policy and program
considerations for developing countries to meet
the new standard?

Review the country‟s epidemiologic context to determine which contextual
and universal recommendations to adopt.
Review established ANC service delivery platforms and country health
system assets to define the health system interventions and associated
policies to adopt (e.g., develop an ANC task-shifting policy).
Review and update national ANC clinical protocols, norms, and standards
based on the recommendations adopted.
Analyze projected costs to implement the country‟s ANC roadmap, and link
the roadmap to a financing plan.
WHO Programs & policy considerations to
attain the new standard.

 Review and update ANC indicators to incorporate in the country‟s Health
Management Information System.
 Review and update (or introduce) standardized ANC registers, women-held
case notes and other data tools needed to track prioritized ANC data (at all
system levels and all ANC contact sites).
 Ensure that there is availability of ANC records and registers (at all ANC
contact sites).

Plan how to procure, distribute, and finance new ANC commodities.
Strengthen logistics systems for essential ANC commodities.
Strengthen midwifery deployment, training, supportive supervision, and
ongoing professional support.
Review and update the scope of practice for each ANC provider cadre, which
includes licensing, and continuing professional development mechanisms.

Develop ANC task-shifting plan including the use of lay workers, and auxiliary
nurses to promote health-related behavior's and the distribution of key
commodities (e.g., Recommended nutritional supplements).
Review and update pre- and in-service ANC training, ANC educational and
supervision strategies, and ANC-specific materials/job aids.
Develop/update patient communication and counselling materials for promotion
of healthy behaviors.

General scholarly recommendations to strengthen the
health care system and attain the new ANC model in
our country.

 Develop a sustainable ANC service delivery model for the country‟s context, which
defines how services will be provided at each ANC contact and by whom , where
(system level), and how (platform).
 Enhancing the capacity of ANC provider by incorporating ANC in BEmONC and
CEmONC training packages.
 Strengthening on job training and mentorship as part of quality improvement efforts.
 Creating a woman-friendly environment: ensure at least 8-hour ANC service a day
in all weekdays, morning and afternoon.
General recommendations

 Creating easy and continuous access of guideline in hard and electronic
copy.
 Introducing woman-held case notes: give the women the summary of each
ANC contact finding and intervention
 Digitizing the health system
 Rewarding well performed providers & good role models, and building a
feedback system.
 Integrating the other RH services within the ANC package.
 Community engagement to increase the ANC coverage
 Continuous quality improvement by monitoring and evaluation.
General recommendations …

 Develop and apply competency-based curriculum that helps students
acquire skills to implement the new ANC recommendations/standard/.
 Support implementation research and scale-up of new and advanced ANC
interventions suggested by research.
Recommendations, particularly to
Ethiopian higher education institutions.

Discussion points
 At a time when we are still struggling to increase ANC visits (FANC)
with only four visits, is adopting the new standard (eight contacts)
really reasonable for our health setup and context?

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