Wrap-up: Next Steps for Program Implementation and for Measuring Success for APC and Calcium Supplementation

May 3, 2012
Dr. Justine A. Kavle, Senior Program Officer for Nutrition, MCHIP

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

Components of successful iron folic-acid supplementation programs

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

Ensure supply -Establish policy - Know problem

M&E

Evaluation

Choose Effective Delivery system

Generate demand

Coverage

Measure Impact reduction in IDA

Compliance

Implementation barriers to APC Potential 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

4

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

NEPAL

Community distribution
Training Situation analysis Ensuring supplies Recording, reporting

Integrated monitoring & supervision Integrated package

Awareness activities

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

A2z project 2011

ANC FP Malaria Deworming Integrate indicators HMIS

Monitor program implementation

Address gaps
Establish supervisionclinic & community level

Complement survey data

Guidance on APC from group exercise

High level advocacy less silent; establish champions, perceptions of anemia of stakeholders, strengthen leadership for anemia; talk across ministries/silos Involve stakeholders at community level and private sector; not to make nutrition complicated Need for policy on IFA and deworming in some countries Long-term funding and commitments, work with scaleup nutrition movement

Guidance on APC from group exercise

Disseminate readily available evidence/technical tools no need to generate evidence make anemia more human Formative research on demand and supply at state and district level; provider practices Address misperceptions/negative beliefs IFA Provide quality IFA Decentralize supply, there are issues with not being able to monitor supply well Focus on messages and counseling on IFA

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

What is the way forward for introduction and implementation of calcium supplementation?

Calcium supplementation: Early introduction

Bangladesh

Policy & financing

SBCC strategy

Preservice/inservice training

Clinical coverage

Local evidence

Guidance on calcium from exercise: early introduction

Advocate with policy makers using global evidence Separate national policy or streamline into clinical guidelines Develop advocacy plan/strategy to reduce PE/E Cost deliver calcium in a cheap way; work with manufacturers to reduce cost Train volunteers and health workers Logistics system calcium part of essential and national drug list, supported by USAID, UNICEF, WHO
12

Guidance on calcium from exercise: early introduction

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 about calcium Product compliance, feasibility

Guidance on calcium exercise: early introduction

Inform prior to pregnancy the benefits of calcium supplementation (adolescents) Generate country-specific information on calcium deficiency and calcium intake

Track through monitoring and evaluation

Develop public/private partnerships

Guidance on calcium exercise: research

Develop different formulations of calcium through research Conduct formative research on practices and understanding 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?)

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

16

Thank you!

wwww.mchip.net Follow us on: