Facilitators and Barriers to the Implementation of the WHO Eight-Contact Antenatal Care Model in Osun State, Nigeria: A Qualitative Study
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Background
The eight-contact antenatal care (ANC) model was introduced by the World Health Organization (WHO) in 2016 to standardize maternal care and reduce maternal and fetal complications by decreasing morbidity and mortality. Despite its widespread adoption, implementation in many low- and middle-income countries, including Nigeria, has been inconsistent. This study explore the factors that facilitate and hinder the implementation of the eight-contact ANC model in specific healthcare facilities in Osun State, Nigeria.
Methods
A qualitative descriptive design was adopted, involving in-depth interviews with antenatal care providers and focus group discussions with pregnant women. Purposive sampling was used to select participants. Data were analysed thematically and triangulated with existing literature to enhance credibility and validity.
Results
Findings indicated that the eight-contact ANC model has not been widely adopted in the studied facilities, as most health facilities still follow traditional visit schedules based on gestational age. Key barriers include a lack of provider awareness and training, staff shortages, inadequate infrastructure, and financial constraints. Pregnant women also reported challenges such as low health literacy, delayed initiation of care, long travel distances, and negative attitudes from providers. Facilitators of implementing the model include healthcare providers’ willingness to adopt new approaches, availability of educational materials, client motivation regarding fetal well-being, and effective health education during visits.
Conclusion
A significant implementation gap exists between WHO guidelines and real ANC practice in Osun State. Addressing systemic weaknesses such as inadequate training, poor supervision, and lack of institutional support is vital. Policy interventions focusing on capacity building, client education, resource provision, and digital health innovations are necessary. Both healthcare providers and pregnant women have shown openness to the eight-contact model, indicating the potential for improved uptake through strategic reforms.
