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The Maternal, Child and Women’s Health Unit, in collaboration with the Population Council’s FRONTIERS in Reproductive Health (FRONTIERS) program, the Reproductive Health Research Unit of the University of Witwatersrand, and the Department of Medical Microbiology and Infectious Diseases of the Nelson Mandela School of Medicine, University of Natal, developed and then pilot-tested this revised model in KwaZulu-Natal, South Africa. The project’s objective was to develop and test an improved and integrated antenatal care program for public-sector clinics that would increase the range and quality of services received by pregnant women and improve their reproductive health behavior and status. Various problems, such as trainer and staff turnover, were encountered during and immediately after introduction that influenced the clinics’ capacity to implement and sustain the reorganized services. This implies that efforts to scale-up or replicate this model must consider such resource issues, and that other support systems, such as staff supervision and educational materials, also need attention. It is possible to conclude, however, that interventions such as this, that rely heavily on training staff in new ways of organizing and providing services, must develop and use training and supervisory strategies or systems that are explicitly designed to incorporate relatively rapid rates of staff turnover. This study also highlights the importance of paying attention to health systems when introducing revised or new services, especially HIV-related services.






Frontiers in Reproductive Health