CURRENT STATUS OF INTEGRATED ANTENATAL CARE COVERAGE AND QUALITY AT COMMUNITY HEALTH CENTERS IN WEST SULAWESI, INDONESIA: A MULTISTAKEHOLDER QUALITATIVE STUDY
DOI:
https://doi.org/10.37268/mjphm/vol.25/no.3/art.3684Keywords:
integrated ANC, antenatal care, maternal health, health service quality, health service coverageAbstract
Antenatal care (ANC) is a service provided to pregnant women to maintain the health of the mother and the baby in the womb. One way to reduce maternal and infant mortality is to increase the coverage and quality of ANC for pregnant women. West Sulawesi Province is one of the regions in Indonesia with a high maternal mortality rate and requires attention. Although integrated ANC has been implemented in Indonesia for some time with established guidelines, limited literature has explored its coverage and quality from the perspectives of multiple stakeholders. The current study explored the implementation of integrated ANC services and identified factors influencing ANC program coverage and quality in West Sulawesi Province. A descriptive qualitative approach was employed using Focus Group Discussions (FGDs) and in-depth interviews (IDIs). Informants in the study included program managers, postpartum mothers, and authorised policy makers. The findings reveal that although the ANC program is implemented in accordance with national guidelines, its execution remains suboptimal due to inadequate monitoring and evaluation. Unequal distribution of human resources, limited facilities and infrastructure, brief health education sessions caused by high workloads, and inconsistent implementation of coverage-enhancing strategies—such as pregnancy classes and cross-sectoral collaboration—continue to hinder the optimization of integrated ANC services in West Sulawesi.
References
World Health Organization. Trends in maternal mortality estimates 2000 to 2023. Geneva: WHO; 2023.
Ministry of Health R of I. Health Profile Health Profile. 1st ed. Farida Sibuea, SKM MsA, editor. Buku. Jakarta: Kemenkes RI; 2025. 534 p.
Kolantunga PM, Mayulub N, Kundrec R. Relationship between pregnant women's knowledge level about danger signs of pregnancy and compliance with antenatal care (ANC): systematic review. J Nursing. 2021;9(2):40–53.
World Health Organization. Maternal mortality. Geneva: WHO; 2023.
Suarayasa K. Strategy to reduce maternal mortality rate (MMR) in Indonesia. 1st ed. Sleman: Deepublish; 2020. 85 p.
Eka MB, Krisnana I, Husada D. Risk factors for stunting in toddlers aged 24–59 months. Indones Med Heal Sci J. 2020;4(4):374–85.
Sari AP, Fruitasari F. Risk factors affecting antenatal care visits in pregnant women. J Sains Kesejahteraan. 2021;28(2):52–29.
Adhikari S, Somrongthong R. Influences on the utilization of antenatal care among reproductive age group women in mid-western development region of Nepal: a population-based study using the Nepal Multiple Indicator Cluster Survey (MICS) data 2014. J Heal Res. 2017;31:17–24.
Wekesa W, Nora M. Effect of maternal and child health service utilization and feeding practices on morbidity and nutritional status of infants in Kwale County, Kenya. Jomo Kenyatta University; 2022. Available from: http://localhost/xmlui/handle/123456789/5954
Shrestha MS, Shrestha MR, Shrestha TK, Erene P. Knowledge and practice of antenatal care among Chepang women from Chitwan, Nepal. ARC J Public Heal Community Med. 2018;3(2):7–11.
Nasir F, Khuan L, Ahmad N, Ying LP. Factors associated with late booking of antenatal care among pregnant women during COVID-19 pandemic. Malays J Public Heal Med. 2023;23(2):47–54.
Lumempouw VJR, Kundre RM. The relationship between socio-economic factors of pregnant women and women in Manado City. Nursing e-journal (e-Kp). 2016;4(November):1–7.
Asmalia R, Makmun A. The correlation between education and occupation with the ANC (antenatal care) visit at Nagaswidak Health Care Center Palembang. Indian J Public Heal Res Dev. 2019;10(09):1886–90.
Wiratmo PA, Sopianah N. Factors influencing antenatal care visits on antenatal care behavior Puji. CoMPHI J Community Med Public Heal Indones J. 2020;1(2):67–76.
Dahiru T, Oche OM. Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria. Pan Afr Med J. 2015;8688:1–17.
Yadav UK, Ghimire P, Amatya A, Lamichhane A. Factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at provincial level hospital of Province 2, Nepal. Anemia. 2021;2021.
Puji D, Astuti T, Ayu K, Sari K. Level of knowledge and antenatal care behavior of pregnant women towards high-risk pregnancy in the working area of Upt Public Health Center I Negara, Jembrana District in 2016. E-Jrnal Med. 2017;6(6):1–9.
Ministry of Health of the Republic of Indonesia. Guidelines for integrated antenatal care. 3rd ed. Jakarta: Ministry of Health; 2020. p.1–85.
Ministry of Health of the Republic of Indonesia. Maternal and child health book. Jakarta: Directorate General of Public Health, Ministry of Health; 2023.
Prihandani E, Syafiq A, Yuliana R. Spatial analysis of determinants of low birth weight (LBW) incidence in East Kalimantan Province. Indones J Heal Promot. 2022;5(9):1074–80.
Marita I, Budiyono, Purnaweni H. Quality of minimum service standards for pregnant women's health in Brebes Regency. Higeia J Public Heal Res Dev. 2021;5(1):39–51.
Chan KL, Chen M. Effects of Social Media and Mobile Health Apps on Pregnancy Care: Meta-Analysis. JMIR Mhealth Uhealth. 2019;7(1):e11836.
Chen HWJ, Marzo RR, Sapa NH, et al. Trends in Health Communication: Social Media Needs and Quality of Life among Older Adults in Malaysia. Healthcare (Basel). 2023;11(10):1455.
Widyani RKP, Suparwati A, Wigati PA. Analisis faktor yang mempengaruhi kinerja bidan dalam pelayanan antenatal care di Puskesmas Kagok Kota Semarang. J Kesehat Masyarakat. 2016;4(4):129–34.
Rakhmah K, Rosyidah H, Wulandari RCL. The relationship between antenatal care (ANC) 10T service standards and pregnant women's satisfaction in the Tlogosari Kulon Community Health Center work area, Semarang City. Link. 2021;17(1):43–50.
Hendarwan H, Lestary H, Friskarini K, Hananto M. Quality of antenatal care services by midwives at public health centers. Health Res Inst. 2018;46(2):97–108.
Mikrajab MA, Agency I, Rachmawaty T. Policy analysis of integrated antenatal care implementation at public health centers in Blitar. Bul Penelit Sist Kesehat. 2016;19(1):41–53.
Marzo RR, Chen HW, Anuar H, Abdul Wahab MK, Ibrahim MH, Ariffin IA, Ahmad AI, Kawuki J, Aljuaid M. Effect of community participation on sustainable development: an assessment of sustainability domains in Malaysia. Frontiers in Environmental Science. 2023;11:1268036.
