Courier Innovation for Community Empowerment and Improved Antenatal Visit Coverage: Evidence from a Mixed Methods Study in Baraka District

Limited transportation facilities remain a major obstacle for pregnant women, especially in remote areas, to access antenatal care (ANC) services. To address this challenge, a standby courier service was developed as a community-based innovation aimed at overcoming geographical barriers and improving ANC coverage. This study employed a mixed methods design using an explanatory sequential model. In the quantitative phase, a quasi-experimental approach was conducted among 60 respondents, divided into intervention (n=30) and control (n=30) groups. Data were analyzed using paired t-test and independent t-test. The qualitative phase involved in-depth interviews and focus group discussions with 12 informants, including pregnant women, couriers, and health workers. Data were analyzed using reflexive thematic analysis. The intervention group demonstrated a significant increase in antenatal visits (mean increase of 1.47 visits; p < 0.001) compared with the control group (0.197). Coverage of K1 and K4 also showed significant improvement (p < 0.05). Furthermore, 80% of pregnant women reported being satisfied to very satisfied with the courier service. Qualitative findings highlighted the multifaceted role of couriers as schedule reminders, travel companions, and providers of emotional support. Challenges included inadequate incentives and logistical limitations. Courier services effectively increase ANC visits and are socially well accepted. Replication of this program is recommended as a cost-effective, adaptive, and empowering community-based intervention, supported by formal policy integration, structured training, and sustainable funding.