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Marion Roche, PhD, Raj Kumar Pokharel & Macha Raja Maharjan Johannesburg, April 14th, 2013
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Situation Assessment: Anemia was recognized as a severe public health concern in Nepal, in 1998
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Policy
Practice
23% coverage IFA
Reality- challenge accessing health center, and little demand for IFA, supply issues also a challenge
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2. 3. 4.
5.
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Pilot- Policy Change: Community Based Delivery by Female Community Health Volunteers (FCHVs)
Intensification of Maternal and Neonatal Micronutrient Program (IMNMP) 1988 FCHV program began as health promoters 1990s brief pilot and then modification to policy so the FCHVs could distribute vitamin A
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Components of the Iron Intensification Project: The Social Marketing Mix: 4Ps
Product: Promoted behaviours, packaging, labels Price: Costs, time, resources, stigma, social Place: Access & delivery point Promotion: Messages, Communication channels, branding
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Product
IFA tablets wrapped in paper
Refillable Plastic Containers
Developed managerial capacity of health workers especially in relation to supplies, reporting Have since began transitioned to blister packaging since 2011 Pokharel et al. 2011
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Price
Decrease time it takes pregnant women to get Iron Tablets Increase perceived value of IFA with packaging
Motivation of the perceived benefits of taking IFA with local messages around anemia and lack of blood using local understanding of altitude and lack of oxygen
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FCHV
9 3 4
Mothers group
Settlement
Nepal 75 districts
Each ward has 80-100 households and there is a Female Community Health Volunteer (FCHV) who provides maternal and child care services in the community. In each ward there is also a mother group coordinated by FCHV for community mobilisation
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20 10
0 NDHS 2001 NDHS 2006 NDHS 2011
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30 20 10 0 7 20
38 % of women who took full dose (180) IFA tablets % women who took deworming tablet
NDHS 2006
NDHS 2011
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Scale up to 74 districts
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Supply Side: Technical support in monitoring and logistics management Continual product improvement, Blister pack challenges being resolved Health System Constraints and Limits for supportive supervision While FCHVs and investments in the program have been far reaching, the health system and centers have not been strengthened at the same rate Debate for role for FCHVs going forward and optimal balance of workloadwww.micronutrient.org and skills needed
Namaste
Acknowledgements A2Z, CIDA, FHI360, MI, NFHD, NMOH, NTAG, Plan, UNICEF, USAID, WHO
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