In this guide
The eight-contact schedule
Kenya follows the World Health Organization's 2016 recommendation of at least eight antenatal contacts. The first should happen in the first trimester, ideally before 12 weeks, and the rest are spread through pregnancy, with contacts at around 20, 26, 30, 34, 36, 38 and 40 weeks. Each contact has a purpose: screening, supplements, vaccination, birth planning and catching danger signs early.
The gap between knowing the schedule and a mother completing it is where most units lose her. Many mothers come for the first visit and then appear again only in labour, or not at all.
Why mothers miss visits
- They forget the date. A date written on a card in the first trimester is easy to lose by week 26.
- They feel well. If nothing hurts, a visit can feel optional, especially when it costs a day's earnings and transport.
- They do not know what the next visit is for. "Come back in four weeks" is weaker than "next visit we check your blood pressure and the baby's growth".
- Something happened at the last visit. A long wait, a harsh word or a confusing bill is enough to lose a mother quietly.
- Another facility reached her first. Mothers move between facilities more than records show.
- Loss or complication. Some mothers stop coming because of a miscarriage or bereavement. These need a human, gentle approach, never an automated reminder.
Eight steps that work
- Capture a working phone number and preferred language at booking. Confirm it by sending a message before she leaves the building.
- Book the next contact before she leaves. A specific date and time beats "in four weeks".
- Tell her what the next visit is for. One sentence, in her language.
- Remind twice. Two days before and on the morning of the visit, with a simple reply option. Our free reminder templates are ready to copy.
- Keep a weekly defaulter list. Every mother more than seven days past a due contact goes on it, with a named person responsible for calling.
- Call, do not only text, the silent ones. A mother who ignores two messages needs a voice.
- Escalate danger signs the same day. Any mention of bleeding, severe headache, blurred vision, reduced fetal movement or severe pain goes straight to a nurse.
- Handle loss with care. Flag bereavement in the record so that no reminder is ever sent, and let a nurse make contact personally.
How to measure progress
Pick one number and review it every month: the ANC completion rate, meaning the share of mothers who delivered this month and completed the contacts due for their gestation. Track the defaulter list size alongside it. If completion rises and the list shrinks, the steps are working. Our guide to measuring patient retention shows how to calculate this from your register.
Where a system helps
Every step above can be done by hand, and some units do it well. It gets hard when the list grows past what one nurse can call, when staff rotate, or when the person who kept the list goes on leave.
HealthBridge MCH runs this workflow automatically: reminders on the MOH schedule in English or Kiswahili, replies read and danger signs escalated to a nurse immediately, silent mothers flagged, and bereaved mothers never auto-messaged. A registered nurse designed it.
See the report owners receive every month
A real sample of the monthly retention report: returning patients, no-shows, ANC completion, immunisations and the patients slipping away. Fictional facility, real format. Free, no follow-up calls.