Anemia is a severe health problem in Nepal affecting all segments of the population. According to the World Health Organization, an anemia prevalence of greater that 20% in a population is considered to be a significant health problem. The 1998 Nepal Micronutrient Status Survey (NMSS) reported an overall anemia prevalence of 68% among women. The prevalence of anemia among pregnant women was even higher at 75%. In other words, three out of every four pregnant women in Nepal were found to be anemic. The NMSS survey also found that some 78% of pre-school children to be anemic in Nepal and virtually all children between 6-12 months are anemic (90%).
Iron supplementation during pregnancy has been a key health initiative in Nepal since 1980. The policy of the government is to provide all pregnant women with a dietary supplement of 60 mg of iron on a daily basis from the beginning of the second trimester of pregnancy through 45 days of postpartum. For the past two decades, the government has been supplying iron tablets to pregnant women through primary health facilities. There have been extensive efforts to increase awareness about anemia and iron supplementation during pregnancy through training of health workers at all levels and through numerous IEC activities.
However, coverage of iron supplementation activities is extremely poor. Only 23% of women receive iron tablets during pregnancy; and only three percent of them take iron supplements for more than 90 days. Poor coverage and compliance could be due to various factors; such as low demand arising from a lack of knowledge about anemia and the importance of iron tablets during pregnancy, inadequate supply of iron tablets, poor access to supplements, and inability of health workers to provide required counseling about iron supplementation.
In 2004, an integrated micronutrient control program was initiated by the Ministry of Health and Population as a part of new nutrition strategy to address micronutrient deficiencies among pregnant and postpartum women. The program is jointly supported by the Ministry of Health and Population, World Health Organization (WHO), Micronutrient Initiative (MI) and UNICEF.
In 2004 NTAG, with the financial support from MI, provided technical assistance to the Department of Health Services in implementing the Phase 1 of the Intensification of Maternal and Neonatal Micronutrient Program (IMNNP) to address micronutrient deficiencies among pregnant and postpartum women in five priority districts (Jhapa, Dhanusha, Mahottari, Morang, and Saptari).
The evaluation of this program revealed positive results in terms of increased coverage and compliance of iron/ folate tablets among pregnant and postpartum women. In view of this encouraging result, MI expanded the program in other districts over the periods of time.
Under this program, NTAG carried out series of orientation and training activities for different categories of health workers and health motivators at different level of health infrastructure. With the financial support from MI and UNICEF, NTAG completed IMNMP training in 68 districts during the period of 2004 to 2011.
Objectives:
The overall objectives of the program were to train all health workers and FCHVs in order to enable them to interact with pregnant and postpartum women and to counsel them regarding the importance of preventing and treating micronutrient deficiencies, to intensify overall maternal micronutrient related activities that include distribution of iron/folate tablets to pregnant/postpartum women, vitamin A capsule supplementation to postpartum women, de-worming of pregnant women, promotion of adequately iodized salt, and diversification of diet and rest during pregnancy, and to develop managerial capacity especially supplies logistics, reporting and supervision.
The IMNMP training package covered:
- Central level coordination, monitoring, and supervision
- Development of Training Guide and Schedule
- Organizing and Conducting District Orientation
- Organizing and Conducting VDC Facility In-charge Training
- Conducting VDC Facility Staff/FCHV Training
Total districts covered by NTAG
| Funding Agency | No. of Districts Covered | Name Of Districts Covered | Completion Date |
| MI (Phase I) |
5 |
Jhapa, Dhanusha, Mahottari, Morang, Saptari |
2004 |
| UNICEF |
3 |
Chitwan, Sunsari, Parsa |
2004 |
| UNICEF |
7 |
Udaypur, Nawalparasi, Dang, Kapilvastu, Dadeldhura, Tanahun and Kavre |
2007 |
| MI (Phase II) |
12 |
Siraha, Rautahat, Sarlahi, Rupandehi, Bardia, Kailali, Kanchanpur, Doti, Jumla, Dailekh, Surkhet, and Baitadi |
2006 |
| MI (Phase III) |
12 |
Ramechhap, Myagdi, Syangja, Baglung, Parbat, Arghakhanchi, Palpa, Salyan, Pyuthan, Dolpa, Mugu, and Darchula |
2007 |
| MI (Phase IV – 1st Stage) |
2 |
Bajhang, Sindhupalchowk |
2007 |
| MI (Phase IV – 2nd Stage) |
9 |
Nuwakot, Rasuwa, Bajura, Gorkha, Gulmi, Lamjung, Sindhuli, Manang, Mustang |
2008 |
| MI (Phase V) |
12 |
Achham, Dhading, Dolakha, Humla, Jajarkot, Kalikot, Kaski, Makwanpur, Rolpa, Rukum, Sankhuwasabha, Solukhumbu |
2009 |
| MI (Phase VI) |
4 |
Bhaktapur, Khotang, OKhaldhunga, Panchthar |
2010 |
| MI (Phase VII) |
2 |
Bhojpur, Lalitpur |
2011 |
| Total # of districts covered |
68 |