Healthcare Providers Experiences and Perceptions in Delivering Preconception Care Services at Primary Healthcare Facilities in Tanzania

Abstract

Background: Preconception care (PCC) is a key strategy for reducing preventable maternal and child deaths. The global Maternal Mortality Rate (MMR) stands at 223 per 100,000 live births, with 545 in Sub-Saharan Africa and 104 in Tanzania. Nearly 95% of maternal deaths occur in Low- and Middle- Income Countries (LMICs). Effective PCC can help identify and manage health issues before pregnancy, but in Tanzania, it remains underappreciated as a standalone service.

Aim of the Study: This study explored the experiences and perceptions of healthcare providers (HCPs) in the provision of preconception care (PCC) services to women of reproductive age at Mnazi Mmoja Hospital, Dar es Salaam.

Materials and Methods: A case study design with a qualitative approach was conducted to explore healthcare providers’ experiences and perceptions of Preconception Care (PCC). Fourteen HCPs from Reproductive and Child Health Clinics, with a minimum of three years of experience, were purposefully selected. In-depth interviews were conducted using a semi-structured guide, recorded, transcribed, and analyzed using inductive-deductive thematic analysis.

Results: HCPs understood the importance of preconception care (PCC) and associated risks of missing it, such as a woman conceiving with pre-existing complications, risk for a child born with neural tube defects and increased chance of high-risk pregnancy and high-risk infant. But lacked adequate knowledge of its full content and expressed low confidence and competence in delivering the services. Major challenges identified included insufficient infrastructure for stand-alone PCC service provision, staff shortages, lack of PCC guidelines and educational materials, lack of refresher training on PCC and limited community awareness towards PCC services. HCPs also shared their experiences on the implementation of PCC that Services were offered inconsistently and opportunistically due to competing clinical demands. However, drivers such as teamwork, organizational support, provider motivation, and awareness of PCC’s health benefits facilitated service delivery.

Conclusion: This study highlights the gaps and opportunities in the provision of preconception care (PCC) services. While healthcare providers understand the value of PCC, challenges such as limited knowledge, lack of guidelines, inadequate infrastructure, and low community awareness hinder effective implementation. However, teamwork, provider motivation, and leadership support were identified as key enablers. Addressing these barriers through capacity building, community education, and system-level planning can strengthen PCC services and improve maternal and newborn health outcomes.

Recommendations: Based on the study findings, it is recommended that preconception care (PCC) services be integrated into existing healthcare units such as family planning, outpatient, and antenatal clinics. Establishing dedicated PCC clinics and involving Community Health Workers (CHWs) can help improve service reach and community awareness. Policy-level engagement is crucial, including incorporating PCC into national reproductive health strategies and allocating appropriate resources. Education and training should be strengthened by including PCC in medical and nursing curricula and offering regular refresher training for providers. Additionally, community outreach through digital platforms, mass media, and engagement with religious and local leaders can enhance public awareness and cultural acceptance of PCC services.