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Table 5 Summary of key findings: adaptation, integration and scale-up

From: Evaluation of the national policy of single screening and treatment for the prevention of malaria in pregnancy in two districts in Eastern Indonesia: health provider perceptions

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