Co-intervention 1: training of selected primary healthcare staff on adapted ANC package
WHO AFRO developed training resources (including facilitator guides and presentations, etc.) for the WHO ANC recommendations. Each country team will tailor these resources for health workers who are involved in the provision of ANC services at selected health facilities. In India, Jhpiego resources were also incorporated into the training materials. Where appropriate, a Training of Trainers (ToT) model will be applied. Thereafter, ANC health workers [and in some cases, catchment area staff, such as community health workers (CHWs)] will be trained on the adapted ANC package during 3–5 day training and orientation sessions. Where applicable, existing ANC registers at selected study facilities (and catchment areas) and client cards issued to all pregnant women used for recording ANC services will be modified to capture service data according to the adapted ANC package. The training and supervision sessions (see co-intervention 2) will include capacity building of health workers on these modified recording tools.In Burkina Faso, Rwanda and Zambia, nurses and/or midwives providing ANC service in study facilities will be trained to conduct ultrasounds (before 24 weeks of gestation). Country teams will develop a package to train primary health workers to use and interpret ultrasound machines and results. A team made up of obstetricians/gynaecologists and/or radiologist technicians will conduct the trainings, which will include an introduction to theory and a practice component. Study facilities will select at least one ANC health worker to attend. Results from the training evaluation will assist in identifying components that will require continuous support through supervision.