TABLE 7.

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
Strengths	Ministry of health involvement and ownership Guidelines and policies exist for most countries Strong political will and partner support exist for this intervention
Opportunities	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
Challenges	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.