Scaling up Malaria in Pregnancy Programs: What It Takes!

This 52-page report, published by Jhpiego, an international non-profit health organisation affiliated with Johns Hopkins University, reviews the organisation's malaria in pregnancy (MIP) programme implementation efforts in five sub-Saharan African countries - Burkina Faso, Kenya, Madagascar, Tanzania, and Uganda. According to the report, it is important to strengthen the quality of MIP services across the continuum of care, including focused antenatal care (ANC) services and increased involvement of communities in the prevention and case management. The report also presents recommendations for scale-up.

According to the report, the programme's approach focuses first on strengthening the enabling environment for successful MIP programme implementation by assisting with developing policy and guidelines, as well as clinical standards. Second, it engages pregnant women and their families to increase understanding of the effects of MIP and increase demand for ANC services. Finally, it works with health facilities to improve service delivery.

The review found that while some country programmes made efforts to promote and distribute insecticide-treated nets or vouchers, linkages through the MIP programmes using the ante-natal care platform were generally weak. The same was found for the case management of pregnant women. The review documents a number of challenges and lessons learned, including but not limited to the following:

• Lack of and late attendance at ante-natal clinics could be rectified by involving communities from the start;
• Advocacy is required to address a lack of coordination and partnership between reproductive health programmes and malaria control programmes;
• Human resource shortages can be addressed through collaborations to provide training and supervision of unskilled providers;
• Lack of support for pre-service education for MIP must be addressed. MIP programmes should be incorporated into pre-service education for medical, nursing, and midwifery schools.

The review contains three key recommendations to scaling up MIP programmes in Sub-Saharan Africa. First, developing a community-based distribution model could increase the uptake of MIP services, given that, according to the authors, most women in sub-Saharan African present at ante-natal clinics late in their pregnancies, and current efforts to increase early attendance have not been wholly successful. The report states that there is a growing body of evidence showing that community-based distribution programmes lead to healthier outcomes for women and their babies and increase use of services.

A second recommendation relates to social mobilisation, including advocacy, behaviour change communication, and social marketing. According to the authors, social mobilisation campaigns can strengthen the link between communities and health care services and increase the capacity of community ownership and responsibility for MIP prevention and case management. Also, as part of a comprehensive MIP strategy, social mobilisation can lead to greater coverage among pregnant women.

A third recommendation is that MIP programmes use standardised, internationally recommended indicators for monitoring and evaluation, and ensure that periodic monitoring and evaluation is conducted. The authors state that monitoring affords programme managers, providers, and community members with the information they need to address challenges and develop appropriate plans for the future. Evaluations should comprehensively examine the outcomes of programmes implemented for the prevention and control of malaria.