Project Summary
The project seeks the following objectives:
- To increase uptake and adherence to IFA supplements among women of reproductive age, including pregnant and lactating women, and adolescents;
- To generate implementation knowledge on how to deliver at scale within the government system; and
- To reduce gender barriers affecting access and adherence to IFA supplements.
The purpose of the program is to design, test, implement, and evaluate impactful interventions focusing on the key target segments to ensure increased uptake of and adherence to IFA supplements in identified geographies of Bihar and develop recommendations for delivering the strategies at scale.
Approach
Working alongside different departments of the state Government of Bihar, the project is applying an implementation science framework to test a set of strategies, initially at a pilot level and then a scalable level. These strategies will aim to increase adherence of IFA supplements among three main groups in rural areas: i) adolescent girls (both in and out of school), ii) pregnant and lactating women, and iii) general women aged 15 to 49 years. A mixed method approach, including Human Centered Design (HCD) and a cluster randomized control trial (CRCT) will be used to design and test a set of strategies. The project will address key implementation research questions to inform feasible and cost-effective strategies to support adherence to and delivery of recommended maternal nutrition interventions.
Process
Proposed Theory of Change
| Long-Term Outcomes | Increased uptake and adherence to IFA supplementation among adolescents, pregnant women & non-pregnant women in reproductive age. | |||
| Intermediate Outcomes | 1) Increased knowledge and more positive attitudes about IFA adherence. 2) Positive social norms supporting IFA supplementation in pregnant and lactating women as well as adolescent girls. | 1) Increased habit formation among pregnant and lactating women for IFA consumption. 2) Higher awareness of need among adolescents for IFA supplementation. | Accurate and real-time monitoring of IFA adherence patterns. | 1) Deeper understanding among health workers & school-teachers about the risks of anemia and its treatments. 2) Greater ability among health workers and school-teachers to respond to queries & concerns. |
| Interventions & Activities | Communication Interventions for General Population: 1) To increase awareness about risks of anemia and benefits of IFA supplementation. 2) To promote social norms around supporting IFA supplementation in pregnant and lactating women, and adolescent girls. 3) Discussions on IFA supplementation thru SHG platform. 4) Discussion with mother-in-law and husband during home visit by the community cadres/FLWs. 5) Digital interventions like mobile app for reminding the pregnant and lactating women and adolescent girls on IFA consumption. | Other Interventions for General Population: 1) Sensitization of mothers of adolescent girls at SHG meetings. 2) Anemia Session for in school adolescents. 3) Activities in the classroom to train adolescent girls to track IFA Consumption. 4) Discussion by paraeducator on benefits of IFA consumption. | Intervention for health administrators: Mobile-based digital monitoring system to track distribution and consumption of IFA tablets by community women. | Interventions for health workers and school-teachers: 1) Chat-bot to engage pregnant women and adolescent girls & answer their FAQs. 2) Training and Orientation of health workers, community cadres and school-teachers. |
| Barriers | Barriers in community and among household members: 1) Low salience of anemia risk and clarity about benefits of IFA supplementation among all segments. 2) Early discontinuation due to side effects. 3) Low prioritization of self-health among women and adolescent girls. 4) Forgetfulness among pregnant women to complete the 180-day course. 5) No clear linkage to health goals which are valued leading to faulty attribution and low salience. 6) Low awareness among husband on benefits of IFA for mother and children. | Barriers among health workers: 1) Difficult to prioritize IFA counseling & follow-up due to competing priorities. 2) Lack of monitoring system with concrete short-term indicators. | Barriers among school-teachers Low awareness of anemia prevalence among adolescents. 2) Lack of awareness about benefits of IFA supplementation and its linkage with education. 3) Heightened perceptions of side-effects of IFA supplementation. Multiple competing tasks during the school day. |