Introduction
PRETERM BIRTH
Successful introduction of any new outpatient care strategy that disrupts the status quo to clinic flow and systems, poses numerous challenges, particularly in low-resource settings. One challenge is to ensure “implementation fidelity,” which is defined as the degree to which an intervention is implemented as intended [The Preterm Birth Initiative (PTBi)–Rwanda conducted a cluster randomized controlled trial of 36 health centers, using a standardized tool to assess number of providers, ANC volume, suitable space for group care, services, and equipment [This study analyzes quantitative data from Master Trainer assessments and explores additional information and insights from qualitative reports completed by Master Trainers. The study’s aims are two-fold. First, we measure the association between implementation time (experience), and implementation fidelity. Second, we aim to assess whether observer assessment and support contribute to facilitator skills improvement over time. We use our results to inform recommendations for monitoring of group ANC in similar contexts.The Rwanda model for group care was aligned with the WHO four visit focused ANC visit model [The Rwanda group ANC model was adapted and developed by a local technical working group and global group care experts. The technical working group was comprised of 10 Rwandan maternal-child health stakeholders who met 3 times over 3 months, for 4 to 8 hours each time. The group considered existing evidence around group ANC as well as constraints of their ANC delivery system. Using these data, the group agreed upon priorities, content and structure of the adapted group ANC model [