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Effects of appointment scheduling on waiting time and utilisation of antenatal care in Mozambique
  1. Maria Steenland1,
  2. Janeth Dula2,
  3. Amanda de Albuquerque3,
  4. Quinhas Fernandes4,
  5. Rosa Marlene Cuco4,
  6. Sergio Chicumbe2,
  7. Eduardo Samo Gudo2,
  8. Sandra Sequeira5,
  9. Margaret McConnell6
  1. 1Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
  2. 2Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
  3. 3Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
  4. 4National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
  5. 5Department of International Development, London School of Economics, London, UK
  6. 6Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Maria Steenland; maria_steenland{at}


Background Poor patient experience, including long waiting time, is a potential reason for low healthcare utilisation. In this study, we evaluate the impact of appointment scheduling on waiting time and utilisation of antenatal care.

Methods We implemented a pilot study in Mozambique introducing appointment scheduling to three maternity clinics, with a fourth facility used as a comparison. The intervention provided women with a return date and time for their next antenatal care visit. Waiting times and antenatal care utilisation data were collected in all study facilities. We assessed the effect of changing from first come, first served to scheduled antenatal care visits on waiting time and complete antenatal care (≥4 visits during pregnancy). Our primary analysis compared treatment facilities over time; in addition, we compared the treatment and comparison facilities using difference in differences.

Results We collected waiting time data for antenatal care from 6918 women, and antenatal care attendance over the course of pregnancy from 8385 women. Scheduling appointments reduced waiting time for antenatal care in treatment facilities by 100 min (95% CI −107.2 to -92.9) compared with baseline. Using administrative records, we found that exposure to the scheduling intervention during pregnancy was associated with an approximately 16 percentage point increase in receipt of four or more antenatal care visits during pregnancy.

Conclusions Relatively simple improvements in the organisation of care that reduce waiting time may increase utilisation of healthcare during pregnancy. A larger scale study is needed to provide information about whether appointment scheduling can be sustained over time.

Trial registration number NCT02938936.

  • quality of care
  • antenatal care
  • maternal health
  • health systems
  • health policy

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  • Handling editor Seye Abimbola

  • Contributors MM and SS co-led the study design and supervised data analysis. MS, JD, AA, SC, ESG, SS and MM contributed to the study design. MS conducted data analysis and drafted the manuscript. All authors contributed to the interpretation of data, reviewed and approved the final version of the manuscript.

  • Funding This study was funded by the Abdul Latif Jameel Poverty Action Lab’s (J-PAL) Urban Services Initiative and the International Growth Center. MS was supported by the NIH training grant (T32 HD007338) and other NIH support (P2C HD041020).

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study received human subjects approval from Harvard TH Chan’s Institutional Review Board (IRB16-0344), the London School of Economics Ethics Committee and from the Mozambican Ministry of Health’s Comité Institucional de Bioética do Instituto Nacional de Saúde. Study participants who completed interviews provided written consent. A waiver of consent was approved for the administrative data collected in this study as these data contained no individual identifying information and was considered minimal risk. This study was registered at

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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