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Table 2 HSS barriers associated with low IPTp coverage in sub-Saharan Africa

From: Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers

Category of barriers

Countries

Keys barriers and evidence

Leadership and governance

Zambia, Senegal, Malawi

Poor integration of services, poor accountability [16]

Tanzania

Conflicting guidelines [11–13]

Tanzania

Policy factors and slow decentralization processes for programme management [12, 14, 15]

Health financing

Zambia, Senegal, Malawi

Budgetary allocation [16]

Tanzania

Out-of-pocket expenditure [13]

Human resources

Nigeria

Lack of health worker training on existing recommendations

Incorrect knowledge [20]

Tanzania

Under-staffing,

Inadequate skills

Poor motivation [13]

Tanzania

Unfriendly supervision

Limited training opportunities [14]

Products, infrastructure and logistics

Tanzania, Zambia

Drugs shortages, Water shortages [11, 13, 17]

Service delivery

Tanzania, Zambia

Long distance, long waiting time, ineffective

Poor organization of educational services and lack of explanation to patients

Failure to link intervention with benefits

Lack of respect to clients [13, 17]

Nigeria

Poor quality of services [20, 21]

Tanzania¸Uganda

Inadequate time for service delivery [22, 23]

Zambia, Malawi, Senegal

Inadequate supervision of service delivery [16]

Tanzania

Low rate of administration of IPTp by health workers at ANC [12]

Information systems

Tanzania

Weak monitoring and evaluation systems [13, 14, 16]