Antenatal care (ANC) is a key maternal health intervention designed to prevent poor pregnancy outcomes, while pregnancy tracking by community healthcare workers (CHWs) serves as an important strategy to monitor its effective implementation and utilization. In Mati City, Davao Oriental, Philippines, a consistent decline in ANC quality and a rise in maternal and infant mortality have been observed, which may be linked to gaps in the implementation of maternal healthcare programs.

To address this concern, the study aims to analyze the strategies and challenges faced by CHWs in pregnancy tracking, assess the perceptions of health officials regarding these gaps, and recommend governance strategies to enhance the overall quality of ANC services.

A qualitative research design was employed, using purposive sampling to select Barangay Health Workers, midwives, and nurses for the focus group discussions, while the City Mayor, City Health Officer, and City Councilor on Health participated as key informants. Thematic analysis was conducted on manually transcribed data while adhering to strict ethical considerations.

Findings revealed that proper implementation and monitoring of maternal healthcare services are crucial for effective pregnancy tracking. CHWs play a significant role in health service delivery; however, gaps such as weak health promotion efforts adversely affect community engagement, health-seeking behavior, and sociocultural dynamics, highlighting the need for stronger policy enforcement and sustained local government support. Systemic and logistical challenges must also be addressed to improve service delivery. Effective maternal healthcare requires robust policy implementation and close collaboration among local government units. A sustainable maternal health system further depends on depoliticized legislative processes, improved health financing, and continuous investments in primary healthcare and infrastructure. Based on these findings, the study developed the Strengthen, Empower, Engage, and Key Policy Reforms Framework – an innovative governance approach aimed at reducing maternal healthcare disparities through multisectoral collaboration, depoliticized legislative action, and evidence-based maternal health interventions.

Adopting the SEEK framework may enable local governments to ensure equitable access to high-quality ANC and ultimately improve maternal and infant health outcomes.