Midwives’ and Nurses’ Perspectives on Implementing the New Antenatal Care Guidelines in Urban Tanzania: A Qualitative Study from Dar es Salaam

Abstract

Background

Maternal and perinatal health remain critical public health priorities and significantly contribute to the global disease burden. Severe maternal morbidity (SMM) is a key determinant of adverse outcomes for both mothers and newborns. Early detection and effective management of maternal complications are vital for improving outcomes, and high-quality antenatal care (ANC) is strongly associated with reduced maternal and perinatal morbidity and mortality. In Tanzania, new ANC guidelines have been in effect since 2020; however, little is known about their implementation, particularly from the perspectives of nurses and midwives, who provide over 80% of ANC services. This study explored their perspectives in public, urban health facilities in Dar es Salaam.

Methods

A descriptive qualitative study was conducted among nurses and midwives working in four Reproductive and Child Health (RCH) clinics in Dar es Salaam, purposively selected. Data were collected from May 6th to June 28th, 2024, using focus group discussions (FGDs) and analyzed using thematic analysis.

Results

A total of 29 nurses and midwives participated in five FGDs. The study revealed three themes: (a) the usefulness of the new ANC guidelines, including reduction of maternal and perinatal mortality, improvement in maternal and perinatal health outcomes, and enhancement of ANC service delivery and providers’ proficiency, (b) facilitators of the new ANC guidelines utilization, including health system-related factors and provider-related factors, and (c) challenges to the utilization of the new ANC guidelines, encompassing health system-related barriers, healthcare providers (HCPs)-related barriers, and client-related barriers.

Conclusion

HCPs viewed the new ANC guidelines as beneficial for improving maternal and perinatal outcomes, service delivery, and provider competence. However, implementation was hindered by systemic barriers, including staffing shortages, inadequate supplies, limited training, provider-related challenges, and client financial constraints. Implementing targeted interventions is crucial to effectively address these challenges.