Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Amanda S. Wendt, Rob Stephenson, Melissa F. Young, Pankaj Verma, Sridhar Srikantiah, Amy Webb-Girard, Carol J. Hogue, Usha Ramakrishnan, Reynaldo Martorell

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

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 contributing 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.
Appendix
Available only for authorised users
Literature
1.
World Health Organization: Worldwide prevalence of anaemia 1993-2005. In: WHO Global Database on Anaemia. Edited by Benoist B, McLean E, Egli I, Cogswell M. Geneva: World Health Organization; 2008.
2.
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Pena-Rosas JP, Bhutta ZA, Ezzati M. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(1):E16–25.CrossRefPubMedPubMedCentral
3.
International Institute for Population Sciences (IIPS), Macro International. National Family Health Survey (NFHS-4): India fact sheet. Mumbai: IIPS; 2016.
4.
International Institute for Population Sciences (IIPS), Macro International. National Family Health Survey (NFHS-4): Bihar fact sheet. Mumbai: IIPSs; 2016.
5.
Kalaivani K. Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009;130(5):627–33.PubMed
6.
Lozoff B, Jimenez E, Smith JB. Double burden of iron deficiency in infancy and low socioeconomic status: a longitudinal analysis of cognitive test scores to age 19 years. Arch Pediatr Adolesc Med. 2006;160(11):1108–13.CrossRefPubMedPubMedCentral
7.
Pena-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2012;12:CD004736.PubMedPubMedCentral
8.
Imdad A, Bhutta ZA. Routine iron/folate supplementation during pregnancy: effect on maternal anaemia and birth outcomes. Paediatr Perinat Epidemiol. 2012;26(Suppl 1):168–77.CrossRefPubMed
9.
Ministry of Health & Family Welfare. Guidelines for control of Iron deficiency anemia. New Delhi: Government of India; 2013.
10.
Ekstrom EC, Kavishe FP, Habicht JP, Frongillo EA Jr, Rasmussen KM, Hemed L. Adherence to iron supplementation during pregnancy in Tanzania: determinants and hematologic consequences. Am J Clin Nutr. 1996;64(3):368–74.CrossRefPubMed
11.
Hyder SM, Persson LA, Chowdhury AM, Ekstrom EC. Do side-effects reduce compliance to iron supplementation? A study of daily- and weekly-dose regimens in pregnancy. J Health Popul Nutr. 2002;20(2):175–9.PubMed
12.
Mora JO. Iron supplementation: overcoming technical and practical barriers. J Nutr. 2002;132(4 Suppl):853S–5S.CrossRefPubMed
13.
Khalafallah AA, Dennis AE. Iron deficiency anaemia in pregnancy and postpartum: pathophysiology and effect of oral versus intravenous iron therapy. J Pregnancy. 2012;2012:630519.CrossRefPubMedPubMedCentral
14.
Galloway R, Dusch E, Elder L, Achadi E, Grajeda R, Hurtado E, Favin M, Kanani S, Marsaban J, Meda N, et al. Women's perceptions of iron deficiency and anemia prevention and control in eight developing countries. Soc Sci Med. 2002;55(4):529–44.CrossRefPubMed
15.
Ghanekar J, Kanani S, Patel S. Toward better compliance with iron-folic acid supplements: understanding the behavior of poor urban pregnant women through ethnographic decision models in Vadodara, India. Food Nutr Bull. 2002;23(1):65–72.CrossRefPubMed
16.
Galloway R, McGuire J. Determinants of compliance with iron supplementation: supplies, side effects, or psychology? Soc Sci Med. 1994;39(3):381–90.CrossRefPubMed
17.
Nagata JM, Gatti LR, Barg FK. Social determinants of iron supplementation among women of reproductive age: a systematic review of qualitative data. Matern Child Nutr. 2012;8(1):1–18.CrossRefPubMed
18.
Sununtnasuk C, D'Agostino A, Fiedler JL. Iron+folic acid distribution and consumption through antenatal care: identifying barriers across countries. Public Health Nutr. 2016;19(4)732-42.
19.
Gill K. A primary evalutaion of service delivery under the National Rural Health Mission (NRHM): findings from a study in Andrea Pradesh, Uttar Pradesh, Bihar and Rajasthan. In: Planning Commission of India; 2009.
20.
International Institute for Population Sciences (IIPS). District level household and facility survey (DLHS-3), 2007–08: Bihar. Mumbai: IIPS; 2010.
21.
Bihar Technical Assistance Support Team (BTAST). Quality improvement efforts in public health facilites of Bihar: some general findings. Patna: BTAST; 2016.
22.
Sector Wide Approach to Strengthen Health (SWASTH) in Bihar. Annual review - summary. Patna: SWASTH; 2015.
23.
National Health Mission (NHM). National health mission programme implementation plan: 2016–17. Patna: NHM; 2016.
24.
CARE India: Integrated family health initiative: catalysing change for health communities. 2013.
25.
Ministry of Health & Family Welfare, Government of India. Indian Public Health Standards (IPHS) guidelines for sub-centers: revised 2012. New Delhi: Government of India; 2012.
26.
Gangbar J, Rajan P, Gayithri. Working paper 318: Integrated Child Development Services in India – A Sub-National Review. Bangalore: The Institute for Social and Economic Change, 2014.
27.
Ministry of Health & Family Welfare. Rural health statistics in India. New Delhi: Government of India; 2012.
28.
Ministry of Women & Child Development. Statewise details of projects, AWC, beneficiaries, vacancy position and nutrition status of children as on March 2011. New Delhi: Government of India; 2011.
29.
