Table 5 Summary of key findings: adaptation, integration and scale-up
Area | Themes | Sub-themes |
|---|---|---|
Adaptation | To what extent have changes been made to existing systems to implement SST? | |
Replacement of microscopes with RDTs | Can microscopes be replaced with more sensitive RDTs? | |
Anti-malarials given by midwives in villages | Can midwives deliver drugs at the village sites? | |
Integration | To what extent has SST been integrated into the existing system? | |
SST at health centres (current strategy) | ANC and labs work together to screen pregnant women; midwives carry out screening and malaria coordinator is responsible for reporting | |
Anti-malarials being given by midwives | Not the role of midwives to prescribe/distribute anti-malarials; important for medications to pass through pharmacy; if no doctor is available, then a midwife can prescribe medications but doctor should be consulted; midwives can prescribe anti-malarials to pregnant women | |
SST at village sites | Midwives request drugs and RDTs from health centre pharmacy/drugstore to take to health post/sub health centres | |
Quantification of supplies | RDTs/anti-malarial orders based on the monthly consumption reports by ANC; orders placed by pharmacy to DHO quarterly; RDTs used for all patients/not exclusively pregnant women | |
SST indicators into HMIS | Indicators collected by ANC at health centres and health posts No. ANC attendees No. received SST by ANC visit no SST recorded in ANC booklet and/or cohort book Diagnostic technique (RDT or microscope) recorded at some facilities but not others Indicators collected at village sites No. ANC attendees, No. received screening, positive/negative results Indicators collected by the lab Lab does not specifically collect data on PW, it reports general malaria data Health facility reporting ANC collects data on SST, malaria coordinator compiles the report but collates all malaria data (no specific report that links SST with pregnant women or ANC visit) | |
Expansion (scale-up) | To what extent has or can SST be scaled up and expanded? | |
Regular RDT supplies | Can RDTs be supplied regularly and stock-outs avoided? | |
Health provider roles | Malaria coordinator is primarily involved in reporting on malaria in general; often has another role such as lab tech or nurse; sometimes directly involved with SST program Doctors are involved with the treatment of malaria in pregnancy Midwife coordinators carry out screening and collect data from various sites; village midwives’ roles vary depending on what malaria related activities are done at the village sites | |
Health provider training | Never been trained on malaria screening/use of RDTs; received training on malaria screening; not received formal training but learned from colleagues | |
HMIS | Can the HMIS system be improved to reduce stock outs of RDTs and monitor SST program? | |
Sustainability of funding | Global Fund may have stopped funding SST related logistics; no specific budget for malaria in pregnancy |