Public health supply chain for iron and folic acid supplementation in India: Status, bottlenecks and an agenda for corrective action under Anemia Mukt Bharat strategy

Abstract

Purpose The IFA supplementation program under the Anemia Mukt Bharat (AMB) program is one of the most ambitious nutrient supplementation programs in India. The delivery of services often suffers due to frequent stock outs and shortages. It is critical to understand the bottleneck in the supply chain adversely affecting the performance and coverage of the program. The paper attempts to identify the bottlenecks of the IFA supply chain in key areas of supply chain i.e., forecasting, procurement, warehousing and inventory management, transportation, distribution, logistic information system and suggests a plan of action aimed at ensuring uninterrupted supplies to the end beneficiaries. Design/methodology/approach The data source for the present paper is the nationwide IFA Supply Chain Assessment (2018–19) conducted across 29 Indian states with a total of 58 districts, 116 blocks, 232 Sub-Centres, 232 Anganwadi centres and 232 schools covered under the assessment as a multi-partner collaborative initiative. Field insights from supply chain strengthening interventions under different public health programs in India and other developing countries were taken to arrive at corrective actions and recommendations. Findings were disseminated to government and an action plan was suggested for connecting service delivery points through an app-based system, developing a micro plan for ensuring fixed distribution schedule, followed by continuous monitoring and review meetings identified for follow up. Findings The average lead time across states was 35 weeks with top three performing states being Goa, Sikkim, and Telangana. The average per unit cost of procurement was Rs 0.35 for IFA Red, Rs 0.25 for IFA Blue, Rs 0.31 for IFA Pink and Rs 7.30 for IFA syrup. Out of the 704 districts in India, only 213 has IFA Red, only 140 had IFA Blue, 152 had IFA Pink and 163 had IFA Syrup available in four quarters of 2018–19. The key issues identified in the assessment were–a lack of standardized forecasting process, absence of inventory management techniques, no fixed distribution schedule, inadequate availability of transport vehicles and an absence of an integrated MIS. Originality/value The identification of bottlenecks in the IFA supply chain and its impact on the performance of the supply chain would provide policy guidelines for the government as well as development partner agencies to design an effective and efficient supply chain. It would also enable the policy planners to understand the challenges associated with managing different components of a supply chain, their interrelation and impact on the overall performance of the supply chain. The suggested recommendations would equip program managers with the tool to devise and implement field level solutions.

Indian adolescents’ perceptions of anaemia and its preventive measures: A qualitative study

“…This could be attributed to ineffective implementation of the AMB programme. Indeed, the public health supply chain for IFA supplementation under the AMB programme has received harsh criticism in the recent past ( 12 , 45 ) . For instance, Ahmed and colleagues highlighted a number of shortcomings in the delivery of AMB services which included lack of fixed distribution schedule; absence of inventory management techniques and integrated management information system, and inadequate availability of transport vehicles ( 45 ) .…”

“…Indeed, the public health supply chain for IFA supplementation under the AMB programme has received harsh criticism in the recent past ( 12 , 45 ) . For instance, Ahmed and colleagues highlighted a number of shortcomings in the delivery of AMB services which included lack of fixed distribution schedule; absence of inventory management techniques and integrated management information system, and inadequate availability of transport vehicles ( 45 ) . Parallel to these findings, Joe and coworkers also found that the IFA supplementation coverage was relatively low among target groups including adolescents who were being supplied through a multi-departmental convergence mechanism (e.g.…”

Trends and socioeconomic disparities in undernutrition among Muslim women in India: evidence from the last two decades (1998–2021)

“…The study highlights a consistent decline in the prevalence of undernutrition among women from 1998 to 2021. The literature has attributed this decline to various reasons like improved awareness, empowerment and education among women (Zajacova and Lawrence, 2018), improvement in Water, Sanitation and Hygiene practices (Kumar and Mohanty, 2023), improved access to healthcare and the impact of nutrition-specific interventions (Joumard and Kumar, 2015; Ahmad et al ., 2023). The role of government initiatives and policies in the reduction of the prevalence of undernutrition among women of reproductive age in India is also documented and is described below: Integrated Child Development Services (ICDS) have been found to have played one of the significant roles in improving the nutritional status and overall development of women and children by providing supplementary nutrition, immunization, health check-ups and pre-school education to pregnant and lactating women (Kapil, 2002).…”

“…Furthermore, the National Food Security Act (NFSA) does not exclusively target women, but has made a substantial contribution by providing subsidized food grains to eligible households, ensuring better access to nutritious food for vulnerable populations, including women (Varadharajan et al ., 2014). Last but not the least, the Anaemia Mukt Bharat initiative focuses on preventing and controlling anaemia through awareness campaigns, iron and folic acid supplementation and improving dietary practices among women, thereby leading to reduced underweight prevalence (Ahmad et al ., 2023).…”

“…For example, it could be used to predict the probability of the prevalence of underweight among women (yes/no) based on predictor variables like caste, place of residence, education, wealth quintiles, region etc. It gives an estimate of the likelihood of the event happening; if the predicted probability of being underweight is 0.75, it suggests a 75% chance that a woman is underweight, given the predictor variables (Muller and Maclehose, 2014).…”