| Indicator | Stage 1: Awareness of Need [Thinking] | Stage 2: Initial Startup [Planning] | Stage 3: Partially Implemented [Action] | Stage 4: Fully Implemented [Maintenance] |
| Integration | ||||
| Central-level MIP programming is harmonized among RH, malaria control, and HIV programs. | National stakeholders in RH, malaria control, and HIV are aware of the need to harmonize their materials. | National stakeholders in RH, malaria control, and HIV have discussed planning to harmonize their materials. | National stakeholders in RH, malaria control, and HIV have started to harmonize their materials. | National RH, malaria, and HIV materials have been harmonized. |
| Central-level MIP programming is coordinated among RH, malaria control, and HIV programs. | National stakeholders in RH, malaria control, and HIV are aware of the need to coordinate program implementation. | National stakeholders in RH, malaria control, and HIV meet on a regular basis to share program strategies. | National stakeholders in RH, malaria control, and HIV meet on a regular basis to coordinate program implementation. | National stakeholders in RH, malaria control, and HIV leverage resources across program areas and implement activities jointly. |
| MIP services are integrated with FANC, PMTCT, and malaria control services at the facility level. | National stakeholders and relevant health care providers are aware of need to integrate MIP with FANC, PMTCT, and/or malaria control services. | MIP guidelines are standardized and integrated across FANC, PMTCT, and malaria control service delivery guidelines and preservice and in-service curricula. | Relevant health care providers have been trained in and are integrating MIP services with FANC and PMTCT but are constrained by commodity stockouts. | Relevant health care providers are trained in and are integrating MIP services with FANC and PMTCT. |
| Policy | ||||
| National policy on MIP exists. | Relevant stakeholders in MCH/RH, HIV, and malaria are aware of need for MIP policy. | MIP policy has been drafted and includes WHO's 3-pronged approach, as appropriate, with involvement and acceptance of relevant stakeholders. | MIP policy has been disseminated to major stakeholder organizations. | All service units (public, nongovernmental, and private) are providing the components of care and services based on national MIP policy. |
| National guidelines and/or performance standards have been developed. | Relevant stakeholders are aware of need for guidelines and standards for MIP. | MIP guidelines and standards have been drafted and include WHO's 3-pronged approach, as appropriate, with involvement and acceptance of relevant stakeholders. | MIP guidelines and standards have been disseminated to major stakeholder organizations and health care providers. | All service units (public, nongovernmental, and private) are providing care and services in accordance with national MIP guidelines and standards. |
| National strategy and action plans for malaria and RH include MIP programming. | Relevant stakeholders are aware that strategies and action plans for malaria and RH need to include MIP. | MIP programming has been integrated into strategies and action plans that include WHO's 3-pronged approach, as appropriate, with involvement and acceptance of relevant stakeholders. | MIP strategies and action plan components have been disseminated to major stakeholder organizations. | All service units (public, nongovernmental, and private) are implementing MIP activities in accordance and on schedule with strategies and action plans. |
| Commodities | ||||
| The health system at all levels is procuring WHO- recommended commodities for prevention and case management of MIP. | MIP commodities and supplies appear in broad essential medicines lists but are not congruent with current WHO guidance. | An updated essential drug list includes only those MIP commodities approved by WHO. | Antenatal and primary health care clinics stock WHO-recommended MIP commodities, but some unapproved medicines remain on shelves. | Only WHO-approved MIP medicines and supplies are stocked in antenatal and primary health care clinics. |
| Systems are in place to guarantee regular provision of MIP commodities to ANC clinics as part of routine service delivery. | Current procurement and supply system does not guarantee MIP commodities, but stakeholders are discussing problems in the system. | Improved supply chain management systems are being designed, including training on procurement for relevant staff at all levels. | Approved MIP medicines and supplies are being provided to ANC and primary health care clinics, but stockouts occur. | Approved MIP medicines and supplies are available on a regular basis at ANC and primary health care clinics. |
| Quality Assurance | ||||
| Supervisory and performance assessment tools, including performance standards, are developed for MIP programming. | Relevant stakeholders are aware of the need for MIP supervisory and performance assessment tools that are based on MIP policies and guidelines. | Supervisory and performance assessment tools have been developed and harmonized in line with national MIP policies and guidelines. | Supervisory and performance assessment tools have been disseminated to all supervisors, in-charges, and health care providers. | Supervisory and performance assessment tools are consistently used in routine performance assessments. |
| Regular supervisory visits and quality assessments are being conducted. | Relevant stakeholders are aware of the need to conduct regular MIP supervisory visits and quality assessments for relevant health care providers, using tools based on MIP policies and guidelines. | Supervisory and performance assessment tools have been developed and harmonized in line with national MIP policies and guidelines. | Supervisors and trainers have been trained in supervisory and performance assessment tools and are supervising health care providers on a limited basis. | Supervisors are routinely providing supervision to health care providers based on national supervisory and performance assessment tools. |
