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Where We Work : Madagascar
Madagascar
Prevention and Management of Malaria in Pregnancy
ACCESS is helping to prevent and manage malaria in pregnancy (MIP) in Madagascar through its participation in the Malaria Action Coalition (MAC). In addition to providing technical support to the National Malaria Control Program, the National Safe Motherhood Program, and drug agency programs, ACCESS adopted a national malaria policy—including providing Intermittent Preventive Treatment of malaria in pregnancy (IPTp) with Sulfadoxine-Pyrimethamine after the first trimester—with the support of MAC and the Ministry of Health and Family Planning (MOH/FP). Upon the adoption of this policy, the MOH/FP selected five model sites from a highly endemic province in which ACCESS would implement IPTp. These sites covered a population of 103,609 with 4,700 pregnant women.
ACCESS developed and validated service delivery guidelines for all aspects of malaria, and created learning materials to train health providers and introduce a performance and quality improvement (PQI) process at the five model sites. A MIP PQI assessment tool was developed, nationally validated and used to conduct a baseline assessment, three follow-up visits, and supportive supervision at each site. In case management, ACCESS supported the MOH/FP in the implementation of artemisinin-based combination treatment (ACT) as the new first line treatment for malaria in Madagascar by developing clinical performance standards for use by service providers. These standards were implemented in six additional sites.
Since 2004, 2,159 service providers have received MIP training from core trainers developed by the ACCESS Program—or approximately 2,144 health facilities in 92 of the 111 districts that implement IPT/SP. Facilities improved their average performance score from 20% of standards achieved at baseline to 65% at six months follow up, and 76% at 25 months follow up. Second dose IPTp coverage increased from 0% to 65% in the five sites compared to 35% nationally. Approximately 2.8 million women of reproductive health age (15 – 49) now have access to MIP services and 4.1 million have access to health facilities that have MIP job aids and other support materials. Moreover, 63 health facilities are implementing improved infection prevention practices related to the delivery of MIP services.
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