Innovation in patient centered antenatal care in Uganda
Creating a communal care and support model for women in Eastern Uganda
High-quality, patient-centered antenatal care (ANC) is a key strategy for improving maternal and newborn health and a critical component in the continuum of care. Many women in low and middle-income countries still face gaps in access to high quality ANC. Recent evidence suggests that current models of ANC are not meeting women’s needs for information and support, limiting uptake of this essential intervention
This project was about designing a contextually adapted patient-centered group model of antenatal care for the needs of communities in Mbale and Bududa, Uganda. The patient-centered group model of antenatal care provides a forum where pregnant women can share experiences, receive essential health information from a midwife or other skilled provider, and track and better understand the progress of their pregnancies. Through facilitated group discussion, this model builds a supportive community of pregnant women to normalize the pregnancy experience, support birth planning, and provide emotional and social support during a stressful, momentous, and often isolating time. The main objective is to enable the health system to sustainably and efficiently improve quality of care, increase ANC coverage, and empower pregnant women to improve their self-care. MSH has recently conducted a 3 month test and pilot of the group model at six sites in Uganda. Due to our success in Uganda, MSH sought to expand this model to Kenya.
Design and Approach
M4ID employed a human centered design approach to identifying specific user needs and preferences for both ANC clients and provide using co-design and creative concepting methods, we directly engaged the key stakeholders in co-creation of a group ANC model that reflects an understanding of the cultural context and responds to local needs.
We conducted 6 co-design workshops, with 41 pregnant women and 20 healthcare professionals across 2 different facilities in Bududa and Mbale. We spoke about the preferences, needs, desires and expectations from pregnant women and healthcare professionals towards the new model, especially regarding groups, communication and engagement format for this group structure.
We learned from women and health providers about their needs, preferences, and expectations.
No one wants another health talk.
A pregnant woman doesn’t want to hear ‘just another health talk’ from a provider that she has no reason to like or trust. Changing the provider-patient dynamic encourages participation and attendance.
Knowledge enables ownership.
Helping a woman better understand her pregnancy and impending motherhood encourages her to take more active responsibility for her health and that of her baby.
Sharing is learning.
Sharing real-life experiences promotes a new and powerful form of learning.
Support is empowering.
A woman is empowered when she feels supported by other women and by her health provider, and has a sense that she belongs.
New rituals for new behavior.
New ways of engaging helps in designing new rituals and behaviors around learning.
Based on these findings, we developed the concept of the ‘pregnancy club.’ The concept of pregnancy club is designed to create an empowering community of pregnant women to normalize the pregnancy experience, support birth planning, and provide emotional and social support during a stressful, momentous, and often isolating time. We designed a prototype for visit flow for the club, and tested it with women and providers. (See image2) We also designed an ANC mat (See image3) and 7 illustrated scrolls (See image4) with information and messages about maintaining a healthy pregnancy.
The impact and next step plans are documented in the MSH blog