Initial implementation supported by implementation research
The Ministry of National Health Services and its Nutrition Wing is developing plans for a national MMS program in Pakistan, where progress on improving maternal nutrition has remained slow.[1] The government is actively collaborating with local civil society organizations, nutrition partners, and other international organizations including UNICEF, Nutrition International, World Food Program, the World Bank, and Junaid Family Foundation, with product support from Kirk Humanitarian.
MMS is central to Pakistan’s National Nutrition strategy and momentum continues to build. The Ministry of Health is working to include MMS on the national Emergency Medicines List, and in June 2023, the Ministry reaffirmed their commitment to MMS in a letter to provincial government health Director Generals. The letter outlined the burden of maternal nutrition in Pakistan and the benefits of MMS compared to iron folic acid and reiterated the government’s policy to transition from iron folic acid to MMS. The letter sparked critical momentum at the provincial level, as it urged local health authorities to take action to support the transition. Additionally, the national cash transfer program is exploring MMS use with targeted balanced energy protein (BEP) for malnourished women.
MMS introduction in Pakistan is supported by an extensive body of implementation research, as nutrition partners have completed several key assessments, including: an assessment of the national nutrition situation; policy and regulatory environment; current delivery platforms; preferred product attributes; local readiness to supply and procure MMS; and an analysis of its cost-effectiveness in Pakistan. Local manufacturers are currently exploring MMS production for local and export markets. Additionally, partners continue to work closely with in-country leaders through a national working group and in the development of advocacy tools and materials to raise awareness of this high-impact intervention.
Additional research is underway to examine and strengthen delivery platforms, integrate MMS within other maternal nutrition interventions such as counseling, monitor reach and effective coverage, as well as the overall process to continue refining the approach. For example, Nutrition International is working with the government in the Swabi district to explore transition from IFA to MMS, assess the population’s perception, acceptance and compliance of MMS, evaluate its feasibility, and identify any concerns and gaps that could be addressed. Vitamin Angels plans to conduct an evaluation of clinical outcomes to further understand the impact of MMS on clinical outcomes. These findings will inform further research and scale-up across the country.
Johns Hopkins Bloomberg School of Public Health is conducting a trial to evaluate the impact of an integrated intervention of Calcium + 81 mg aspirin + MMS (“CAMMS”) compared to IFA on preterm birth. The trial will be conducted in Pakistan (partnering with Dept Community Health Sciences, Aga Khan University), Burkina Faso (partnering with L’Institut Africain de Santé Publique (IASP), and Zimbabwe (partnering with Institute for Maternal and Child Health Research). The trials will enroll about 10,000 pregnant women early in pregnancy and follow them to delivery.
[1] Government of Pakistan and UNICEF. Pakistan Maternal Nutrition Strategy 2022-2027.
- Start Date: 2020
- End Date: ongoing