4 Obstetrics and Gynecology International Ensure advocacy and political commitment Increase access to and quality of services Screen and treat pregnant women and partners Establish surveillance, monitoring, and evaluation Promote partnerships Increase awareness of adverse outcomes Develop linkages with other programmes Demonstrate cost-beneﬁt Promote early prenatal care Expand screening, treatment, and partner management Ensure supplies and treatment available Increase access and decrease barriers to care Improve quality of care Improve community awareness Elimination of Congenital Syphilis Provide point of care diagnosis and treatment for all Increase use of rapid diagnostics Test and treat woman at delivery as necessary Treat infants born to infected mothers Oﬀer STI prevention counselling in pregnancy Diagnose and treat genital ulcer disease Screen for STI Support baseline data and eﬀective reporting Clarify roles and responsibilities Develop systems for monitoring progress and evaluating outcomes Improve systems for evaluating sustainability Develop indicators to measure programme eﬀectiveness Figure 1: The four pillar strategy for elimination Congenital Syphilis. an Investment Case for resource mobilization and to raise awareness of the issue and the proposed solutions. Cost calculations within the Investment Case have highlighted the signiﬁcant DALY burden associated with untreated syphilis in pregnant women and have demonstrated how this DALY burden disproportionately aﬀects people in low- and middle- income countries. The Investment Case shows how the elimination of congenital syphilis is a relatively “easy win” for programmes in aﬀected countries as the intervention is rel- atively simple, highly cost-eﬀective, technically feasible, and already politically acceptable (as demonstrated by consistent policies already in existence). Moreover, the Investment Case stresses that elimination of congenital syphilis is timely for countries that are aiming to reach their Millennium Development Goal commitments by 2015. 6. Next Steps With suﬃcient resources, several additional areas can be better addressed to ensure that public health eﬀorts aimed at the global elimination of congenital syphilis are eﬀective, sustainable, and support overall MCH systems strengthen- ing. 6.1. Addressing Barriers and Ensuring Sustainability of Pro- grammes. As noted, a number of barriers currently exist that limit maternal syphilis screening and treatment eﬀorts in developing world settings. Despite this situation, evi- dence based on current programmes supports that many of these barriers can be eﬀectively countered if resources and eﬀorts focus on antenatal health systems strengthening [22, 23]. An important component of the global initiative to eliminate congenital syphilis is that it promotes maternal syphilis screening and treatment as part of basic antenatal health services, thus is framed as a means of strengthening overall MCH systems rather than only battling congenital syphilis. In its promotion of early antenatal care with the recommended basic package of health services, the initiative intervenes against a range of preventable causes of perinatal morbidity and mortality. Similarly, in promoting integration of ANC service delivery through strategies such as incorporating integrated professional training and cur- ricula for health care providers, coordinating distribution systems for critical commodities around ANC services, or integrating data systems monitoring, the initiative sup- ports building capacity for improved antenatal outcomes overall.