Using the Problem Tree and Results Chain to Improve Uptake of Intermittent Preventive Treatment in Pregnancy Services—Case Study of the Malaria Action Program for Districts in Uganda
Abstract Malaria in pregnancy contributes considerably to poor pregnancy outcomes. The U.S. Agency for International Development’s Malaria Action Program for Districts project in Uganda used the Problem Tree and Results Chain tool to identify demand and supply barriers responsible for the low uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in 52 districts of Uganda. The key supply-side barriers identified were related to leadership/governance, health financing, medicines and technologies, health information systems, human resources, service delivery, and users. The project used the results to plan and implement interventions targeting the barriers. As a result, from October 2018 to September 2019, the project reported an apparent improvement in uptake of three or more doses of IPTp (49–67%). Malaria in pregnancy cases and stock out of sulfadoxine-pyrimethamine (SP) did not change considerably. The Problem Tree and Results Chain tool is a useful and complementary project management tool to identify root causes and their solutions during planning and implementation. Projects using this tool should periodically re-assess performance of IPTp policy implementation and develop appropriate solutions to address the key bottlenecks identified to increase the likelihood of sustained improvement. Further evaluation of the utility of the tool in other settings is recommended.
