Background: Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was
to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines.

Methods: A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal
care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied
in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs,
laboratory testing, protocols, ambulance and equipment.

Results: Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were
randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was
48.1 % (95 % CI: 41.8–54.2 %), varying significantly amongst the types of facilities, with highest rate in the
polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the
hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available
in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal
service protocols and equipment were also available in all facilities.

Conclusion: Although antenatal workload varies across different facility types in the Greater Accra region, other health
facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities.
These factors therefore do not adequately account for the low and varying proportions of complete adherence to
guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their
adherence to these guidelines.

Keywords: Adherence, Facility factors, First antenatal care, Guidelines, Providers, Support