A Health Systems Approach to Implementing Malaria in Pregnancy - - PowerPoint PPT Presentation

A Health Systems Approach to Implementing Malaria in Pregnancy Programs

Goals and targets for malaria control

• Roll Back Malaria (RBM) 80%

and President’s Malaria Initiative (PMI) 85% targets for coverage of people at risk by 2010 for:

• Intermittent preventive treatment

for pregnant women (IPTp)

• Use of long lasting Insecticide

Treated Nets (ITNs)

• Diagnosis and treatment of

malaria

• Through 2012, we have still

not achieved targets for coverage of pregnant women

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Most Recent IPTp2 Coverage Data

18 1 5 44 47 25 45 23 60 40 33 36 52 27 47 32 70 7 33 10 20 30 40 50 60 70 80 Percent Coverage From most recent available surveys: DHS, MIS, MICS, NHIS

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Most Recent LLIN Coverage Data for Pregnant Women

26 20 43 29 51 47 41 33 71 60 55 42 13 72 49 57 50 44 46 10 43 10 20 30 40 50 60 70 80 Angola Benin DRC Ethiopia Ghana Guinea Kenya Liberia Madagascar Malawi Mali Mozambique Nigeria Rwanda Senegal Tanzania Zanzibar Uganda Zambia Zimbabwe Average Percent Coverage

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From most recent available surveys: DHS, MIS, MICS, NHIS

Moving targets… (Les cibles mobiles…)

• Updated Global Malaria Action Plan (GMAP)
• bjectives beyond 2011:
• Achieve universal access to case management in

public sector by end 2013; in private sector by end 2015; to community case management of malaria (in countries where it is an appropriate strategy) by end 2015

• Achieve universal access to and use of prevention

measures by end 2013; sustained by 2015 and beyond

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Advancing MIP programming

• MIP interventions are not one-shot actions
• Must be delivered as part of comprehensive

focused antenatal care (FANC)

• Eight essential program components that are

needed to put MIP policy into practice

• While each component is distinct, they are

inter-related; when one is weak, other components can be negatively affected.

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Core Components of MIP Programming

• 1. Integration
• Collaboration among reproductive health, malaria and

HIV/AIDS for effective planning

• Coordination of implementation efforts
• 2. Health Policy/Guidelines
• Harmonized: malaria, reproductive health, HIV/AIDS
• Simple and clear dissemination to health workers
• 3. Procurement/Commodities
• Availability of ITNs, SP and RDTs at ANC

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MIP Program Components, cont’d

• 4. Quality Assurance
• Performance standards in place based on national

guidelines

• Linked with supervision support
• 5. Capacity Building
• In-service training
• Pre-service education
• 6. Community Awareness and Involvement
• Bridging the link between communities and facilities
• Promotion of ANC, ITN use, IPTp uptake

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MIP Program Components, cont’d

• 7. Monitoring and Evaluation
• MIP data incorporated into malaria and overall health

management information systems and used to assess if expected results are being achieved

• 8. Financing
• Advocacy for MIP funding based on the fact that

pregnant women are most vulnerable

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MIP Implementation Components and Stages of Implementation

• Program Components

1.

Integration

2.

Policy

3.

Commodities

4.

Quality Assurance

5.

Capacity Building

6.

Community awareness & involvement

7.

Monitoring and Evaluation

8.

Financing

Stages of Implementation

Country has achieved MIP readiness 4 Country is approaching MIP readiness 3 Country is developing and testing MIP systems 2 Policy in MIP being

• r very recently

formulated 1

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MIP program assessments

• MCHIP conducted three country case studies,

looking across the 8 MIP program components, to better understand:

• Best practices/strategies that have supported MIP programming

success;

• Existing bottlenecks in MIP program implementation and how

these are addressed; and

• Lessons learned that inform future MIP programming.
• At April 2012 RBM MIP Working Group meeting,

program managers from 8 countries used the MIP stages matrix to self-assess and develop individual country MIP updates and action plans

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Status of MIP Programs: Integration

• Countries are using

FANC platform

• Services are integrated at

facility levels

• Meetings for coordination

between RH and malaria control not regular

• Partner coordination

impacted

• Vertical funding streams
• Competition created across

MOH units

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Status: Commodities

• Stock-outs of SP &

ITNs at ANC

• Inappropriate use of

SP to treat cases of malaria

• Some countries are

implementing universal free access to ITNs for pregnant women

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Status: Quality Assurance

• MIP performance

standards in place

• QA systems officially

include routine supervision and performance assessments

• QA systems not

functioning due to

• Lack of funding
• Competing priorities

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Status: Community Involvement, Awareness

• Community volunteers

active in education and mobilization for FANC/MIP

• Attributed to increasing

ITN use by pregnant women

• More strategies are

needed to generate resources from within target communities

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Recommendations

1. Identify local champions 2. Promote integration and coordination mechanisms at all levels 3. Advocate to overcome commodities problems and ensure adequate and consistent stocks 4. Increase community initiatives to overcome barriers to care-seeking 5. Develop capacity-building through pre-service education, on-the- job-training, mentorship and supervision, group-based in-service training 6. Strengthen quality assurance systems 7. Better coordination and local support for financing

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Conclusion

Stakeholders should review country-level MIP programs from the health systems perspective, considering successes and challenges across all inter-related program components, in order to set MIP program goals and determine actions that will lead to their achievement.

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