{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:15:37Z","timestamp":1785420937067,"version":"3.56.0"},"reference-count":35,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: The integration of diagnostic services presents a critical opportunity to improve health outcomes in low- and middle-income countries (LMICs), potentially averting up to 1 million premature deaths annually. Antenatal care provides a critical platform for diagnosing multiple diseases in an integrated manner.\n\nAim: This study explored the experiences of healthcare providers and pregnant women using integrated diagnostic services at a primary care facility in Zimbabwe.\n\nSetting: A qualitative case study was conducted at Mabvuku Polyclinic in Harare, Zimbabwe.\n\nMethods: Using purposive sampling, 14 healthcare workers and 22 pregnant women participated in interviews. Observations and semi-structured interviews were recorded, transcribed and analysed using NVivo software. Thematic analysis was applied to identify key themes related to access, patient-provider interactions and systemic barriers.\n\nResults: According to the interviewees\u2019 reports, challenges such as limited resources, medical equipment and staff hinder efforts to integrate diagnostic services. The women strongly preferred integrated diagnosis, even if it meant enduring long waiting times, and valued the convenience of receiving all necessary services in a single visit. The study highlighted the hidden socio-economic barriers to \u2018free\u2019 healthcare and underscored the importance of addressing systemic inefficiencies.\n\nConclusion: The insights gained from this study are transferable and contribute to the understanding of integrated diagnostic services in maternal healthcare contexts.\n\nContribution: They offer practical recommendations for improving service delivery and health outcomes in similar settings.<\/jats:p>","DOI":"10.4102\/phcfm.v17i1.4847","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T20:12:36Z","timestamp":1748635956000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of integrated services in antenatal care: A case study of Mabvuku Polyclinic, Zimbabwe"],"prefix":"10.4102","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3068-6504","authenticated-orcid":false,"given":"Gamuchirai P.","family":"Gwaza","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/052gg0110","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7907-2442","authenticated-orcid":false,"given":"Danai T.","family":"Zhou","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04ze6rb18","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2101-0390","authenticated-orcid":false,"given":"Annette","family":"Pl\u00fcddemann","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/052gg0110","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1009-1992","authenticated-orcid":false,"given":"Carl","family":"Heneghan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/052gg0110","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Oxford"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Fleming KA, Horton S, Wilson ML, et al. 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Zimbabwe National Statistics Agency; 2022."},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Mbunge E, Chemhaka G, Dzinamarira T, et al. Determinants of under-five mortality in Zimbabwe: Evidence from the 2015\u20132016 Zimbabwe demographic Health Survey data. Women Child Nurs. 2024;2(1):1\u20138. https:\/\/doi.org\/10.1016\/j.wcn.2024.02.001","DOI":"10.1016\/j.wcn.2024.02.001"},{"key":"ref6","unstructured":"International ZNSAaI. Zimbabwe Demographic Health Survey 2015: Final report. Rockville, MD: Zimbabwe National Statistics Agency; 2016."},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"David R, Evans R, Fraser HS. Modelling prenatal care pathways at a Central Hospital in Zimbabwe. Health Serv Insights. 2021;14:11786329211062742. https:\/\/doi.org\/10.1177\/11786329211062742","DOI":"10.1177\/11786329211062742"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Dudley L, Garner P. Strategies for integrating primary health services in low- and middle-income countries at the point of delivery. Cochrane Database Syst Rev. 2011;7:CD003318. https:\/\/doi.org\/10.1002\/14651858.CD003318.pub3","DOI":"10.1002\/14651858.CD003318.pub3"},{"key":"ref9","unstructured":"WHO. Integrated Health Services \u2013 What and Why? World Health Organisation; 2008."},{"key":"ref10","unstructured":"WHO. WHO global strategy on people-centred and integrated health services. 2015."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Teo KW, Hu Y, Chew KT, et al. Health System Transformation Playbook and Unified Care Model: An integrated design, systems & complexity thinking approach to health system transformation. Front Health Serv. 2023;3:1157038. https:\/\/doi.org\/10.3389\/frhs.2023.1157038","DOI":"10.3389\/frhs.2023.1157038"},{"key":"ref12","unstructured":"WHO. Integrated care models overview. 2016."},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42(8):846\u2013854. https:\/\/doi.org\/10.1080\/0142159X.2020.1755030","DOI":"10.1080\/0142159X.2020.1755030"},{"key":"ref14","unstructured":"Gwaza G. Evaluation of ZimHealth\u2019s investment in upgrading Mabvuku Polyclinic Zimbabwe. 2024."