Assessment of 2016 World Health Organization Antenatal Care Policy Domesticationand Implementation by Policy Makers and Providers in Ebonyi State, Nigeria

This study aimed to assess the domestication and implementation of the WHO 2016 antenatal care (ANC) policy in Ebonyi State, Nigeria. Specific objectives included evaluating the role of the Ebonyi State Primary Health Care Development Agency (EB- SPHCDA) in adopting the policy, assessing the implementation by healthcare workers, identifying constraints, and determining the impact of interventions. The study employed an intervention design with three phases: baseline, intervention, and post-intervention, targeting 32 key policymakers and 18 healthcare workers from six local government areas (LGAs) selected through multistage sampling. Data collection involved structured questionnaires for policymakers and healthcare workers, supplemented with secondary data from the national DHIS2 database. Interventions included workshops, training, and job aids distribution to improve policy implementation. Results indicated poor domestication of the WHO 2016 ANC policy, with only 15.6% of policymakers agreeing that the policy had been domesticated. Constraints such as insufficient funding, lack of training, and inadequate tools hindered the domestication process. Similarly, only 38.1% of healthcare workers reported effective policy implementation, with the major barriers being insufficient staff, increased workload from eight ANC contacts, and inadequate public awareness. Despite these challenges, post-intervention assessments showed significant improvements, with all participants scoring above the pass mark in post-tests following orientation on the policy. This study highlights the need for improved funding, training, and public awareness to enhance the domestication and implementation of the WHO 2016 ANC policy in Ebonyi State. Further interventions targeting these constraints could facilitate better maternal health outcomes in the state.