This post is part of a blog series on Malaria in Pregnancy. To view the entire series, click here.
In Mozambique, malaria constitutes a primary cause of demand for health care, including among pregnant women and children under five years of age. Malaria also contributes to significant mortality among children under five years of age and is the leading cause of indirect maternal deaths.
Although the country has adopted the strategy of Intermittent Preventive Treatment in pregnancy (IPTp) as a measure of prevention, implementation has encountered numerous difficulties that have limited national coverage. Our experience coordinating public health activities from the primary health care level to the national level demonstrates how addressing barriers is vital to ensuring adequate coverage of interventions to prevent malaria in pregnancy.
In the following paragraphs, I will share four critical components of health systems that need to be strengthened in order to see improvements in coverage of IPTp.
1. Coordination and integration in the implementation of malaria control and maternal and child health programs
In Mozambique, several policy documents and strategies advocate a coordinated management of health interventions and programs and, whenever possible, an integration of services offered to the communities. Despite clear expression of political support and strategic objectives, the degree of integration at different management levels and the provision of care remain poor. Although it is common for program managers to speak to each other, we have not yet reached the stage where programs are complementary. At the health unit level maternal and child health care, as well as malaria prevention services, are implemented in the same location and by the same person, yet an urgent need for unification and standardization of instruments (program management guidelines, supervision guidelines, etc.) for the management of malaria in pregnancy remains.
2. Management of logistics and capacity to forecast commodities stock outs
The capacity of the system at different levels to forecast the need for commodities and to ensure arrival at health facilities remains a major obstacle to ensuring access. The indicators of coverage for pregnant women receiving at least two doses of SP in the past three years is 67%, 14% and 19% respectively, although nearly 100% of women accessed prenatal care at least once. Often there are stock outs in health facilities that do not correspond to stock outs in the national system or at the district level. Commodities related training activities for health workers, improved communication strategies between health workers at various levels of the system, and better tools for forecasting stock outs at the facility level are recommended.
3. Lack of awareness of the danger posed by malaria among health workers and communities
Despite clear evidence that malaria in pregnancy has significant impact on the health of women and newborns, health workers at various levels and communities do not always recognize the threat that malaria poses and do not always prioritize malaria prevention activities. Many times, other health issues take precedence—such as prevention of mother-to-child transmission of HIV. Increasing education and training for health workers and communities about the health implications of malaria in pregnancy is crucial for the success of any intervention aimed at preventing malaria in pregnancy.
4. The role of leadership in preventing malaria in pregnancy
In my opinion, strong leadership is a cornerstone for the success of prevention programs that aim to address malaria in pregnancy. Strong leadership is needed at every level–from communities and health units up to the highest level of political leadership of the country. This strong leadership around the issue of malaria in pregnancy should result in continued support of prevention efforts—specifically, prevention efforts that build the capacity of health workers and influence community members to seek prevention and care for malaria.