BACKGROUND:
Primary health care (PHC) systems are vital to support maternal and neonatal health through access to antenatal care (ANC), nutrition education, and micronutrient supplementation. In Pacific lower-middle-income countries such as Vanuatu, PHC systems face geographic, resource, and sociocultural challenges which may constrain the delivery of maternal nutrition guidance1,2. Previous research among parous Ni-Vanuatu women identified limited nutrition literacy and suboptimal adherence to WHO ANC recommendations3. However, little is known about the health-system drivers of these outcomes from the perspective of frontline health workers. This study explored health workers’ knowledge, experiences, and perspectives, to identify system-level barriers and enablers to equitable maternal nutrition support.

METHODS:
Semi-structured interviews co-designed with local stakeholders explored maternal nutrition knowledge, practices, training experiences, and clinical confidence among Ni-Vanuatu health workers. Fifteen frontline health workers were interviewed, including village health workers (n=2), a nurse aide (n=1), nurses (n=8), midwives (n=3), and a doctor (n=1). Interviews were conducted one-on-one in English or Bislama (lingua franca of Vanuatu) and analysed thematically using the Braun and Clarke Framework.

RESULTS:
Health workers described systemic constraints limiting their capacity and confidence to provide effective maternal nutrition guidance. Key themes included workforce shortages, insufficient nutrition-specific training and disparities in resource provision and professional development, particularly in rural settings. Substantial knowledge gaps were identified in relation to optimal maternal-fetal nutrition. For example, most participants (n=13, 87%) were unaware of dietary sources of folate, the risks associated with inadequate maternal intake, or the WHO-recommended therapeutic window for folic acid supplementation.

CONCLUSIONS:
Improving maternal nutrition outcomes will require targeted, context-appropriate workforce upskilling alongside stronger PHC system-level support, particularly in rural communities. Efforts to improve maternal nutrition and PHC delivery in Vanuatu and other low-resource settings should prioritize the perspectives of healthcare workers, whose local knowledge is critical to informing effective and sustainable policies and interventions.