Patient and Provider Barriers to Implementing the WHO Eight-Contact Antenatal Care Model in Osun State, Nigeria

ABSTRACT

Background: The WHO recommended a minimum of eight antenatal care (ANC8+) contacts to improved maternal and neonatal outcomes. However, the adoption of this guideline is slow in low- and middle-income countries. This study aimed to evaluate the extent of the ANC8+ implementation gap in Osun State, Nigeria, and identify key patient and provider-side barriers.

Methods: A sequential explanatory that is mixed methods design was employed. The quantitative phase involved a cross section survey of 400 postpartum women in selected Osun State public health facilities to determine ANC8+ utilization prevalence and associated factors using multivariable logistic regression. The qualitative phasse included indepth interviews (IDIs) with 25 mothers and focus group discussions (FGDs) with 15 healthcare providers to explore barriers and facilitators guided by the Socio-Ecological Model (SEM).

Results: Only 28.5% of the sampled women completed that the recommended ANC8+ contacts. Multivariable analysis showed that low educational attainment (AOR: 2.15; 95% CI: 1.45–3.20) and residence in rural LGAs (AOR: 1.88; 95% CI: 1.29–2.75) were significantly associated with non completion. Qualitative finding reveal that critical barriers at the institutional and individual levels. Provider side barriers centered on staffing shortages, lack of specific ANC8+ training, and prolonged patient waiting timing. Patient side barriers included high indirect costs example transport and tests, limited health literacy regarding the necessity of eight visits, and poor male partner involvement.

Conclusion: The implementation of the WHO ANC8+ model in Osun State is severely constrained by the both systemic health service deficiencies and significant socio-economic barriers. So bridging this gap requires urgent, coordinated policy reforms, focusing on health worker capacity building, resource decentralization, and targeted financial support for vulnerable populations to achieve health equity.