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Wrap-up: Next Steps for

Program Implementation and

for Measuring Success for

Anemia Prevention and Control

(APC) and Calcium

Supplementation

April 14, 2013

Dr. Justine A. Kavle, Senior Program

Officer for Nutrition, MCHIP

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What have we learned about anemia control

program implementation?

2

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Demand side:

Interplay between product, how it is provided,

and how it is used

Demand

IFA

Continueto use

Correct

use

Product: Acceptability, packaging

Service: Practical counseling fromprovider on what to expect

Personal/Cultural: Motivation

Willingand able

to use

3

Sociocultural

Context

Users

needs

and

desires

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Supply side:

Balance between push and pull

Respond to demandcommunity and/or facility-

based needs

- Ensure on essential drugs list, correctformulations, budget allocated

- Clear coordination + roles for procurement

- Accurate forecasting at local level

- Inventory control to monitor expirationdates of supplies

4

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Harmonization is needed to achieve integration

of IFA and IPTp

5 mg dose of folic acid should be removed

Combined IFA supplement with 0.4 mg of folic acid is

recommended and should be given with IPTp for

malaria in pregnancy

5

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Anemia Prevention and Control (APC)

Components for integration at various levels

IFA - focusedANC andadolescents

Homefortification

ITNs - Malaria

Deworming

Multiple

strategies

MultisectoralMicronutrientDeficiencyCouncil

Partner with

Private sector

Budgetallocated

Government

leadership

Integrate:Key plans,policies,guidelines

Stakeholder

commitment:Capacitybuilding,BCC

Strategic

integration

KENYA

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What have we learned about measuring success

for anemia prevention and control?

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Components of successful iron folic-acid

supplementation programsStoltzfus & Dreyfuss, INACG, 2001, World Bank, 2004

M & E Evaluation

MeasureImpactreduction

in IDA

Coverage

Ensuresupply

ChooseEffectiveDeliverysystem

ComplianceGeneratedemand

8

-Establishpolicy

- Know

problem

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Implementation barriers to APC

Potential challenges to scale-upKlemm, Harvey, Wainwright, Faillace 2009

Inadequate political support

Low priority for IFA

Insufficient bundling of interventions IFA, deworming,antimalarial (IPTp with SP), delayed cord clamping

Inadequate supplies - low utilization - weak demand

Lack of evidence for effective program implementation

Lack of community-based programs -- complement ANC

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APC: What is needed for Scale-up

Training

Awarenessactivities

Community-baseddistribution

Ensuringsupplies

Recording,reporting

Integratedmonitoringsupervision

Integrated

package

NEPAL

Situation

analysis

S h M & E i i d

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Strengthen M & E: integrate, monitor, and

supervise to achieve scale-upA2z project 2011

ANC

FP Malaria

Deworming

Integrate

indicators -

HMIS

Complementsurvey data

Monitor program

implementation Addressgaps

Establish

supervision-

clinic &

communitylevel

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How does APC inform on calcium

supplementation? What research is underway?

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We can build on the experience of APC:

Iron folic-acid (IFA) & calcium share common elements

Formativeresearch to

generatedemand

Behaviors -adherence tosupplements

Forecastingfor supplies

SameDeliveryPlatform

Cost Differs: IFA -$0.48 for 90 pills, ferrous fumarate

Calcium carbonate - $13.44 per pregnancy

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Calcium Acceptability and Preference Pilot

in Nepal

- High compliance to Ca

- Reason for missing IFA

and calcium dose wasforgetfulness, takingextra Ca pills and GIeffects did not affectadherence to IFA

- Acceptable to take atIFA and calcium atdifferent times

- Bulky- storage space

- Cost for scale-up

- Different platform than IFA

- More reported GIsymptoms w/ sprinkles

- Ingestion of large pills

difficult

14

Preference for Pills vs. Sprinkles

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Operations research underway to address

challenges in program design

Challenge 1: Address low uptake, low ANC coverage and

late and infrequent contact with health care system

Determine optimum delivery platform for calcium and

IFA

Challenge 2: Address compliance to IFA and calcium

Collect perspectives of health care providers and users

to design effective behaviour change communication

Design models for delivery and promotion of calciumand IFA supplements in pregnancy.

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Next steps for Calcium Research

Evidence supports effectiveness of lower dose of calcium

(500 mg 1 pill) - which could be feasible and address

some of the challenges presented today. More research

is needed.

Research interactions between calcium and iron,

currently testing pill with both calcium and iron

Research on supplementation in early pregnancy (before

20 weeks) and before pregnancy

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Thank you!

wwww.mchip.net

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