Operations research as a tool to integrate vertical programs in antenatal care in Mozambique

Background

Antenatal care (ANC) attendance rates are high in urban and rural areas in Mozambique and other African countries where the use of health care services is otherwise limited. Implementing vertical programs into ANC can divert critical resources, altering the patient flow and generating barriers of access. Operations research (OR) can be a useful tool to integrate services into a comprehensive package. Taking advantage of the first ANC visit to provide a package of services that responds to the main problems in the epidemiologic profile should prevent adverse pregnancy outcomes and open the doors for women and children to further care services when required.

Methods

Between 2002 and 2005 various OR were developed in two provinces of Central Mozambique to demonstrate feasibility for implementing new public health priority programs in ANC such as the prevention of mother to child transmission of HIV (PMTCT), intermittent preventive treatment of malaria (IPT) and syphilis screening using a rapid test (SRT) and provide operational recommendations. Emphasis was put into integrating those services into routine ANC and providing them in the first visit. Use of OR results and close monitory and evaluation were used to rapidly scale-up the interventions.

Results

PMTCT was piloted in 2002, SRT in 2003 and IPT in 2004; the programs became national policy and were progressively scaled-up. By December 2008 of the nearly 190 health facilities providing ANC services in those two provinces, 188 were offering syphilis screening and IPT, and 168 PMTCT. In 2008 96% of the expected pregnancies received ANC in the above mentioned sites; 96% were screened for syphilis, 89% tested for HIV, and 75% received at least one dose of sulphadoxine-pyrimethamine (IPT) and 65% received a long-lasting insecticide treated bednet.

Conclusions and Recommendations

Successful implementation, integration and scaling-up of proven public health interventions into ANC provided nearly universal access to a comprehensive package of services and resulted in the prevention of several negative pregnancy outcomes. Offering this package in the first ANC visit optimizes results and decreases the lost opportunities. The use of OR results and routine data to monitor implementation were instrumental in the achievement of those results.