Opinion: Strengthening Supply Chain Management To Countervail Iron Deficiency Anaemia

In India, anaemia is a serious public health concern with a high prevalence among women, children, and adolescents. India has the highest numbers of anaemic individuals globally with nearly 53 per cent of all women aged 15-49 years being anaemic, states the National Family Health Survey (NFHS-4). In Jharkhand, 62.6 per cent of pregnant women, 65.3 per cent of women between 15-49 years and 69.9 per cent of children between 6-59 month were found to be anaemic in NFHS-4. But, only 15.3 per cent of mothers consumed iron-folic acid for 100 days or more when they were pregnant (NFHS 4), whereas only 6.3 per cent of children between 9-59 months received IFA supplement 6 months prior to the survey (Rapid Survey On Children 2013-14).

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Anaemia has harmful consequences on maternal as well as child survival, thus grossly affecting the productivity of the nation. Iron deficiency is the most common cause of anaemia, estimated to contribute to approximately 50 per cent of all cases of anaemia among non-pregnant and pregnant women, and 42 per cent of cases in children under 5 years of age worldwide (WHO 2017 Nutritional anaemias: tools for effective prevention and control).

Anaemia is a major contributor to poor pregnancy and birth outcomes as it predisposes to premature delivery, increased perinatal mortality, and increased risk of death during delivery and postpartum.

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In Jharkhand, iron deficiency anaemia is largely due to nutritional and dietary causes, the main reasons for so being low intake of iron-rich foods, lack of vitamin B12 and folic acid. The problem of nutritional anaemia can be addressed by recommending a diet diverse in animal as well as plant-based sources of iron. Besides iron-rich dietary recommendations, iron supplementation also helps improve the anaemic status of an individual along with deworming.

Though the Government of India has implemented national programs such as National Nutritional Anaemia Prophylaxis Program since 1970, more recently emphasis has been given under POSHAN Abhiyaan and Anaemia Mukt Bharat (AMB), which aims at accelerating the decline in the prevalence of anaemia among all age groups using a multi-pronged strategy.

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The National Health Mission, Government of Jharkhand (NHM GoJ), used a multidimensional strategy to strengthen the supply chain management of micronutrients and implement interventions across the state. One of the key objectives of the intervention is to strengthen the supply chain management of IFA by increasing the availability and adequacy of IFA, increasing coverage of IFA supplementation, building the capacity of personnel, and real time monitoring of IFA supply and coverage. Hence, to achieve this objective, the state government has prioritised evidence-based forecasting, adequate budgetary allocations in Programme Implementation Plan (PIP), for improving the supply and coverage of IFA in the state.

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Jharkhand has prioritised Anemia Mukt Bharat Programme in the state with an adequate budget since the inception of the program in 2018. The budget for Anemia Mukt Bharat Programme in Jharkhand increased from Rs. 1,266.08 lakhs in 2018-19 to Rs. 3,431.59 lakhs in 2020-21 [Source: PIP-ROP]. This increase in budget was based on addressing the programme and budget gaps aligned to the target population and Anemia Mukt Bharat Guidelines. There has also been an increase in coverage of IFA distribution among pregnant women by 25 per cent and 60 per cent among lactating women from 2017-18 to 2019-20 [Source: Health Management Information System].

Likewise, there has been an increase in the coverage of IFA distribution among adolescent girls in the state by 61 per cent in the last three years. The key challenges which still need to be addressed are ensuring uninterrupted supply of IFA to ensure last mile delivery supported with a robust Social Behavioural Change Communication Campaign, intensified training of personnel at all facilities and community level, monitoring and supportive supervision. The sustainability of supply chain management across all the levels will surely ensure the last mile delivery of IFA in Jharkhand to address Iron Deficiency Anemia.

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(Dr. Deepawali, Nodal Officer – Maternal Health and Nutrition, National Health Mission, Jharkhand; Dr. Asha Kiran is the Associate Professor, Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences; Dr. Sarita Lakra, Maternal, Infant and Young Child Nutrition (MIYCN) Consultant, WeCan IPE Global.)

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

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