Scaling up antenatal syphilis screening in Mozambique: transforming policy to action.

Objectives: This paper examines the decade-long scale-up process of antenatal syphilis screening through Mozambique's National Health System. Goal: The primary goal is to provide lessons learned in the provision of integrated antenatal care resource-poor settings and identify key challenges to successful scale-up. Study Design: We documented health systems activities associated with improvements in the proportion of women tested, treated, and partners treated for syphilis. Results: The proportion of women in antenatal visit screened for syphilis in the two target provinces has risen from 5% in 1992 to between 60% and 95% consistently since 1999. This success required multiple levels of health system strengthening. Conclusions: The Mozambique experience shows that key elements to effective antenatal syphilis screening include adequate workforce, facilities, coherent systems of care, community involvement, donor management, advocacy, and leadership.