Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study.
Ontology highlight
ABSTRACT:
SUBMITTER: Wendt AS
PROVIDER: S-EPMC5898001 | biostudies-literature | 2018 Apr
REPOSITORIES: biostudies-literature
Publications
Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study.
Wendt Amanda S AS Stephenson Rob R Young Melissa F MF Verma Pankaj P Srikantiah Sridhar S Webb-Girard Amy A Hogue Carol J CJ Ramakrishnan Usha U Martorell Reynaldo R
BMC health services research 20180412 1
<h4>Background</h4>Maternal anaemia prevalence in Bihar, India remains high despite government mandated iron supplementation targeting pregnant women. Inadequate supply has been identified as a potential barrier to iron and folic acid (IFA) receipt. Our study objective was to examine the government health system's IFA supply and distribution system and identify bottlenecks contributing to insufficient IFA supply.<h4>Methods</h4>Primary data collection was conducted in November 2011 and July 2012 ...[more]
Similar Datasets
Project description:PurposeThe IFA supplementation program under the Anemia Mukt Bharat (AMB) program is one of the most ambitious nutrient supplementation programs in India. The delivery of services often suffers due to frequent stock outs and shortages. It is critical to understand the bottleneck in the supply chain adversely affecting the performance and coverage of the program. The paper attempts to identify the bottlenecks of the IFA supply chain in key areas of supply chain i.e., forecasting, procurement, warehousing and inventory management, transportation, distribution, logistic information system and suggests a plan of action aimed at ensuring uninterrupted supplies to the end beneficiaries.Design/methodology/approachThe data source for the present paper is the nationwide IFA Supply Chain Assessment (2018-19) conducted across 29 Indian states with a total of 58 districts, 116 blocks, 232 Sub-Centres, 232 Anganwadi centres and 232 schools covered under the assessment as a multi-partner collaborative initiative. Field insights from supply chain strengthening interventions under different public health programs in India and other developing countries were taken to arrive at corrective actions and recommendations. Findings were disseminated to government and an action plan was suggested for connecting service delivery points through an app-based system, developing a micro plan for ensuring fixed distribution schedule, followed by continuous monitoring and review meetings identified for follow up.FindingsThe average lead time across states was 35 weeks with top three performing states being Goa, Sikkim, and Telangana. The average per unit cost of procurement was Rs 0.35 for IFA Red, Rs 0.25 for IFA Blue, Rs 0.31 for IFA Pink and Rs 7.30 for IFA syrup. Out of the 704 districts in India, only 213 has IFA Red, only 140 had IFA Blue, 152 had IFA Pink and 163 had IFA Syrup available in four quarters of 2018-19. The key issues identified in the assessment were-a lack of standardized forecasting process, absence of inventory management techniques, no fixed distribution schedule, inadequate availability of transport vehicles and an absence of an integrated MIS.Originality/valueThe identification of bottlenecks in the IFA supply chain and its impact on the performance of the supply chain would provide policy guidelines for the government as well as development partner agencies to design an effective and efficient supply chain. It would also enable the policy planners to understand the challenges associated with managing different components of a supply chain, their interrelation and impact on the overall performance of the supply chain. The suggested recommendations would equip program managers with the tool to devise and implement field level solutions.