Pratichi Insitite and Asian Development Institute. The Pratcihi Child Report II: ICDS in West Bengal and Bihar. New Delhi and Patna, India: Pratichi Trust and Asian Development Institute; 2015.
30.
31.
Selvaraj S, Chokshi M, Hasan H, Kumar P: Improving governance and accountability in India's medicine supply system. New Dehli: Public Health Foundation of India; 2010.
32.
33.
34.
State Health Society, National Rural Health Mission, Government of Bihar: Consolidated revised NRHM state project implementation plan 2012–13 of Bihar. Patna: Government of Bihar; 2011.
35.
Padmanathan P, Singh M, Mannarath SC, Omar M, Raja S. A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India. Int J Ment Heal Syst. 2014;8:29.CrossRef
36.
Directorate General of Health Services, Ministry of Health & Family Welfare. Indian Public Health Standards (IPHS) guidelines for primary health centres. New Delhi: Government of India; 2012.
37.
Directorate General of Health Services, Ministry of Health and Family Welfare. Indian Public Health Standards (IPHS) guidelines for sub-Centres. New Delhi: Government of India; 2012.
38.
Monthly Village Health Nutrition Day: Guidelines for AWWs/ASHAs/ANMs/PRIs. In. Edited by National Rural Health Mission, Ministry of Health & Family Welfare. New Dehli: Government of India; 2007.
39.
40.
National Rural Health Mission, Ministry of Health & Family Welfare, Government of India: Monthly village health nutrition day: guidelines for AWWs/ASHAs/ANMs/PRIs. 2007.
41.
Bossert TJ, Bowser DM, Amenyah JK. Is decentralization good for logistics systems? Evidence on essential medicine logistics in Ghana and Guatemala. Health Policy Plan. 2007;22(2):73–82.CrossRefPubMed
42.
Roy C, Das JK, Jha HK, Bhattacharya V, Shivdasani JP, Nandan D. A study on the logistics and supply management system of drugs at different levels in Darbhanga district of Bihar. New Delhi: National Institute of Health and Family Welfare; 2008.
43.
State Health Society Bihar, Department of Health and Family Welfare, Government of Bihar: State project implementation plan 2011–12. Patna, Bihar, India.
44.
45.
Yadav P: Analysis of the public, private and mission sector supply chains for essential drugs in Zambia. London: DFID Health Resource Centre; 2007.
46.
Nandan D, Singh CM, Jain PK, Nair KS, Kumar P, Dhar N. An assessment of utilization of untied fund provided under national rural health mission in Uttar Pradesh. New Delhi: National Institute of Health and Family Welfare; 2009.
47.
Sah PK, Raut AV, Maliye CH, Gupta SS, Mehendale AK, Garg BS. Performance of village health, nutrition and sanitation committee: a qualitative study from rural Wardha, Maharashtra. In: The health agenda, vol. 1; 2013. p. 112–7.
48.
Directorate General of Health Services, Ministry of Health and Family Welfare. Procurement and operation manual for medical store organisation and government medical store depots. New Delhi: Government of India; 2008.
49.
Planning Commission of India: High level expert group report on universal health coverage for India. New Delhi: Government of Bihar; 2011.
50.
Kumar P. Health for all challenges in Bihar. Indian J Appl Clin Sociol. 2015;10(4):13–28.
51.
52.
Organization. WH: A framework for good governance in the pharmaceutical sector: GGM model framework. 2008.
53.
Roy C, Das JK, Jha HK, Bhattacharya V, Shivdasani JP, Nandan D. Logistics and supply management system of drugs at different levels in Darbhanga District of Bihar. Indian J Public Health. 2009;53(3):147–50.PubMed
54.
World Health Organization. 4.1 competitive mechanism in public drug supply. In: Selected topics in health reform and drug financying - health economics and drug series, no 006. Geneva: WHO; 1998.
55.
Singh PV, Tatambotla A, Kalvakuntla RR, Chokshi M. Replicating Tamil Nadu’s drug procurement model. Econ Polit Wkly. 2012;47(39):26–9.
56.
Ministry of Health and Family Welfare. Guidelines for control of Iron deficiency Anaemia. New Delhi: Government of India; 2013.
57.
Mkoka DA, Goicolea I, Kiwara A, Mwangu M, Hurtig AK. Availability of drugs and medical supplies for emergency obstetric care: experience of health facility managers in a rural district of Tanzania. BMC Pregnancy Childbirth. 2014;14:108.CrossRefPubMedPubMedCentral
Metadata
Title
Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study
Authors
Amanda S. Wendt
Rob Stephenson
Melissa F. Young
Pankaj Verma
Sridhar Srikantiah
Amy Webb-Girard
Carol J. Hogue
Usha Ramakrishnan
Reynaldo Martorell
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3017-x

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

The financial transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative study

Research article

The impact of regional screening policies on the diffusion of cancer screening participation in Belgium: time trends in educational inequalities in Flanders and Wallonia

Research article

Telephone health services in the field of rare diseases: a qualitative interview study examining the needs of patients, relatives, and health care professionals in Germany

Research article

Assessing a novel point-of-care ultrasound training program for rural healthcare providers in Kenya

Research article

Developing a model of family focused practice with consumers, families, practitioners and managers: a community based participatory research approach

Research article

The professional culture among physicians in Sweden: potential implications for patient safety