Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers

Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evi...
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Autor*in:	Thiam, Sylla [verfasserIn] Kimotho, Victoria Gatonga, Patrick

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2013

Schlagwörter:	IPTp Access Uptake Coverage Barriers Malaria Prevention Africa

Anmerkung:	© Thiam et al.; licensee BioMed Central Ltd. 2013

Übergeordnetes Werk:	Enthalten in: Malaria journal - London : BioMed Central, 2002, 12(2013), 1 vom: 03. Okt.
Übergeordnetes Werk:	volume:12 ; year:2013 ; number:1 ; day:03 ; month:10

Links:	Volltext

DOI / URN:	10.1186/1475-2875-12-353

Katalog-ID:	SPR028628985

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520			\|a Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness.
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allfields	10.1186/1475-2875-12-353 doi (DE-627)SPR028628985 (SPR)1475-2875-12-353-e DE-627 ger DE-627 rakwb eng Thiam, Sylla verfasserin aut Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Thiam et al.; licensee BioMed Central Ltd. 2013 Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. IPTp (dpeaa)DE-He213 Access (dpeaa)DE-He213 Uptake (dpeaa)DE-He213 Coverage (dpeaa)DE-He213 Barriers (dpeaa)DE-He213 Malaria (dpeaa)DE-He213 Prevention (dpeaa)DE-He213 Africa (dpeaa)DE-He213 Kimotho, Victoria aut Gatonga, Patrick aut Enthalten in Malaria journal London : BioMed Central, 2002 12(2013), 1 vom: 03. Okt. (DE-627)355986582 (DE-600)2091229-8 1475-2875 nnns volume:12 year:2013 number:1 day:03 month:10 https://dx.doi.org/10.1186/1475-2875-12-353 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2013 1 03 10
spelling	10.1186/1475-2875-12-353 doi (DE-627)SPR028628985 (SPR)1475-2875-12-353-e DE-627 ger DE-627 rakwb eng Thiam, Sylla verfasserin aut Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Thiam et al.; licensee BioMed Central Ltd. 2013 Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. IPTp (dpeaa)DE-He213 Access (dpeaa)DE-He213 Uptake (dpeaa)DE-He213 Coverage (dpeaa)DE-He213 Barriers (dpeaa)DE-He213 Malaria (dpeaa)DE-He213 Prevention (dpeaa)DE-He213 Africa (dpeaa)DE-He213 Kimotho, Victoria aut Gatonga, Patrick aut Enthalten in Malaria journal London : BioMed Central, 2002 12(2013), 1 vom: 03. Okt. (DE-627)355986582 (DE-600)2091229-8 1475-2875 nnns volume:12 year:2013 number:1 day:03 month:10 https://dx.doi.org/10.1186/1475-2875-12-353 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2013 1 03 10
allfields_unstemmed	10.1186/1475-2875-12-353 doi (DE-627)SPR028628985 (SPR)1475-2875-12-353-e DE-627 ger DE-627 rakwb eng Thiam, Sylla verfasserin aut Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Thiam et al.; licensee BioMed Central Ltd. 2013 Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. IPTp (dpeaa)DE-He213 Access (dpeaa)DE-He213 Uptake (dpeaa)DE-He213 Coverage (dpeaa)DE-He213 Barriers (dpeaa)DE-He213 Malaria (dpeaa)DE-He213 Prevention (dpeaa)DE-He213 Africa (dpeaa)DE-He213 Kimotho, Victoria aut Gatonga, Patrick aut Enthalten in Malaria journal London : BioMed Central, 2002 12(2013), 1 vom: 03. Okt. (DE-627)355986582 (DE-600)2091229-8 1475-2875 nnns volume:12 year:2013 number:1 day:03 month:10 https://dx.doi.org/10.1186/1475-2875-12-353 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2013 1 03 10
allfieldsGer	10.1186/1475-2875-12-353 doi (DE-627)SPR028628985 (SPR)1475-2875-12-353-e DE-627 ger DE-627 rakwb eng Thiam, Sylla verfasserin aut Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Thiam et al.; licensee BioMed Central Ltd. 2013 Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. IPTp (dpeaa)DE-He213 Access (dpeaa)DE-He213 Uptake (dpeaa)DE-He213 Coverage (dpeaa)DE-He213 Barriers (dpeaa)DE-He213 Malaria (dpeaa)DE-He213 Prevention (dpeaa)DE-He213 Africa (dpeaa)DE-He213 Kimotho, Victoria aut Gatonga, Patrick aut Enthalten in Malaria journal London : BioMed Central, 2002 12(2013), 1 vom: 03. Okt. (DE-627)355986582 (DE-600)2091229-8 1475-2875 nnns volume:12 year:2013 number:1 day:03 month:10 https://dx.doi.org/10.1186/1475-2875-12-353 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2013 1 03 10
