Experiences and lessons learned for delivery of micronutrient powders interventions

Abstract

An effective delivery strategy coupled with relevant social and behaviour change communication (SBCC) have been identified as central to the implementation of micronutrient powders (MNP) interventions, but there has been limited documentation of what works. Under the auspices of "The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance," three working groups were formed to summarize experiences and lessons across countries regarding MNP interventions for young children. This paper focuses on programmatic experiences related to MNP delivery (models, platforms, and channels), SBCC, and training. Methods included a review of published and grey literature, interviews with key informants, and deliberations throughout the consultation process. We found that most countries distributed MNP free of charge via the health sector, although distribution through other platforms and using subsidized fee for product or mixed payment models have also been used. Community-based distribution channels have generally shown higher coverage and when part of an infant and young child feeding approach, may provide additional benefit given their complementarity. SBCC for MNP has worked best when focused on meeting the MNP behavioural objectives (appropriate use, intake adherence, and related infant and young child feeding behaviours). Programmers have learned that reincorporating SBCC and training throughout the intervention life cycle has allowed for much needed adaptations. Diverse experiences delivering MNP exist, and although no one-size-fits-all approach emerged, well-established delivery platforms, community involvement, and SBCC-centred designs tended to have more success. Much still needs to be learned on MNP delivery, and we propose a set of implementation research questions that require further investigation.

Keywords: behaviour; communication; complementary feeding; iron deficiency anaemia; micronutrients; programming.

Figure 1

Case study examples of delivery strategies. Delivery strategies for three country case studies are presented. The delivery strategy for Madagascar is denoted with a dashed line, for Mexico with a dotted line, and for Nepal with a straight line. Models are presented as cost to the consumer ranging from free (as with Mexico and Nepal) to subsidized (as with Madagascar) to full cost. Platforms are presented as the programme, system, or structure used to deliver micronutrient powder (MNP) ranging from health sector, which generally include maternal and child services and/or programs for infant and young child feeding (as with Nepal), growth monitoring, maternal child health week distribution; nonhealth sector, which generally include small‐scale agriculture‐nutrition programs, early childhood development, and social protection programs (as with Mexico); and nongovernmental organizations, which are outside of the government system (as with Madagascar). Delivery channels are presented as the distributor or mode through which an intervention is delivered ranging from health workers, which generally include public sector physicians (as with Mexico), public sector nurses (as with Mexico), and other public health facility staff (as with Nepal); community health workers, which generally include paid community health workers or volunteer community health workers (as with Madagascar and Nepal); and private sector providers, which generally include private sector physicians (as with Madagascar), private sector nurses, and other private health facility staff. Community retailers can serve as the delivery channel by providing the micronutrient powders directly to consumer or serve as a supplier linking the platform to the community delivery channel provider (as with Madagascar). Based on information from key informants 9, 11, and 12.