Using Program Impact Pathways to Improve Anemia Reduction Programs

Abstract

Recent evidence of the benefits of iron supplementation during pregnancy to reduce low birth weight and maternal mortality highlights the need for iron supplementation in pregnancy, an intervention known to be efficacious. Despite implementation of anemia reduction programs in many developing countries, the worldwide prevalence of maternal anemia in pregnancy remains over 40%. This suggests limitations in program delivery.To improve the delivery of a large‐scale anemia reduction program delivered through a mobile clinic program in rural Haiti, we designed a “Program Impact Pathway” (PIP) to delineate the mechanisms by which program activities resulted in desired outcomes. Survey data (n=663) from program beneficiaries were used to asses each essential component of the PIP, including consistent distribution of iron folic acid (IFA) at monthly clinics, women's understanding of how and why to IFA and barriers to adherence. Although knowledge about IFA benefits was high, irregular clinic attendance and inconsistent delivery of IFA resulted in a low median number of times women received IFA during pregnancy.Iron supplementation programs will be successful only if all essential elements linking program efforts to desired outcomes are identified and understood. The PIP provides such a method, and the lessons from its use in Haiti can be applied to other such programs.Research support: USAID, NIH/NIDDK