Conclusion
This study aims to contribute to the limited body of research on monitoring group ANC implementation fidelity, in the context of low and middle income countries. We suggest a greater investment in monitoring and mentoring at program onset, with periodic visits thereafter. Our study’s findings also display the importance of using both quantitative and qualitative measures to assess implementation fidelity. This is particularly significant in identifying areas of implementation requiring greater support, such as room preparation, keeping time and curriculum knowledge. Future programs must consider contextual factors as well as innovation and flexibility in program monitoring and implementation when designing group ANC programs.