Initiating and sustaining large-scale encapsulated ferrous fumarate double fortified salt interventions in the public distribution system in India poses several challenges that can be minimized by strengthening double fortified salt value chains.

Back Background ground Iron deficiency anemia (IDA) exerts an enormous public health burden in low-income countries, primarily affecting women and children. Double fortified salt (DFS)-salt fortified with Iodine and Iron-has the potential to prevent and correct iron deficiencies. Major challenges relate to the implementation and scaling-up of the production, distribution, and promotion of DFS. Methods Methods A pilot project for scaling up DFS through integration with the public distribution system (PDS)-a federal food security program in India-was implemented for a one-year period. One of the objectives was to test the scale-up model, critically evaluate its scalability, and assess drivers and spaces for the scale-up. Using the case study methodology, we reviewed program records, monitoring data, and key informant interviews with stakeholders. "Scalability considerations" and "drivers and spaces" framework from scale-up literature were used for synthesizing findings. * † ‡ Jadhav MH, Venkatesh Mannar MG, Wesley AS. A case study on the scaling-up of double fortified salt through the public distribution system of a food security program in Uttar Pradesh, India: experiences, challenges, and achievements.

Background: Micronutrient deficiencies are a cause of significant public health burden and loss of gross domestic product, especially in developing countries. Multiple fortified salt can potentially address this challenge at scale and in a cost-effective manner. Objective: This laboratory-based sensory trial evaluated the acceptability of quintuple fortified salt (Q5FS), that is, iodized salt (IS) fortified with additional 4 micronutrients: iron, folic acid, vitamin B12, and zinc. Iodized salt and double fortified salt (DFS), that is, IS fortified with iron, are used for comparison. Methods: Forty-five respondents were recruited by open invitations to the university staff and their families. Each study participant rated 10 food items each in a set of 3 identical preparations differing only in the salt used. A 5-point hedonic scale was used to rate each dish on 6 sensory attributes: appearance, color, aroma, taste, texture, and aftertaste. Finally, the dish was rated on the attribute of overall acceptability—a subjective combined score based on all sensory attributes considered together. Results: Among the 3 salt types, there was no difference in scores for the sensory attributes of appearance, aroma, taste, texture, and aftertaste, and the attribute of overall acceptability. Color in IS scored significantly higher than in Q5FS and DFS, but there was no difference between the scores of DFS and Q5FS. Conclusions: The 3 salts IS, DFS, and Q5FS are comparable to each other in all sensory properties, except for color. This study concludes that Q5FS is organoleptically acceptable under ideal conditions.

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Back Background ground Combining health programs with microfinance is gaining more recognition as a pathway for improving health and increasing access to health services among the poor, especially women living in low-income countries. Recently published reviews have summarized the changes in health behaviors and health outcomes due to the effective layering of health interventions with microfinance initiatives. However, a large gap remains in defining and understanding the organizational strategies for implementing effective health programs and services that improve the health and social well-being of women and their families. Method Method As microfinance organizations and the global health community recognize the largely untapped potential of developing effective multidimensional channels of providing access to a variety of health interventions through a microfinance platform, there is a need for more evidence to guide organizational strategies that are feasible, sustainable and produce results. We developed a framework and classification scheme for identifying organizational arrangements between microfinance and health, outlined the criteria for article identification and selection, and reviewed original articles that included a discussion on organizational strategies published in peer-reviewed journals to better inform future research and effective program development. R Results esults Our review found that most MFIs operate in cooperative and collaborative partnerships for expanding health and social services with health education as the leading intervention. The extreme ends of the integration-partnership continuum, ie, no partnership on one end and complete merger on the other, are rare if they exist. C Conclusions onclusions The drivers of organizational strategy are related to the context, health needs of the clients, and individual capacities of MFIs to develop effective services. However, approaches to establishing these processes and decision-making for effectively structuring and delivering health and microfinance services is an inadequately explored area. Future progress depends on bridging public health, microfinance, and organizational research silos to study how different organizational arrangements affect implementation and outcomes.