Independent Research on Improving Early Antenatal Care (ANC) Visits in the First Trimester

Location: Kenya, Malawi, Uganda, and Zambia

Consultancy Duration: Up to 45 days

Timeline: July – September 2025

1. Background

In November 2014, St John International launched the “Mama Na Mwana / Mother and Baby” programme, implemented by St John associations in Malawi, Uganda, Zambia, and Zimbabwe, with St John Kenya joining as a pilot in 2025. Over the past decade, this initiative has contributed significantly to improving maternal and newborn health across Sub-Saharan Africa.

 

To date, the programme has:

– Enrolled over 204,000 primary beneficiaries

– Reached 961,863 secondary beneficiaries

– Delivered health consultations to over 537,000 individuals

– Improved key maternal health indicators, including a 46% increase in ANC access and a 96% adoption rate for family planning

 

Through community engagement and stronger relationships between local health providers and families, the programme has helped instil a culture of partnership and sustained health improvement through household visits and clinical support

 

Despite this progress, the proportion of women enrolled in the programme attending antenatal care in the first trimester remains low. Anecdotal reasons for this are varied: due to limited awareness of the need to engage with the health service; sociocultural barriers around recognising the pregnancy; financial hardship; and the lack of service availability.

2. Programme Goal

Primary Goal:To reduce preventable maternal and infant mortality and morbidity in both rural and urban settings across Lilongwe and Blantyre (Malawi), Ongata Rongai Sub-County, Kajiado North (Kenya), Buikwe (Uganda), Lusaka and Chibombo (Zambia), and Zvimba (Zimbabwe).

Achieved through:Pregnant Women and new mothers are encouraged to adopt 7 healthy behaviours (as identified by WHO). Community volunteers provide education and encouragement while clinical services are supported to extend services.

3. Research Objectives

• Identify factors contributing to low first-trimester ANC attendance among women enrolled in the programme
• Assess current actions and interventions of St John volunteers to encourage attendance at first trimester ANC
• Explore interventions by other actors that have been successful in increasing uptake of ANC in the first trimester in similar contexts.
• Assess current policies and interventions targeting early ANC
• Document best practices from similar contexts
• Recommend evidence-based interventions that could be implemented within reasonable reach of the current programme set up, and outline implementation frameworks for their delivery

4. Scope and Approach

• Literature review of existing programmes, national health policies, and ANC-related data
• Field data collection through interviews and focus group discussions (FGDs) with enrolled women or previous enrolled first, based on their responses, further lines of enquiry to be developed targeting, community leaders, healthcare workers, and policymakers
• Comparative analysis of successful models in similar settings
• Development of practical recommendations and an implementation plan

5. Methodology

• Desk review of programme reports, government policy documents, and previous studies
• Qualitative research using key informant interviews (KIIs) and FGDs with target stakeholders and groups
• Stakeholder engagement involving Ministry of Health (DHO/Medical Office), NGOs, and community-based health actors
• Optional quantitative component, such as household surveys or facility-based assessments (as feasible)

6. Deliverables

• Inception Report: Research plan, detailed methodology, tools, and analytical approach
• Interim Report: Preliminary findings from the literature review and early data collection
• Draft Research Report: Full analysis including findings and draft recommendations
• Final Research Report: Revised based on feedback from stakeholders
• Presentation and Dissemination: Online for internal staff

7. Timeline & Milestones

July 2025: Inception, Literature Review

July – August 2025: Data Collection

August – September 2025: Data Analysis, Interim Report

September 2025: Draft Report and Feedback; Final Report Submission and Dissemination

8. Required Expertise

The consultant or institution should have demonstrated experience in maternal and child health research in sub-Saharan Africa. Key qualifications include:

• Experience with qualitative and quantitative research in resource-limited settings
• Strong background in community-level projects, public health, or health policy
• Ability to engage communities and interpret culturally sensitive issues
• Experience with the Three Delays Model will be considered an added advantage
• Previous research experience in at least two of the four focus countries is an added advantage

9. Supervision and Coordination

The consultant will report to the Programme Manager at St John International and work in close coordination with National Coordinators and field teams in each participating country.

10. Submission Requirements

• A cover letter introducing the applicant and summarising relevant experience
• A technical proposal detailing their understanding of this Terms of Reference, proposed approach, and methodology
• CV(s) of the lead researcher and key team members
• A statement of availability confirming exclusive engagement during the consultancy
• A budget proposal, excluding local travel and accommodation (to be covered by St John International)
• References from at least two recent, relevant assignments, with contact details
• A statement confirming that all liability and personal and professional insurance will be covered by the applicant, and that St John International will not be required to fulfil these needs.

11. Intellectual Property

All data and research outputs will remain the property of St John International. The final report and any derived publications will credit the consultant but will be published under the St John International name.

All documents must be submitted by email to the Programme Manager, Sylvia Chopamba, via recruitment@orderofstjohn.org by close of business Monday 9th June 2025.