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Table 2 Facilitators and barriers to Micronutrient Powder Initiative (MPI) implementation in 4 districts in Ghana based on data collected during a 2-month period from November to December 2019

From: Lessons learned from implementing the pilot Micronutrient Powder Initiative in four districts in Ghana

Aspect of program Facilitatorsa Barriersb
MNP acquisition at district level and in health facilities • Fairly regular availability of the MNPs at the health facilities ensure regular supply to mothers/caregivers • Difficulty with transportation to collect MNP from regional or district capital to health facilities.
MNP distribution to mothers and caregivers • Several contact points to introduce or supply MNP to mothers and caregivers, including: Child Welfare Clinics, community durbars, home visits by community health nurses, information centers, out-patient departments of health centers, radio, and outreaches.
• Frontline nurses’ ability to deliver messages on MNP use to mothers/caregivers, including how to mix the MNP with home-prepared food.
• Generally good social mobilization including involvement of community health committee members, community volunteers, opinion leaders, chiefs, and queen mothers to endorse and support the program.
• Effective integration of the MNP program with the promotion of infant and young child feeding counselling reinforces each other.
• Strong involvement of District Nutrition Officer offers strong support to frontline nurses.
• Tracing mothers to their homes to monitor adherence and address the concerns.
• Absence of counselling cards, flip charts, posters, and leaflets specially made for the MNP distribution is making education about MNP difficult.
• Inadequate training for the MNP Program managers and frontline nurses, and no refresher training thereafter.
• High turn-over of health workers means that those initially trained on MNP may no longer be available to support implementation.
Records keeping and monitoring • None identified • Register used to record the particulars of beneficiary children are loose sheets with no serial numbers; it is difficult to handle these loose sheets, especially during outreach services, since the papers can easily get torn or lost.
• Inadequate supply of registers to record the particulars of beneficiary children.
MNP acceptability and consumption • Mothers’/caregivers’ and health workers’ motivation to improve or promote the health and nutrition of children in the district.
• Understanding (among frontline nurses and women/caregivers) of the positive outcomes associated with MNPs consumption is necessary to motivate families to use MNPs regularly and appropriately.
• Good counselling technique by frontline nurses, e.g. in Ho West, frontline nurses use the acronym “AFATVRAH” (Age, Frequency, Amount of food, Texture, Variety, Responsive feeding and Hygiene) to remind themselves regarding what they are supposed to counsel women/caregivers about.
• Frontline nurses’ reported show of respect and patience as they deal with mothers and caregivers promote uptake of the program.
• “One-on-one” education and counselling sessions for some mothers help to address specific issues such as potential side-effects, reported refusal to consume food mixed with MNP, misconception that MNPs are a birth control substance for children, etc.
• Frontline nurses often provide the opportunity for mothers to share success stories about MNP consumption with others.
• Food preparation demonstration to let mothers know that MNPs do not change taste of food considerably.
• Perceived inadequate community sensitization before program implementation
• Lack of full community support for the program.
• Skeptism of some mothers/caregivers about the MNPs being effective, especially during the early phase of the program.
• Claims that the MNP changes the colour and/or taste of food (eg if mixed with a small quantity of food) tend to reduce acceptance.
• Children’s experience of side-effects (whether perceived or actual) may reduce adherence to supplement intake.
• Conflicting or inappropriate advice concerning MNP administration received by mothers/ caregivers.
• Misconception and rumours that MNPs are a birth control substance for children tend to reduce acceptance.
  1. a Facilitators were defined as factors promoting the implementers’ ability and willingness to execute the program successfully and caregivers’ ability accept and utilize the program as promoted
  2. b Barriers were defined as factors militating against successful program implementation or uptake