Tanzania has been noted for its high levels of antenatal care (ANC) attendance. Four out of five health facilities offer ANC. Over 94% of pregnant women attend ANC offered by a trained provider including nurse/midwifes, other clinicians and MCH Aids. It appears that 95% of these attend ANC two or more times, making it theoretically possible for Tanzania to achieve the RBM target of 80% of pregnant women receiving two doses of Intermittent Preventive Treatment (IPTp). National Policy has supported IPTp in ANC for over six years. Unfortunately the DHS also shows less than 22% of pregnant women receiving two doses.
Tarimo (2007) offers some explanations for this “IPTp Gap” in the East African Journal of Public Health. ANC clinic exit interviews revealed that only 60% of women received IPT and some of the reasons for the gap. A key problem was unavailability of sulfadoxine-pyrimethamine (SP) for IPTp. About 40% of those who actually received SP did not take it as directly observed treatment in the clinic for reasons including not wanting to take it on an empty stomach and aversion to sharing drinking cups with other women. Who knows what they did with the SP when they got home?
Finally while 90% were aware of IPTp, only 30% knew the correct timing and dosage. Thus, they were not even in a position to make educated demands on service providers for timely and adequate provision of IPTp. These problems represent a clear failure of the health system: failure to stock SP, failure to ensure conducive conditions to take SP and failure to educate clients thoroughly.
We have previously raised the question about community delivery of IPTp, which while effective in increasing coverage, raises concerns about reducing utilization of ANC and delivery services. But what do we do when the health service is clearly squandering an opportunity to deliver this live saving intervention through ANC?