You’ve heard of drive-through COVID-19 testing. But what about a drive-through for adolescent girls to access essential micronutrients?

When the pandemic shuttered schools globally, it cut off access to more than in-person learning. One of Nutrition International’s core interventions is to help prevent anaemia in adolescent girls through Weekly Iron and Folic Acid Supplementation (WIFAS) programs. Schools provide the ideal avenue to reach this target demographic. Nutrition education is woven into curriculum and tablet distribution can be monitored in the same fashion as school attendance. But in March 2020, when schools closed, the system built to get these essential micronutrients to girls ground to a halt.

In Indonesia, teachers in separate parts of the country took it upon themselves to come up with creative solutions to continue delivering iron and folic acid (IFA) supplements to their students even though they were no longer meeting for class in person.

Drive-by solutions

Dwi Purwati, a language teacher at a junior high school in Lumajang, East Java, participated in an anaemia prevention training facilitated by Nutrition International in 2018. She was the teacher responsible for running the anaemia prevention program at her school, but prior to the training she said the level of compliance for taking the tablets was low in her school as they were distributed without nutrition education. She would often find tablets in the trash, thrown away by students who did not understand their purpose.

The training improved her knowledge of anaemia and the connection between nutrition, micronutrients and anaemia prevention. It also provided her with posters, booklets, videos and monitoring cards she could use to spread awareness and understanding to her students. She started a student group focused on anaemia prevention and good nutrition. She also incorporated assignments on anaemia into her language classes. Students wrote poetry, made posters and penned articles that highlighted what it meant to be anaemic and how to prevent it. Her students even made a short video about anaemia in 2019, which they put on the school’s YouTube channel.

Purwati cites the 2018 training as a turning point: “Previously we only distributed IFA tablets. There was no nutrition education for students. After the training, we became more confident explaining the importance of IFA supplements and how to prevent anaemia. We had the knowledge.”

That knowledge is what motivated her when the pandemic hit.

She pitched her school’s principal the idea of providing students with a monthly supply of tablets when they came to drop off their homework assignments. Although students were learning from home, they still needed to come by the school to hand in work. As many of the students came by motorbike, she thought to make it a “drive-through” system to limit physical contact, and adhere to pandemic health and safety measures.

The drive-through started picking up steam. Students who were part of the anaemia prevention group assisted with distribution, under her leadership. Since they could no longer take the supplement in person together, monitoring was shifted to WhatsApp where they could virtually track intake and students could check in with each other. Although Purwati admits the current situation is not ideal, she’s committed to making it work. The effort she put in pre-pandemic to create buy-in and spread awareness is paying off.

Student health ambassadors step up

Over one-third of adolescent girls in Indonesia are anaemic. Nutrition International has supported over 9,000 schools in four provinces across the country. In Garut, West Java, social studies teacher Ai Maryati participated in a training facilitated by Nutrition International in January 2020, less than two months before schools were mandated to close. At the time, she had no idea how helpful that training would come to be.

Iron and folic acid supplements started being given out at her school in 2018. With the program underway, the school documented a drop in anaemia cases from 28% in 2018 to 9% in 2019. After attending the training in 2020, Maryati wanted to deepen her students’ nutrition knowledge. She realized the power of peer counselors and created an opportunity for her students to become health ambassadors to take control of their own health and well-being, and support their families and communities.

When schools closed, she knew her female students who were once anaemic were at risk of becoming anaemic again. In consultation with a nutritionist from the local health centre, they came up with a plan to distribute the iron and folic acid supplements by leveraging the student health ambassadors and establishing youth groups affiliated with the local puskesmas (government health centres). Maryati started the first group connected to the health centre by her house. As news of the youth groups spread, more groups began springing up. By the end of 2020, there were 15 youth groups all working towards community-based health initiatives, focused on awareness and distribution of iron and folic acid supplements. This provided students with the opportunity to get the micronutrients they needed to keep anaemia rates down while schools remained closed.

“I can’t believe what I do can inspire people,” Maryati said, reflecting on how the program has evolved. “I am so proud that all of my student became Duta Gebetan [Adolescent Health Ambassadors] to distribute and ensure adolescent girls take iron and folic acid tablets regularly during the pandemic.”

In January 2021, one year after training with Nutrition International, Maryati spoke at a National Nutrition Day Celebration virtual show, addressing almost 500 participants. She shared how the distribution of iron and folic acid supplements was able to continue despite COVID-19 through the youth health groups. She said her hope and prayer is for all girls in Garut district to be free from anaemia now, and into their futures.

These are just two examples of teachers taking extraordinary steps to safeguard the nutritional status of their students. As COVID-19 exacerbates gender inequalities globally, it’s the everyday actions of leaders like Purwati and Maryati that are protecting adolescent girls from anaemia — and connecting the dots between nutrition, education and equality.

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