Nurse/midwives’ perspective on the implementation of the new national antenatal care guidelines at the reproductive and child health clinics in Dar es salaam city council

Abstract

ABSTRACT Background Antenatal care guidelines are a worldwide known technical document that guides the provision of Antenatal care (ANC) to pregnant women, their unborn babies, and neonates. In Tanzania, three different ANC models have been practiced, which were the traditional model used in 2002 back, the Focused Antenatal Care (FANC) model from 2002 to 2019, where the new ANC model took over. Implementing the ANC guidelines contributes to positive pregnancy outcomes. Midwives and nurses play a crucial role in the implementation of ANC guidelines as 80% of ANC services in our country are provided by them. The number of contacts and quality of care during pregnancy are associated with maternal and neonatal outcomes. Recent studies found that the FANC model contributed to more perinatal deaths than the eight contacts ANC model. This is because asymptomatic conditions may occur suddenly in the third trimester and therefore increased number of visits may help to detect them earlier and allow for timely management. In Tanzania despite shifting from the FANC model to the new model in 2020, perinatal mortality remains unchanged (38 per 1000 live births). This study aimed to explore the nurses/midwives’ perspectives on implementing the new national ANC guidelines at the RCHC in the Dar es Salaam city council. Material and Method This study is an exploratory qualitative design. The study participants were nurse-midwives working in the RCH clinics, who were involved in antenatal care at the selected health facilities in Dar es Salaam City Council, nurse-midwives with a minimum of six months of experience in antenatal care were included and those who were sick, on leave, or out for other duties at the time of the study were excluded. A purposive sampling method was used to obtain the health facility and participants of the study. The data was collected using focused group discussions. An audio recorder and notebook were used to store the collected data from the field. Thematic analysis as developed by Braun and Clarke used to analyze the data. Study findings Participants in this study perceived that the implementing of the new national ANC guidelines was usefulness in reducing maternal and neonatal death, improving pregnancy outcomes, and enhancing antenatal care service delivery and provider's proficiency with ANC. The perceived factors facilitating new national ANC guidelines implementation were the availability of health commodities, together with provider's awareness, positive attitude, knowledge and skills, refresher training, supervision, and clinical audit regarding the new national ANC guidelines. Perceived challenges to implementing ANC guidelines included inadequate staff, insufficient health commodities, lack of training and supervision, and improper health facility set up. Additionally, client's inability to afford some of ANC services were perceived as a barrier to the successful implementation of the new ANC guidelines. Conclusion We found that, while nurses/midwives perceived the implementation of the new ANC guidelines as useful and recognized factors that facilitated its implementation, several challenges were also perceived to hinder it. Therefore, all key stake holders involved in implementing the new ANC guidelines must work to enhance the existing facilitators and address the challenges to improve the implementation within the Dar es Salaam city council.