ACS Implementation Lessons Learned, Strengths, Opportunities, and Challenges Reported by Key Informants

Lessons Learned
  • ACS should be added to the EML for obstetric use

  • Intervention needs to be cost-effective

  • Need comprehensive package, not just guidelines

  • Stakeholders need to be informed of new WHO recommendations

  • Policies, guidelines, preservice education, in-service education, and regulatory bodies all need alignment

  • Need increased community awareness of preterm birth

  • Ministry of health involvement and ownership

  • Guidelines and policies exist for most countries

  • Strong political will and partner support exist for this intervention

  • Expand standards and guidelines to include assessment (i.e., how to determine who should receive ACS)

  • Need studies of ACS impact at scale

  • Partner commitment, political will

  • Strengthen quality of ANC

  • Increase community awareness to reduce delay in diagnosis

  • Inadequate training and capacity building

  • Inadequate information available to safely scale up the intervention in low-income countries

  • Delay in diagnosis of preterm labor

  • ACS not in preservice training

  • Poor supply chain

  • Lack of trained health care workers

  • No specific implementation guidelines for new WHO recommendations

  • Lack of diagnostics such as ultrasound to determine gestational age

  • Many deliveries are occurring at lower-level facilities where it is not appropriate to provide ACS

  • Abbreviations: ACS, antenatal corticosteroids; ANC, antenatal care; EML, essential medicines list; WHO, World Health Organization.