Abstract
Objectives: This study aimed to introduce specific practices and analyze the effects of people-oriented integration of antenatal care services in Chongqing.Methods: A qualitative case study was conducted in Chongqing. A semi-structured interview was conducted by the research team, and interviewees included six government officials and eight executives of medical and antenatal care institutions. 466 pregnant women were also included in the study to analyze their utilization and satisfaction with maternal and infant health services.
Results: Approach : According to the time nodes, antenatal care is divided into five stages: pre-marriage, pre-pregnancy, pregnancy, delivery, and postpartum period, corresponding to 7 service links，connecting 28 related technical service items, deeply integrating similar service contents, and integrating related service items to form a complete Antenatal Care Full-cycle Service Package. Approach 2: On the basis of integrating fragmented service projects, Chongqing has explored needs and service gaps, developed new service projects, enriched the full-cycle service content, and provided comprehensive services to the demand side, such as integrating family planning consultation, follow-up, contraceptive device distribution, adverse reaction monitoring, and health education services are integrated into Care Project. Approach 3: Chongqing has improved the service information referral mechanism through institutional construction and information construction to ensure the accuracy and timeliness of service information. The maternal and child health information system has been added with maternal medical, health care and management information modules. The municipal maternal and child health care institutions can check the maternal information of the whole city, and primary medical institutions can check the maternal information within their jurisdiction, which is convenient for information management, service leakage detection and reminder for pregnant women. Approach 4: Chongqing has also innovated its service methods. The first is appointment referral service. In carrying out family doctor contract services for pregnant women, Chongqing has opened a green channel for appointment referral from primary medical institutions to the Municipal Maternal and Child Health Hospital. The second is to innovate the service purchase method. The Chongqing Municipal Health Commission has signed a service purchase agreement with medical institutions across the city and has developed prenatal and postnatal health service vouchers which are distributed free of charge, including five prenatal and two postnatal prenatal health services. Finally, we found that more than 85% of pregnant women believe that the medical treatment process in Chongqing is efficient. Chongqing has a high degree of equality in maternal health services, with prenatal examination rates, postpartum visit rates and maternal system management rates reaching around 95% or above.Conclusions: The integrated practice of antenatal care services in Chongqing can better meet the needs of local pregnant women. However, it should also be noted that the pregnant women have not enough understanding of integrated services, which has certain constraints on the service utilization. Therefore, it is necessary to continue to improve the public's awareness of integrated care.
Implications: Our findings offer valuable insights for bettering integrated care for the pregnant women in other regions of China and countries confronting fragmented care systems.Key words: integration, implementation, antenatal care services, case study.