DESIGNING A PROGRAM FOR LARGE SCALE DELIVERY OF SPRINKLES

J van Hees, E Martini, D Foote, MA Bloem�, S de Pee, R Moench-Pfanner, S Halati, I Sumarno, MW Bloem

Problem: Up to 70% of young children in urban poor areas of Indonesia are anemic. The negative consequences of anemia for child health and development warrant urgent intervention, but only very few larger scale anemia prevention programs have yet been implemented in developing countries.

Objectives: The overall aim is to design a program for large scale delivery of an in-home fortificant (sprinkles) to under five children. Specific objectives include: to evaluate the effectiveness of sprinkles distribution on the nutritional status of underfives; and to identify appropriate distribution channels and promotion strategies for the sprinkles product.

Framework: In-home fortification may be a highly feasible intervention to address child anemia, especially in urban Indonesia. Mothers are accustomed to sachet use in preparing foods. Local corner shops and/or the community health posts are potential distribution points that are in close proximity to, and regularly used by mothers. Household expenditure data from this population suggest that the product would be affordable for mothers, and current production of sprinkles by private sector partners within Indonesia adds to potential sustainability. Program: In three cities of Java and Sulawesi in 2004-2005, sprinkles will be distributed via local NGOs and community health posts in the context of their ongoing health and nutrition programs.

Methods: Formative research in 2003 employed focus group discussions and in-depth interviews with key informants to develop a local product name (Vitalita, meaning vitamins for underfives), package design, and key message for promoting Vitalita as part of good child care, health care and nutrition. A social marketing campaign is being developed based on these findings. A monitoring and evaluation activity will be conducted in intervention communities to track the use of the product and the impacts on nutritional status of young children, including anemia. Lessons from developing the name and packaging and implementing the distribution/purchasing program are expected by late 2004.

Implications: In home fortification ('sprinkles') is an innovative potential strategy to address the problem of child anemia, and evidence of its effectiveness will facilitate large scale expansion complementary to other nutrition and disease prevention efforts.