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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