Use of Monitoring Data to Inform Program Implementation of a Multiple Micronutrient Powders Program in Bihar, India

The objective of this study was to describe how systematic monitoring using mixed methods can be used to track project performance and inform program activities that were conducted as part of an ongoing community cluster randomized control trial in West Champaran, Bihar, designed to evaluate the program effectiveness of delivering multiple micronutrient powders (MMPs) to reduce anemia in children 6–18 months. Communities (n=70; 35 in each arm) were randomized to receive either counselling on infant and young child feeding (IYCF) or both counselling and MMPs. Implementation was driven by government frontline workers (FLW) including Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWWs). Monitoring data were collected using check‐lists to assess (i) receipt of MMP sachets at decentralized storage sites designated to be the Anganwadi Centre (AWC) (n = 30/month, total N = 210), (ii) attendance, powder supply, delivery and training content at Field Level Worker (FLW) meetings held at the Health Sub‐center (HSC) (n = 70/month, total N = 840) and receipt/use of MMP sachets at the household (HH) level (n = 90/ month; total N = 630). At midline (month 4), 840 households and 420 FLWs were interviewed to assess program maturity. In addition, qualitative in‐depth interviews were conducted with 20 HHs and 31 FLWs from low and high performing intervention HSCs (n= 2, 1 in each arm). Monitoring data showed high levels of MMP distribution to households (70–85%) early in the project, that was followed by a steady decline in distribution and receipt of MMP, reaching a low of 40% of HHs reporting receipt of MMP at midline (month 4). The main barriers to consumption were a lack of supply of MMP at the HH level, with 21% reporting shortages. In contrast, shortages were rarely reported at AWCs by program staff. Qualitative data and FLW survey data indicated high compliance and community acceptance of MMPs, in addition to a good understanding of the program by FLWs. Lack of HH visits by FLWs was a key program delivery barrier and a majority of HHs (70.9%) used the MMPs if they received them in the last month. This methodology and approach to using monitoring data helped us make key program decisions in real time. Specifically, we focused on systems strengthening as the project was conducted within the framework of the existing government structure. We involved various levels of the government apparatus within the district and state, to carry out course corrections that led to improving delivery and consumption of MMP. Results from ongoing monitoring also helped define strategies to promote community demand for the program through community meetings that were combined with top down efforts to increase supportive supervision to FLWs which in turn ensured adequate supply of MMPs from AWCs to HHs. Support or Funding Information Funding support provided by a BMGF grant through a subcontract with CARE‐India.This graph tracks monitoring data collected via HSC checklists and HH checklists between months 1 to 9 of program roll‐out as was available at the time of submission of this abstract. HH checklist data was compiled in months 1,2,3,6, and 8 (10, 12 pending as of submission) of program roll‐out. HSC checklists were completed each month.