WHO and most Ministries of Health support initiation of iron-folic acid (IFA) supplements early in pregnancy as part of an integrated anemia prevention and control package. Unfortunately, low coverage of these programs remains a problem due to lack of supplies, late or no attendance to antenatal care (ANC) and demand-side issues. Community-based distribution (CBD) of IFA through private sector pharmacies and shops may aid with supply and/or access issues. A review of CBD of IFA was conducted to understand how to improve coverage and utilization for pregnant women and young girls.
A literature review of peer-reviewed and grey literature on CBD of IFA supplementation for pregnant women, girls and women of reproductive age was conducted. Components of program implementation including type of health worker, supply and demand issues, and coverage were reviewed.
CBD programs had moderate success with midwives, and community health workers who counseled on health benefits and compliance with IFA supplementation. CHWs were more likely to identify and reach a greater number of women earlier in pregnancy, as women tended to present late to ANC. CBD channels tended to have consistent supplies of IFA compared to clinics and vendors, who faced stock-outs. Targeting women of reproductive age through school and community settings demonstrated high compliance and reductions in anemia (10% -18%). Challenges at the facility level included a lack of counseling for side effects and cost
CBD of IFA has potential to create demand, and ensure IFA supply to prevent and control anemia.