Antenatal syphilis control: people, programmes, policies and politics

• Published in: Bulletin of the World Health Organization Vol. 82; no. 6; pp. 417 - 423
• Main Authors: HAWKES, Sarah, MILLER, Suellen, REICHENBACH, Laura, NAYYAR, Anjali, BUSE, Kent
• Format: Journal Article
• Language: English
• Published: Genève Organisation mondiale de la santé 01.06.2004; World Health Organization; The World Health Organization
• Subjects: Antenatal care; Bacterial diseases; Bacterial diseases of the genital system; Biological and medical sciences; Community; Control; Cost analysis; Data collection; Data collection/methods; Decision making; Decision making, Organizational; Delivery of health care; Epidemiology; Female; Focus groups; Focus groups/utlization; Health care; Health Policy; Health Policy & Services; HIV; Human bacterial diseases; Human immunodeficiency virus; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Infectious diseases; Interdisciplinary approach; Intervention; Mass Screening - organization & administration; Mass screening/utlization; Medical sciences; Policy Making; Politics; Pregnancy; Pregnancy Complications, Infectious - prevention & control; Pregnancy complications, Infectious/diagnosis; Pregnancy complications, Infectious/epidemiology; Prenatal Care - organization & administration; Prenatal diagnosis; Process assessment (Health care)/methods; Program Development; Public health. Hygiene-occupational medicine; Reproductive health; Risk Assessment; Sexually transmitted diseases; Socioeconomic Factors; Stakeholders; STD; Syphilis; Syphilis, Congenital - prevention & control; Syphilis/diagnosis; Syphilis/economics; Syphilis/epidemiology; Womens health; Infection; Sanitary program; Sexually transmitted disease; Sanitary control; Health policy; Congenital; Spirochaetosis; Syphilis; Bacteriosis; Public health; Treponematosis; Dépistage systématique; Evaluation méthodes santé; Delivery of health care; Prestación de atención de salud; Evaluación de proceso (Atención de salud); Facteur socio-économique; Factores socioeconómicos; Tamizaje masivo; Sífilis; Délivrance soins; Politique sanitaire; Complicaciones infecciosas del embarazo; Recolección de datos; Collecte données; Pregnancy complications, Infectious; Diagnóstico prenatal; Toma de decisiones (Administración); Focus groups; Groupe focal; Mass screening; Decision making, Organizational; Diagnostic prénatal; Prenatal diagnosis; Política de salud; Socioeconomic factors; Data collection; Complication infectieuse grossesse; Prise décision institutionnelle; Grupos foco; Process assessment (Health care)
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862004000600006

Antenatal syphilis control is an integral component of reproductive health policies in most countries. In many of these countries, however, the existence of a health policy does not automatically translate into an effective health programme. We argue that neglecting to take into account the perspectives of all stakeholders when planning programmes may be the reason that functional and sustained interventions for antenatal syphilis are lacking. Stakeholders may include health policy decision-makers, programme managers, service delivery personnel (on whom implementation depends), as well as the pregnant women, families, and communities who will most benefit from the intervention. We describe how to undertake a multilevel assessment in order to identify stakeholders, identify interlinked perspectives, and analyse these perspectives within the socioeconomic, cultural and political environment within which an intervention is designed to be delivered. Using this multidisciplinary approach, we propose that the barriers to, and opportunities for, turning health policy into effective practice will be identified, and the result will be the formulation of a broad programme response to ensure implementation of the policy. Undertaking a multilevel assessment is but the first step in identifying barriers to successful programmes. Currently there is a lack of strong political support for this intervention at national and international levels. Devising strategies to address these potential barriers requires a broad range of skills and approaches some of which are outlined in this paper.