Background: The present study was performed to evaluate the effectiveness of a training course designed to improve the knowledge, skills, and attitudes of healthcare personnel to allow them to provide a comprehensive community-based antenatal care (ANC) program in rural Paraguay. Methods: Sixty-eight of 110 healthcare personnel in the Caazapa Region of Paraguay participated in a nine-day training course between November 1997 and March 1998. The knowledge of the participants related to maternal healthcare services was assessed both before and after the training course, and enrollment rates of pregnant women in ANC before and after the training were compared as a measure of patient satisfaction. The participants were also asked to evaluate the appropriateness of each individual method used in the training course. Results: The average scores of the participants' knowledge increased significantly from 41.0 before to 60.1 after training (p less than 0.001). The enrollment rates of pregnant women in ANC increased from 2.2 times per pregnancy in 1996 to 3.4 times in 1998 (p less than 0.001). The participants reported that role-playing, demonstrations using visual information, and hands-on practice at a hospital were useful training methods. Conclusions: Continuous training for healthcare personnel in rural Paraguay contributes to an increase in their capacity to carry out community-based ANC program. The participants reported that learning through peer-educators, interactive communications, role-playing, and supervision provided in actual community services were beneficial. Continuous supervision should be provided to enable healthcare personnel to maintain the knowledge and skills acquired in the training.