allfieldsSound	10.1186/1475-2875-12-353 doi (DE-627)SPR028628985 (SPR)1475-2875-12-353-e DE-627 ger DE-627 rakwb eng Thiam, Sylla verfasserin aut Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers 2013 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Thiam et al.; licensee BioMed Central Ltd. 2013 Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. IPTp (dpeaa)DE-He213 Access (dpeaa)DE-He213 Uptake (dpeaa)DE-He213 Coverage (dpeaa)DE-He213 Barriers (dpeaa)DE-He213 Malaria (dpeaa)DE-He213 Prevention (dpeaa)DE-He213 Africa (dpeaa)DE-He213 Kimotho, Victoria aut Gatonga, Patrick aut Enthalten in Malaria journal London : BioMed Central, 2002 12(2013), 1 vom: 03. Okt. (DE-627)355986582 (DE-600)2091229-8 1475-2875 nnns volume:12 year:2013 number:1 day:03 month:10 https://dx.doi.org/10.1186/1475-2875-12-353 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2013 1 03 10
language	English
source	Enthalten in Malaria journal 12(2013), 1 vom: 03. Okt. volume:12 year:2013 number:1 day:03 month:10
sourceStr	Enthalten in Malaria journal 12(2013), 1 vom: 03. Okt. volume:12 year:2013 number:1 day:03 month:10
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	IPTp Access Uptake Coverage Barriers Malaria Prevention Africa
isfreeaccess_bool	true
container_title	Malaria journal
authorswithroles_txt_mv	Thiam, Sylla @@aut@@ Kimotho, Victoria @@aut@@ Gatonga, Patrick @@aut@@
publishDateDaySort_date	2013-10-03T00:00:00Z
hierarchy_top_id	355986582
id	SPR028628985
language_de	englisch
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Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. 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author	Thiam, Sylla
spellingShingle	Thiam, Sylla misc IPTp misc Access misc Uptake misc Coverage misc Barriers misc Malaria misc Prevention misc Africa Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers
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topic_title	Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers IPTp (dpeaa)DE-He213 Access (dpeaa)DE-He213 Uptake (dpeaa)DE-He213 Coverage (dpeaa)DE-He213 Barriers (dpeaa)DE-He213 Malaria (dpeaa)DE-He213 Prevention (dpeaa)DE-He213 Africa (dpeaa)DE-He213
topic	misc IPTp misc Access misc Uptake misc Coverage misc Barriers misc Malaria misc Prevention misc Africa
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title	Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers
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title_full	Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers
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doi_str_mv	10.1186/1475-2875-12-353
title_sort	why are iptp coverage targets so elusive in sub-saharan africa? a systematic review of health system barriers
title_auth	Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers
abstract	Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. © Thiam et al.; licensee BioMed Central Ltd. 2013
abstractGer	Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. © Thiam et al.; licensee BioMed Central Ltd. 2013
abstract_unstemmed	Background Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent. Methods and findings Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. Conclusions For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness. © Thiam et al.; licensee BioMed Central Ltd. 2013
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title_short	Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers
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Why are IPTp coverage targets so elusive in sub-Saharan Africa? A systematic review of health system barriers

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