Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study

• Type of Material: Article
• Authors: Amanda S. Wendt, Universitäts Klinikum Heidelberg; Rob Stephenson, University of Michigan; Melissa Fox Young, Emory University; Pankaj Verma, CARE Bihar; Sridhar Srikantiah, CARE Bihar; Amy Webb Girard, Emory University; Carol J Hogue, Emory University; Usha Ramakrishnan, Emory University; Reynaldo Martorell, Emory University
• Language: English
• Date: 2018-04-12
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-018-3017-x
• Title of Journal or Parent Work: BMC Health Services Research
• ISSN: 1472-6963
• Volume: 18
• Start Page: 281
• End Page: 281
• Grant/Funding Information: Funding support was provided by a Bill & Melinda Gates Foundation grant (#0000011951) through a subcontract with CARE-India (Cooperative for Assistance and Relief Everywhere) and the Integrated Family Health Initiative in Bihar, India (www.care.org; RM) and T-32 Reproductive, Perinatal, Pediatric Predoctoral National Institutes of Health Grant #2T32HD052460.
• Keywords: Science & Technology; Supply chain; DEFICIENCY; BARRIERS; Maternal health; PREGNANCY; ANEMIA; Evaluation; COUNTRIES; CONSEQUENCES; Life Sciences & Biomedicine; Antenatal care; WOMEN; Health Care Sciences & Services; PREVALENCE; Qualitative; SUPPLEMENTATION; Iron and folic acid; DETERMINANTS
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: Maternal anaemia prevalence in Bihar, India remains high despite government mandated iron supplementation targeting pregnant women. Inadequate supply has been identified as a potential barrier to iron and folic acid (IFA) receipt. Our study objective was to examine the government health system's IFA supply and distribution system and identify bottlenecks con tributing to insufficient IFA supply. Methods: Primary data collection was conducted in November 2011 and July 2012 across 8 districts in Bihar, India. A cross-sectional, observational, mixed methods approach was utilized. Auxiliary Nurse Midwives were surveyed on current IFA supply and practices. In-depth interviews (n = 59) were conducted with health workers at state, district, block, health sub-centre, and village levels. Results: Overall, 44% of Auxiliary Nurse Midwives were out of IFA stock. Stock levels and supply chain practices varied greatly across districts. Qualitative data revealed specific bottlenecks impacting IFA forecasting, procurement, storage, disposal, lack of personnel, and few training opportunities for key players in the supply chain. Conclusions: Inadequate IFA supply is a major constraint to the IFA supplementation program, the extent of which varies widely across districts. Improvements at all levels of infrastructure, practices, and effective monitoring will be critical to strengthen the IFA supply chain in Bihar.