Chelwa Nachela, Ngabo Bernard R, Nyirenda Muyereka, Sabine Musange F, Barreix María, Tamrat Tigest, Okpara Natasha, Phiri Chifundo, Murindahabi Nathalie K, Nzeyimana David, Makai Tobias, Uwayezu Gilbert, Yabalwazi Gladys, Kangwa Mwamba, Muliokela Rosemary K, Mehrtash Hedieh, Chizuni Caren, Mutabazi Vincent, Sayinzoga Felix, Mbizvo Michael T, Bucagu Maurice, Tunçalp Özge
Population Council, Lusaka, Zambia.
School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
PLOS Digit Health. 2025 Jun 23;4(6):e0000910. doi: 10.1371/journal.pdig.0000910. eCollection 2025 Jun.
The Ministries of Health in Zambia and Rwanda have adapted and validated their national antenatal care (ANC) guidelines in line with WHO 2016 recommendations. Both countries conducted implementation research, composed of five implementation strategies to support the adapted ANC package service delivery. One implementation strategy deploys a digital module, a point of service digital tool that encompasses clinical decision support and person-centric record management to support health workers in implementing the adapted ANC packages. The formative phase of the study, included countries' adaptation of the WHO digital ANC module to their contexts in three steps: (i) the reference module was tailored to create Rwanda and Zambia ANC digital modules and training materials; (ii) health workers were trained to use the module and provide feedback; (iii) country research teams conducted qualitative assessments to understand the health worker experience using the adapted ANC module. ANC health workers at selected facilities completed a three-day training on the use of the module. Qualitative methods were used to understand health worker's perspectives on the module's use for service provision and feedback for its refinement. The three major themes emerged: i) experiences using digital interventions in the health profession; ii) strengths and challenges related to the use of digital interventions; iii) considerations for improving the use of digital interventions within health systems. Rwanda and Zambia ANC modules were modified to improve their use for ANC services delivery. Initial testing led to the identification and fixing of bugs in the system. The module was updated to include dashboards to support facility-based monitoring of ANC indicators. Training materials were also improved based on feedback from interviews of health workers. The iterative process in developing country-adapted digital ANC modules is key to their deployments for routine use and a key proof of concept for the WHO SMART guideline approach.
赞比亚和卢旺达的卫生部已根据世界卫生组织2016年的建议调整并验证了本国的产前保健（ANC）指南。两国都开展了实施研究，该研究由五项实施策略组成，以支持经调整的ANC套餐服务的提供。其中一项实施策略部署了一个数字模块，这是一种服务点数字工具，包含临床决策支持和以人为本的记录管理，以支持卫生工作者实施经调整的ANC套餐。该研究的形成阶段包括各国分三步将世界卫生组织的数字ANC模块因地制宜进行调整：（i）对参考模块进行定制，以创建卢旺达和赞比亚的ANC数字模块及培训材料；（ii）培训卫生工作者使用该模块并提供反馈；（iii）国家研究团队进行定性评估，以了解卫生工作者使用经调整的ANC模块的体验。选定设施的ANC卫生工作者参加了为期三天的该模块使用培训。采用定性方法来了解卫生工作者对该模块用于服务提供的看法以及对其改进的反馈。出现了三个主要主题：i）在卫生专业中使用数字干预措施的体验；ii）与使用数字干预措施相关的优势和挑战；iii）改善卫生系统内数字干预措施使用的考虑因素。卢旺达和赞比亚的ANC模块进行了修改，以更好地用于ANC服务的提供。初步测试发现并修复了系统中的漏洞。该模块进行了更新，以纳入仪表板，支持对ANC指标进行基于机构的监测。培训材料也根据对卫生工作者访谈的反馈进行了改进。开发适合各国国情的数字ANC模块的迭代过程是其用于常规使用的关键，也是世界卫生组织SMART指南方法的关键概念验证。
