Background

As the saying goes, a healthy mother leads to a healthy baby. This statement acts as the back
born of this write-up. It is only through proper antenatal care that this can be materialized.
According to the United Nations Population Fund (UNFPA), the maternal mortality rate has,
over the decades, become a cause for concern for many countries. In Kenya specifically, this
ratio stands at 352 deaths /100000 births. This means that almost 5000 women die annually due
to pregnancy-related conditions. This is only a fraction of the statistics. A closer look at the
stillbirth rates indicates that more still needs to be done to curb this menace.

This and similar factors were the cause for the adoption of Focused Antenatal Care FANC.
FANC is a streamlined approach to ANC that emphasizes evidence-based interventions and
counselling tailored to the individual needs of pregnant women. The World Health Organization
(WHO) recommends that all pregnant women should receive at least four FANC visits during
their pregnancy, with the first visit occurring in the first trimester. FANC provides an
opportunity for early detection and management of pregnancy-related complications and
promotes healthy behaviors for the mother and the unborn child

To lay light on some of the recent statistics, in Kenya, antenatal care is provided through a tiered
system, with level 1 facilities providing basic ANC services, level 2 facilities providing
comprehensive ANC services, and level 3 facilities providing specialized ANC services.
Additionally, while Kenya has made efforts to comply with the WHO requirements for antenatal
care, the 2014 KDHS report indicates that only 61% of pregnant women in Kenya received at
least four ANC visits, while 16% received no ANC visits. The same report also shows that the
percentage of pregnant women who received ANC services from a skilled provider (doctor,
nurse, or midwife) in Kenya was 86%, with Vihiga County recording 85%. Despite the high
percentage of pregnant women who receive ANC services from skilled providers in Kenya, the
quality of ANC services remains a concern. A study in western Kenya found that only 38% of
pregnant women who attended ANC received all the recommended services, including FANC
services.

Vihiga County is located in Western Kenya and has a population of approximately 590,013
people, with an estimated 10% being pregnant women. Bugina Model Health Centre is a health
facility in Vihiga County, Kenya, providing primary healthcare services to the local community,
including antenatal care. Despite the availability of ANC services at Bugina Model Health
Centre, the uptake of FANC among pregnant women is low. According to the 2018 Kenya
Demographic and Health Survey, only 59% of pregnant women in Kenya received FANC
services during their last pregnancy, with Vihiga County recording a lower percentage of 54%.

The low uptake of FANC services among pregnant women in Bugina Model Health Centre and
Vihiga County can be attributed to various factors. These factors include poor knowledge of
FANC among pregnant women, inadequate staffing and training of healthcare providers,
inadequate supplies and equipment, and inadequate community engagement. These factors
contribute to poor maternal and child health outcomes, including high maternal and neonatal
mortality rates.
The Kenya Ministry of Health has implemented several initiatives to improve ANC services in
the country, including implementing the FANC model, training healthcare providers on FANC,
and providing essential supplies and equipment for ANC services. Antenatal care (ANC) is a key
component of maternal and child health services. It provides an opportunity for early detection
and management of pregnancy-related complications and promotes healthy behaviors for the
mother and the unborn child. In Kenya, the Ministry of Health recommends that all pregnant
women should receive at least four focused antenatal care (FANC) visits during their pregnancy.
FANC is a streamlined approach to antenatal care that focuses on providing evidence-based
interventions and counseling to pregnant women based on their individual needs.

Problem statement:

Maternal mortality remains a significant public health challenge in Kenya, with a maternal
mortality ratio of 362 deaths per 100,000 live births according to the 2014 KDHS. Antenatal care
is a critical component of maternal and child health services, and the FANC model has been
adopted in Kenya to provide evidence-based interventions and counseling to pregnant women.
Despite the availability of ANC services at Bugina Model Health Centre in Vihiga County, the
uptake of FANC among pregnant women is low, with only a small proportion of pregnant
women attending all four recommended visits. This low uptake may be attributed to several
factors, including inadequate knowledge and awareness of FANC among pregnant women,
insufficient staffing and training of healthcare providers, inadequate supplies and equipment, and
inadequate community engagement. Therefore, there is a need to enhance the implementation of
FANC at Bugina Model Health Centre to improve maternal and child health outcomes in the
local community.

In Kenya, the 2014 KDHS showed that only 61% of pregnant women attend at least four ANC
visits during their pregnancy, with only 37% attending the first visit in the first trimester.
Furthermore, only 24% of pregnant women receive all the recommended components of FANC,
which indicates a low uptake of FANC interventions in the country. The situation is similar in
Vihiga County, where only 58% of pregnant women attend at least four ANC visits, with a low
proportion attending the first visit in the first trimester.

At Bugina Model Health Centre, the uptake of FANC is lower than the national and county
averages, with only a small proportion of pregnant women attending all four recommended
visits. In 2021, a survey conducted at the health facility showed that only 30% of pregnant
women attended all four recommended visits, with the majority attending only one or two visits.
The low uptake of FANC among pregnant women attending antenatal care at Bugina Model
Health Centre is a concern because it can contribute to poor maternal and child health outcomes.
The high maternal mortality ratio in Vihiga County suggests that there is a need to improve the
quality and uptake of ANC services in the county.

The lack of knowledge and awareness of FANC among pregnant women is a significant barrier
to the uptake of FANC at Bugina Model Health Centre. A study conducted in a rural area of
Kenya found that pregnant women who had adequate knowledge of ANC were more likely to
attend at least four ANC visits, including FANC visits. Therefore, there is a need to improve
pregnant women's knowledge and awareness of FANC to increase its uptake at Bugina Model
Health Centre.

The insufficient staffing and training of healthcare providers is another barrier to the
implementation of FANC at Bugina Model Health Centre. The KHIS report indicates that the
health facility has a shortage of skilled personnel, including midwives and nurses. Furthermore,
the report indicates that only 50% of the healthcare providers at Bugina Model Health Centre
received training on FANC. This shortage of skilled personnel and inadequate training on FANC
may result in suboptimal delivery of FANC services and a low uptake of FANC among pregnant
women.

The inadequate supplies and equipment at Bugina Model Health Centre also hinder the
implementation of FANC. The KHIS report indicates that the health facility has inadequate
supplies of essential medicines and equipment, such as blood pressure machines and urine testing
kits. The shortage of essential supplies and equipment may limit the ability of healthcare
providers to provide FANC services, resulting in a low uptake of FANC among pregnant
women.

Finally, inadequate community engagement may also contribute to the low uptake of FANC at
Bugina Model Health Centre. Community engagement involves mobilizing communities to
participate in their health, including ANC services. The lack of community engagement may
result in low awareness and demand for FANC services among pregnant women.

In conclusion, enhancing the implementation of FANC at Bugina Model Health Centre is crucial
to improving maternal and child health outcomes in the local community. This could involve
improving knowledge and awareness of FANC among pregnant women, providing training and
support to healthcare providers, ensuring adequate supplies and equipment are available, and
engaging the community to increase awareness and demand for FANC.