Study design – Rwanda & Zambia
The study will be implemented in two sequential phases. The first is a formative phase (approximately 6 months) to establish operational requirements and assess the country-adapted ANC digital module’s functionality. The WHO digital ANC module is a tool based on WHO-guideline-derived algorithms that provides clinical decision support and person-centric management, including tracking and patient records, to assist health workers in implementing the ANC package [The second, demonstration phase (24 months), employs a mixed methods stepped-wedge cluster randomized design implementation trial to test the introduction of the adapted ANC package and the digital tool in selected health facilities in both clusters (Fig. Baseline phase: Facilities will all begin with at least one four-month period of baseline data collection. Cluster 1 facilities will collect an additional four months of baseline data.Preparation phase for the deployment of the national package of ANC interventions: This will be a transition phase where all co-interventions, except the digital module, will be initiated. Adapted ANC package implementation phase: Health facilities will then have four months to implement the adapted ANC package.Adapted ANC package implementation and preparation for deployment of country-adapted ANC digital module: This will be a transition phase where the digital co-intervention will be initiated; the other four co-interventions will continue to be implemented.Adapted ANC package and adapted ANC digital module implementation: Facilities will deploy both the adapted ANC package and the digital tool to assist health workers in implementing the former.