In Bangladesh, BRAC has been implementing a market based approach to implement the home fortification (HF) program with micronutrient powder (MNP) by using volunteer health workers. The mid-term assessment identified that there was a mixed performance in terms of implementation of the program against key outcomes. This study was aimed at understanding the programmatic factors that affected the performance of the program since its implementation.
We conducted this study by using qualitative techniques including, conducted key informant interviews, in-depth interviews, focus group discussions (FGD) and document reviews in 2 high performing and in 2 low performing districts under BRACs program areas. We used purposive sampling strategies to select study participants and performed thematic analysis to analyze data.
We conducted 21 interviews with BRACs health workers and staff, 8 FGDs with first-line supervisors. In low-performing districts, BRACs health workers were suffering from inadequate training on HF with MNP, not receiving timely incentives, shortage of supply, inadequate monitoring and supervision, and lack of coordination among other BRAC health programs. These barriers were less likely to be observed in the high-performing districts. Additionally, in the high-performing districts BRACs staff have been taken a number of other initiatives such as: performed joint crash program to increase MNP sales in low coverage areas, counsel pregnant mother, arranged timely quarterly meetings and maintained regular collaboration with government staff.
The programmatic factors we identified were influencing the implementation of the HF with MNP program. These factors should be carefully considered for further course-correction in BRACs program districts.