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Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study
- Source :
- BMC Health Services Research, BMC Health Services Research, Vol 18, Iss 1, Pp 1-12 (2018)
- Publication Year :
- 2018
- Publisher :
- BioMed Central, 2018.
-
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. Electronic supplementary material The online version of this article (10.1186/s12913-018-3017-x) contains supplementary material, which is available to authorized users.
- Subjects :
- Adult
Iron
Maternal Health
India
Antenatal care
Efficiency, Organizational
Interviews as Topic
Young Adult
610 Medical sciences Medicine
Folic Acid
Pregnancy
Surveys and Questionnaires
parasitic diseases
Humans
Evaluation
Qualitative Research
Iron and folic acid
lcsh:Public aspects of medicine
lcsh:RA1-1270
Anemia
Supply chain
bacterial infections and mycoses
Cross-Sectional Studies
Dietary Supplements
Female
Qualitative
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14726963
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- BMC Health Services Research
- Accession number :
- edsair.pmid.dedup....d5f3c456334ddabacbc71e92f48eb958