More from Day Two at MiP2012: Exploring What We Know Works-and Looking Towards Innovation
This post is part of a blog series on Malaria in Pregnancy. To view the entire series, click here.
Take Away Messages from Day Two, June 27th, 2012, at Malaria in Pregnancy: A Solvable Problem—Bringing the Maternal Health and Malaria Communities Together.
Day two of the meeting, Malaria in Pregnancy: A Solvable Problem–Bringing the Maternal Health and Malaria Communities Together, focused on distilling existing evidence around current interventions and exploring innovative new approaches to reaching pregnant women with prevention efforts.
The first session of the day was a global and regional-level roundtable discussion with panelists from the World Health Organization, Roll Back Malaria, Centers for Disease Control, President’s Malaria Initiative, and Population Services International. Read more about the global and regional-level roundtable discussion here.
After the roundtable, several presenters shared their work to better understand the effectiveness of current MiP interventions and others discussed innovative approaches to understanding, preventing and treating malaria among pregnant women.
Jayne Webster, of Liverpool School of Tropical Medicine, presented recent research on the effectiveness of the delivery of IPTp and ITNs in Mali and Kenya. She looked specifically at intermediate process indicators for delivery. Her analysis revealed that the delivery of both interventions is ineffective in both Mali and Kenya. The assessment also showed that while stock-outs contribute to the problem, they are far from the only issue. Even when supplies were in stock, delivery was still ineffective. Lack of knowledge and misinformation emerged as a major barrier. Webster urged the meeting participants to consider how guidelines for IPTp dosing might be reviewed—particularly for specific cases such as HIV-positive women.
Rifat Atun, of Imperial College, discussed the challenges with diffusion of innovation throughout health systems. He explained that health systems often take a very long time to adopt innovations, citing scurvy as an example. He said that the key barriers to diffusion of an innovation are a linear view of innovation adoption, limited evidence for new ideas, an imbalance in health and financing policies, not enough emphasis on demand side factors, inadequate incentives, and institutional logic. He explained that integration is a complex process—and is not binary. He said that when exploring integration as an approach to a health problem, groups must consider what is being integrated, into what, and why. Atun made the point that communities need to feel that they are part of the solution and only then will they join in the process of delivering and/or demanding the innovation. He also discussed inequities in malaria funding and the fact that funding is often not in line with actual burden of disease.
Marcia Castro, of the Harvard School of Public Health, explored the distribution of ANC services in Kenya using survey data and Geographic Information Systems (GIS). She explored the extent to which availability of services correlates with use of these services, controlling for potential social, economic, environmental, and spatial effects. Her work considered barriers to uptake of IPTp at three levels: the woman, the facility, and the district. Her assessment revealed that cost was not a considerable issue, but distance and waiting times were significant barriers to uptake. Castro explained that there is far more to the story than access, pointing out that roads do not equal access but lack of roads does serve as a proxy indicator for isolation. She suggested better tracking of pregnant women as an approach to improving forecasting of commodities. Castro also discussed big challenges with measuring quality of care, explaining that the global health community does not fully understand the various perceptions of quality among users.
Ib Christian Bygbjerg, of University of Copenhagen, discussed the potential of m-health innovations to strengthen efforts to address MiP. He said that in the past ten years, phone connections have more than tripled around the world. Bygbjerg sees this as an enormous opportunity. He shared promising results from an m-health project aimed at improving maternal health in Zanzibar, and asked questions about whether a similar project could work to address MiP. Bygbjerg also explained that mobile phones were designed for communication (not health) and raised important ethical questions surrounding m-health: Who picks up the phone? Who reads the text message? Who owns your health data? Bygbjerg said that he sees m-health as an under-used and under-researched tool with great potential. He told participants that when he ran a PubMed search for “malaria” and “m-health”, it returned zero results. He called on the group to consider more operations research for m-health initiatives. In closing, Bygbjerg shared a mobile app that walked a user through the steps of managing post-partum hemorrhage (PPH). He asked participants to spend some time thinking about what a mobile app for the management of MiP might look like—and if it would be useful?
Jayne Webster, of LSTM, presented her recent work to develop a decision-making tool for use by countries to assess barriers and priority actions required to increase coverage of MiP interventions. Webster explained that major research questions remain about the effectiveness of the delivery of MiP interventions—and that improvements in data collection and collation are needed. But, in the meantime, the global health community must use the wealth of knowledge that already exists to start taking action! Webster described the newly developed decision-making tool, explaining that it was designed for use by health managers to help them assess country and/or sub-national barriers and priority actions required for effective scale-up of two key MiP control interventions: IPTp and ITNs.
Nancy Nachbar, of Abt Associates, focused on the current and potential involvement of the private sector in addressing malaria in pregnancy. She explained that in planning any health intervention, the complete health system must be considered. She said that if the global health community fails to consider the role of the private sector, they are failing to consider the whole system. Nachbar described challenges to private sector participation from the perspective of the public sector such as quality concerns, lack of trust and corresponding lack of dialogue, profit motives, equity concerns, fragmentation, and lack of information. She also described challenges to private sector participation from the perspective of the private sector such as lack of appreciation of investment requirements; data ownership; market planning; challenge of proving safety; tender system focuses on lowest cost—driving out innovation; limited or no access to financing, preferential pricing, tax/tariff waivers; and missing or inability to access supportive quality assurance systems. In conclusion, Nachbar shared a number of factors that she sees as opportunities for improving private sector participation in MiP prevention: giving consumers products they prefer; addressing communication and mobilization gaps; filling supply gaps; improving supply and distribution; tackling human resource gaps; addressing quality issues; expanding access to financing; and improving stewardship.
Stay tuned to the MHTF Blog for an upcoming post on major themes from the meeting and next steps for increasing coverage of MiP interventions.
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