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

• Published in: BMC health services research Vol. 18; no. 1; p. 281
• Main Authors: Wendt, Amanda S, Stephenson, Rob, Young, Melissa F, Verma, Pankaj, Srikantiah, Sridhar, Webb-Girard, Amy, Hogue, Carol J, Ramakrishnan, Usha, Martorell, Reynaldo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.04.2018; BioMed Central; BMC
• Subjects: Adult; Anemia; Anemia - epidemiology; Anemia - prevention & control; Antenatal care; Cross-Sectional Studies; Dietary Supplements; Efficiency, Organizational; Evaluation; Female; Folic acid; Folic Acid - supply & distribution; Health aspects; Humans; India - epidemiology; Interviews as Topic; Iron - supply & distribution; Iron and folic acid; Maternal Health; Pregnancy; Pregnant women; Qualitative; Qualitative Research; Risk factors; Supply chain; Surveys and Questionnaires; Young Adult; India; Supply chain; Evaluation; Qualitative; Iron and folic acid; Maternal health; Antenatal care
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3017-x

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. 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. 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. 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.