| S-EPMC9955604 | biostudies-literature
Project description:Nearly two thirds of young children are anaemic in Bihar, India. Paediatric iron and folic acid syrup (IFAS) and multiple micronutrient powders (MNPs) are two evidence-based interventions to prevent anaemia. Using a randomized crossover design, we examined the acceptability of IFAS versus MNPs for children 6-23 months. In a catchment area of 2 health centres in Bihar, health front-line workers (FLWs) delivered either (a) IFAS twice weekly or (b) MNPs for 1 month followed by the other supplementation strategy for 1 month to the same families (NCT02610881). Household surveys were conducted at baseline (N = 100), 1 month after receiving the first intervention (1 month; N = 95), and 1 month after the second intervention (2 months; N = 93). Focus group discussions (10 FLWs) and in-depth interviews (20 mothers) were held at 1 and 2 months. We used chi-square and Fisher exact tests to test mothers' product preferences. Qualitative data were analysed using MaxQDA and Excel employing a thematic analysis approach. There was high adherence and acceptability for both products (>80%). There was no significant difference in preference (p < .05) on perceived benefits (39% MNPs, 40% IFAS), side effects (30% MNPs, 30% IFAS), ease of use (42% IFAS, 31% MNPs), child preference (45% IFAS, 37% MNPs), and maternal preference (44% IFAS, 34% MNPs). Mothers and FLWs indicated that the direct administration of IFAS ensured that children consumed the full dose, and MNPs intake depended on the quantity of food consumed, especially among younger children, which emphasizes the need to integrate supplementation with the promotion of optimal child feeding practices.
| S-EPMC5900720 | biostudies-literature
Project description:OBJECTIVE:To quantify the prediagnostic loss to follow-up (PDLFU) in an active case finding tuberculosis (TB) programme and identify the barriers and enablers in undergoing diagnostic evaluation. DESIGN:Explanatory mixed-methods design. SETTING:A rural population of 1.02 million in the Samastipur district of Bihar, India. PARTICIPANTS:Based on their knowledge of health status of families, community health workers or CHWs (called accredited social health activist or locally) and informal providers referred people to the programme. The field coordinators (FCs) in the programme screened the referrals for TB symptoms to identify presumptive TB cases. CHWs accompanied the presumptive TB patients to free diagnostic evaluation, and a transport allowance was given to the patients. Thereafter, CHWs initiated and supported the treatment of confirmed cases. We included 13 395 community referrals received between January and December 2018. To understand the reasons of the PDLFU, we conducted in-depth interviews with patients who were evaluated (n=3), patients who were not evaluated (n=4) and focus group discussions with the CHWs (n=2) and FCs (n=1). OUTCOME MEASURES:Proportion and characteristics of PDLFU and association of demographic and symptom characteristics with diagnostic evaluation. RESULTS:A total of 11 146 presumptive TB cases were identified between January and December 2018, out of which 4912 (44.1%) underwent diagnostic evaluation. In addition to the free TB services in the public sector, the key enablers were CHW accompaniment and support. The major barriers identified were misinformation and stigma, deficient family and health provider support, transport challenges and poor services in the public health system. CONCLUSION:Finding the missing cases will require patient-centric diagnostic services and urgent reform in the health system. A community-oriented intervention focusing on stigma, misinformation and patient support will be critical to its success.
| S-EPMC7232626 | biostudies-literature
Project description:ObjectiveThe Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnered with the Ethiopian Pharmaceutical Supply Agency (EPSA) in 2018-2019 to reform procurement and supply chain management (PSCM) procedures within the Ethiopian healthcare system. This assessment sought to determine the impact of the reforms and document the lessons learnt.DesignMixed-methods study incorporating qualitative and quantitative analysis. Purposive and snowballing sampling techniques were applied for the qualitative methods, and the data collected was transcribed in full and subjected to thematic content analysis. Descriptive analysis was applied to quantitative data.SettingThe study was based in Ethiopia and focused on the EPSA operations nationally between 2017 and 2021.ParticipantsTwenty-five Ethiopian healthcare decision-makers and health workers.InterventionGlobal Fund training programme for health workers and infrastructural improvements OUTCOMES: Operational and financial measures for healthcare PSCM.ResultsThe availability of antiretrovirals, tuberculosis and malaria medicines, and other related commodities, remained consistently high. Line fill rate and forecast accuracy were average. Between 2018 and 2021, procurement lead times for HIV and malaria-related orders reduced by 43.0% relative to other commodities that reported an increase. Many interview respondents recognised the important role of the Global Fund support in improving the performance of EPSA and provided specific attributions to the observed successes. However, they were also clear that more needs to be done in specific critical areas such as financing, strategic reorganisation, data and information management systems.ConclusionThe Global Fund-supported initiatives led to improvements in the EPSA performance, despite several persistent challenges. To sustain and secure the gains achieved so far through Global Fund support and make progress, it is important that various stakeholders, including the government and the donor community, work together to support EPSA in delivering on its core mandate within the Ethiopian health system.
