coverage of all pregnant women with at least two doses of IPTp-SP by 2005 in line with the Abuja Declaration of 2000. However, the target was later on increased to a coverage rate of 85% pregnant women attending ANC clinics by 2010 \[[@B15]\]. The latter decision was in line with the Roll Back Malaria Partnership's aim that emphasized countries to target covering at least 80% of all the pregnant women living in areas with stable or high intensity of malaria with IPTp doses. The same projection was made about targeting to cover pregnant women using ITNs by 2010. Discouragingly, most countries did not succeed attaining this target due to a number of demand and supply barriers \[[@B16]\].

The issue of administration of IPTp-SP following the existing national guidelines inwere the frontline HWs who were traced at public and private HFs implementing ANC services. The perspectives of these respondents have been partly supported and partly challenged by the experiences obtained from the users of the existing ANC clinics/services, particularly pregnant women also assessed during the present study period as well as the lactating mothers who were recently using such services. Additional views were obtained from the national and district level officers \[[@B17],[@B18]\].

Study sites
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Mkuranga is located in the Pwani (officially known as Coast) Region in the East near the Indian Ocean, an area of stable and perennial malaria transmission. Mufindi is located in Iringa Region in the southern highlands of Tanzania, an area of seasonal malaria transmission. Selection of these districts was done purposefully and based on criteria