**5. The basic antenatal care (BANC) approach**

Pattinson [28] describes the BANC approach as the minimum level of ANC that every pregnant woman should receive. Every aspect of the BANC approach has been developed from the best research evidence, and the only aspects of ANC that have been shown to be effective are included in the BANC approach [28]. The BANC approach does not intend to replace any existing programme but aims to combine all resources and to facilitate their use [28]. The BANC approach was introduced as a quality improvement strategy based on the belief that good-quality ANC could reduce maternal and perinatal mortalities and improve maternal health, aiming to achieve MDGs 4 and 5 [30]. This then led to the introduction of the BANC approach in the PHC clinics. Thus, the BANC was an approach being used in South Africa to render ANC services during the time of this study.

The BANC approach has been simplified to the bare minimum so that ANC services can be provided by every PHC clinic's midwives [28]. Because the BANC approach is a modified version of the FANC approach, it has many characteristics similar to the FANC approach. These include the approach focusing on early ANC attendance by all pregnant women and on limiting the total number of ANC visits to a minimum of four or five visits per pregnancy for low-risk women. This requires that ANC services should be provided daily at every facility frequented by pregnant women so that the first ANC visit takes place as soon as the pregnancy has been confirmed or the very first time that a pregnant woman visits a health facility [28]. If a pregnant woman is brought into the health system early, her health problems could be detected and managed or controlled early and treatment then has a greater chance of success. Pattinson [28] also states that all pregnant women with high-risk factors should be referred to the next level of care so that nurses at PHC level have sufficient time to attend to women with low-risk factors. Every site where pregnant women make contact with health services should be utilised because if all PHC clinics are providing BANC, then ANC could be started as soon as the pregnancy had been confirmed [2].

The BANC approach requires that two sets of checklists be used for recording purposes during ANC visits: one checklist to record the first visit and the other to use during subsequent follow-up visits. Pattinson [28] recommends that before commencing implementation of the BANC approach, each facility has to develop its own specific protocols for the management of obstetric conditions which must be in line with the South African National Maternity Care Guidelines and should be displayed in the facility. All the protocols should be counter-signed by the head of the obstetric unit from the hospital to which the facility refers the women with high-risk factors or complications during pregnancy. The protocols should be reviewed annually. Regular auditing of the ANC service should be an on-going process to ensure continuous improvement based on identifying and addressing potential shortcomings [2].

The BANC approach focuses on the quality rather than on the quantity of visits, with special emphasis on the fact that every visit should be goal directed [31]. The approach is included in the list of strategies provided by the NDoH to achieve MDGs 4 and 5 which are to reduce perinatal deaths and improve maternal health by 2015 [32]. A baseline audit of the ANC service and an analysis of the strengths, weaknesses, opportunities and threats (SWOT) of the facility should be conducted before commencing the implementation of the BANC approach. This enables the midwives to compile a realistic plan and process map for the implementation of the BANC approach [2]. Documents such as the handbook, guidelines and facility manager's guides are available to be used by the midwives during the implementation of the BANC approach [2]. According to the BANC handbook, each clinic should have one or more supervisors to perform the clinical supervision and the administrative tasks [2]. The manager is responsible for providing supportive supervision to the staff members in order to ensure that the clinic's programmes are implemented successfully [2].