| S-EPMC10729206 | biostudies-literature
Project description:INTRODUCTION:South Asia is home to more than 300?million smokeless tobacco (ST) users. Bangladesh, India and Pakistan as signatories to the Framework Convention for Tobacco Control (FCTC) have developed policies aimed at curbing the use of tobacco. The objective of this study is to assess the compliance of ST point-of-sale (POS) vendors and the supply chain with the articles of the FCTC and specifically with national tobacco control laws. We also aim to assess disparities in compliance with tobacco control laws between ST and smoked tobacco products. METHODS AND ANALYSIS:The study will be carried out at two sites each in Bangladesh, India and Pakistan. We will conduct a sequential mixed-methods study with five components: (1) mapping of ST POS, (2) analyses of ST samples packaging, (3) observation, (4) survey interviews of POS and (5) in-depth interviews with wholesale dealers/suppliers/manufacturers of ST. We aim to conduct at least 300 POS survey interviews and observations, and 6-10 in-depth interviews in each of the three countries. Data collection will be done by trained data collectors. The main statistical analysis will report the frequencies and proportions of shops that comply with the FCTC and local tobacco control policies, and provide a 95% CI of these estimates. The qualitative in-depth interview data will be analysed using the framework approach. The findings will be connected, each component informing the focus and/or design of the next component. ETHICS AND DISSEMINATION:Ethical approvals for the study have been received from the Health Sciences Research Governance Committee at the University of York, UK. In-country approvals were taken from the National Bioethics Committee in Pakistan, the Bangladesh Medical Research Council and the Indian Medical Research Council. Our results will be disseminated via scientific conferences, peer-reviewed research publications and press releases.
| S-EPMC7304837 | biostudies-literature
Project description:ObjectivesThis study aims to understand if fatigue, the main symptom of anaemia, is a health concern that cues women and their referent groups to obtain iron folic acid supplements.DesignThis is a mixed methods study that consisted of a cross-sectional perceptual mapping and card sorting activity along with 16 focus group discussions with women of reproductive age, mothers-in-law and men. Participants of the perceptual mapping and card sorting activity were asked to compare images of anaemia-related items and concepts. Participants in the focus group discussions were asked about their daily life, aspirations and concerns among women and perceptions of anaemia and iron supplementation in the community. The quantitative data were analysed through multidimensional scaling and analyses of variance in SPSS. The qualitative data were analysed through applied thematic analysis using NVivo.SettingBhubaneswar, Odisha, India.ParticipantsWomen of reproductive age (n=30), mothers-in-law (n=30) and married men (n=30) were randomly selected to participate in the perceptual mapping and card sorting exercise. A separate sample of each group was randomly selected for the focus group discussions (n=148).Primary and secondary outcome measuresWe collected perceptions of dissimilarity between anaemia-related items, including fatigue and medical items; the extent to which these items were perceived as important to health or likable; and qualitative information about gender norms.ResultsCognitive maps and card sorting revealed that fatigue was conceptualised distinctly from items related to medical treatment and that perceptions around fatigue's importance to health were low. Women from the focus groups reported that fatigue is a regular part of their daily life.ConclusionOur results indicate that fatigue is currently not an adequate cue to seek treatment, perhaps due to the normalisation of fatigue as a part of women's daily life.
