Investigator(s)
| Submitter |
Puja Rai Vitamin Angels Puja Rai 
|
| Principal Investigator |
Puja Rai Vitamin Angels Puja Rai
|
Title(s) and abstract
| Scientific title | MMS Program Review in Bhutan: A situational assessment |
| Public title | MMS Program Review in Bhutan: A situational assessment |
| Background | In 2024, in response to the ongoing micronutrient challenges among pregnant women, the Ministry of Health (MoH), Bhutan in partnership with Vitamin Angels and other stakeholders, scaled up the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) Multiple Micronutrient Supplementation (MMS) program nationally, transitioning from the traditional Iron and Folic Acid (IFA) supplementation. As MMS becomes part of routine antenatal care (ANC) services, it is important to understand how the program is being implemented across different geographies in Bhutan, identify operational challenges, highlight best practices, and inform future program strengthening and sustainability. |
| Objectives | a. Collate recent evidence on maternal nutritional status including micronutrient deficiencies, national policies, and ANC service delivery mechanisms. b. Document the status of MMS program implementation across Bhutan including distribution, delivery mechanisms, and integration into ANC services. c. Identify implementation strengths and challenges at national, district, and facility levels. d. Map key stakeholders involved in planning, coordination, delivery, and monitoring of MMS. e. Understand perceptions of MMS among health workers and PLW. f. Provide strategic recommendations to the MoH to strengthen MMS implementation within Bhutan’s health system. |
| Study Methods | The study will include four components: (a) a desk review of Bhutan-specific scientific articles/reports, including grey literature/publications to explore the local evidence on maternal nutritional status, (b) qualitative data collected through stakeholder consultations using in-depth interviews to generate an understanding of barriers and enablers of transitioning from IFA supplementation to MMS; (c) facility-level observations and exit interviews of MMS distribution to PLW, and (d) a consensus-building workshop among key stakeholders to build consensus on the way forward. For qualitative data and facility observations, six districts (two per region: high- and low-performing based on ANC utilization) were purposively selected to ensure urban-rural representation. From each district, one health facility was chosen. Stakeholders for IDIs include Ministry of Health officials, UN agencies, and health workers (n≈24), while 36 PLWs (2–3 pregnant and 2–3 lactating per facility) will be interviewed. Participants are selected based on direct involvement with MMS services and must be ≥18 years; those unable to consent or not involved in MMS are excluded. Semi-structured tools will guide interviews, conducted in English or Dzongkha, and audio-recorded. Facility observations will use structured checklists assessing MMS availability, storage, counselling, record-keeping, and supply chain issues. Exit interviews will capture women’s understanding and satisfaction with MMS counselling. Desk review data will be extracted into a standardized evidence matrix, while qualitative interviews will be transcribed, coded, and analyzed thematically using software (e.g., MAXQDA). Observation and exit interview data will be summarized descriptively. Triangulation of findings across all components will inform recommendations. Ethical approval will be obtained from the REBH. Written informed consent will be obtained from all participants, with procedures in place for illiterate individuals. Confidentiality and secure storage of data are ensured. |
| Expected outcomes and use of results | A comprehensive overview of the MMS program's implementation status across Bhutan. This includes identifying strengths, operational challenges, best practices, and the perceptions of both health workers and recipients. The findings will generate evidence to guide policy and operational decision-making for the Ministry of Health. The results will be used to provide strategic recommendations, strengthen program implementation, develop a structured MMS roadmap, and inform future advocacy and research initiatives |
| Keywords | Multiple Micronutrient Supplementation (MMS), maternal nutrition, antenatal care (ANC), micronutrient deficiencies, implementation challenges, pregnant and lactating women (PLW). |
Research Details
| Student research | No |
| Start Date | 01-Jun-2025 |
| End Date | 01-Mar-2026 |
| Key Implementing Institution | Ministry of Health |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| Bhutan, Bhutan, Bhutan, Bhutan, Bhutan, Bhutan | |
| Research Domain(s) | Maternal, Reproductive and Child Health |
| Research field(s) | Nutrition |
| Involves human subjects | Yes |
| Qualitative Study | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | No |