12 th RBM Board Meeting, Geneva | May 2007 | RBM Working Group for Malaria in Pregnancy (MIP) Juliana Yartey Chair, RBM MIP Department of Making Pregnancy Safer WHO, Geneva 12 th RBM Board Meeting May 2007, Geneva

12 th RBM Board Meeting, Geneva | May 2007 | Background Informal Working Group Established (Convened by USAID) 2003 – Working Group formalized by RBM and TOR developed in support of the RBM partnership strategic plan for "going to scale" with key interventions targeted to pregnant women at risk of malaria – TOR reviewed and revised to align with recommendations of RBM Change initiative

12 th RBM Board Meeting, Geneva | May 2007 | Terms of Reference (TOR) Generate consensus on key strategic issues related to MIP implementation. Identify critical strategic and programmatic issues and gaps for follow up action by MIP Partners and other RBM groups. Synthesize experiences and disseminate best practices related to MIP implementation. Advocate for increased attention and resources for MIP (MAWG) Develop mechanisms for tracking progress of MIP interventions in countries (MERG) Assist to coordinate partner resources for MIP (through HWG) Foster collaboration between malaria and reproductive health programs at all levels and promote the development of strategic partnerships at the country level. Disseminate relevant information to all MIP partners and other RBM WGs.

12 th RBM Board Meeting, Geneva | May 2007 | Rationale Pregnant women are main adult target group affected by malaria. Consequences include fetal loss/abortion, low birth weight, maternal anemia and death. Recent studies: malaria infection during pregnancy is associated with an increased risk of i) infant anemia; ii) malaria infection during infancy; and iii) infant death. Prevention and treatment of MIP is critical to child survival and achievement of RBM Goals and MDGs.

12 th RBM Board Meeting, Geneva | May 2007 | WHO Strategy for MIP 3-pronged Strategy –Intermittent preventive treatment (IPT) by DOT –Use of insecticide treated nets (ITNs/LLINs); –Effective case management Interventions to be delivered through antenatal clinics. Requires strong collaboration between malaria and reproductive health programs and partners at all levels.

12 th RBM Board Meeting, Geneva | May 2007 | Purpose of MIP Working Group Generates consensus among Partners on key strategic issues and best practices for ensuring the effective delivery and scale-up of interventions for the prevention and control of malaria during pregnancy in order to achieve RBM targets and MDGs. Members: Malaria and Reproductive Health Partners and country program representatives.

12 th RBM Board Meeting, Geneva | May 2007 | Achievements (I) Contribution to the development of the WHO/AFRO Strategic Framework for the Prevention and Control of Malaria during Pregnancy. Supporting the adoption and implementation of the strategy in countries. –32 / 33 countries have adopted IPT –19 are implementing at national scale –13 are at various stages of implementation Development of Monitoring and Evaluation Guidelines for MIP (in collaboration with MERG)

12 th RBM Board Meeting, Geneva | May 2007 | Achievements (II) Establishment and support for sub-regional MIP Coalitions: –MIPESA: Malaria in Pregnancy Eastern and Southern Africa Coalition –RAOPAG: Réseau d’Afrique de l’Ouest contre le Paludisme pendant la Grossesse). –Coalitions are core mechanisms for exchange of experiences and best practices among countries. –Countries in MIP networks have developed strong collaboration among reproductive health and malaria control programs. –Countries in two networks have gone to scale with MIP interventions as a direct result of the shared experiences and implementation best practices.

12 th RBM Board Meeting, Geneva | May 2007 | Data source: Malaria Unit Map production: ATM division World Health Organization/AFRO Small scale implementation (14) Implementation country wide or in all endemic districts (19) Not AFRO or IPT not recommended. Not started (1) Status of IPTp adoption and implementation December 06

12 th RBM Board Meeting, Geneva | May 2007 | Achievements (III) Documentation and dissemination of experiences, best practices and lessons learned from MIP programs –Documentation in MIPESA countries completed & disseminated –Documentation of experiences from RAOPAG ongoing. Extending experiences from successful RH and malaria collaboration to HIV/PMTCT programs to strengthen collaboration among malaria, HIV and reproductive health programs at the regional, sub-regional and country levels. Establishment of MIP Research Consortium (Gates F.)

12 th RBM Board Meeting, Geneva | May 2007 | Challenges (I) Alternate drugs for prevention and treatment in pregnant women Missed opportunities for providing MIP interventions in ANC –High ANC utilization (>70%); low IPT uptake, low ITN/LLIN coverage Collaboration between malaria and RH programs at all levels (resource mobilization, planning, implementation, monitoring and evaluation). –Involvement of RH in resource mobilization for MIP: High resource availability; very little resources dedicated to MIP – mainly for procurement of drugs and commodities; no provision made to support delivery of MIP interventions within ANC; no provision made for strengthening RH Services (HR, M&E, Lab, others). Support for MIP sub-regional coalitions to sustain their viability and effectiveness as core mechanisms for RH/Mal collaboration.

12 th RBM Board Meeting, Geneva | May 2007 | Planned Activities/Future Priorities (I) Develop and disseminate relevant technical materials and consensus statements through MIP coalitions and sub- regional networks. –Consensus statements and technical updates to provide clarity on strategic and technical issues related to the implementation and uptake of MIP interventions (Relevant RBM Partners and WGs): Update on the effectiveness of IPT with SP in areas of high resistance to SP following WHO Technical Consultation in June Technical Brief on IRS and Pregnancy (WIN) –Document, synthesize and disseminate MIP implementation best practices (ongoing in RAOPAG countries)

12 th RBM Board Meeting, Geneva | May 2007 | Planned Activities/Future Priorities (II) Disseminate MIP M&E guidelines and standardize mechanisms for data collection, analysis and interpretation for M&E purposes across countries (WHO, MERG, MACEPA). –Equip MIP Coalitions to provide support to countries to: incorporate MIP indicators into their maternal health cards and registers; and establish a common regional understanding and methodology for data collection and reporting within RH services for monitoring and evaluation purposes.

12 th RBM Board Meeting, Geneva | May 2007 | Planned Activities/Future Priorities (III) Strengthen capacity of MIP coalitions to : –serve as resource centres for dissemination of MIP materials, –conduct country-based situation analysis to identify MIP program implementation bottlenecks, –provide technical assistance for overcoming MIP bottlenecks and support scale-up of MIP interventions, –provide support to GFATM proposal development and other resource mobilization mechanisms with adequate reflection of MIP issues, –foster collaboration between Malaria and RH (HIV) programs, –advocate for increased attention and resources for MIP.

12 th RBM Board Meeting, Geneva | May 2007 | Planned Activities/Future Priorities (IV) Extend support to other geographical regions, particularly Latin America, Asia and the Pacific regions who have initiated efforts to intensify the control of MIP and are requesting support from partners. Initiate development of Global Strategy for malaria in pregnancy which will highlight the epidemiology and burden of MIP in all regions and current WHO recommendations for prevention and control in various epidemiologic situations (In collaboration with WHO).

12 th RBM Board Meeting, Geneva | May 2007 | Thank You!

12 th RBM Board Meeting, Geneva | May 2007 | Proposed Board Actions Endorse TOR for MIP Determine that MIP networks (MIPESA and RAOPAG) are core structures and mechanisms for engaging countries directly in MIP activities and should be supported by the RBM Partnership Secretariat and funded through Partnership resources Endorse the role of MIP Networks and prioritization of their activities. Confirm Board support for the funding of MIP Networks (RAOPAG/MIPESA) and their activities through the RBM Partnership Secretariat. Approve MIP workplan for