Table 1 Recommended actions for the scale-up of IPTp

Governance

Integration between programmes at the ANC platform

➢ National health institutions in malaria-endemic countries

➢ Establish or strengthen national technical working groups on, or including, MiP to improve the quality of service delivery of focused ANC in both the public and private sector^a

Policy ensuring consistent, clear and widely disseminated information

➢ National health institutions in malaria-endemic countries

➢ Disseminate clear guidelines with simplified language for IPTp based on the WHO 2012 policy update and ensure that IPTp is in national strategic and operational plans

Financing

Finance for health systems strengthening with focus on the ANC platform and removing costs as a barrier to ANC and IPTp uptake as well as support operational research

➢ National health institutions in malaria-endemic countries

➢ Reduce, or eliminate where possible, ANC fees to overcome cost as a barrier to ANC access for end-users and the uptake of IPTp

➢ Donor community

➢ Increase levels of financial support for health systems strengthening with focus on the ANC platform

➢ Provide support for operational research to improve the quality of service delivery and increase IPTp coverage

➢ Promote the inclusion of IPTp and malaria control in pregnancy within grant proposals (e.g. The Global Fund and President’s Malaria Initiative) from endemic countries, alongside all programme areas of health systems strengthening

➢ Support private sector engagement in increasing funding and support for improved IPTp coverage

Human Resource

Capacity development to improve healthcare provider knowledge and skills for the delivery of IPTp

➢ National health institutions in malaria-endemic countries

➢ Ensure healthcare providers in the public and private sectors have access to and training on the updated IPTp guidelines

Product & Technology

Commodities supply chain management strengthening

➢ National health institutions in malaria-endemic countries

➢ Earmark funding for procurement for IPTp delivery through ANC channels in both the public and private sector to prevent stock-outs

➢ Pharmaceutical industry

➢ Meet the demand for SP procurement and register quality SP in all malaria-endemic countries

➢ Meet the demand for procurement and register low-dose folic acid in all malaria-endemic countries

➢ Identify and develop new drugs suitable for use as IPTp

Health Management Information Systems

Monitoring and evaluation to assess IPTp effectiveness and progress and challenges to delivery and uptake at national and local levels

➢ National health institutions in malaria-endemic countries

➢ Ensure IPTp coverage indicators are in line with new policy

➢ Use District Health Management Information System (HMIS) to measure coverage of IPTp, report changes in coverage, identify bottlenecks and take necessary action

➢ Research community; National health institutions in malaria-endemic countries and WHO

➢ Collaborate with WHO and Ministries of Health to establish monitoring and evaluation plans for:

 ◦ SP resistance and its impact on IPTp-SP effectiveness;

 ◦ Reducing malaria transmission and its impact on IPTp-SP effectiveness;

 ◦ Data on uptake and coverage of IPTp from district and facility levels that will help to identify implementation bottlenecks.

Service Delivery

Quality assurance to monitor implementation and eliminate gaps in service delivery

➢ National health institutions in malaria-endemic countries

➢ Explore innovative opportunities in the community for service delivery, both to extend antenatal clinic-based programmes and to serve women where ANC services are under-developed

➢ Research community

➢ Evaluate alternative strategies for the delivery of IPTp in hard-to-reach populations or communities

Community engagement to promote ANC, raise awareness of IPTp benefits and increased uptake of IPTp

➢ National health institutions in malaria-endemic countries

➢ Undertake targeted communication campaigns at both the community and facility levels to promote ANC attendance among pregnant women and to raise awareness of the benefits of IPTp

➢ Research community

➢ Identify, promote and evaluate successful behaviour change communication strategies based on the RBM toolkit^b to:

 ◦ Increase demand and acceptance of IPTp-SP by pregnant women;

 ◦ Improve healthcare provider attitudes and performance;