What do we know about effective approaches and systems to malaria in pregnancy?

Malaria 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. Report by James Kisia, Kenya Red Cross (with Bill Brieger)

dscn8356sm.jpgAssessing the effectiveness of delivery of IPT and ITNs: Lessons from Mali and Kenya was the topic presented by Jayne Webster of the London School of Hygiene and Tropical Medicine as the Malaria in Pregnancy Consortium.

Jayne explained the process by which a woman goes to ANC to get IPT and ITNs. Her presentation looked at the effectiveness of intermediate processes as well as indicators for maternal health programming. Her analysis revealed that delivery for both IPTp and ITN interventions are ineffective in both countries.

Stock outs are not the only issue; even where in-stock, delivery was still ineffective. Providers lack of knowledge; misinformation was a major barrier. Content of IPTp guidelines must be reviewed for inconsistencies and clarity. Supervisors may even contradict national guidelines.

Guidelines themselves may be restrictive. In Mali they confine IPT to 4-8 months of pregnancy only, and health workers are even reluctant to give IPT in the 8th month.

Delivery of ITNs during ANC is better than IPTp. Many missed opportunities – even if women attend, they may not get the SP tablets. Giving IPTp as directly observed treatment rarely practiced.

An analysis of achievements and limitations to meeting women’s comprehensive needs during pregnancy was presented by Rifat Atun of the Imperial College using a systems approach.  He said we need complex systems approach to heath innovation that addresses perceptions, scalability, opportunity, and whether the innovation is desirable or threatening.

Unfortunately health systems tend to suppress innovation. We often ignore consumer perspectives and demand which can drive innovations.

He pointed out the Inequities in funding for malaria control—often not in line with burden of disease. Much of our funding goes into delivery systems, so we need to focus innovation on these systems.

He explained that innovation takes a long time to diffuse into the system using example lemon juice for scurvy which took 200 years for the Royal Navy to adopt. IPTp has been an innovation that has been also slow in adoption – not necessarily in terms of policy, but in terms of actual implementation. Malaria in pregnancy receives only 2% of Global Fund malaria funding.

Some of the key barriers to diffusion of an innovation include a linear view of innovation, limited evidence, imbalance in health and financing policies (not enough emphasis on demand, inadequate incentives, etc.), and institutional logic He explained that integration is a complex process; not binary.

We must consider what is being integrated and why? The communities need to feel that they are part of the solution and then they will join in the delivery of the innovation.

This panel helped us focus on the systems and processes that inhibit MIP service delivery even if women do attend ANC.

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