FACTORS INFLUENCING THE IMPLEMENTATION OF FOCUSED ANTENATAL CARE (FANC) IN HEALTHCARE FACILITIES A STUDY OF ST. PHILOMENA HOSPITAL

Abstract

This study examined the factors influencing the implementation of Focused Antenatal Care (FANC) in healthcare facilities, with a specific focus on St. Philomena Hospital. A descriptive research design was adopted to gather relevant data, and a structured questionnaire was used to collect responses from a sample of 106 healthcare professionals, including nurses and midwives. The data collected were analyzed using SPSS version 27, which helped in presenting the findings through descriptive and inferential statistics.The study revealed that while a significant number of respondents (84.9%) were familiar with the principles of FANC, and the majority (93.4%) had received formal training, there were substantial barriers to its effective implementation. The primary challenges included insufficient resources, high workload, and limited administrative support. Despite these obstacles, the benefits of FANC for both pregnant women and newborns were clearly recognized, with respondents emphasizing the early detection of complications, improved maternal health, and better outcomes for newborns such as reduced neonatal complications and better growth and development. In conclusion, the study found that while awareness and training for FANC were high among healthcare professionals, factors such as resource constraints, workload, and inadequate institutional support significantly hindered the full implementation of FANC practices. Recommendations include enhancing resources, improving staffing levels, and providing stronger administrative support to facilitate the effective delivery of FANC in healthcare settings.

CHAPTER ONE

INTRODUCTION

BACKGROUND OF STUDY

Focused Antenatal Care (FANC) is a comprehensive approach to antenatal services designed to improve maternal and neonatal health by emphasizing quality over quantity of visits. Unlike traditional antenatal care models, FANC prioritizes individualized care, early detection, prevention, and management of complications, promoting optimal outcomes for both mother and child. Despite its proven effectiveness and endorsement by global health organizations, the implementation of FANC in many healthcare facilities, particularly in low- and middle-income countries, remains inconsistent.

In Nigeria, maternal and neonatal health outcomes continue to be a significant public health concern, with high rates of maternal mortality and morbidity. While FANC has the potential to address these challenges, its adoption has been hindered by various factors. Focused antenatal care emphasizes the identification of risks and complications early in pregnancy, timely intervention, and the promotion of healthy practices for both the mother and the fetus. Despite the adoption of this model globally, its implementation remains a significant challenge, particularly in low- and middle-income countries (LMICs). A variety of factors contribute to the failure of focused antenatal care to be effectively implemented. These factors include inadequacies in health system infrastructure, socio-cultural barriers, economic constraints, policy limitations, and gaps in knowledge among both healthcare providers and recipients. These elements combine to create significant barriers to the successful uptake and delivery of quality focused antenatal care. In this background study, we will explore these factors in detail, using recent studies and data to highlight the challenges and provide insights into potential solutions.

The infrastructure of the healthcare system is a primary factor affecting the implementation of focused antenatal care. In many LMICs, the lack of well-equipped healthcare facilities and the absence of sufficient healthcare personnel are major obstacles. Rural and remote areas, in particular, face greater challenges in accessing healthcare services. The shortage of trained healthcare providers, including midwives and doctors, means that the few professionals available are often overwhelmed with patient loads that compromise the quality of care. This inadequate staffing results in delays in providing necessary services such as regular monitoring, diagnostic testing, and counseling that are core components of focused antenatal care.

Furthermore, health facilities often lack essential resources, including medical supplies and equipment, which further limits the ability to carry out focused care. Umeh and Okeke (2020) conducted a study in rural Nigeria and highlighted that the absence of basic medical equipment such as ultrasound machines, blood pressure monitors, and laboratory services in these areas contributes significantly to the inability to offer quality antenatal care. Inadequate training among healthcare providers also plays a crucial role in the non-implementation of Focused antenatal care. Many health workers in LMICs are not sufficiently trained in the principles and practices of focused antenatal care, leading to inconsistent care delivery. Adamu et al. (2021) found that many healthcare workers were either unfamiliar with the guidelines for focused antenatal care or had insufficient knowledge about how to incorporate them into daily practice. This knowledge gap contributes to the failure to provide individualized care tailored to the needs of pregnant women, which is a hallmark of the Focused antenatal care model. Furthermore, lack of proper supervision and monitoring in healthcare facilities exacerbates the problem, leading to variations in the quality of care provided and undermining efforts to improve maternal and fetal health.

