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Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review
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Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review

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Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review …

Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review

SilvanaFaillace, A2Z Project

CORE Group Spring Meeting Pre-Session, Monday April 26, 2010

Published in: Health & Medicine
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  • Addressing anemia rather than iron deficiency anemia specifically, but in many countries iron deficiency is the primary cause. Often the terms are used interchangeably and this is one factor in anemia programs having established a reputation as failing propositions. Barriers are known, need to address the surmountable ones, Root causes in poverty (lack of resources) & inequality (including gender bias) Immediate causes in low awareness, health management, logistics, weak communications Access, preferably through ANC where quality of care is a major issue, Motivation determined by many factors, some are resulting from lack of resources and inequality. motivation can be strengthened in many ways quality of communication materials, this includes job aids. Training materials, and educational materials for clients -- two sets specially designed for each target group -- provider, and client Clearly programs must be modified to fit the country context. For example, IPT may not be necessary in all contexts
  • ANC is a key outcome of most of the CSGP programs reviewed. However, high ANC coverage does not immediately guarantee high IFA coverage or compliance.
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    • 1. Maternal Anemia within Child Survival Grants Program:  Lessons Learned and a Way Forward? - A Selected Review - SilvanaFaillace, A2Z Project April 26, 2010 Baltimore, United States
    • 2. <ul><li>Overview </li></ul><ul><li>Child Survival Grants Program (CSGP) selected review </li></ul><ul><li>Part I: </li></ul><ul><li>Maternal Anemia programs and effectiveness at scale </li></ul><ul><li>Part II: </li></ul><ul><li>Findings and lessons learned from CSGP programs review </li></ul><ul><li>Recommendations </li></ul>
    • 3. <ul><li>Child Survival Grants Program (CSGP) selected review </li></ul><ul><li>Objective </li></ul><ul><li>Critically review a sample of CSGP programs to i dentify maternal anemia program components and barriers to implementation and/or scale-up </li></ul><ul><li>Methods </li></ul><ul><li>Program selection </li></ul><ul><ul><li>CSGP information system and portfolio mapping (Macro International) </li></ul></ul><ul><ul><li>Search done for programs with iron folate and maternal anemia that ended in 2009 or planned to end in 2010 and 2011 </li></ul></ul><ul><li>Identified “inputs”, “outputs”, “outcomes” and “impacts” specific to maternal anemia reduction activities, as well as self-reported barriers to implementation and scale up </li></ul><ul><li>Assessed identified maternal anemia program components against commonly accepted benchmarks from “Anemia-What Works”, systematic reviews of effective large-scale maternal anemia programs </li></ul>
    • 4. <ul><li>Child Survival Grants Program (CSGP) </li></ul><ul><li>Programs reviewed </li></ul>PVO Country Program Project end date Finished Projects       HKI Niger YALLANDO KLEYA Child Survival Project 9/30/2009 HKI Mali Synergy and Action for Nutrition 9/30/2009 CPI India Jeevan Daan Maternal and Child Survival Cost Extension program 9/30/2009 On-going Projects       Hope Worldwide India Chotton Ki Asha Child Survival Program 9/29/2010 Goal Ethiopia Sidama Child Survival Program 9/29/2011 INMED Peru Healthy Babies Project 9/30/2010 MIHV Tanzania Tanzania Child Survival Project 9/29/2011 Plan International Nepal Local Innovation for Better Outcomes for Neonates Project 9/29/2011 Relief International Niger Healthy Start Child Survival Program 9/30/2011 The Salvation Army World Service Office (SAWSO) Zambia Chikankata Child Survival Project 9/29/2010
    • 5. Maternal anemia programs and effectiveness at scale
    • 6. <ul><li>Key Program Components for Anemia Control </li></ul><ul><li>Increasing iron intake </li></ul><ul><ul><li>Iron/folate supplementation </li></ul></ul><ul><ul><li>Food fortification </li></ul></ul><ul><ul><li>Dietary diversity </li></ul></ul><ul><ul><li>Malaria control (where relevant) </li></ul></ul><ul><ul><li>Reducing parasitic worm loads </li></ul></ul>
    • 7. <ul><li>Maternal Anemia Integrated Intervention Package </li></ul>Effectiveness IFA Supplement supply Delivery system Compliance Supplements taken Iron status improves Anemia and other iron-related health outcomes improve Efficacy Adapted from Ekstrom 2002 Malaria Control: Bednets, IPTl Deworming Motivation
    • 8. <ul><li>Characteristics of Effective Maternal Anemia Programs </li></ul><ul><li>Comprehensive approaches addressed major preventable causes (iron deficiency, malaria, parasitic worms) </li></ul><ul><li>Addressed known barriers </li></ul><ul><ul><li>Commitment to action </li></ul></ul><ul><ul><li>Awareness of benefits by both clients &amp; providers </li></ul></ul><ul><ul><li>Logistics (supply, tablets &amp; packaging) </li></ul></ul><ul><ul><li>Access to quality ANC (motivation, training &amp; supervision) </li></ul></ul><ul><ul><li>Communication materials &amp; counseling (e.g. memory prompts, anticipate &amp; cope with side-effects) </li></ul></ul><ul><li>Tailored to country context </li></ul>
    • 9. <ul><li>Nicaragua: Prevalence of anemia in mothers/caregivers 1993, 2000 &amp; 2003 </li></ul>Percentage Hb&lt;12 g/dL Source: SIVIN 2004 <ul><li>ANC increased from 62% to 70% from ’97-’01 </li></ul><ul><li>80% women reported taking 90+ IFA tablets in ‘01 </li></ul><ul><li>CB programs and pharmacies possible sources of IFA also </li></ul>
