Implementation research studies on the access and use of MiP interventions

New interventions and new combinations of existing interventions to control malaria in pregnancy can only achieve public health impact if, in addition to being efficacious and safe, they 1) can be delivered to pregnant women 2) are acceptable and are used by pregnant women, and 3) if decision makers at various levels of the health system are convinced that they are cost-effective and affordable within available budgetary resources.

Observational studies are used to identify the determinants of access to and the use of MiP services in a variety of health system, policy and household contexts that will provide the information needed to improve pregnant women’s access to the full package of care through ANC and non-ANC channels.

Studies to examine the broader social, cultural and economic determinants of demand for MiP services using a combination of qualitative methods and household surveys are undertaken in non-trial settings in selected countries in Africa and Asia. Factors which affect treatment and prevention seeking behaviour among both pregnant and non-pregnant women, expenditure on treatment and prevention, attendance and services received at ANC, use of and services received at other sources, and barriers to access among service users and non-users, will be explored.

Studies to identify the factors at facility and district levels which influence the supply of MiP services in the context of other reproductive health (or ANC) interventions will be undertaken targeting ANC facilities.

Facility based surveys using a combination of qualitative methods and quantitative methods are employed to explore: the range of services provided (malaria and non-malaria interventions) and reasons for variations in service provision (e.g. where services are available but not provided); provider perceptions of users’ preferences and needs; provider priorities with respect to service provision and the importance they place on malaria interventions compared with other services; provider perceptions of health systems related issues (financing, supply chain, logistics, planning and management processes etc); and costs. Studies at district level use qualitative methods to identify the factors affecting MiP services identified in the facility based surveys.

Case studies will be used to explore the factors affecting policy uptake and nationwide implementation at the level of national decision makers, including the cost and affordability of scaling up prevention and/or treatment strategies. The case studies will link to ongoing efforts to scale up MiP interventions in sub-Saharan Africa which examine the cost of scale up, health systems issues, demand creation, affordability and sustainability. This analysis will include modelling the costs of such scaling up.