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Background: The prevalence of syphilis among antenatal care (ANC) attendees in Indonesia is estimated to be between 1.49% and 3.95%. In 2013, the Ministry of Health introduced a new policy to integrate services to screen all pregnant women for syphilis into ANC. We examined bottlenecks on the delivery of services to screen and treat syphilis at primary and secondary health facilities in Sorong city, West Papua Province, Indonesia.
Methods: An analysis of quantitative service data from 2013 to 2015 was performed to identify bottlenecks to the delivery of services at primary and secondary health facilities.
Results: In 2013, before the new policy was commenced, the coverage of syphilis screening of pregnant women was equally low both primary and secondary health facilities. The prior policy to only test pregnant women with risk factors for syphilis, the lack of test kits and lack of capacity of health workers contributed to the low coverage. Following the new policy to screen all pregnant women with a rapid diagnostic test (RDT) at primary health facilities, midwives were trained, RDT kits were procured, and mobile services were introduced with intensified health promotion. By the end of 2015, 78.4% of pregnant women were screened for syphilis and 95.3% of women with syphilis were treated in these facilities. Meanwhile, secondary health facilities continued to only test pregnant women with known risk factors for syphilis, and stock-outs of benzathine penicillin persisted; only 38.2% of pregnant women were tested, and no women were treated. Bottlenecks at secondary level included lack of coordination with the District Health Office to implement the new policy and the lack of supplies.
Conclusions: The uneven implementation of the new policy at primary and secondary health facilities resulted in large disparities in the coverage of screening and treatment of pregnant women for syphilis.