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Wrap-up: Next Steps forProgram Implementation

and for Measuring Successfor APC and CalciumSupplementation

May 3, 2012

Dr. Justine A. Kavle, Senior Program

Officer for Nutrition, MCHIP

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What have we learned about measuring successfor anemia prevention and control (APC)?

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Components of successful iron folic-acidsupplementation programs

Stoltzfus & Dreyfuss, INACG, 2001, World Bank, 2004

M & E Evaluation

MeasureImpact reduction

in IDA

Coverage

Ensuresupply

ChooseEffectiveDeliverysystem

ComplianceGeneratedemand

3

-Establishpolicy- Know

problem

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Implementation barriers to APCPotential challenges to scale-up

Klemm, Harvey, Wainwright, Faillace 2009

Inadequate political support

Low priority for IFA

Insufficient bundling of interventions

Inadequate supplies - low utilization - weak demand

Lack of evidence for effective program implementation Lack of community-based programs - complement ANC

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Anemia prevention and control:What is needed for scale-up

Training

Awarenessactivities

Communitydistribution

Ensuring

suppliesRecording,reporting

Integratedmonitoring &supervision

Integrated

package

NEPAL

Situationanalysis

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Strengthen M & E: integrate, monitor, andsupervise to achieve scale-up

A2z project 2011

ANC

FPMalaria

Deworming

Integrateindicators -

HMIS

Complementsurvey data

Monitor program

implementationAddress

gaps

Establishsupervision-

clinic &

communitylevel

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Guidance on APC from group exercise

High level advocacy less silent; establish champions,perceptions of anemia of stakeholders, strengthenleadership for anemia; talk across ministries/silos

Involve stakeholders at community level and privatesector; not to make nutrition complicated

Need for policy on IFA and deworming in somecountries

Long-term funding and commitments, work with scale-up nutrition movement

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Guidance on APC from group exercise

Disseminate readily available evidence/technical tools no need to generate evidence make anemia morehuman

Formative research on demand and supply at stateand district level; provider practices

Address misperceptions/negative beliefs IFA

Provide quality IFA

Decentralize supply, there are issues with not beingable to monitor supply well

Focus on messages and counseling on IFA

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Guidance on APC from group exercise

Add HMIS indicators (receipt and consumed IFA),frequency and quality of ANC visits

Promotion of IFA supplementation at the community

level

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What is the way forward for introduction andimplementation of calcium supplementation?

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Calcium supplementation:Early introduction

Bangladesh

Policy &

financing

SBCC

strategy

Pre-service/in-

service

training

Clinicalcoverage

Local evidence

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Guidance on calcium from exercise: earlyintroduction

Advocate with policy makers using global evidence

Separate national policy or streamline into clinicalguidelines

Develop advocacy plan/strategy to reduce PE/E

Cost deliver calcium in a cheap way; work withmanufacturers to reduce cost

Train volunteers and health workers

Logistics system calcium part of essential andnational drug list, supported by USAID, UNICEF,WHO

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Guidance on calcium from exercise: earlyintroduction

Raise awareness of community and health workers

Develop IEC materials (benefits to child, consequences lower risk of PE/E),

Carry out social marketing for calcium

Address misperceptions of health workers aboutcalcium

Product compliance, feasibility

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Guidance on calcium exercise: earlyintroduction

Inform prior to pregnancy the benefits of calciumsupplementation (adolescents)

Generate country-specific information on calcium

deficiency and calcium intake

Track through monitoring and evaluation

Develop public/private partnerships

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Guidance on calcium exercise: research

Develop different formulations of calcium throughresearch

Conduct formative research on practices andunderstanding of PE/E; BCC strategy

Research interactions between calcium and iron,currently testing pill with both calcium and iron

Research on optimal dose of calcium (500 mg?)

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Next steps

Fill out country-level maps in your country

MCHIP to follow-up in 3 months on anemia

prevention and control and calcium maps

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Thank you!

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