Increase the uptake and access of primary health care services by standardization of the Antenatal care clinics at urban health posts: Evidence from Maharashtra, India

The numbers of maternal deaths in low-income countries reflect inequities in access to health services and highlight the gap between rich and poor. Most are preventable through primary care. Nevertheless, primary level urban... [ view full abstract ]

The numbers of maternal deaths in low-income countries reflect inequities in access to health services and highlight the gap between rich and poor. Most are preventable through primary care. Nevertheless, primary level urban health posts serving outsized slum communities suffer from deficient infrastructure, supplies, human resources and access.
The Society for Nutrition, Education and Health Action (SNEHA) partners with Mumbai and three adjoining municipal corporations to ensure the provision of basic primary care services for pregnant and lactating women through the establishment of weekly antenatal care clinics at 53 urban health posts located nearby slum communities. To standardize those clinics it required obtaining buy-in, consistent advocacy and follow up with the administrative heads, persuasion to issue official circular, motivation of the health post staff to consider the weekly clinic as part of their daily routine, identify equipment and infrastructure upgrade needs and bridge the gap, requisite clinical trainings of the health care providers and Behavior Change Communication trainings for the outreach workers. Standard observation tool was used as a strategy to improve the quality of care to pregnant and lactating women. Periodic observations by trained workers helped providing constructive feedback to the health post staff and line managers and supportive supervision. As a result antenatal services have expanded from provision of iron and folic acid tablets and tetanus toxoid to include abdominal examination, blood pressure measurement, counseling, referral advice and documentation. It also documents referrals to higher facilities and the regularity of clinics. Over a period of one and half year 96% health post reported providing five or more core services regularly and the clinics were accessed by 8198 pregnant and lactating women.
SNEHA successfully encouraged municipal cadres to provide routine antenatal care through constructive feedback based on observation.