From visit counts to quality care
A qualitative study on early implementation of a new model for antenatal care in Kavre district, Nepal
Bibliographic Data
| ID | 24219197 |
|---|---|
| Authors | Samita K C (0009-0006-7182-9985, Dhulikhel Hospital, Kathmandu University Hospital), Rajani Shakya (0009-0000-3266-7852, Dhulikhel Hospital, Kathmandu University Hospital), Abha Shrestha (0000-0002-8465-0590, Kathmandu University School of Medical Sciences), Emma Radovich (0000-0002-8975-8015, London School of Hygiene & Tropical Medicine) |
| Editors | Massy Mutumba (0000-0002-0636-891X, Washington University in St. Louis) |
| Year | 2026 |
| Volume | 6 |
| Issue | 10 |
| Pages | e0005076 |
| Publication date | 2026-10-05 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | PLOS Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2767-3375 • E-ISSN: 2767-3375 |
| Publisher | Public Library of Science (PLoS) (PUBLISHER) |
| DOI | 10.1371/journal.pgph.0005076 |
| PMID | 42832487 |
| OpenAlex | W7220413387 |
| Language | EN |
| References cited | 23 |
In 2016, WHO updated its antenatal care (ANC) guidelines, increasing the minimum number of ANC visits from four to eight and recommending practices for those visits. Nepal adopted this new ANC model in 2022, but limited research has examined how the model has been implemented. This study explored the perspectives of pregnant women, ANC providers and local policymakers on the rollout of the new ANC model in Kavre district of Nepal. We conducted an exploratory qualitative study involving interviews with pregnant women, ANC providers and local policymakers along with semi-structured facility observations. Six primary care level government health facilities offering ANC services were purposively selected from three municipalities of Kavre district, Nepal. Data included eight interviews with pregnant women, seven with providers and three with local policymakers along with field notes from observations in six facilities. Interview transcripts and observation field notes were coded manually and analyzed thematically. Three major themes emerged from the analysis of the interviews and observations. Providers and policymakers viewed the new ANC model mainly as increase in visit frequency for documentation rather than enhanced quality care. Although orientation on the increased number of visits was presented to providers, most providers lacked understanding on the content and purpose of each visit. Pregnant women, particularly those in rural areas, reported logistical, financial and physiological challenges in completing all recommended visits and accessing care at referral sites. Implementation of new ANC model in Kavre district largely remained focused on visit quantity rather than quality. Strengthening provider’s capacity, ensuring availability of guidelines, enhancing understanding of its purpose and implementation, and fostering person centered care are essential to achieve the intended benefits of the model.
guideline implementation · health provider perspectives · local health policy · person-centred care · pregnant women's experiences · Prenatal care · quality of care · rural healthcare access · Global Maternal and Child Health · Health Policy Implementation Science · Maternal and Neonatal Healthcare
Making sense of implementation theories, models and frameworks
WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care
A conceptual framework for implementation fidelity
The impact of implementing the 2016 WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience on perinatal deaths
Saturation in qualitative research
More is not enough
Qualitative Thematic Analysis in a Mixed Methods Study
One size fits all? What counts as quality practice in (reflexive) thematic analysis
Implementing, Embedding, and Integrating Practices
| Highly cited | No |
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