Written national policies and/or MOH documentation of   recommendations or guidelines for a minimum package of ANC are needed to provide evidence for this indicator.  The documents should reflect the range of recommended essential ANC services under the WHO four categories of care listed above and reflect specific needs for country and regional settings, such as malaria treatment in endemic areas.

Data Source(s):

National policy documents and/or MOH written guidelines for ANC; interviews with key informants.

Purpose:

This indicator measures the level of national commitment provision of quality ANC services through the health system. Quality ANC is associated with a better overall pregnancy outcome for both mother and infant.  Many health problems experienced by pregnant women can be prevented, detected and treated during ANC visits with trained health workers. ANC can foster a rapport between the mother and the father and the health care provider, provide preventive care and health education, identify and treat illness, encourage skilled attendance at birth and prepare the mother, other family members, and birth attendants for possible emergencies (WHO, 2006). Good ANC can help prevent factors associated with newborn mortality such as low birth weight and complications from infectious diseases, including reducing MTCT. Male partner participation in antenatal health care can encourage male partner support and involvement in pregnancy and delivery (WHO, 2006). Overall, women’s access to quality ANC is central to achieving the Millennium Development Goals #5. improve maternal health and #4. reduce child mortality.

Issue(s):

Evaluators may have difficulty obtaining evidence that the full range of recommended minimum ANC services have been incorporated into government policy or MOH guidance. This indicator does not measure if the recommendations are being distributed throughout the ANC health system and if the minimum package guidelines are being followed or monitored at the facility level. Evaluators would need to follow-up to verify if and to what extent these recommendations are being operationalized.

Mailman School of Public Health, 2007, Package of Care to be provided according to type of Health facility, New York City: Columbia University/Mailman SPH Website.