Group Antenatal Care Model as an innovative and sustainable maternal and child health service delivery in a Northern Nigerian State

The maternal and child health situation in developing countries remains critical and deeply concerning, These regions account for 99% of global maternal and under-five deaths. In Nigeria, uptake of critical life-saving maternal, neonatal and child health (MNCH) services, delivered through antenatal care (ANC), are sub-optimal, leading to poor outcomes. Group antenatal care (G-ANC) is an evolving antenatal care delivery model in low and medium-income countries. G-ANC models can improve quality and uptake of maternal health services.G-ANC model was implemented across 255 primary health facilities (PHFs) to ensure pregnant women receive components of a well-defined package of MNCH services at regular intervals through facilitated learning approaches delivered by trained health care workers. PHFs were selected based on predetermined criteria including availability of four health care workers, 24 hours operation, capacity to conduct antenatal and delivery services, and availability of space to conduct group activities. A total of 765 health care workers were trained and facilitated 26,769 G-ANC sessions between January 2021-February 2022 for 309,751 pregnant women who together formed a total of 23,220 cohorts. A total of 78,015 (25%) of pregnant women enrolled for the G-ANC were referred by Community Influencers. Post-intervention, at end-line there was more than two-fold increase (228%) in uptake of four-doses of Intermittent Preventive Treatment (IPT) of malaria (6.5% vs 21.5%), 152% increase in acceptance of post-partum contraceptives (11.4% vs 28.9%), and 66.4% increase in 8^th ANC visit (10.2% vs 16.9%). G-ANC provides opportunities to layer other high impact interventions across the RMNCAH+N continuum of care and should be scaled-up to all health facilities to improve uptake of RMNCAH+N services. Intersectoral collaboration, including relevant government agencies and other key players in the RMNCH space should seek to empower and educate communities on G-ANC to further increase ANC uptake by pregnant women.