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Table 4 Identified bottlenecks of Bihar’s IFA supply chain, proposed actions, and key stakeholders

From: Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study

Identified bottleneck

Proposed action

Key stakeholders

Lack of appropriate IFA need forecasting

Standardized demand forecasting based on accurate estimates of district needs and previous consumption

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper, ANM

 

Computerization and clear documentation of inventory, stock requests, and expiry dates

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper, ANM

 

Estimates to include lactating women population; IFA distribution and counseling standard

SHS, BMSICL, District Storekeeper, Block Storekeeper, ANM, ASHA, AWW

Late supplier deliveries resulting in inconsistent supply

Utilization of updated BMSICL policy to deduct payment upon late delivery, damaged stock, etc.c

SHS, BMSICL, District Officialsa, District Storekeeper

Indents not being utilized nor perceived as effective

Training and monitoring to assure indent use and effectiveness

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper, ANM, ASHA

Perceived or actual inability to procure IFA when needed through local purchasing

Explore use of untied funds through Rogi Kalyan Samiti or others to purchase IFA locally in times of shortage

SHS, BMSICL, District Officialsa, District Storekeeper, RKS, Block Officialsb, Block Storekeeper, ANM, ASHA

Lack of buffer stock use at all levels

Implementation, monitoring, and evaluation of existing buffer stock requirementsd

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper, ANM, ASHA

 

Ensure adequate storage facilities so stock can be stored safely

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper, ANM

No safe disposal plan for expired medicines and pushing of expiring drugs to patients and frontline workers

Transparent plan to prevent expired medicines through appropriate purchasing practices and safe disposal of expired medicines

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper, ANM, ASHA

Storeroom transiency and disorder

Construct, purchase, or long-term rental of adequate storerooms. Funding for racks, labels, and shelves.

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper, ANM

 

Training for storekeepers including storeroom order and inventory protocols.

SHS, BMSICL, District Officialsa, District Storekeeper, Block Officialsb, Block Storekeeper

Inconsistent training on IFA counseling/distribution across FLW types

IFA counseling/distribution training for all frontline workers who work with pregnant women

Block Officialsb, ANM, ASHA, AWW

 

Training for all frontline workers together at health sub-centre level to improve coordination and communication

Block Officialsb, ANM, ASHA, AWW

  1. SHS State Health Society, BMSICL Bihar Medical Services and Infrastructure Corporation Ltd., ANM Auxiliary Nurse Midwife, ASHA Accredited Social Health Activist, AWW Anganwadi Worker, RKS Rogi Kalyan Samiti (Patient Welfare Committee)
  2. aDistrict Officials, Civil Surgeon, District Programme Manager
  3. bBlock Officials, Medical Officer In Charge, Block Health Manager
  4. cBihar Medical Services and Infrastructure Corporation Ltd. Bid document for supply of drugs & medicines for various medical institutions of Government of Bihar for the year 2013–14. Patna, Bihar: BMSICL; 2013: http://bmsicl.gov.in/uploads/Drug%20Tender%20new.pdf. Accessed 05/11/2014
  5. dState Health Society, National Rural Health Mission, Government of Bihar. Consolidated Revised NRHM State Project Implementation Plan 2012–13 of Bihar. Patna, Bihar, India2011