Anaemia is a leading public health concern for adolescent girls the world over, impacting an estimated 30% of 10-19 year olds. Weekly iron and folic acid supplementation (WIFAS), as recommended by the World Health Organization, is one of the most effective adolescent health and nutrition programs to prevent anaemia. Schools offer the ideal avenue to reach this target demographic.

However, since March 2020, COVID-19 related school closures disrupted the delivery mechanism for this significant adolescent health and nutrition intervention, putting millions of girls at risk.

As per UNESCO reporting, 173 countries closed in-classroom learning by April 1, 2020. Since then, more than 1.5 billion students have been impacted by school closures from grade school through to university. Although country-wide school closures have lessened, the long-term impact on students’ behaviour, and potential that some students may not return to school due to reduced family incomes, is still unknown. What is known is that adolescent girls are facing an increased risk of anaemia at a time when their immune system needs to be its strongest.

More than 1.5 billion students have been impacted by school closures from grade school through to university.

There have been multiple factors complicating the ability to deliver WIFAS in many countries. Lockdowns impact transport and supply chains, which in turn can create shortages of iron and folic acid tablets. In some countries, attempts to engage frontline health workers to distribute tablets faltered as the same workers were called to focus on the COVID-19 response. In others, the lack of ample personal protective equipment and the fear of COVID-19 transmission created further roadblocks. Additionally, female frontline workers have been disproportionally hit with the double burden of stepping up to meet the COVID-19 response in their jobs while often being primary care givers at home, compounding the issue.

Nutrition International is supporting governments to overcome these barriers by streamlining supplies and engaging with frontline health workers and community-based platforms.

In Indonesia, prior to the pandemic, Nutrition International supported the delivery of WIFAS to in-school adolescent girls in Banten, West Java, East Java and East Nusa Tenggara. After school closures disrupted the WIFAS program, different models of programming emerged in different provinces with one key similarity – they were all pioneered from the local level. Teachers, frontline health workers and adolescent girls found innovative ways to ensure continuation of the WIFAS program. In Banten and in some districts of East Java and East Nusa Tenggara, one to three months’ supply of IFA tablets were provided to girls before schools were closed. In other districts of East Java, village midwives, health workers or youth ambassadors stepped in to provide tablets to girls at their homes. In West Java, village youth outreach centres were reactivated by health workers and functioned as WIFAS supply centres. In other areas, village level youth groups helped ensure supply by encouraging independent procurement of the tablets from public health centres or private sources. In all of these methods, creative ways of monitoring, such as asking girls to take selfies, share short videos, or e-report via google forms, were adopted to promote compliance.

In India, Nutrition International supported the WIFAS program in Uttar Pradesh, Gujarat, Madhya Pradesh, Chhattisgarh and West Bengal. When schools closed, Nutrition International advocated for and supported the delivery of WIFAS through community outreach. State governments worked to streamline the supply of tablets by leveraging anganwadis (community health centres) across the country. From April to June 2020, over three million adolescents were reached. From July to September 2020, this number increased to over six million. While not reaching every adolescent the program typically would, the efforts from the government and community level enabled programming to meaningfully continue. Youth participants of the WIFAS program have helped to raise awareness amongst their peer group.

Creative ways of monitoring, such as asking girls to take selfies, share short videos, or e-report via google forms, were adopted to promote compliance.

In Kenya, the adolescent nutrition program started in 2016 in Nakuru and Busia, and has since expanded to Nandi, Vihiga and Makueni. When COVID-19 caused schools to close, Nutrition International supported training in Nakuru to mobilize community health volunteers as nutrition advocates, connecting adolescents with WIFAS from their local health unit.

These innovative approaches are successfully continuing anaemia prevention programming, despite COVID-19’s multifaceted challenges. Fuelled by these initiatives, after an initial period of decreased WIFAS coverage due to school closures, the trend is starting to reverse. More and more girls are being reached via community organizing. Core to all these innovations is the collaboration with local champions such as village midwives, teachers, health workers and youth groups.

As countries unlock and reopen schools, Nutrition International is committed to supporting governments to build back the WIFAS program. Investment in nutrition is the need of the hour in order to build resiliency and healthy immune systems that will pave the way for global economic recovery and stability.

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