1. Memo To The Director of the Division of Reproductive Health of Senegal. Dr Bocar Daff From:The Director of Laboratory services of Senegal: Prof Iyane Sow Subject:Improving ANC guidelines for a better utilization of screening test for maternal health Date: 28/01/2015

2. Exercise I 1.Decision maker The Director of the Division de la Santé de la Reproduction et du Suivi de la Mère et de l’enfant 2. What do you expect the stakeholder to do? Become aware of the issue Adapt and disseminate the guidelines for ANC testing 3.Policy-related To engage the division of Reproductive health alongside the laboratory services in efforts to improve the utilization of ANC testing 4. A policy brief can serve as evidence in advocacy effort. It is more visible and credible.

3. Exercise 2 1.Who is the main decision maker to put the recommendation into action? The division of Reproductive Health in conjunction Recommendations Revise and provide clear and practical guidelines for ANC testing in conjunction with the Directorate of Laboratory and the PMTCT program Disseminate the guidelines at all level of ANC providers Build capacity of mid-wives to implement the guidelines Reinforce human resources at the level of ANC services

4. 3.Evidence Results from the WOTRO funded SOCIALAB study in 16 representative health facilities 50% of women (69% form health posts) do not receive complete ANC screening 45% of mid-wives do not request a complete set of test even in facilities hosting a laboratory: mid wives are gate keepers to the lab! National guidelines from the Div Rep. Health, ANC registers at the site of ANC and consultation booklets feature different set of tests. More than half of the mid-wives do not know about the guidelines from the division of Rep Health

5. Exercise 2 4.Alternative actions Empower the community to demand for a complete set of tests Involve NGOs in disseminating the guidelines and train the midwives 5.Why is it the best option? It is feasible in the mid-term Formulating a clear and sound policy guides service delivery down- stream It has the most impact