eprintid: 24330
rev_number: 11
eprint_status: archive
userid: 1589
dir: disk0/00/02/43/30
datestamp: 2018-04-30 07:13:22
lastmod: 2024-03-25 22:11:19
status_changed: 2018-04-30 07:13:22
type: article
metadata_visibility: show
creators_name: Wendt, Amanda S.
creators_name: Stephenson, Rob
creators_name: Young, Melissa F.
creators_name: Verma, Pankaj
creators_name: Srikantiah, Sridhar
creators_name: Webb-Girard, Amy
creators_name: Hogue, Carol J.
creators_name: Ramakrishnan, Usha
creators_name: Martorell, Reynaldo
title: Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study
subjects: ddc-610
divisions: i-912800
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.
date: 2018
publisher: BioMed Central
id_scheme: DOI
ppn_swb: 1656057352
own_urn: urn:nbn:de:bsz:16-heidok-243309
language: eng
bibsort: WENDTAMANDIDENTIFYIN2018
full_text_status: public
publication: BMC Health Services Research
volume: 18
number: 281
place_of_pub: London
pagerange: 1-12
issn: 1472-6963
citation:   Wendt, Amanda S. ; Stephenson, Rob ; Young, Melissa F. ; Verma, Pankaj ; Srikantiah, Sridhar ; Webb-Girard, Amy ; Hogue, Carol J. ; Ramakrishnan, Usha ; Martorell, Reynaldo  (2018) Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study.  BMC Health Services Research, 18 (281).  pp. 1-12.  ISSN 1472-6963     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/24330/1/12913_2018_Article_3017.pdf