Pelayanan Antenatal Care (ANC) merupakan strategi penting dalam menurunkan angka kematian ibu melalui deteksi dini komplikasi kehamilan. Kabupaten Oecusse-Ambeno, Timor-Leste, masih menghadapi tantangan pelayanan ANC yang ditunjukkan oleh rendahnya cakupan kunjungan ANC K4 di Puskesmas Baqui dan Puskesmas Oesilo. Penelitian ini bertujuan mengevaluasi pelayanan ANC berdasarkan komponen struktur, proses, output, outcome, dan feedback.  Penelitian menggunakan pendekatan kualitatif dengan desain studi kasus melalui wawancara mendalam, observasi, dan telaah dokumen pada Februari-Maret 2026. Analisis dilakukan menggunakan pendekatan Donabedian, Logic Model, dan PDSA. Hasil penelitian menunjukkan bahwa pelayanan ANC belum optimal akibat keterbatasan tenaga kesehatan, sarana prasarana, dan pendanaan. Pelaksanaan pelayanan juga masih lemah pada aspek konseling, edukasi kesehatan, monitoring, dan evaluasi. Cakupan ANC K4 masih rendah, komplikasi kehamilan masih ditemukan, namun tidak terdapat kematian maternal. Sebagian besar ibu hamil merasa puas terhadap sikap tenaga kesehatan, meskipun mekanisme umpan balik masyarakat belum berjalan optimal. Kesimpulan penelitian menunjukkan perlunya penguatan monitoring dan evaluasi, peningkatan edukasi kesehatan, serta perbaikan sarana prasarana, sumber daya manusia, dan pendanaan untuk meningkatkan mutu pelayanan ANC.

Antenatal Care (ANC) services are a crucial strategy for reducing maternal mortality through the early detection of pregnancy complications. Oecusse-Ambeno District, Timor-Leste, continues to face challenges regarding ANC services, evidenced by low coverage of the fourth ANC visit (K4) at the Baqui and Oesilo Community Health Centers. This study aimed to evaluate ANC services based on the components of structure, process, output, outcome, and feedback. A qualitative approach with a case study design was employed, utilizing in-depth interviews, observations, and document reviews conducted between February and March 2026. Analysis was performed using the Donabedian model, the Logic Model, and the PDSA cycle. The results indicate that ANC services were suboptimal due to limitations in healthcare personnel, facilities and infrastructure, and funding. Service delivery was also weak in areas such as counseling, health education, monitoring, and evaluation. While K4 coverage remained low and pregnancy complications were detected, no maternal deaths occurred. Most pregnant women were satisfied with the attitude of healthcare personnel, although community feedback mechanisms were not functioning optimally. The study concludes that there is a need to strengthen monitoring and evaluation, enhance health education, and improve facilities, human resources, and funding to elevate the quality of ANC services.