Building a Global Evidence Base to Guide Policy and Implementation for Group Antenatal Care in Low- and Middle-Income Countries: Key Principles and Research Framework Recommendations from the Global Group Antenatal Care Collaborative

Group Antenatal Care Start-Up in the Indian Private Sector: An Implementation Journey to Improve Quality of Care

Introduction

The introduction of the innovative group antenatal and postnatal care model into the private health sector in India has the potential to pivot the experiences of families during pregnancy and beyond. Growing evidence worldwide shows this model moves fragmented healthcare systems toward a more integrated model to improve quality in care and outcomes for mothers and children. The aim of this study was to better understand the challenges and benefits of implementation of the group model of antenatal care in the Indian private health sector for the purpose of improving quality of care.

Methods

Through a collaborative innovation project led by a master's student of public health and an international organization with expertise in implementing this model, an urban 35-bed private hospital in Pune was identified with readiness to explore the model with stakeholders, train hospital staff as facilitators, and initiate group antenatal care. Semi-structured interviews with facilitators, along with feedback from participants in cohorts and observation of the groups by the trainer, were done for qualitative analysis of themes related to the strengths and barriers in implementing the model.

Results

A total of 31 pregnant women participated in two cohorts over their second to third trimesters for group antenatal care with a team of three facilitators from November 2022 to June 2023. On review of experiences in implementing the model, the top strengths demonstrated were meeting of felt needs of the participants, high engagement, and relative advantage of the model. Challenges for implementation included for scheduling and attendance, adapting the model for compatibility, capacity-building, and need for more ongoing planning, monitoring, and evaluation.

Conclusions

Through this innovation project, important lessons were learned for robust planning for a future pilot study. Patient-centered and integrated antenatal care are markers of quality of care that this group model can bring not only in the private healthcare sector but throughout India.

Improving respectful maternity care through group antenatal care: findings from a cluster randomized controlled trial

Background

Disrespect and patient mistreatment are identified as barriers to care-seeking and low uptake of facility-based deliveries. These mitigating factors have led to slow progress in the achievement of maternal and child health targets, especially in Ghana. Group antenatal care, as an alternative to individual antenatal was implemented to explore the impact on outcomes, including mothers' perception of respectful care.

Methods

A cluster randomized controlled trial was conducted in 14 health facilities across four districts in the Easter Region of Ghana. These facilities were randomized to intervention or control using a matched pair. Data was collected at several timepoints: enrollment (Time 0), 34 weeks gestation to 3 weeks post-delivery (Time 1), 6 to 12 weeks post-delivery (Time 2), 5 to 8 months post-delivery (Time 3), and 11 to 14 months post-delivery (Time 4). Questions related to respectful care were asked at Time 2, while a focus group discussion (FGDs) was conducted as part of a process evaluation to examine participants' experiences about respectful maternity care.

Results

The findings from the intervention group indicate that participants perceived higher levels of respect in comparison to the control group. Privacy and con dentiality were maintained. They believed they had been provided with adequate information, education, and counseling, empowering them to make informed decisions. Participants perceived a shortened waiting time and reduced discrimination in care provision. Generally, there were higher levels of satisfaction with antenatal care.

Conclusion

The provision of respectful maternity care, which is essential to increasing healthcare utilization, has been demonstrated to correlate positively with group antenatal care.

Adapting group care to the postpartum period using a human-centered design approach in Malawi

BACKGROUND

Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi.

METHODS

We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2-4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper.

RESULTS

All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period.

CONCLUSIONS

Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.