Service Delivery Issues in the Provision of Antenatal Care in South Africa

Barbara S. Janowitz, Family Health International
Saiqa Mullick, Reproductive Health Research Unit
Busisiwe Kunene, Reproductive Health Research Unit
Nudgga Maggwa, Population Council
Carmen Cuthbertson, Family Health International
Laura Johnson, Family Health International
Stirling Cummings, Family Health International
Mags Beksinska, Reproductive Health Research Unit

We conducted a study to evaluate the provision of antenatal services to clients in South Africa in 2001. We used client flow analysis (CFA) to determine contact and waiting times for types of clients and activity sampling to determine how providers spent their time. The average antenatal first visit client spent over 4 hours in the clinic with mostly waiting. By 8:30 over 50% of antenatal clients had their first contact. The minimum package is a series of examinations that includes history taking, physical examination, weight, blood pressure, urine, blood taking and treatment. A high percentage of clients did not get the full package. Providers spent an average of 37% of their day in direct contact with clients. In only 52% of antenatal first visit contacts and 41% of repeat visit contacts was information provided on eight key counseling topics. Contacts in which clients received counseling were longer.