| Self-assessments are being conducted. | Relevant stakeholders are aware of the need for ongoing self-assessment by relevant health care providers using MIP supervisory and performance assessment tools based on MIP policies and guidelines. | Supervisory and performance assessment tools have been developed and harmonized in line with national MIP policies and guidelines. | Relevant health care providers are trained in and are performing self-assessments using performance standards on a limited basis. | Relevant health care providers are trained in and are using self-assessment tools routinely. |
| Capacity Building | ||||
| IST on MIP is organized and provided. | Relevant stakeholders are aware of the need to adapt MIP policies and guidelines into IST for relevant health care providers. | MIP IST curriculum has been developed in line with national policies and guidelines with involvement and acceptance of relevant stakeholders. | Training is in initial phases of rollout with national plans for scale up. | IST training in MIP, in line with national policy and guidelines, is currently ongoing for relevant staff in all service units (public, nongovernmental, and private), including through integration with FANC, malaria control, and/or PMTCT. |
| PST on MIP is organized and provided. | Relevant stakeholders are aware of the need to adapt MIP policies and guidelines into PST for relevant service providers. | MIP PST curricula has been developed in line with national policies and guidelines with involvement and acceptance of relevant stakeholders. | Training of trainer teams from among the relevant stakeholders has been undertaken, and instructors, tutors, and preceptors have been trained. | Students in all training institutions (public, nongovernmental, and private) have received MIP PST in line with national policies and guidelines. |
| Community-Based MIP Programs | ||||
| Interventions are in place to promote community awareness, education, and communication about MIP and its control options. | No community awareness activities have been planned, but partners have been consulted about designing these. | MIP communication plan and guidelines have been developed, and materials are being designed and channels selected. | MIP communication activities are being aired and disseminated through mass media and community-based interpersonal communication. | MIP awareness and communication activities are sustained through the media, health centers, community volunteers, and other channels. |
| Resources are provided so that the community itself can take action to control MIP. | Policies are being debated to enable community involvement in MIP prevention and case management. | Community MIP prevention and case management guidelines are adopted; training and supply processes are being set up to ensure communities have the skills and resources needed for action in MIP prevention and case management. | Community members have been trained on MIP prevention and case management and provided initial resources and supplies to undertake MIP prevention and case management activities. | Wide coverage of MIP prevention and case management resources are sustained in the communities to guarantee universal access to MIP prevention and case management. |
| Data are collected and disseminated that show the community has increased uptake of MIP program interventions. | Partners are discussing ways to monitor the results of community awareness and action in MIP programming. | Specific data collection tools have been designed and pretested for documenting uptake of MIP interventions resulting from community action, including a process by which such data are incorporated into facility, district, and national HMIS. | Malaria data collection forms have been distributed to communities and community members have been trained on use of the forms. | Communities are submitting malaria forms regularly to nearest health facility where information is summarized and submitted to HMIS as well as being used to make decisions to improve community MIP interventions. |
| Monitoring and Evaluation | ||||
| MIP control data are collected routinely and used for decision making at all points of care (facility, district, regional). | Partners are discussing ways to monitor the results of MIP care and action in MIP programming. | Data collection tools have been designed and pretested for documenting uptake of MIP interventions delivered at health facilities. | Malaria data collection forms have been distributed to health facilities, and health care providers have been trained on use of the forms and are using them routinely. | Health facilities are reporting MIP data regularly to the district level where the information is summarized and passed on to the national level. MIP information is being used to make decisions to improve MIP interventions and care at national and lower levels. |
| National population-based surveys are collecting data on trends in MIP intervention coverage and health outcomes. | National governments are aware of the need to prioritize MIP into national level surveys. | National governments and partners are committed to the inclusion of WHO-promoted MIP indicators into national surveys. | National surveys include WHO-promoted MIP indicators. | National surveys are being used to discern trends in MIP intervention coverage and health outcomes, and data are used for policy dialogue and planning. |
| Financing | ||||
| National governments are providing funding to MIP programs. | National governments are aware of the need to prioritize MIP in their annual program funding. | National governments commit funding that is not yet adequate to support projected costs. | National governments contribute significant funding that supports majority of projected costs for MIP priorities in their national malaria strategies. | National governments have committed and disbursed funds to MIP programs that are adequate for all projected costs. |
| Donors are investing in national MIP programs. | Donors are aware of the need to prioritize funding for MIP programs. | Governments are submitting proposals for funding and limited donor funding exists. | Governments are successful in soliciting support and strong donor funding exists. | Ample donor funding exists for MIP and is being used effectively. |
Abbreviations: ANC, antenatal care; FANC, focused antenatal care; IST, in-service training; HMIS, health management information system; MCH, maternal and child health; MIP, malaria in pregnancy; PMTCT, prevention of mother-to-child transmission of HIV; PST, preservice training; RH, reproductive health; WHO, World Health Organization.