Improving antenatal and postnatal care for mothers and newborn babies

Photo Credit: UNICEF Ethiopia 2015 Tesfaye, Courtesy of FLICKR

Antenatal and Postnatal care: why does it matter?
Fifty essential interventions are expected to have a significant impact on maternal and newborn survival. Of these, sixteen are expected to be implemented as part of antenatal care (during pregnancy) and twelve as part of postnatal care (after birth).

Globally, it is estimated that just over 80% of all women attend a healthcare provider for antenatal care on at least one occasion, and 64% attend four times or more. There are missed opportunities to address the comprehensive health needs of women and babies. Underlying complications during pregnancy account for an estimated 27.5% of maternal deaths globally. Additionally, most maternal and baby deaths occur in the first week after birth, yet currently it is estimated only 48% of women and babies globally receive postnatal care.

Most healthcare providers are trying to deliver quality care to women within a poorly supported health system with challenges including shortage of staff, equipment, drugs and poor health system infrastructure. Current pre-service training often does not fully equip healthcare providers for the roles they are in and there is generally a lack of competency based in-service (“on the job”) training available. CMNH has conducted large scale studies which show that the burden of disease during and after pregnancy is very significant. There is a need to improve the content of ANC and PNC such that this meets the health needs of mothers and babies in low-and-middle-income-countries.

Antenatal and postnatal workshop
In 2017, CMNH developed a new competency-based workshop package for healthcare providers working in low and middle-income countries, to address the identified health needs of mothers and babies during and after pregnancy with integration of care across three main diseases – HIV/AIDS, TB and malaria. The new workshop package covers what is needed to meet the physical, mental and social aspects of maternal and newborn health. The focus is on evidence-based screening, therapeutic interventions and health promotion during and after pregnancy. It also supports healthcare providers regarding how they can provide respectful maternity care and screen for and manage domestic violence and depression during and after pregnancy.

The workshop package consists of:

  • ‘Training of the trainers’:  a standardised programme for training of facilitators to deliver the workshop
  • Facilitator Manual: a resource for Facilitators which consists of 52 interactive stations and modules that form the basis of the workshop. 
  • The workshop is delivered over 5 days using a multidisciplinary approach including short lectures (15%), simulation training (40%), case scenarios and workshops (30%), mentoring/peer-to-peer support (5%) and monitoring and evaluation built into the workshop to assess the impact of training (10%)
  • Participant Manual: a comprehensive pre-course resource for healthcare providers covering all aspects of antenatal and postnatal care
  • In-built assessment: monitoring and evaluation tools to assess skills and knowledge of healthcare providers

How were these workshops developed?
The workshop was developed by the Centre for Maternal and Newborn Health team in collaboration with more than 50 maternal and newborn health experts across 10 in three low and middle-income countries to ensure stakeholders and partners were able to provide expert inputs and feedback.

Preliminary data indicates an increase in healthcare providers knowledge across all aspects of the training, routine antenatal care, routine postnatal care, medical and obstetric complications and newborn care (Preliminary results show that 93.5% of healthcare providers (n=96) increased their knowledge with a median (IQR) 14.7% (12.1) absolute percentage point increase and 27.6% (32.6) increase compared to baseline.