Cultural beliefs and practices significantly influence maternal health-seeking behavior, including the uptake of antenatal care services. In many communities, especially in rural areas, traditional medicine is often preferred over formal healthcare, and pregnant women may choose to rely on traditional birth attendants rather than attending antenatal clinics. This preference is influenced by deep-rooted cultural beliefs about pregnancy and childbirth, which may view modern medical interventions with suspicion. For example, some cultures hold the belief that frequent medical check-ups may harm the unborn child or disrupt the natural process of childbirth, leading women to avoid healthcare facilities altogether. Kumbi et al. (2019) found that misconceptions about the risks of antenatal visits, especially in early pregnancy, were prevalent among women in rural Ethiopia, significantly affecting their decision to seek formal care. Additionally, social norms and gender roles often play a role in limiting women’s autonomy in making healthcare decisions. In many patriarchal societies, women may not have the financial independence or social support to attend regular antenatal visits. They may need permission from their husbands or other male family members to seek healthcare, which can result in delayed or missed appointments. Socio-cultural factors are further compounded by the stigma surrounding maternal health issues, which may lead to women avoiding medical facilities due to fears of judgment or discrimination. As highlighted by Adebayo and Omoyeni (2020), pregnant women in some regions may feel embarrassed about their condition, particularly if they are experiencing

complications, leading them to delay seeking care until the situation becomes more urgent. Economic factors are among the most

significant barriers to the implementation of focused antenatal care, especially in resource-limited settings. The direct and indirect costs associated with antenatal care, including transportation, consultation fees, and out-of-pocket expenses for medication, are substantial obstacles for many pregnant women. In many cases, these costs are prohibitive, especially for women living in poverty or in remote areas far from healthcare facilities. Studies have shown that financial barriers significantly reduce the likelihood that women will attend antenatal visits as recommended. Adebayo and Omoyeni (2020) found that women in rural Nigeria often faced financial constraints that made it difficult for them to access even basic healthcare services, including ANC. The cost of transportation to the nearest health facility, which may be located many miles away, further exacerbates this issue, especially when women lack access to reliable public transport or private means of travel. Long distances to healthcare centers also create logistical barriers to the regular implementation of focused antenatal care. Women living in rural areas or isolated communities may face significant travel time to reach healthcare facilities. For many, the physical effort and time required to access care can be a deterrent, particularly during pregnancy when mobility is already limited. A study by Akanbi et al. (2019) emphasized that the lack of accessible transportation and poor road infrastructure in rural areas significantly reduces the uptake of ANC services. These logistical barriers are often compounded by geographical and infrastructural challenges, which further undermine the effective implementation of focused antenatal care.

At the policy level, the inconsistent implementation of focused antenatal care can be attributed to weak governance, lack of political will, and inadequate funding. While many countries have adopted guidelines and frameworks for ANC, these policies are not always effectively implemented. In many cases, the policies are either not enforced or are poorly monitored, leading to discrepancies in the delivery of services. Furthermore, there is often a lack of coordination between various levels of government and healthcare providers, which can result in fragmented service delivery and misalignment between policy and practice. Akanbi et al. (2019) noted that the absence of strong policy implementation frameworks in Sub-Saharan Africa has led to variations in the quality and accessibility of maternal health services across regions. In some cases, the national health policies may be poorly funded, leading to a lack of resources needed to support the infrastructure required for focused antenatal care. Budget cuts, inefficiency, and mismanagement of health funds are persistent issues that hinder the effective delivery of maternal health services.

As a result, policies aimed at improving ANC and focused antenatal care services often fall short of their intended impact, particularly in rural and underserved areas.

Finally, the lack of awareness and education among pregnant women about the importance of focused antenatal care is a significant contributing factor to the non-implementation of focused antenatal care. Many women are unaware of the benefits of regular, comprehensive antenatal visits, which can detect complications early and prevent adverse outcomes. Jega et al. (2021) highlighted that a lack of knowledge among pregnant women about the significance of focused antenatal care leads to delays in seeking timely medical care. Without proper education, women may not recognize the signs of pregnancy-related complications or may fail to understand the importance of preventive interventions, such as screening for hypertension, gestational diabetes, or infections. Educational campaigns at the community level, involving healthcare workers, local leaders, and women’s groups, are crucial to promoting the uptake of focused antenatal care services.

