MiP2012 Day Two: Learning From Global and Regional Programs

This post is part of a blog series on Malaria in Pregnancy. To view the entire series, click here.

Take Away Messages from Day Two, June 27th, 2012, at Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together.

Day two of the meeting, Malaria in Pregnancy: A Solvable Problem–Bringing the Maternal Health and Malaria Communities Together, focused on distilling existing evidence around current interventions and exploring innovative new approaches to reaching pregnant women with prevention efforts.

The first session of the day was a global and regional-level roundtable discussion with panelists from the World Health Organization, Roll Back Malaria, Centers for Disease Control, President’s Malaria Initiative, and Population Services International.

Koki Agrawal, of MCHIP and Roll Back Malaria, moderated the session and opened with a description of the evolution of the concept of focused antenatal care. She also called on the global and regional panelists to consider a number of concepts in their remarks:

• The current state of antenatal care as a platform for the delivery of intermittent preventive treatment (IPTp) and insecticide treated nets (ITN) for pregnant women in sub-Saharan Africa (SSA)
• Ideas for how to fund systems, not just interventions
• Thoughts on how to better measure quality of care, integration of programs, and processes that facilitate the delivery of care
• The concept of taking health services beyond the walls of the health facility—and creating stronger linkages between the facility and the community.

Viviana Mangiaterra, of the World Health Organization and Roll Back Malaria, described a number of systematic issues relating to malaria in pregnancy. She pointed out that the Global Fund, the major funder of malaria programming in recent years, is currently undergoing organizational restructuring. As a result, numerous countries are struggling to secure the necessary funds for malaria programming and commodities. She also discussed the importance of considering different entry points as a way to improve and strengthen prevention and treatment along the continuum of care. As an example, she cited community case management (CCM) as a component that could be bolstered with this approach.

Mary Hamel, of the Centers for Disease Control and the President’s Malaria Initiative, described the variations and contradictions in the WHO guidelines for dosing of IPTp. She discussed examples of how these discrepancies in guidelines translate into confusion at the country and program implementation levels. She pointed out that health workers, faced with confusion and a fear of doing harm, often opt for doing nothing. Hamel shared an experience from Kenya in which a memo, with clear and direct messages and guidelines for IPTp dosing, was shared by a senior government health official with all of the health facilities in one district. The distribution of the memo combined with an explanation of the guidelines in follow-up supervision visits resulted in significant increases in uptake of IPTp in the districts. This example made the point that innovation is not necessarily high-tech and/or complicated.

Susan Youll, of the President’s Malaria Initiative, pointed to a lack of availability of data, challenges with securing commodities, and hidden user fees for ANC services as major barriers to uptake of IPTp. She also explained that SP is not tracked in the same way that other important drugs are tracked. Youll said that creative approaches to generating demand for malaria prevention services at the community level should be explored.

Elena Olivi, of Population Services International, focused on ITNs and made the point loud and clear that lack of funding is the major problem when it comes to nets. Olivi explained that the delivery mechanism for nets is well established and it works. The challenge is that nets expire after three years and must be replaced. Without a new and substantial source of funding, the public health community runs the risk of losing significant ground in malaria control. She said that she believes the advocacy community has not yet recognized the severity of the funding crisis. Olivi also discussed the lack of incentives for companies to produce truly long-lasting bednets. She also shared an example from Burundi as a creative approach to addressing some of the supply chain management issues related to nets. She said that bednets were “prescribed” by a provider through the ANC platform which allowed for better tracking and forecasting of nets.

More from day two on innovative approaches to reaching pregnant women with malaria prevention and treatment coming soon!

Read about day one of the meeting here.

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