WHO recommendations on antenatal care for a positive pregnancy experience

the Department of RHR. 8 The ANC guideline
<strong>recommendations</strong> will be made available via this new
search function.
The Maternal and Perinatal Health and Preventing
Unsafe Abortion team of the <strong>WHO</strong> Department
of RHR, in collaboration with the Departments of
NHD and MCA and other partners, will support
national and subnational working groups to adapt
and implement the guideline. This process will
include the development or revision of existing
national guidelines or protocols in line with the <strong>WHO</strong>
guideline. The GREAT Network (Guideline-driven,
Research priorities, Evidence synthesis, Application
of evidence, and Transfer of knowledge) will be used
to bring together relevant stakeholders to identify
and assess the priorities, barriers and facilitators to
guideline implementation, and to support the efforts
of stakeholders to develop adaptations and guideline
implementation strategies tailored to the local
context (214). This includes technical support for
local guideline implementers in the development of
training manuals, flow charts and quality indicators,
as well as participation in stakeholder meetings.
6.2 Applicability issues
Anticipated impact of the guideline on the
organization of ANC
Effective implementation of the <strong>recommendations</strong>
in this guideline will likely require reorganization of
care and redistribution of health-care resources,
particularly in low- and middle-income countries
(LMICs). The potential barriers to implementation
include the following:
• nlack of human resources with the necessary
expertise and skills to implement, supervise and
support recommended practices, including client
counselling;
• nlack of infrastructure to support interventions, e.g.
lack of power to support ultrasound equipment;
• nlack of physical space to conduct individual or
group-based counselling;
• nlack of community understanding of the new
model of care, particularly around the contact
schedule and potentially longer wait times;
• nlack of physical resources, e.g. equipment, test kits,
supplies, medicines and nutritional supplements;
8 This can be accessed at: search.optimizemnh.org
• nlack of effective referral mechanisms and care
pathways for women identified as needing
additional care;
• nlack of understanding of the value of newly
recommended interventions among health-care
providers and system managers.
• nlack of health information management systems
(HMISs) designed to document and monitor
recommended practices (e.g. client cards,
registers, etc.).
Given the potential barriers noted above, a
phased approach to adoption, adaptation and
implementation of the guideline <strong>recommendations</strong>
may be prudent. Various strategies for addressing
these barriers and facilitating implementation have
been suggested in the list of considerations at the end
of Chapter 4.
Monitoring and evaluating the impact of
the guideline
The implementation and impact of these
<strong>recommendations</strong> will be monitored at the healthservice,
regional and country levels, based on clearly
defined criteria and indicators that are associated
with locally agreed targets. In collaboration with
the monitoring and evaluation teams of the
<strong>WHO</strong> Departments of RHR and MCA, data on
country- and regional-level implementation of the
<strong>recommendations</strong> will be collected and evaluated in
the short to medium term to evaluate their impact on
national policies of individual <strong>WHO</strong> Member States.
Interrupted time series, clinical audits or criterionbased
audits could be used to obtain the relevant
data on the interventions contained in this guideline.
6.3 Updating the guideline
In accordance with the concept of <strong>WHO</strong>’s GREAT
Network, which employs a systematic and continuous
process of identifying and bridging evidence gaps
following guideline implementation (214), the
proposed guideline will be updated five years
after publication unless significant new evidence
emerges that necessitates earlier revision. The <strong>WHO</strong>
Steering Group will continue to follow the research
developments in the area of ANC, particularly for
those questions for which no evidence was found and
those that are supported by low-quality evidence,
where new <strong>recommendations</strong> or a change in the
published recommendation may be warranted,
Chapter 6. Dissemination, applicability and updating
121