Introduction of Point-of-Care Ultrasound in Primary Healthcare in Edo State, Nigeria: Achievements, Barriers, and Implementation Realities

Background: Imagine a disaster of finding major placenta previa during delivery in a rural setting without a facility to manage? This would have been averted with a prior obstetric imaging. Antenatal care without imaging is like “groping in the dark”. Unfortunately, in low- and middle-income countries (LMICs), this is obtainable. Due to limited access to ultrasound equipment and/ trained personnel, these often delay the detection of high-risk pregnancy conditions until delivery. The integration of point-of-care ultrasound into antenatal care (ANC) is critical for improving maternal-fetal outcomes. Implementation of the task-shifting strategy following requisite training and quality assurance is an option in the deployment of this technology. Aim: To explore the achievements and barriers of implementation of Obstetric Point-Of-Care Ultrasound Scan (POCUS) in Primary Healthcare Centers (PHCs) in Edo state. To conduct a post-training assessment of participants' utilization of and explore the facilitators and barriers to POCUS in the PHCs in Edo state. Methods: It was an exploratory qualitative study conducted in Edo state PHCs, with some elements of implementation research design involving healthcare providers that had undergone basic obstetric ultrasound training. Purposive sampling was used to select one participant from each of the eighteen local government areas of the state. Two health care workers (one nurse and one doctor) were selected from each of the 18 local government areas to participate in an accredited basic ultrasound training program delivered by qualified and experienced trainers. These participants underwent a 3-week training in point-of-care obstetric ultrasound. Four months following the training and deployment of the machines to their stations, in-depth interviews were conducted to obtain the experiences of the participants regarding the service delivery of POCUS. Result: Of the eighteen respondents, 17 had commenced service delivery of POCUS. One was yet to commence work as the PHC was being renovated. A total of 622 obstetric scans were done within 4 months of the introduction of POCUS at the PHC facilities. Four key themes emerged from the interviews: (1) Obstetric ultrasound skills gained; (2) Increase in maternity services utilization at the PHC and improved management of pregnant women; (3) Providers’ perception of clients’ experiences, and (4) Challenges. Conclusion: The introduction of point-of-care obstetric ultrasound scan in PHC facilities in Edo state is a reality and is currently ongoing. Implementation has resulted in increased and satisfactory antenatal service utilization in Edo State PHCs. The trainees reported positive experiences amidst power outages and increased workload challenges.