Challenges in supervision, monitoring, and reporting in anemia programme implementation in Odisha, India: A qualitative process documentation

Introduction: Anemia is a major public health challenge in India. Despite national programmes and targeted interventions over the years, the decline has been unsatisfactory. National Iron Plus Initiative (NIPI) was launched by the Government of India with a vision to combat anemia. In this context, we discuss the programmatic facilitators and issues in the monitoring, supervision, and reporting aspects of NIPI implementation. Materials and Methods: A process documentation study was undertaken in four districts of Odisha to assess the NIPI implementation. A total of 170 interviews were conducted during March-May 2016 among officials and frontline workers through qualitative techniques such as in-depth interviews, focus group discussions, and process observation. Data analysis was thematic using NVivo software. Results: Monitoring and supervision consisted primarily of visiting field sites by supervisors and review of the progress in meetings with inadequate documentation. Lack of coordination and ownership among the various departments involved were observed as revealed in the interviews. Some of the reporting formats were outdated and missed section for IFA syrup. Focus had been on the collection of data, but its utilization for informed decision-making and policy decisions was lacking. Conclusion: Better interdepartmental coordination and ownership, streamlining the reporting system and web-based monitoring system need to be prioritized to improve the effectiveness of the programme. The three key departments involved must strengthen the evaluation process for sustained outcomes to reduce anemia burden.