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7/30/2019 Kavle_Next Steps for Program Implementation and for Measuring Success for Anemia Prevention and Control (APC) and Calcium Supplementation
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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?
7
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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
9
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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.
15
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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!
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