| S-EPMC7577027 | biostudies-literature
Project description:Effective management of hypertension in low- and middle-income settings is a persistent public health challenge. This study examined supply- and demand-side barriers to receiving quality care and achieving effective hypertension management in rural Bihar, India. A state-representative household survey collected information from adults over 30 years of age on characteristics of the hypertension screening, diagnosis, and management services they received. A linked provider assessment determined the percent of providers who provided quality hypertension care (i.e., had a functioning BP measurement device, measured a patient’s BP, could correctly diagnose hypertension, had at least one first-line antihypertension medication, and could prescribe correctly based on standard guidelines). Patients were linked with their provider to determine the quality-adjusted coverage of hypertension management and logistic regression analysis was conducted to determine characteristics associated with receiving quality care. A total of 14,386 patients and 390 providers were studied. Nearly a quarter (22.5%) of adults had never had their BP measured before and 8.1% of adults reported a previous hypertension diagnosis. Less than one third (31.0%) of all interviewed providers demonstrated ability to provide quality hypertension care, and quality varied between provider types (14.8% of private homeopathic, 25.2% of informal, 40.0% of private modern medicine, and 60.0% of public providers gave quality care). While 95.8% of diagnosed individuals received some treatment, only 10.9% of patients received care from quality local providers. Nearly 45% of individuals with hypertension received care from non-local providers. Individuals from the general caste with comorbidities living in villages with more high-quality providers were most likely to receive quality care from a local provider. Whereas the coverage of services for individuals diagnosed with hypertension is high, the quality of these services is suboptimal for economically and socially vulnerable populations, which limits effective management and control of hypertension in rural Bihar. Efforts should be targeted towards providers to initiate quality treatment upon diagnosis, including correct prescription of antihypertensives.
| S-EPMC10021531 | biostudies-literature
Project description:BackgroundThis study examines family support for professional work and domestic labour among Elected Women Representatives' (EWR) in rural Bihar, India, and associations of this support with EWRs' professional performance during the COVID-19 pandemic.MethodsWe conducted a cross-sectional, mixed-method study, surveying 1338 EWRs and conducting in-depth interviews with 31 EWRs (Oct 14- Nov 6, 2020). Purposive sampling was used to select the participants. Our team has been working for more than a decade with EWRs across 10 districts in Bihar, providing them with capacity building and community interventions. All EWRs are part of our network, and around 2000 were reached out for the survey. Of these, 1338 consented to participate. Four survey participants from each district were randomly selected and invited for the in-depth interviews. Independent variables for our quantitative analysis included help from husband and other family members on a) EWR work and b) domestic work. Dependent variables, dichotomised as yes/no, assessed EWR workload, COVID-19 work, intervening on violence against women or child marriage, and belief EWRs can have impact. Separate multivariate logistic regression models assessed the hypothesised relationships. All models were adjusted for socio-demographic variables and indicators related to EWR's work experience and community perception or respect.FindingsMost women (76%; n = 1016 EWRs) received help from their husbands with EWR work while 39% reported husband help with domestic labour. Receipt of help from husband with domestic work was associated with increase in official work since the pandemic (aOR: 2.62; 95% CI: 1.84-3.71), arrangement of needed services during COVID-19 (aOR: 2.54; 95% CI:1.65-3.90), and self-belief regarding possibility of EWR impact (aOR: 3.49; 95% CI: 2.25-5.43). Husband's help with EWR work was related to increased odds for intervening to stop violence against women only (aOR: 2.18; 95% CI: 1.32-3.60). In-depth interviews with the selected 31 EWRs underscored an increase in their EWR work under COVID-19. The increase in EWR workload under the pandemic created time constrictions for EWR's domestic labour responsibilities, even as domestic labour responsibilities increased.InterpretationOur study highlights the importance of husband's help and support in strengthening EWRs outcomes at work in India, with help in domestic work being related to a relatively wider range of outcomes that are indicative of EWR's performance, compared to husband's help with EWR work. These findings emphasize the need for building male responsibility for domestic labour, to improve women's professional performance and outcomes. Our study has few key limitations such as lack of causal interpretations due to reliance on cross-sectional research design, potential for social desirability bias in self-reported data, and absence of information related to changes in patterns of spousal and family support received by the EWRs as a result of the pandemic. Nonetheless, our findings are important, particularly for the context of Bihar, India, where appalling gender gaps still persist in all social and economic aspects of society.FundingBill & Melinda Gates Foundation: 2017, OPP1179246 and EMERGE COVID-19 (2019, OPP1163682); David & Lucile Packard Foundation: 2017- 66202.
