How are Malaria in Pregnancy (MIP) Programs Measuring Up? Aimee Dickerson and Mary Drake USAID Mini-University March 7, 2014

Learning objectives  Understand the latest WHO guidance on MIP  Understand the common issues affecting the quality of national-level MIP guidance and the key recommendations  Understand the common issues affecting the quality of MIP data and use through HMIS systems and the key recommendations 2

MIP is a maternal and child health issue  207 M cases in 2012  627,000 deaths  90% of cases in Africa  50M pregnant women at risk  10,000 maternal deaths/yr  200,000 infants deaths/yr 3

World Health Organization guidance For pregnant women in areas of moderate to high malaria transmission: 1.Long-lasting insecticide-treated nets (LLINs) 2.Intermittent preventive treatment in pregnancy (IPTp)- currently with sulfadoxine-pyrimethamine 3.Effective case management of malaria and anemia in pregnancy 4

How are countries doing? 5

Review of MIP guidance 6 To better understand: 1.How closely national MIP documents (policies, guidelines, training & supervision materials) reflect WHO MIP guidance and 2.How consistent documents produced by the national malaria control program and reproductive health divisions are

MIP guidance review findings COMMON ISSUESKenyaMali Mozam- bique TanzaniaUganda Total # of countries with issue Need for interrupting folic acid intake after taking SP in countries that use high doses of folic acid (low-dose folic acid is recommended during pregnancy and is compatible with SP use) X X X3 Unclear timing and dosing guidance for IPTp- SPXXXXX5 Designation of IPTp-SP by specific week intervalsXX X4 Prohibition of IPTp-SP before 20 weeks XX 2 Prohibition of IPTp-SP after 36 weeks or in the last month of pregnancy X X 2 7

MIP guidance review findings 8 COMMON ISSUESKenyaMali Mozam- bique TanzaniaUganda Total # of countries with issue Unclear guidance regarding DOT for IPTp X 1 Inconsistent guidance about malaria prevention for HIV+ women X X X X4 Unclear guidance on when and how pregnant women should obtain ITNs X X X X X5 Lack of guidance on use of microscopy or RDTs for diagnosis X X X3 Incomplete or confusing guidance on treatment of malaria by trimester X X X X4

Recommendations to countries 9  Form national technical working groups (TWGs) to develop consistent and harmonized guidance on all aspects of MIP  IPTp guidance should be updated to reflect revised WHO 2012 IPTp policy recommendation  Review WHO’s guidance for administration of folic acid

Recommendations to countries 10  Coordinate with national HIV programs to ensure consistent guidance on prevention and treatment of MIP for HIV+ pregnant women  Emphasize distribution of ITNs and counseling on their use at antenatal care  Stress the need for diagnosis prior to treatment  Develop clear algorithms on treatment medications, doses and timing

Way forward  Dissemination at country level  Encourage countries to use MIP document review as starting point to update policy and national documents 11

MNH HMIS Review Purpose:  To better understand what information on MNH service content, quality and health outcomes is currently included in national HMIS for select priority countries. Specific objectives include:  Document current MNH (ANC/L&D) indicators included in the HMIS  Document current MIP indicators in PMI focus countries  Identify gaps and advocate at the national level for incorporation of new indicators on content and quality of MNH services where  Provide recommendations to WHO on MIP-related indicators and data collection formats

Method  Focus on ANC, delivery and immediate post- natal care  Collected HMIS tools from 14 countries  Content Analysis of:  Client record, Register, facility monthly/quarterly summary forms, commodity stock-out  Used standardized data abstraction template  Guidance/documents for completing tools 13

Method (Cont.)  For PMI focus (6) countries  Review of national policy documents, M&E plans, and grey literature on MIP  Identify key stakeholder in PMI focus countries  Conduct In-depth interviews on use of MIP- related data National MOH staff (RH and NMNCP) Health care providers 14

Initial Findings: Emerging Themes (1 of 2) 1.Coordination of malaria and RH partners a gap- some work in progress 2.Recognition of lack of data on case management of malaria in pregnant woman  Concern for system/ people to be over-burdened, high cost of revisions to system  Synchronization with policy/ guidelines updates 15

Initial Findings: Emerging Themes (2 of 2) 4.Uptake of DHIS2 by many countries offers an opportunity to more easily share and review data and may have implications for quality and use 5.Strengthen NMCP & RH program capacity in data use and data quality improvement to address data quality concerns 6.Facility level coordination of data manager and in-charges a key opportunity to improve data quality 16

Discussion & Next Steps  Consensus among MNH community on key indicators, including MIP case management indicators, will move M&E of MNH forward  RBM M&E working group being engaged to consider standardized case management indicators  Where strong, consider surveillance site monitoring systems as a platform for gauging quality of MIP care 17

Next Session Room Numbers: Please fill out an evaluation by going to this session’s page on your mobile app OR by filling out a paper evaluation in the back of the room. Thank you! Integration of Family Planning Services into MNCH Programming in Liberia301 The Realities of Integration: NCDs and TB in Ethiopia (Continued)302 Integrating Family Planning with Obstetric Fistula Services: Achieving Reproductive Intentions307 Operational Research Training in the 21st Century308 Constant Contact: Reinforcing Provider Training with Mobile Messages and Supervision in Ghana (Continued)310 Indoor Residual Spraying: A Weapon in the Fight Against Malaria311 Increasing District Level, Evidence-Based Decision Making in Cote d'Ivoire405 Making Every Life Count: Strengthening Civil Registration-Vital Statistics Systems407 How Strengthening Medicines Regulatory Authorities Can Increase Access to Medicines (Continued)413 Child TB: No More Crying, No More Dying?414 Creating the Next Condom: TPPs for Next Generation MPTsBetts Theatre Sustainable Health Gain from Smart Governance of Hospitals and Health Systems Continental Ballroom Gender, Medicines, and the Road to Equity #AreWeThereYet? Grand Ballroom