Momentum for policy change: Using the community to safeguard women from malaria in pregnancy

Photo: PATH/Eric Becker.

Photo: PATH/Eric Becker.

By Rosemarie Muganda-Onyando
Deputy Country Director for PATH’s Kenya office

We need a new approach to protect women and newborns from malaria in pregnancy in Kenya; our communities may be the solution.

For the past year, our staff in Kisumu has worked to find innovative ways to deliver preventive malaria treatment to expectant mothers in the community. Through a pilot study, we demonstrated that community health workers (CHWs) can successfully distribute sulfadoxine-pyrimethamine (IPTp-SP), a cost-effective antimalarial safe for use in pregnancy, while also encouraging women to seek antenatal care (ANC) at the local clinic.

In Kenya, however, current policies limit IPTp-SP administration to skilled health workers at the facility level. As a result, this critical antimalarial treatment remains out of reach for too many mothers because of long distances to facilities and concerns about quality of care. But even in health facilities, missed opportunities are common; almost half of women seeking ANC are not given IPTp-SP. For these reasons, coverage and uptake have remained well below Kenya’s targets.

At the Malaria in Pregnancy Stakeholders’ Forum hosted by PATH last week, advocates, program implementers, and government officials challenged the current approach, agreeing that expectant mothers should be able to access preventive malaria care in health facilities and at the community level. The results of the pilot program in Kisumu—and other evidence from the region—show that CHWs can serve as a complementary mechanism for reaching as many pregnant women as possible in the community. Moreover, CHWs are able to promote ANC visits during their interaction with women; our pilot study showed an increase in ANC attendance, demonstrating that CHWs enhance health facility distribution, rather than deterring women from going to clinics.

As we continue to gather evidence confirming that new channels can increase access to IPTp-SP and reduce morbidity and mortality from malaria in pregnancy, it is critical that we advocate for policy change to institutionalize these approaches. By creating a positive policy environment that increases community-based options for IPTp-SP distribution, Kenya could extend the reach of the health system into the community, increasing the number of women who receive preventive treatment and positively impacting ANC visits.

Dr. Onditi looks on during the celebration in Kisumu. Photo: Michel Pacque.

Dr. Onditi. Photo: Michel Pacque.

There is clear momentum for community-based solutions to malaria in pregnancy, and with our growing evidence, the time is right for policy that uniformly links CHWs and mothers throughout Kenya. Alongside our partners, PATH made this case at the National Malaria Forum this week, where Dr. Samwel Onditi presented our pilot evidence and highlighted the all too common problem of contracting malaria during pregnancy. It is clear that the government, through the Malaria Control Unit and the Reproductive and Maternal Health Division, is prioritizing malaria prevention; it is our job as advocates to ensure that interventions for malaria in pregnancy are part of the national malaria and reproductive health dialogues.

I am incredibly proud of the work that PATH and partners have done to generate evidence around this important issue. Now maternal and newborn health advocates, program implementers, and technical experts must use this evidence to call on the Government of Kenya to pursue policy change. We owe it to our community to safeguard all women and newborns from malaria during pregnancy.

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