Antenatal care (ANC) is essential for protecting the health of women and their unborn babies. Demand has increased and continues to do so in most parts of the world. Globally, it is estimated that just over 7 out of 8 pregnant women attend a healthcare provider for antenatal care on at least one occasion, and only 59% attend four times or more 1.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. Antenatal care is essential for protecting the health of women and their unborn children2. Many of the antecedents or conditions associated with the direct causes of maternal mortality can be recognised and management instituted during pregnancy to prevent adverse outcome for both the mother and her unborn baby.
Additionally, most maternal and newborn deaths occur in the first week after birth, yet currently it is estimated only 48% of women and babies globally receive postnatal care3. Care in the period following birth is critical not only for survival but also for the future health and development of both the mother and her baby.
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 infrastructure4. 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. This leaves many healthcare providers feeling poorly supported. LSTM has conducted large scale studies which show that the burden of disease during and after pregnancy is very significant5. 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.
Of the 50 essential interventions for reproductive, maternal, newborn and child health for which there is evidence of effectiveness and which can be expected to have a significant impact on maternal, newborn and child survival sixteen (including the specific components of the antenatal care package) are expected to be implemented as part of antenatal care6 and 12 are intended to be provided as part of postnatal care6.
Developed in 2017 by LSTM in collaboration with more than fifty maternal and newborn health experts across ten low and middle-income countries, a competency-based workshop package for healthcare providers working in low and middle-income countries addresses 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 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 package consists of:
‘Training of the trainers’: standardised 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. Both in English and French
Four-day interactive workshop: the workshop is delivered over 4 days using a multidisciplinary approach including short lectures (15%), simulation training (40%), case scenarios and workshops (30%), mentoring/peer-to-peer support (5%) and in-course monitoring and evaluation 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. Both in English and French
In-built assessment: monitoring and evaluation to measure increase in skills and knowledge.