This study aims to explore the factors contributing to the non-implementation of FANC at St. Philomena Catholic Hospital, including systemic, institutional, and individual-level barriers. By identifying these challenges, the research seeks to provide actionable recommendations to improve the quality of antenatal care delivery and contribute to better health outcomes for mothers and their newborns.

Statement of Problem

Focused antenatal care (FANC) is a proven strategy for improving maternal and neonatal health outcomes, yet its implementation faces significant barriers, particularly in low- and middle- income countries (LMICs). Focused antenatal care, which emphasizes fewer but targeted visits, aims to reduce maternal mortality and prevent complications, but several factors hinder its successful adoption. Key barriers include inadequate healthcare infrastructure, particularly in rural areas, with limited access to trained healthcare providers and essential medical supplies. Socio-cultural factors, such as traditional beliefs and gender norms, also discourage women from seeking formal antenatal care. Economic challenges, including high transportation costs and financial barriers, further restrict access to services, especially among economically disadvantaged communities. Additionally, gaps in policy enforcement, lack of coordination among health sectors, and insufficient awareness about the benefits of focused antenatal care contribute to its underutilization. This research aims to explore the factors preventing the effective implementation of focused

antenatal care, with the goal of identifying solutions to improve the quality and accessibility of antenatal care, ultimately reducing maternal and fetal health risks.

Research Objectives

To assess the knowledge level of nurses regarding the principles and practices of focused antenatal care?

To examine the factors responsible for non-implementation of Focused antenatal care among nurses in St. Philomena

To evaluate the benefit of focus antenatal care to both pregnant women and their new born babies

To investigate the influence of health provider workload and staff shortage on Focused antenatal care implementation

To assess the impact of institutional policies and administrative support in implementation of Focused antenatal care.

Research Questions

What is the level of knowledge among nurses about the principles and practices of focused antenatal care in St. Philomena?

What factors contribute to the non-implementation of focused antenatal care among nurses in St. Philomena?

What are the benefits of focused antenatal care for pregnant women and their newborns in St. Philomena?

How do health provider workload and staff shortages affect the implementation of focused antenatal care in St. Philomena?

What is the impact of institutional policies and administrative support on the implementation of focused antenatal care in St. Philomena?

Significance of the Study

To the profession

This study will contribute to the professional development of healthcare providers, particularly nurses and midwives, by highlighting their knowledge gaps and understanding of focused antenatal care (FANC). By assessing the level of knowledge among healthcare workers about the principles and benefits of focused

antenatal care, this research will provide valuable insights into the areas where further training and capacity-building are required. Improving healthcare providers' knowledge and competence in focused antenatal care can lead to better care delivery, greater adherence to international healthcare standards, and ultimately, improved maternal and neonatal outcomes. Additionally, understanding the barriers that prevent healthcare professionals from effectively implementing focused antenatal care will help refine training programs, policies, and clinical guidelines, ensuring that healthcare providers are better equipped to meet the needs of pregnant women.

To the healthcare providers

For healthcare providers, this study will provide an opportunity to critically examine the effectiveness of current antenatal care practices, especially the challenges in integrating focused antenatal care into routine care. It will offer healthcare providers an understanding of the factors contributing to the preference for traditional antenatal care over focused antenatal care, thus enabling them to address patient concerns and misconceptions more effectively. The findings may also serve as a basis for advocacy for policy changes, improved resource allocation, and enhanced training programs. Furthermore, by exploring the benefits of focused antenatal care for both mothers and babies, the study can encourage healthcare providers to adopt more evidence-based approaches in their practice, resulting in improved patient outcomes and greater professional satisfaction.

To Society

This study has significant societal implications by contributing to the broader goal of improving maternal and child health in communities. By identifying the factors that hinder the implementation of focused antenatal care, such as cultural beliefs, financial constraints, and lack of awareness, this research will help policymakers, public health organizations, and communities develop targeted interventions to address these barriers. These interventions can improve pregnant women's access to quality care, reduce maternal and neonatal morbidity and mortality, and promote healthier communities. In the long term, this study can contribute to the development of more effective antenatal care programs, raise awareness about the importance of proper prenatal care, and reduce reliance on traditional practices that may be less effective or unsafe. Ultimately, this study aims to empower women, families, and communities to make informed health choices, enhancing the overall well-being of society.