Use of On-the-job Training (OJT) to Cascade Antenatal Care (ANC) Guidelines to Health Care Workers (HCWs) in Improve Uptake of IPTP in Pregnancy: Case Study for Usaid Boresha Afya- Lake and Western Zone

Introduction: The World Health Organization (WHO) updated Antenatal Care (ANC) guidance (2016) recommends eight ANC contacts during pregnancy with a focus on positive pregnancy experience. In Tanzania, only 51% of pregnant women have four or more ANC visits (TDHS 2015/16 and only 8% of women take three or more doses of SP to prevent malaria in pregnancy. Tanzania revised the ANC guidelines intending to prevent maternal deaths by improving the quality of delivery of ANC. In October 2017, the USAID Boresha Afya Program, Ministry of Health, and other stakeholders supported the operationalization of these revised WHO ANC guidelines in the Lake & Western zone through On-the-Job Training (OJT)

Methods: The project used the OJT approach to improve the quality of ANC care, including Malaria in Pregnancy (MiP) services. National trainers and mentors capacitated 925 HCWs in the project supported health facilities and orientated on five critical ANC interventions through various skills stations and then assessed using an Objective Structured Clinical Examination (OSCE). To reinforce learning after orientation, peer practice coordinators at each site utilized high-frequency practice sessions using ANC checklists, case studies, manikins, and job aids.

Results: Project supported regions have made impressive gains in increasing uptake of IPTp2 and IPTp3 coverage from 0% & 49% (2016) to 66% & 83% (2019) and dropped down 56% &71% (March 2020) due to Covid 19 where the pregnant women feared to go ANC.

Conclusion Utilizing on-site orientations with skills-building through facilitated skills stations and knowledge updates paired with frequent skills practice via OJT was an effective way of rolling out new ANC guidelines in our supported regions. The new ANC guidelines, including malaria in pregnancy, needs to be scaled up nationally. Providers need to continue to practice post orientation to become competent and confident in skills using peer-to-peer mentorship. Supportive supervision and continued mentorship is recommended to continue midwifery professional development and ensure quality ANC services.