Transforming Antenatal Care: The Impact of Decentralized Ultrasound Services in South Africa

Decentralizing routine antenatal ultrasound into a rural South African primary health center meaningfully increased access and shifted gestational dating earlier—scans before 24 weeks rose from 52% to 66%, broadening the window for accurate dating and early anomaly screening.

Moving imaging out of referral hospitals and into primary care brought ultrasound closer to where women attend routine antenatal visits, improving timeliness of gestational dating and opportunities for earlier screening. The implementation evaluation highlights operational feasibility: task-shifting to trained primary-care staff, short-course focused training, and integration with clinic workflows produced reliable image acquisition and reporting without disrupting throughput.

The timing impact was substantial: the proportion of women scanned before 24 weeks increased from 52% to 66% within 18 months after introduction of antenatal ultrasound services at one community health center, in an interrupted time-series of 1,239 women. This shift expands the diagnostic window for fetal anomaly screening and improves dating accuracy—affecting decisions such as surveillance intervals and timely referral. Reported monthly uptake gains were sustained, indicating the earlier-scan advantage became embedded in clinic practice.

Routine-engagement metrics moved in parallel: women completing four or more antenatal visits rose from 52% to 82% after decentralization. Onsite primary-care ultrasound also changed referral behavior—referrals became timelier and better targeted, with fewer late transfers and more referrals arriving with actionable imaging—reducing delays for specialist input and preserving hospital capacity for higher-acuity cases.

Key Takeaways:

• Decentralizing routine antenatal ultrasound into primary care increased scans before 24 weeks from 52% to 66% within 18 months, expanding the window for fetal anomaly screening and accurate dating.
• Pregnant women in this rural South African district (1,239 pregnancies evaluated) experienced higher antenatal continuity (four-plus visits rose from 52% to 82%) and more timely, better-informed referrals.
• Scale-up should pair task-shifted training and scheduled twice-monthly clinic imaging with routine monitoring of timing endpoints and referral metrics to embed earlier detection into existing antenatal workflows.