| S-EPMC9676563 | biostudies-literature
Project description:In low- and middle-income countries, poor autonomy prevents women from making financial decisions, which may impact their access to improved sanitation facilities. Inadequate access to improved sanitation disproportionately affects women's and children's health and wellbeing. Although socio-cultural factors are known contributors to gender inequity, social beliefs that potentially motivate or dissuade women from making sanitation-related household decisions are not well understood. These beliefs may vary across settlement types. To empower more women to make sanitation-related decisions, the relevant socio-cultural norms and underlying social beliefs need to be addressed. In this mixed methods study, we explored women's role in sanitation-related decision making in three settlement types, urban slums, peri-urban, and rural communities in Bihar. Trained qualitative researchers conducted six focus group discussions with women of two age groups: 18-30 years old, and 45-65 years old to understand the norm-focused factors around women's role in getting a toilet for their household. Using insights generated from these group discussions, we developed and conducted a theory-driven survey in 2528 randomly selected participants, to assess the social beliefs regarding women making toilet construction decisions in these communities. Overall, 45% of the respondents reported making joint decisions to build toilets that involved both men and women household members. More women exclusively led this decision-making process in peri-urban (26%) and rural areas (35%) compared to urban slums (12%). Social beliefs that men commonly led household decisions to build toilets were negatively associated with women's participation in decision making in urban slums (adjusted prevalence ratio, aPR: 0.53, 95% CI: 0.42, 0.68). Qualitative insights highlighted normative expectations to take joint decisions with elders, especially in joint family settings. Surrounding norms that limited women's physical mobility and access to peers undermined their confidence in making large financial decisions involved in toilet construction. Women were more likely to be involved in sanitation decisions in peri-urban and rural contexts. Women's involvement in such decisions was perceived as widely acceptable. This highlights the opportunity to increase women's participation in sanitation decision making, particularly in urban contexts. As more women get involved in decisions to build toilets, highlighting this norm may encourage gender-equitable engagement in sanitation-related decisions in low-resource settings.
| S-EPMC8794139 | biostudies-literature
Project description:The COVID-19 crisis has notably impacted global supply chains as it has disrupted manufacturing operations. To recover from the aforementioned disruptions, supply chain digitalization [SCD] is increasingly being acknowledged to help the recovery process. Based on this, scholars have called for additional research on how SCD can enhance supply chain visibility [SCV] and boost supply chain performance [SCP] in turbulent environments. Based on 399 valid responses collected through cross-sectional method from Turkish manufacturing firms and using a non-probabilistic sampling method [i.e., purposive sampling], this research explores the effect of SCD on SCP. The mediating role of SCV and the moderating role of supply chain survivability [SCS] on the SCD-SCP relationship were also explored. The findings showed that SCD has a positive effect on SCP. SCD has a positive effect on SCV. SCV has a positive effect on SCP. The link between SCD and SCP is mediated by SCP. The results also revealed that SCS moderated the SCD-SCV link such that SCD has a stronger, positive relationship with SCV when SCS is high than when it's low. SCS moderates the SCD-SCP link, such that at low levels of SCS, the positive effect of SCD on SCP is weakened. The indirect positive effect of SCD on SCP via SCV is strongest when supply chain survivability is high. The findings suggest that SCD can improve cost-effectiveness, promote communication and information efficiency, and enhance supply chain resilience to improve performance after disruptions. This study provides insightful new implications for both supply chain literature and practitioners.
| S-EPMC10881317 | biostudies-literature