Improving MIP programs: Lessons learned from country case studies

Transcription

1 Improving MIP programs: Lessons learned from country case studies Elaine Roman, MCHIP/Jhpiego Malaria Team Leader Koki Agarwal, MCHIP/Jhpiego, Director

2 Recent IPTp2 Coverage Data Percent Coverage From recent available surveys: DHS, MIS, MICS, NHIS 2

3 Recent LLIN Coverage Data for Pregnant Women Percent Coverage Angola Benin DRC Ethiopia Ghana Guinea Kenya Liberia Madagascar Malawi Mali Mozambique Nigeria Rwanda Senegal Tanzania Zanzibar Uganda Zambia Zimbabwe Average From recent available surveys: DHS, MIS, MICS, NHIS 3

4 Data Challenges The number and type of surveys that collect data related to MIP have grown over the last decade Malaria Indicator Survey Multi Indicator Cluster Survey Demographic and Health Survey But there remain gaps in timely information For example Benin s most recent was from 2006 National surveys cannot be repeated often 4

5 THE CASE STUDY APPROACH 5

6 Case Study Purpose and Objectives The purpose of the case studies was to gain a better understanding of MIP programs in Zambia, Senegal and Malawi, including: Best practices/ strategies that have supported MIP programming success; Existing bottlenecks in MIP program implementation and how these are addressed; and Lessons learned that inform future MIP programs. 6

7 Case Study Methodology Data collection Desk review of secondary data sources Qualitative interviews with key stakeholders Developed a MIP framework for analysis based on: WHO MIP M&E Guidance* Malaria Action Coalition MIP Implementation Guide** Data from desk review and interviews were integrated and interpreted together using the framework for analysis * ** 7

8 MIP Implementation Components and Stages of Implementation Program Components 1. Integration 2. Policy 3. Commodities 4. Quality Assurance 5. Capacity Building 6. Community awareness & involvement 7. Monitoring and Evaluation 8. Financing Stages of Implementation Country has achieved MIP readiness Country is approaching MIP readiness Country is developing 2 and testing MIP systems Policy in MIP being or very recently formulated

9 Scoring System Interpreted for Select Components Component Score = 0 Score = 4 Integration Training/ Capacity Community Awareness and Involvement No integration among ANC, RH, malaria, HIV, and other related MIP service areas No MIP in-service or preservice training; inadequate human resources for MIP No MIP community education or involvement MIP is integrated into ANC and other related services through joint planning Adequate graduates and providers with MIP knowledge and skills deployed Communities and facilities partner to ensure pregnant women receive appropriate MIP services 9

10 Overview of Country Stages Malawi Senegal Zambia Integration Policy Commodities Quality Assurance Capacity Building Community Involvement Monitoring & Evaluation Financing Average Weakest areas are shaded 10

11 Integration Countries are using focused ANC platform Services are integrated at facility levels Meetings for coordination between RH and malaria control not regular Partner coordination impacted Vertical funding streams Competition created across units 11

12 MIP Policy Policies in place reflect WHO guidance - will now need to be revised. Guidelines and training materials are harmonized but inconsistencies exist. Dissemination to all providers not complete 12

13 Commodities Stock-outs of SP & ITNs at ANC Inappropriate use of SP ITNs free for pregnant women in Malawi and Zambia and now Senegal 13

14 Quality Assurance Performance standards in place Routine supervision and performance assessments ad hoc QA systems not functioning Lack of funding Competing priorities 14

15 Capacity Building Each country targeting inservice training and preservice education Duplicative training on MIP by both national malaria programs and national RH programs Staff transfers result in excess training and missed opportunities 15

16 Community Involvement, Awareness Community volunteers active Varied job descriptions Community Campaigns Promoting ANC attendance and ITN use Community targeted efforts limited 16

17 Monitoring and Evaluation IPTp uptake recorded in registers for HMIS Missing in all 3 countries from national level data % ANC staff trained in past 12 months % of screened pregnant women with severe anemia in 3rd trimester, by gravidity ITN distribution through ANC absent from national data collection tools in Zambia and Malawi; instead, it is collected on parallel, program-specific reporting forms In Senegal, ITN indicators have been integrated effectively into the HMIS 17

18 Financing Some level of funding supporting MIP programming. Still donor reliantespecially for ITNs Delays in GF support even before cancellation of Rnd

19 Results: What happened next? (1) 1. Senegal- Developed its annual malaria plan to include recommendations based on case study including development of joint coordination committee between RH and Malaria 2. Zambia- Focusing on targeting gaps in implementation including- expansion of community level work, reinforced coordination between RH and malaria and addressing stock-outs of SP. 3. Malawi- Dissemination ongoing targeting both RH and malaria control 19

20 Results: What happened next? (2) RBM MIP Working Group brought together malaria and RH Ministry representatives from eight countries Rwanda, Tanzania, Uganda, Zambia, Kenya, Ghana, Guinea, Mozambique This resulted in action plans for each country based on MIP framework and 8 MIP program components Each of these countries has applied local solutions to accelerate MIP programming further in their countries. Reinvigoration of technical working groups with both RH and malaria control; Text messaging to improve IPTp uptake and ITN use; Addressing stock outs at source; Improving capacity to record data. 20

21 Conclusions Partnership between RH and malaria is critical to ensure harmonization of national level guidance as well as coordinated implementation. Addressing MIP as a key component of comprehensive maternal health services at community, facility and national level is key. The eight MIP health system components afford countries an opportunity to review progress in MIP program implementation and accelerate progress, while lending to strengthening the health system. 21