March 24, 2015 |

Task-shifting: an effective way to protect expecting mothers from malaria

A pilot in Kenya shows how moving some tasks from trained medical providers to community health workers can help safeguard pregnant women from malaria.
A woman's hand next to a newborn infant lying on a bed.
When a pregnant woman has access to preventive malaria care, it can lead to improved health outcomes for her and her newborn. Photo: PATH/Gabe Bienczycki.

Malaria is a life-threatening illness for anyone. But what are the consequences when a pregnant woman gets malaria?

During pregnancy, it can cause serious, life-threatening risks for a woman and her baby. Common problems include maternal anemia, miscarriage, prematurity, stillbirth, and low birthweight in newborns.

Safe and effective treatment to prevent malaria in pregnancy is available, but it is often out of reach for those at risk. Task-shifting—or moving specific tasks from trained medical providers to community health workers—is a low-cost, effective way to improve access to health services that save lives.

Women hold insecticide-treated nets in a lobby; a woman getting tested for malaria; a woman standing outside.
Clockwise from left: Women receive insecticide-treated nets during antenatal care visits; a woman gets tested for malaria using a rapid diagnostic test; a woman from Kisumu West makes her way to a health facility for antenatal care. Photos: PATH/Gena Morgan, PATH/Gena Morgan, PATH/Eric Becker.

In Kenya, a pilot study in Kisumu West sub-county is showing the positive impact of new policies that allow health workers to provide health services and administer certain medicines at the community level to better protect expecting mothers and their newborns from malaria.

Protective malaria treatment is often out of reach

Sulfadoxine-pyrimethamine (IPTp-SP) is a safe and effective intervention that can be administered during antenatal care visits to reduce malaria-caused health complications in expecting mothers and their newborns. Unfortunately, long distances to health facilities and a lack of access to high-quality care can deter many pregnant women in resource-limited settings from seeking early care or completing four recommended health care visits.

In Kenya, where many women remain at risk of malaria in pregnancy, current policies limit IPTp-SP administration to skilled health workers. As a result, critical antimalarial treatment remains out of reach for many mothers who have difficulty accessing facility-level care.

The success of a new task-shifting policy in one area could improve the situation.

Health system innovation for improved community care

Task-shifting extends the reach of the health system, successfully bridging the gap between communities and health facilities.

Through the pilot study in Kenya, PATH (in partnership with USAID-funded APHIAplus and the Bill & Melinda Gates Foundation) has shown that community health workers can effectively deliver treatment and care to expecting mothers to better prevent malaria.

Report cover of "Policies and Actions for Improved Malaria in Pregnancy Efforts in Communities."
Download Policies and Actions for Improved Malaria in Pregnancy Efforts in Communities, which details the results of a pilot program addressing malaria in pregnancy. Photo: PATH.

The pilot study has already demonstrated an increase in the number of women receiving IPTp-SP preventive treatment. And, in pilot health clinics where community health workers administered the medicine, 25% more women completed the recommended four antenatal care visits for a safer pregnancy.

Evidence for advocacy impact

Similar research has emerged from other regions of Kenya and multiple sub-Saharan African countries.

In order to share this new evidence and build support for community-based approaches to prevent malaria in pregnancy, PATH hosted a stakeholders’ forum in Nairobi, which brought together technical experts, government officials, and civil society representatives. After presentations on global recommendations and country-level research, participants identified policy change recommendations that—if implemented—would ensure a community-centered approach to safeguarding women from malaria in pregnancy.

The results of the forum—detailed in the newly released report Policies and Actions for Improved Malaria in Pregnancy Efforts in Communities—will be shared with key Ministry of Health leaders in Kenya to demonstrate the positive health impact of community distribution of IPTp-SP.

PATH is committed to engaging with decision-makers and carrying this agenda forward with our partners; we believe that by turning the emerging evidence into policy action, we can ensure that no woman is left unprotected from malaria in pregnancy.

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  • Wanjiku Manguyu is a family health advocacy officer in our Advocacy and Public Policy Program at PATH in Kenya.