An Implementation Study to Assess a Health Worker-based Platform for a Home Fortification Program in Bihar.

ABSTRACT

Objectives: The main objectives of the study were to explore the feasibility of using Frontline health Workers (FLW) as a platform to deliver Multiple Micronutrient Powders (MMP) to the target population (children of 6-18 months) and to assess the acceptability of MMP among the community. This work was part of a multi-phase formative research study for contextualizing a home fortification strategy in Bihar. Methods: The program was implemented in three Health Sub Centers (HSCs) in West Champaran over a two-month duration. Key programmatic activities included FLW training for MMP distribution and counseling on complementary feeding; and community sensitization events to increase MMP acceptability. We conducted 5 focus group discussions and 3 in-depth interviews with FLWs along with monthly monitoring at the household level (n=20/HSC) to assess the program implementation. Results: Important implementation findings emerged through the soft roll-out. Firstly, the HSC meetings were found to be suitable as a FLW training platform but not for MMP distribution to FLWs due to logistical constraints. Secondly, the counseling brochures and community sensitization meetings were perceived to be important facilitators for MMP uptake by the community. Thirdly, FLWs reported positive levels of engagement, low perceptions of work burden and adopted diverse strategies for program delivery. Lastly, community uptake was found to be positive and primary barriers to compliance were mainly associated with supply issues rather than user preferences. Conclusions: The implementation study proved to be a valuable step in identifying critical operational and programmatic factors to inform future large-scale program activities.