Beyond Attendance: Gaps in Essential Antenatal Care Delivery During Group ANC in Tanzania

Beyond Attendance: New PHIT Study Highlights Gaps in Essential Antenatal Care Delivery During Group ANC in Tanzania

Prime Health Initiative Tanzania (PHIT) has published new research examining whether high attendance in Group Antenatal Care (G-ANC) translates into women receiving the full package of essential antenatal care services.

The study, published in BMC Health Services Research, analysed routine implementation data from the Mlinde Mama Project, which integrated Group Antenatal Care into routine public health services in Geita Region, Tanzania.

The analysis included 5,936 pregnant women enrolled in 149 G-ANC cohorts across six public health facilities between January 2023 and August 2024. The facilities included two dispensaries, two health centres and two district hospitals.

High attendance — but was every woman receiving the full package of care?

The findings showed consistently high levels of ANC attendance and facility delivery. Across the six facilities, completion of four or more ANC visits ranged from 90.2% to 95.0%, while facility delivery ranged from 94.1% to 97.7%.

Blood pressure monitoring reached 100% across all six facilities, while malaria testing was also consistently high, ranging from 91.5% to 95.5%.

However, a different picture emerged when researchers examined the content of care women received during those visits.

Important variations in essential ANC interventions

Despite high attendance, coverage of several preventive and diagnostic interventions varied substantially between facilities.

• IPTp3+ for malaria prevention: 60.1%–86.3%
• Iron–folate supplementation: 75.0%–92.7%
• HIV testing: 59.9%–95.0%
• Syphilis testing: 59.9%–95.0%
• Urine testing: 30.1%–70.0%

These findings demonstrate an important distinction between contact with healthcare services and effective coverage. A woman may attend antenatal care as recommended but still miss one or more interventions that are important for protecting her health and that of her baby.

Attendance tells us whether women reached care. Effective coverage tells us whether they received the care they needed.

Performance differed between health facilities

The researchers developed a composite performance score based on nine essential ANC indicators to examine how consistently facilities delivered the recommended package of care.

Composite scores ranged from 80.1% to 91.9%. Bwanga Health Center achieved the highest overall performance score at 91.9%, followed by Nkome Dispensary at 86.2% and Katoro Health Center at 84.5%.

Overall, health centres demonstrated particularly strong performance across several preventive and screening interventions. For example, IPTp3+ coverage was 79.3% in health centres compared with 76.1% in dispensaries and 68.3% in district hospitals. HIV and syphilis testing coverage reached 92.2% in health centres compared with 77.5% in dispensaries and 75.5% in district hospitals.

Why do these findings matter?

The study suggests that measuring the number of ANC visits alone may provide an incomplete picture of maternal healthcare quality.

Even when women attend ANC regularly, facility-level factors such as commodity availability, laboratory capacity, staffing, workflow, supportive supervision and adherence to clinical protocols may influence whether the complete package of recommended services is delivered.

The findings therefore support moving maternal health monitoring beyond attendance towards effective coverage — measuring not only whether women attend care, but also whether they receive the essential interventions expected during those contacts.

Implications for maternal health programmes

As Group Antenatal Care and other innovative maternal health service-delivery models are expanded, the study highlights the importance of strengthening facility-level monitoring and continuous quality improvement.

Routine monitoring systems should complement ANC attendance indicators with measures of the actual content of care. Facility-level performance dashboards could help programme managers identify gaps early and target supportive supervision and quality-improvement efforts where they are most needed.

Particular attention should be given to interventions showing greater variation, including malaria prevention with IPTp3+, HIV and syphilis testing, urine testing and other preventive and diagnostic services.

About the Mlinde Mama Project

The Mlinde Mama Digital Health Project was implemented by Prime Health Initiative Tanzania (PHIT) in collaboration with regional and district health authorities and participating public health facilities in Geita Region.

The project integrated Group Antenatal Care into routine maternal health services and used the Unified Community System (UCS) to support client registration, cohort management, appointment tracking, service documentation, follow-up and routine programme monitoring.

The project was funded by the Gates Foundation through the Grand Challenges Global Call-to-Action, Digital Health Services (Investment ID: INV-046249).

Key message

Successful Group Antenatal Care should not be judged only by how many women attend. What ultimately matters is whether every contact delivers the complete package of high-quality, evidence-based care needed to improve maternal and newborn health.

Read the full article in BMC Health Services Research