    • 10. <ul><li>Thailand: Trend in anemia in pregnant women in Thailand </li></ul>Source: Routine MOH data based on women receiving ANC at health facilities <ul><li>National program linked health facilities with community-based workers </li></ul><ul><li>De-worming, sanitation and hygiene, dietary diversification also major emphases </li></ul><ul><li>Economic development accompanied decline in anemia </li></ul>
    • 11. <ul><li>Evidence on effective large scale programs </li></ul><ul><li>Nicaragua : ANC increased from 62% to 70% from ’97-’01. Brigadistas (community health worker) follow-up and counsel. Supply is acceptable; no major side effects. 80% women reported taking 90+ IFA tablets in ’01. Fortification also in effect. </li></ul><ul><li>Thailand : National program linked health facilities with community-based workers. Emphasis on reducing stockouts through district health fund. Deworming, sanitation and hygiene, dietary diversification, birth spacing also. Economic development accompanied decline in anemia but later continued. </li></ul><ul><li>Source: Sanghvi T, P. Harvey, E. Wainwright. “Maternal Iron-Folic Acid Supplementation Programs: Evidence of Implementation and Impact. Beijing May 2009 </li></ul>
    • 12. <ul><li>Elements of program are in place, but implementation? </li></ul><ul><li>Most countries have MMR reduction goals: IFA given priority? </li></ul><ul><li>ANC guidelines include preventive IFA: monitoring? </li></ul><ul><li>Varied causes recognized, e.g. IDA, worms, malaria: package? </li></ul><ul><li>Essential Drugs Lists have IFA, deworming, malaria drugs: stock outs </li></ul><ul><li>Basic health worker training covers anemia: counseling and follow up for IFA? </li></ul><ul><li>Source: Sanghvi T, P. Harvey, E. Wainwright. “Maternal Iron-Folic Acid Supplementation Programs: Evidence of Implementation and Impact. Beijing May 2009 </li></ul>
    • 13. <ul><li>Iron/Folate Supplement Program Framework </li></ul>MOST, USAID Micronutrient Program. 2004. A Strategic Approach to Anemia Control Programs. Arlington, Virginia, USA KPC Baselines, BEHAVE Framework, Focus Groups, Key Informants Target groups Health services and providers focus of trainings and program activities Areas where capacity building, health systems strengthening and program monitoring , can be tailored and strengthened to ensure maternal nutrition and anemia objectives are being achieved. CSGP
    • 14. <ul><li>Child Survival Grants Program (CSGP) </li></ul><ul><li>Key Findings </li></ul>Program Components - Good Practices and Benchmarks Number of Programs Programs conducted initial formative research, qualitative research on attitudes and behaviors related to anemia and iron-folic acid (IFA) supplementation, e.g KPCs, BEHAVE, etc. 10 Programs with communications strategy designed to develop and deliver effective messages to overcome consumer resistance and ensure compliance in taking IFA supplements 7 Programs with increase in ANC attendance as an outcome 7 Programs reviewed with reduction of maternal anemia as an outcome 3 Programs reviewed with integrated anemia reduction approach ANC, IPT, IFA, De-worming, nutrition counseling 5 Programs explicitly working on improving supply and logistics systems for IFA, IPT or anti-helminths, e.g. stock outs 3 Programs with IFA receipt as outcome 6 Programs training health workers at all levels 10 Programs collaborating with community, district and national level decision makers 10
    • 15. <ul><li>Source: Sanghvi T, P. Harvey, E. Wainwright. “Maternal Iron-Folic Acid Supplementation Programs: Evidence of Implementation and Impact. Beijing May 2009 </li></ul><ul><li>Low IFA coverage even where ANC is high </li></ul>
    • 16. <ul><li>Child Survival Grants Program (CSGP) </li></ul><ul><li>Lessons Learned </li></ul><ul><li>Variation between DIP plans and results at MTE and EOP (where available), due to variety of contextual, management and implementation issues </li></ul><ul><li>Quality of ANC services not being systematically monitored </li></ul><ul><li>Supplies </li></ul><ul><li>Receipt of IFA does not equate intake </li></ul><ul><li>Missed opportunity to reduce maternal anemia </li></ul><ul><ul><li>All programs focusing on ANC attendance and quality of service </li></ul></ul><ul><ul><li>All programs focusing on health systems improvement </li></ul></ul><ul><ul><li>All programs have strong IEC/BCC components at household, community and health system level </li></ul></ul>
    • 17. <ul><li>Child Survival Grants Program (CSGP) </li></ul><ul><li>Recommendations and Next Steps </li></ul>- Given that CSHGP projects already program and invest in activities to improve maternal nutrition, such as IFA, de-worming, ANC service provision/counseling, nutrition counseling, would be beneficial to improve in the design, implementation and monitoring of these activities e.g. - Measure receipt and compliance of IFA tablets by pregnant women - Assess quality of ANC services and HW knowledge on anemia and its prevention activities offered - Use RHFA to report of health service content and quality   Discussion - What is do-able within the Child Survival Grants Program? - What are the overall limitations that PVO see in having more integrated anemia control programs?
    • 18. <ul><li>Acknowledgements </li></ul>NazoKureshy, Stacey Maslowsky and Emily Wainwright - USAID Leo Ryan and David Cantor - Macro International Rolf Klemm - A2Z Project and Johns Hopkins University Jennifer Burns - Johns Hopkins University Elizabeth Deal - A2Z Project
    • 19. <ul><li>THANK YOU </li></ul>This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. GHS-A-00-05-00012-00  . The contents are the responsibility of the Academy for Educational Development and do not necessarily reflect the view of USAID or the United States Government.

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