Lessons from successful micronutrient programs. Part II: program implementation

Abstract

National programs for vitamin A supplementation and iodization of the salt supply were launched and sustained with high (but not universal) coverage in most of the countries studied. Iron programs (requiring daily or weekly supplementation, in contrast to vitamin A), which were distributed mainly through antenatal care, had lower coverage and acceptance. Constraints to supplementation were supply, awareness of health staff and communities, and (for vitamin A) insecurity with phasing out of the national immunization days, which have been a major vehicle for distribution. Administration to women postpartum becomes even more important and needs greater coverage. Iodized salt programs have expanded well, with good interagency collaboration and local management, supported by legislation (which may need strengthening); constraints remain in terms of too many salt producers, inadequate quality, import issues, and prices. More integrated, multifaceted programs are needed, with priority to developing and implementing fortification--especially in finding effective ways to iron-fortify rice. Data are lacking, with fewer surveys once programs start, constraining monitoring and program control and adaptation. Nonetheless, interventions appear to have gone to scale remarkably successfully.