author(s)
Eyvonne Ngequih Tumasang, David Ayim, 5Relindis Kinsa Mborong and Wilfred Mbacham

abstract

Despite relatively high antenatal care (ANC) coverage in Cameroon, maternal and neonatal mortality remain high, suggesting that service quality rather than access alone may be the limiting factor. Oakland’s Total Quality Management (TQM) framework of the 4Ps (People, Planning, Processes, Performance) and 3Cs (Culture, Communication, Commitment) provides a structured approach for assessing ANC quality. A descriptive cross-sectional study was conducted. Data was collected from February to May 2021 in 14 health facilities in the Bamenda Health District. These facilities were classified at faith-based or public some instances and according to the level of care they rendered at others. Data were collected through structured observation of 224 ANC consultations and interviews with 14 ANC providers and managers and 356 pregnant women. A checklist aligned with WHO recommendations and the TQM framework was used for the observation. Quantitative data were analyzed using SPSS ver 21.

People: Faith-based facilities had more qualified ANC providers, while public facilities relied more on nursing assistants. Supportive supervision was limited, with managers consistently present only 28.6% of the time.

Planning: Only 35.5% of facilities offered ANC services daily. Essential equipment and ANC guidelines were inconsistently available, and half of providers were unaware of the national guideline.

Processes: First ANC consultations were rarely provided on the day pregnancy was confirmed (25%). Higher-level facilities better implemented laboratory tests, supplementation, and screening, while mid-level facilities engaged husbands and communities more effectively.

Performance: Basic services such as registration, urine testing, and iron-folic acid supplementation were consistently delivered (>95%), but tuberculosis screening and arranged delivery transportation were inadequate.

Culture: Providers were courteous, collaborative, and maintained privacy, though space constraints occasionally caused breaches.

Communication: Women were informed of examination findings 94.6% of the time, but emergency response systems functioned promptly only 25% of the time.

Commitment: Providers demonstrated strong dedication, yet only 27% of women booked ANC in the first trimester, reflecting weak early client engagement.

Conclusion:ANC coverage in Bamenda Health District is undermined by inconsistent service quality across the 4Ps and 3Cs dimensions. Strengthening supervision, ensuring daily service availability, enforcing guideline use, and integrating horizontal service delivery models are critical to improving maternal and neonatal outcomes.