TERMS OF REFERENCE FOR DEVELOPING ANTENATAL CARE (ANC) GUIDELINE for MINISTRY of HEALTH ETHIOPIA               

October, 2022 

 BY MATERNAL AND CHILD HEALTH DIRECTORATE MINISTRY of HEALTH 

Background

Over the past decade, the Ministry of Health of Ethiopia has made huge strides in reducing the Maternal Mortality (MMR) of the country.  In 2000, the MMR of the country was 871 per 100,000 (EDHS), major causes include hemorrhage (25%) hypertension (16%), sepsis (10%) and unsafe abortion which accounted for 10%.  According to the WHO estimates in 2019, the MMR went down to 401 per 100,000 lives and annual 42, 000 maternal deaths. The MMR and NMR ( 30/1000 LB)  are very high and requires effective coverage of high impact interventions to end preventable maternal and newborn deaths as well as stillbirths.

Proper care during pregnancy and delivery is important for the health of the mother and child.  Skilled care during pregnancy, childbirth, and the postpartum period are important interventions in reducing maternal and neonatal morbidity and mortality. Improving the quality of Antenatal Care  (ANC) as well as providing a positive experience is directly linked  with maternal and child survival. For example, the recent Every Newborn Coverage Targets and Milestones for 2025 (WHO 2022) emphasizes and promotes the importance of high quality ANC.  The Mini EDHS 2019 highlights the importance of monitoring pregnancy on reduction of morbidity and mortality of the mother and child and shows that 74% and 43 % of women who gave birth in the previous 5 years had at least one and four or more visits from a skilled provider during their last pregnancy. In addition to the importance of monitoring, the survey also showed that there are geographical and economical inequities when it comes to coverage.  In addition, the 2016 EDHS stresses that even among mothers who received regular checkup that the quality of ANC service needs to improve very much. All these challenges in ANC implementation indicates the need for more specific guidance in ANC implementation.

Over the years, MCHD has developed different strategies and guidelines; however, this is the first time that the department will be focusing and developing an ANC guideline. The development of this guideline comes at a time where there have been, multiple developments, evidences and global guidelines that have made this a necessity for Ethiopia. This guideline reaffirms the Ministry’s continued commitment to take the momentum forward by showing the way to effective coverage of high quality ANC and settings this agenda as a top priority.

Rationale

Over the past few years, there are many national and global changes and evidence in the area of ANC intervention. It is imperative that the ANC guideline incorporate evidence based interventions that will support effective implementation efforts to improve the coverage and quality of ANC and pregnancy outcomes in Ethiopia. Guidelines are an important input for service provision in laying out expected standards of care; how care should be provided including principles of quality, equity and dignity and how ANC can be monitored and measured. They also serve as a key resource for supporting compliance with evidence-based care and standardization of practices across the continuum of care from community to health facility.

Objectives

To develop a comprehensive national ANC guideline to be used as a standard for all levels of health facilities.

The development process/approach

National ANC guideline development process will be undertaken by the leadership of the FMOH and through the technical advice of national SMH –TWG members.  In order to develop a thorough guideline, a consultant will be hired to guide the development of the National ANC guideline.

Scope of work

• Prepare a detailed Plan of Action based on the Terms of Reference and share with TWG for input within one week of recruitment. The plan of action is expected to outline details activities and timeframe. In addition of plan of action, consultant is also expected to share ideas and or suggestions how best to enhance the National ANC guideline development process with the TWG.
• Review and identify list of key documents (in-country and global) on ANC guideline for situation analysis
• Conduct a quick situational assessment on ANC implementation, to date, in Ethiopia.
• The situational assessment will include a thorough desk review of different national interventions, various global guidelines, national RH strategy, and relevant assessments.     The review should also include key global documents including 2016 ANC model for a positive pregnancy experience (WHO), and for M&E WHO ANC framework as well as regional and local resources to identify best practices and research.  Additionally, review should also include examples of successful programs, gaps, and challenges which will strengthen the evidence base for the guidelines. This can also include different pilot models across all levels of the health systems.
• Produce a thorough report based on this assessment. In addition, analyze and package the area of interest National ANC guideline and discuss with the MOH focal person followed by  preparation of  an outline for the ANC guideline to be presented at the first consultative workshop with the situation analysis.
• Once assessment is finalized, organize  a consultative workshop with support from FMOH and TWG. During the workshop present and hold in-depth discussion on the draft National ANC guideline outline, actively participate in the discussions and debates that shape the National ANC guideline and organize relevant inputs and feedbacks
• Prepare a zero draft of the ANC implementation guideline and share with the TWG.
• Incorporate the comments provided and develop a first draft of the ANC guideline
• Prepare and deliver presentations of the draft National ANC guideline at external consultation and validation workshop
• Prepare a final draft and submit to FMOH for final review

MOH responsibilities

• MOH will assign a relevant expert from the maternal case team to coordinate and lead the process of the development of the National ANC guideline
• MOH will establish a core team among the TWG members to technically lead the process of the development of the National ANC guideline
• Closely work with the core team in preparing plans and setting timelines for the development of the National ANC guideline.
• Mobilize resources to organize and conduct consultative meetings and workshops to facilitate the development of National ANC guideline
• Set schedules and agendas of such consultative meetings and workshops
• Organize and conduct the consultative meetings and workshops
• Facilitate approval process of the final National ANC guideline by relevant MOH

Responsibilities of the core team

• Map relevant source documents
• Come up with a provisional outline of the National ANC guideline and refine the outline in consultation with the larger TWG
• Advice the development of zero draft to the National ANC guideline and share to the larger SMH TWG
• Plan and support facilitations of workshops
• Conduct regular core group meetings as per the call from the MOH focal point

Responsibilities of the SMH TWG members

• Provide expert advice to the MOH, core group and subgroups regarding coordination of the development of the National ANC guideline
• Assign responsible members based on relevant experience and organizational mandate to take assignments and provide technical assistance
• Actively participate throughout the development process of the National ANC guideline
• Solicit potential funding options with in the respective organizations to host the workshop and printing
• Attend meetings and actively participate in the discussions and debates
• Take time to read relevant documents and share their insights

Timeline of the development of the National ANC guideline