While this Toolkit recommends an integrated package to control anemia, in most countries the components of the integrated package already exist as a policy of the Ministry of Health, although coverage of malaria control, deworming, and iron-folic acid supplements still may be low. Global programs have emphasized an integrated package, in particular the Integrated Management of Childhood Illnesses (IMCI) which includes addressing anemia in children. Family planning has been combined with various health themes with some evidence of improved health outcomes.
Food-based approaches to control anemia are most promising through increased production of iron-rich foods, food fortification and biofortification. Increasing the production of meat and fruit to improve iron status of poor families is not often part of an integrated package implemented by the agriculture sector. The Ministry of Education also can play a role by providing useful nutrition information in school curriculums. Since older siblings care for their younger siblings, school children should be learning practical skills in feeding young children. The Ministry of Education can deworm school children and give them iron supplements, as resources permit. Where school feeding programs exist, school lunch programs should include iron-rich or fortified foods.
This Program Guidance tab focuses on helpful actions in planning an integrated approach to anemia control, within the health sector and across relevant public sectors and the private sector that can contribute to reducing the problem. The Toolkit also provides information and tools on how to improve existing programs. Many of our examples (e.g., behavior change communications) are related to iron-folic acid supplementation. We would like to add examples of trainings, messages and materials, and monitoring and evaluation related to all components of the integrated package (e.g., nutrition, malaria, helminths, agriculture). Please send any resources you think would be helpful to firstname.lastname@example.org or email@example.com.
While the Toolkit starts with a sub-tab on “developing a strategy,” improving existing programs can and should take place at any time during the strategy development process. Many of the problems with existing programs (lack of supplies, demand, and monitoring and evaluation) are probably already known, and the Toolkit provides some tools and resources to address these barriers. This Toolkit does not give information on the benefits of integrating these services within health or among sectors as this information has not been extensively collected for anemia prevention and control or for other health problems. Click here for information on developing an anemia prevention and control strategy.
Partners should be invited to the table within health and nutrition divisions, among sectors (Ministries of Agriculture, Education and Finance), and representatives from the private sector. Conducting a situational analysis on the state of existing programs will be useful in planning the way forward. Click here for an instrument for a situational analysis on anemia control programs which can be easily adapted to collect information on the entire integrated package.
Most surveys do not collect data on causes of anemia, so surveys can be limited in helping decide on effective strategies to address anemia. This is why country-level information on the prevalence of factors which contribute to the development of anemia, which include iron deficiency and also parasitic and infectious diseases, are useful to guide a country-level strategy on anemia. For migrant communities or specific segments of a population, check with partners working in specific geographic areas to see if any surveys have been conducted that may include useful data on these groups.
MCHIP has developed a visual decision tree for delivering IFA and other components of the integrated package which countries can use in identifying which channels are the most effective in reaching the target group. Activities and interventions for anemia control should cover both demand and supply issues needed to make delivery of the integrated package possible. Coverage of antenatal care is an important factor in determining the channels for IFA distribution. If coverage of women coming is low or they come in for ANC late, then community-based distribution may be the most effective channel in providing IFA. Ministries of Health do not want IFA distributed in the community because they think it will discourage use of ANC which is needed by women for many other interventions; however, where community-based distribution has been used, it has increased ANC utilization. Click here for the MCHIP brief on Community-Based Distribution of IFA.
Strategy development should determine the cost of anemia prevention and control, secure funding, and define timing (usually 3-5 years). Development of the strategy might be spearheaded by a small task force involving interested and relevant stakeholders which uses a collaborative process to develop the strategy. Development of a monitoring and evaluation plan should be designed during strategy development and before implementation of programs.
Click on the following sub-tabs for more information and tools on cross-cutting program components important to BCC Strategy Development, Developing BCC Messages and Materials, Logistics and Supplies, and Monitoring and Evaluation.