Assessing and addressing barriers to IPTp uptake in Uganda
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This document summarizes a study conducted in Uganda to identify barriers to the uptake of intermittent preventive treatment for malaria in pregnancy (IPTp) and test an intervention to address the key barriers. The study employed an "embedded approach" involving stakeholders throughout the research process. Formative research identified supply issues and confusion over IPTp guidelines as barriers. The study is now piloting text messages to health workers to reinforce guidelines. Early results include commitments to address identified barriers, such as providing anti-malarial drugs to private facilities and updating IPTp guidelines. The Ministry of Health is overseeing the pilot intervention and hopes to scale it nationwide if effective.
Assessing and addressing barriers to IPTp uptake in Uganda
- 1. Putting research into practice: Assessing and addressing barriers to IPTp uptake in Uganda Badru Gidudu Walimbwa ResUp MeetUp Symposium, Nairobi, 9th -12th February 2015
- 2. Malaria in pregnancy and IPTp • Malaria infection during pregnancy poses substantial health risks to mother and child. • WHO recommends intermittent preventive treatment in pregnancy (IPTp), delivered as part of focused antenatal care (ANC), as a strategy for the prevention and control of malaria in pregnancy. • In many countries, IPTp coverage is low despite high ANC attendance and efforts to address some of the bottlenecks.
- 3. Study on barriers to IPTp uptake in Uganda • Malaria Consortium conducted formative research to explore barriers that continue to impede uptake of IPTp in Uganda. • Based on the findings from the formative research, the team is currently developing a pilot intervention that aims to increase coverage of this crucial service. • The pilot involves sending text messages to health workers to reinforce IPTp provision guidelines.
- 4. Research uptake In addition to exploring barriers to IPTp uptake in Uganda and testing an intervention that addresses the key barriers identified, the study also specified an objective relating to research uptake: To engage with national and international stakeholders throughout the project in order to maximise the study’s potential to achieve change in policy and practice with regard to IPTp provision. In order to achieve this objective, the team adopted an “embedded approach” to research uptake.
- 5. The embedded approach • Developed by COMDIS-HSD, a research programme consortium which aims to support and develop feasible and effective health service delivery strategies in low and middle income countries. • Multi-stage approach based on the assumption that operational research is best prioritised, designed, conducted and replicated when it is embedded within Ministry of Health (MoH) structures. Download the booklet here.
- 6. Embedded approach in practice Applying the principles of the embedded approach, the study on barriers to IPTp uptake in Uganda included the following research uptake activities: • Study designed in consultation with MoH to address a national research priority. • Analysis of relevant stakeholders, including analysis of stakeholders’ interest in malaria in pregnancy and their alignment with the study’s objective of increasing IPTp uptake.
- 7. Embedded approach in practice • Research uptake strategy outlined how key stakeholders would be informed and involved throughout the project. • For each stakeholder, key messages, appropriate activities and expected measurable targets/outputs/outcomes were defined. • Stakeholder engagement supported by appropriate materials, e.g. a project brief and a research brief. Download the project brief here.
- 8. Embedded approach in practice • Progress, results and implications were discussed regularly at national stakeholder meetings. • Relevant MoH departments represented on steering committee, which oversees implementation of pilot intervention. • Study was discussed at two UK all-party parliamentary meetings. • A poster was presented at the Third Global Symposium on Health Systems Research.
- 9. Early successes Study finding Change in policy and practice The current supply mechanism leads to stock-outs of the drug used for IPTp in private sector facilities. MoH has pledged to provide the drug free-of-charge to private sector facilities. Current guidelines for IPTp provision are not in line with most recent WHO policy recommendations. Stakeholders have committed to treating the adoption of the current WHO policy recommendations for IPTp provision as a matter of priority. Health workers are confused about correct timing and dosage of IPTp provision. Stakeholders have tasked Malaria Consortium with developing a pilot intervention addressing this issue.
- 10. Scale-up and stakeholder feedback As relevant MoH departments are closely involved in overseeing the pilot intervention of sending text messages to improve health worker knowledge of IPTp provision guidelines, it is expected that, if shown effective, the intervention will have strong endorsement from MoH for nationwide scale up. “This study pointed out which areas need attention if MoH and Uganda are to improve on the uptake of IPTp services. The study significantly challenged our perception of where the limitations lie. I would expect the harmonisation of IPTp guidelines to be the most significant change resulting from the study.” Quote from a Roll Back Malaria partner
- 11. Funding The study is conducted by Malaria Consortium through COMDIS- HSD, a research programme consortium funded by the UK government. It also received Programme Partnership Arrangement funding from the UK government. Malaria Consortium is a not-for-profit organisation which aims to improve lives in Africa and Asia through sustainable, evidence- based programmes that combat targeted diseases and promote child and maternal health.
- 12. www.malariaconsortium.org Thank you For more information, please contact b.gidudu2@malariaconsortium.org