Table 1 Themes and factors contributing to quality of ANC services
Domains | Themes | Facilitators | Barriers | Countries |
|---|---|---|---|---|
Inputs | Organisational factors | Better structural quality (inputs) [31], better infrastructure and health systems [32,33,34] | Poor readiness for ANC services, lack of certain services and provisions [35,36,37] | Nepal, Sub-Saharan Africa (SSA), Benin, Ghana, Ethiopia, Kenya, SSA, Lao People Democratic Republic, Pakistan |
Supplies of commodities | Better supply of essential commodities [38, 39], laboratories facilities [40, 41] | Stock-out of medical supplies [42,43,44,45], lack of facilities [35, 46], late reimbursement of funds, lack of policy definition, out of pocket payment [33, 37, 40, 44, 45, 47,48,49,50] | Ghana, Ethiopia, Jordan, Tanzania, LMICs, SSA, | |
Trained health workforces | Trained and skilled providers [31, 51, 52], better qualification and training of staff [32, 40], staff supervision [31], and flexible time for appointment [41] | Lack of feedback, motivation and competence, shortage of staff, lack of human resources, limited skills, and non-availability [42, 47, 49], heavier workload, inequitable distribution, unavailability of skilled providers, lack of privacy and confidentiality [45, 47, 49, 53, 54] | Nepal, Rwanda, SSA, Ethiopia, Jordan, Lao PDR, Tanzania, Pakistan, Namibia, | |
Structural determinants | Education, SES, job and income [11, 38, 52, 55,56,57,58,59,60,61,62,63,64,65,66,67,68] [69]. [40], middle age and lower parity [38, 56, 57, 59, 60, 62, 66], settled residence [57] | Poor socioeconomic status, low education, low family income, Indigenous groups, unemployed, [52, 68, 70,71,72,73,74,75] | Malawi, Mexico, Pakistan, Iran, LMICs, Camron, Ethiopia, Tanzania, Nigeria, Nepal, Zambia, East African countries, Egypt, Myanmar, India | |
Intermediary determinants | insured women [11, 76], women with higher empowerment and decision-making power [52, 58, 65], urban areas [38, 52, 56, 58,59,60, 62, 63, 66, 68], attended big hospitals and private HFs [52, 55, 56, 59, 62,63,64, 71, 77], non-smokers women, intended pregnancy or first baby, networking women, received the maternal and child health handbook, previous history of complication [52, 60, 61, 65, 68, 73, 78, 79], media exposure and women empowerment [52, 61, 80] | Rural and remote locations, slum areas [64, 65, 70, 75, 80], high birth order, low age at marriage and childbirth (e.g., adolescents), short time intervals, old age, unmarried [52, 65, 68, 70, 72,73,74,75, 80], inadequate ANC, poor priority and awareness, late recognition of pregnancy, single parent, smoker, unplanned place of delivery, without insurance [74, 81, 82] | Kenya, Mexico, LMICs, Nepal, Ghana, Pakistan, Ethiopia, Tanzania, Nigeria, Cameroon, East African countries, Brazil, Malawi, Egypt, Kenya, Myanmar, South Asia, Madagascar, Oman, India, High income countries, Bangladesh, Brazil | |
Services delivery approaches | Cultivating quality care at public facilities, supportive supervision of providers [40, 83], group ANC approach, collaboration with local government clinics [84], task shifting and training of care providers [85], home visitation, community mobilization, training of CHWs, logistical support, monitoring and documentation [84, 85], digital technology [86] | Poor knowledge and attitude, lack of decision-making autonomy, poor empowerment, poor access to media exposure [57, 68, 80, 81, 87], superstitions around pregnancy [81], client awareness [49] | LMICs, Ethiopia, Nepal, Bangladesh, south Asia, East African, Afghan, Uganda Pakistan, | |
Process of care | Skilled care | Interaction with providers, privacy, attentiveness of providers, trained personnel, extended time, hospital care [38, 63, 75, 78, 88], birth preparedness, and counselling [88] | Improper registration, history taking and assessment, lack of counselling on prevention and treatment, and poor client-provider interactions [49, 66, 88] | India, Tanzania, Ghana, Oman, Nigeria, Ethiopia, Pakistan, |
Timely care | Early initiation of 1st ANC visit [63], longer appointment [89], ANC in the first trimester [59, 64, 70, 78, 90, 91] | No early visit, high birth order [37, 59, 92], short time care [47], high dropout in subsequent visit [49], late first ANC visit [79] | Nigeria, Ghana, LMICs, Ethiopia, Cameroon, Peru, Zambia, Lao PDR, Pakistan, Madagascar | |
Adequate care | High ANC visits [37, 89, 93, 94] better health promotion in counselling (e.g., healthy eating, danger signs) [39, 46, 59, 79] | Low uptake of ANC interventions [60, 65, 75, 78, 80, 95], low quality and coverage gaps [11, 46, 57, 59, 68, 70, 77, 89, 92,93,94, 96], ANC visit but no uptake of interventions [63, 90, 91, 94, 97], low clinical quality [36, 66], low uptake of technical interventions [36] | Zambia, Mexico, Ghana, Cameroon, Madagascar, Ethiopia, Zambia, Oman, India, Nepal, South Asian countries, Afghan, Brazil, Mexico, Sierra Leone, Nigeria, East African Countries, Peru, Kenya | |
Adherence to guideline | Adherence to some guidelines (tetanus toxoid, lifestyle, blood test) [62, 91, 94, 98, 99], counselling and iron folate uptake [100] | Poor adherence to local guidelines and standards [44, 67, 82, 90, 98], evidence-based guidelines [43, 44, 50, 63, 82, 97, 99,100,101,102,103,104] | Peru, Australia, Tanzania, Ethiopia, Bangladesh, LMICs, Brazil, Zambia, eight countries of SSA and SA, Indonesia, west and central Africa, Ghana, Nigeria | |
Effective communication | Communication between providers and users [103], interpersonal communication, and training on communication skills [41, 55, 105] | Ineffective communication behaviour and attitude, lack of privacy, unequal treatment to clients [53, 54, 69, 87], poor awareness of complications, lack of understanding of tests and medicine, cost and quality [41, 69, 87], inadequate communication skills of providers [53, 83] | Ghana, Malawi, Jordan, Kenya, Namibia, Uganda, LMICs | |
Client satisfaction | Providers, explanation of procedures, consent seeking, encouragement to ask questions, confidentiality, and good interpersonal relations [41, 55, 106,107,108] | Poor satisfaction with ANC services [106, 109, 110], lack of privacy, discrimination, being left unattended, providers’ attitude, delayed and inadequate care, physical abuse, inappropriate position in the examination, lack of privacy, negative assumptions and disregard for mothers’ options in care, long waiting time [54, 95, 105, 107,108,109,110] | Malawi, Jordan, Ethiopia, Rwanda, Myanmar, Kenya, Zambia, | |
Outputs | Quality- adjusted coverage | Lower average coverage for care content and quality-adjusted coverage [67, 71, 73, 94, 101, 111,112,113] | Ethiopia, Zambia, Rwanda, Myanmar, LMICs, Egypt | |
Equity gaps | Equity gaps within and between countries [101, 113, 114], regional inequity [77], regional and ethnicity-based inequity [11, 115], SES and regional inequity [56, 58, 68, 75, 112], [75] | Ethiopia, Kenya, LMICs, SSA, eight countries, Brazil, Mexico, East African countries, Rwanda, India, Pakistan, | ||
Effectiveness | ANC quality was inversely associated with preterm birth and neonatal mortality [116, 117] | Low mortality reduction for people with minorities [115] | LMICs, Mexico |