1. Health Systems Strengthening to Improve
Malaria in Pregnancy Service Delivery
Bill Brieger, Aimee Dickerson and Elaine
Roman
Malaria Core Team, Jhpiego
May 2, 2012

2. Session Objectives: By the end of the
session participants will
 Describe how a comprehensive MIP program
strengthens the health system
 Outline the 9 core elements of MIP programming
including successes and common challenges
 Review how strengthened systems leads to
improved MIP outcomes
 Describe the opportunities and challenges with
health systems strengthening for improved MIP
programming
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3. Presentations
 Overview: Strengthening Health Systems
through MIP Programming
 Expansion of a Comprehensive MIP Program in
Post-conflict South Sudan
 Pharmaceutical Management for MIP Control
 Engaging Men to Prevent MIP
 Monitoring and Evaluation of MIP Programs
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4. The Threat
 Malaria poses a major health risk to pregnant
women and their unborn babies in endemic
areas
 For the Woman
 Increased anemia and greater threats of pre-
eclampsia, post-partum hemorrhage and mortality
 For the Child
 Fetal growth retardation, miscarriage, still birth, low
birth weight, perinatal/infant mortality
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5. The Interventions
 MIP interventions are not one-shot actions
 WHO promotes a three-pronged approach
 Intermittent preventive treatment (IPTp)
 Insecticide treated nets (ITNs)
 Appropriate case management with
– Prompt diagnosis using rapid diagnostic tests (RDTs)
– Treatment with Artemisinin-Based Combination Therapy
(ACT)
 Must be delivered as part of comprehensive
focused antenatal care (FANC)
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6. The Situation
Most Recent IPTp2 Coverage Data From surveys
(DHS, MIS, MICS) or NHIS
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7. Similarly LLIN Coverage is Low
From most recent available data:
DHS, MIS, MICS, NHIS 7

8. The System: Core Components of MIP
Implementation
1. Health Policy/Guidelines
 Harmonized: malaria, reproductive health, HIV/AIDS
 Simple and clear dissemination to health workers
2. Integration/Coordination
 Collaboration among reproductive health, malaria
and HIV/AIDS for effective planning
 Coordination of implementation efforts
3. Human Resource Capacity
 In-service training
 Pre-service education
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9. Core Components of MIP Implementation
4. Procurement/Commodities
 Availability of ITNs, SP and RDTs at ANC
5. Community Involvement
 Bridging the link between communities and facilities
 Promotion of ANC, ITN use, IPTp uptake
6. Quality Assurance
 Performance standards in place based on national
guidelines
 Linked with supervision support
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10. Core Components of MIP Implementation
7. Governance
 Leadership: coordinating partners to support on
national policy/strategy
 Accountability
8. Adequate Financing
 Advocacy for MIP funding based on fact that
pregnant women are most vulnerable
9. Monitoring and Evaluation
 MIP data incorporated into malaria and overall
health management information systems
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11. For more information…
 Malaria in Pregnancy Resource Package
 http://www.jhpiego.org/files/malarialrp/index.htm
 MIP Program Implementation Guide
 http://www.jhpiego.org/files/malarialrp/english/progra
mResources/files/Malaria_ImpGuide_web.pdf
 Three country MIP case studies
 http://www.mchip.net/Documentation_and_Dissemina
tion
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