Malaria in Pregnancy: Learning from Global and Regional Programs

dscn8947sm.jpgMalaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together – a meeting in Istanbul organized by the Maternal Health Task Force, Harvard University.

Take Away Messages from Day 2 Presentations by James Kisia, Kenya Red Cross.

The first roundtable of the second day was moderated by Koki Agrawal of MCHIP. Key lessons were the need to strengthen ANC as a platform for IPTp and ITN delivery. We need to address how to get the ANC systems funded—not just the interventions. Dr Agarwal challenged the panel to examine how to better measure processes that facilitate the delivery of care and to consider taking service beyond the walls of the health facility… and building stronger linkages between the facility and the community. We must develop indicators for quality of care and integration of programs

Viviana Mangiaterra of WHO explained that there are systematic issues in MIP; little investment has been realized (Global Fund has been doing most of the funding and is currently getting reorganized to increase technical guidance on MIP interventions as well as delivery mechanisms). There are different entry points – each provides opportunities for improvement in continuum of care. We must strengthen at different levels (for ex: CCM) to influence process

Mary Hamel of CDC demonstrated variations and contradictions in WHO guidelines on IPTp which can translate to country-level and implementation level confusion. She explained that, in the face of confusion, health workers are likely not to want to do harm—and, hence, do nothing. A simple clarifying memo from the Ministry of Heakth to health staff can help reach the desired level of IPT uptake.

Susan Youll of PMI talked about major challenges of poor data availability, stock outs. SP is not included in “tracer” commodity; not tracked in the same way other essential drugs are tracked. She discussed the negative effects of hidden fees for ANC services and the impact of this on IPT uptake and encouraged promoting the role of community to create demand.

Elena Olivi from PSI said of Nets that —“funding, funding, funding!” – is the answer. She reminded us of the overwhelming evidence that the biggest contributor to decrease in malaria cases was nets and cited by World Bank study on Kenya. Net delivery mechanisms are established and known. Nothing fancy about it! ANC is one of many platforms to deliver nets. She cited an example of nets treated like medicine with a prescription, enabling better tracking and forecasting. Behavior not an issue; knowledge about nets not a barrier to usage. There are technical champions for nets (PSI). The Advocacy community has not recognized the severity of the funding crisis—and lack of incentive to make bednets truly longlasting!

In conclusions, international partners have found that malaria in pregnancy cannot be controlled without basic resources and commodities. Advocacy is needed.

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