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med. 2022;292:114523. https:\/\/doi.org\/10.1016\/j.socscimed.2021.114523","DOI":"10.1016\/j.socscimed.2021.114523"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Braun V, Clarke V. Thematic analysis. In APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological, American Psychological Association. 2012, p. 57\u201371. https:\/\/doi.org\/10.1037\/13620-004","DOI":"10.1037\/13620-004"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Eric Omo I, Chikodili Adolphus M, Godwin Bernard O, Onyekwuo Chinonye F, Angela Adaugo J-I. Effect of Rhesus factor incompatibility on maternal outcome (fertility): A comprehensive review. Int J Front Life Sci Res. 2023;5(2):001\u2013007. https:\/\/doi.org\/10.53294\/ijflsr.2023.5.2.0081","DOI":"10.53294\/ijflsr.2023.5.2.0081"},{"key":"ref18","unstructured":"WHO. Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. World Health Organisation; 2010."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Gengiah S, Barker PM, Yende-Zuma N, et al. A cluster-randomized controlled trial to improve the quality of integrated HIV-tuberculosis services in primary healthcareclinics in South Africa. J Int AIDS Soc. 2021;24(9):e25803. https:\/\/doi.org\/10.1002\/jia2.25803","DOI":"10.1002\/jia2.25803"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Alemnji G, Mosha F, Maggiore P, et al. Building integrated testing programs for infectious diseases. J Infect Dis. 2023;228(10):1314\u20131317. https:\/\/doi.org\/10.1093\/infdis\/jiad103","DOI":"10.1093\/infdis\/jiad103"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Tapela N, Tshisimogo G, Shatera BP, et al. Integrating noncommunicable disease services into primary health care, Botswana. Bull World Health Organ. 2019;97:142\u2013153. https:\/\/doi.org\/10.2471\/BLT.18.221424","DOI":"10.2471\/BLT.18.221424"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Sweeny S, Obure C, Terris-Prestholt F, et al. The impact of HIV\/SRH service integration on workload: Analysis from the Integra Initiative in two African settings. Hum Resour Health. 2014;12:42. https:\/\/doi.org\/10.1186\/1478-4491-12-42","DOI":"10.1186\/1478-4491-12-42"},{"key":"ref23","unstructured":"Corneli A, Jarrett N, Sabue M, et al. Patient and provider perspectives on implementation models of HIV counseling and testing for patients with TB. Int J Tuberc Lung Dis. 2008;12(3):579\u2013584."},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"De Jongh TE, Gurol-Urganci I, Allen E, Zhu NJ, Atun R. Integration of antenatal care services with health programmes in low- and middle-income countries: Systematic review. J Glob Health. 2016;6(1):010403. https:\/\/doi.org\/10.7189\/jogh.06.010403","DOI":"10.7189\/jogh.06.010403"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Gwaza G, Pluddemann A, McCall M, Heneghan C. Integrated diagnosis in Africa\u2019s low- and middle-income countries: What is it, what works, and for whom? A realist synthesis. Int J Integr Care. 2024;24(3):20. https:\/\/doi.org\/10.5334\/ijic.7788","DOI":"10.5334\/ijic.7788"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Hyle P, Naidoo K, Su A, El-Sadr M, Freedberg A. HIV, tuberculosis, and non-communicable diseases: What is known about the costs, effects, and cost-effectiveness of integrated care? J Acquir Immune Defic Syndr. 2014;67(1):S87\u2013S95. https:\/\/doi.org\/10.1097\/QAI.0000000000000254","DOI":"10.1097\/QAI.0000000000000254"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Church K, Wringe A, Lewin S, et al. Exploring the feasibility of service integration in a low-income setting: A mixed methods investigation into different models of reproductive health and HIV care in Swaziland. PLoS One. 2015;10(5):e0126144. https:\/\/doi.org\/10.1371\/journal.pone.0126144","DOI":"10.1371\/journal.pone.0126144"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Kerrissey M, Tietschert M, Novikov Z, et al. Social features of integration in health systems and their relationship to provider experience, care quality and clinical integration. Med Care Res Rev. 2022;79(3):359\u2013370. https:\/\/doi.org\/10.1177\/10775587211024796","DOI":"10.1177\/10775587211024796"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Hope R, Kendall T, Langer T, Barningausen T. Health systems integration of sexual and reproductive health and HIV services in sub-Saharan Africa: A scoping study. J Acquir Immune Defic Syndr. 2014;67:S259\u2013S270. https:\/\/doi.org\/10.1097\/QAI.0000000000000381","DOI":"10.1097\/QAI.0000000000000381"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Duffy M, Ojikutu B, Andrian S, Sohng E, Minior T, Hirschhorn L. Non-communicable diseases and HIV care and treatment: Models of integrated service delivery. Trop Med Int Health. 2017;22(8):926\u2013937. https:\/\/doi.org\/10.1111\/tmi.12901","DOI":"10.1111\/tmi.12901"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Doherty T, Chopra M, Tomlinson M, Oliphant N, Nsibande D, Mason J. Moving from vertical to integrated child health programmes: Experiences from a multi-country assessment of the Child Health Days approach in Africa. Trop Med Int Health. 2010;15(3):296\u2013305. https:\/\/doi.org\/10.1111\/j.1365-3156.2009.02454.x","DOI":"10.1111\/j.1365-3156.2009.02454.x"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Torpey K, Iwelunmor J, Ezechi O, et al. Capabilities, opportunities and motivations for integrating evidence-based strategy for hypertension control into HIV clinics in Southwest Nigeria. 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