Nutrition International, in collaboration with the Government of Senegal, has released a comprehensive landscape analysis aimed at informing the transition from iron and folic acid supplementation (IFAS) to multiple micronutrient supplementation (MMS) for pregnant women in Senegal. With support from the Eleanor Crook Foundation and the Waterloo Foundation, the report evaluates the policy landscape, service delivery, product supply and financing frameworks essential for improving maternal and neonatal health.

MMS is more effective and cost-effective than IFAS in improving birth outcomes, has equivalent benefits in preventing maternal anaemia and is safe for mothers and babies. In 2020, the World Health Organization (WHO) recommended that implementation research be conducted in settings where the transition from IFAS to MMS is being considered in low- and middle-income countries.

Guided by the recent WHO recommendation and the maternal and newborn needs in the country, the Government of Senegal is considering the introduction of MMS for pregnant women as part of comprehensive antenatal care (ANC). Nutrition International worked in partnership with the Government of Senegal, with funding and support from The Eleanor Crook Foundation and the Waterloo Foundation, to complete a landscape analysis to better understand opportunities and challenges related to the potential introduction and scaling of MMS. The analysis focuses on four key pillars essential for delivering quality ANC and nutrition services: policy, service delivery, product supply and financing. It investigates and analyzes these pillars in the context of a potential introduction and SMART (sustainable, measurable, achievable, resourced, and tailored) integration of MMS into Senegal’s public ANC system, replacing IFAS as the standard of care.

In recent years, maternal and child health indicators in Senegal have shown mixed progress. Anaemia remains a pressing concern, with rates among women of reproductive age decreasing slightly from 59.1% in 2005 to 54.1% in 2017, and from 70.6% to 62.7% among pregnant women during the same period. The country has made progress in reducing maternal mortality from 401 per 100,000 live births in 2005 to 273 in 2017. Meanwhile, low birthweight rates have risen from 6.3% in 2005 to 11.6% in 2019. Encouragingly, the 2023 Demographic and Health Survey reported some progress, revealing that approximately 60% of pregnant women attended at least four ANC visits in 2023, compared with just 40% in 2005.

These indicators highlight the ongoing health needs of mothers and their newborns in Senegal and emphasize the need to strengthen the integration and delivery of essential nutrition services as part of antenatal care.

The report identifies both opportunities and challenges within Senegal’s health system for introducing MMS, providing recommended next steps for consideration by Senegal’s MMS Taskforce across the four pillars:

• MMS research should be conducted in Senegal to test potential solutions to identified barriers and further unpack prioritized pain points. Results from MMS research can provide critical information to guide the SMART transition and scale-up of MMS in Senegal. 

• Policies and protocols: A clear process should be developed and executed for alignment and updating of content across policies and protocols.

• Service delivery: The equitable redistribution of ANC providers within Senegal is essential to address disparities in access to care. This effort should be complemented by the reallocation of resources, along with additional training and tools to strengthen maternal nutrition services.

• Supply chain: Stock outs at the central level and the cascading repercussions were identified as one of the biggest barriers to IFAS programming in Senegal and must be resolved. In addition, MMS should be added to WHO’s Essential Medicines List. 

• Financing: A specific budget line is required to ensure a sustainable supply of MMS at the central level and domestic resource mobilization for MMS should be explored. If IFAS is replaced with MMS, a similar cost-sharing structure should ensure that pregnant women continue to pay only a small fee.

As the Government of Senegal considers scaling up MMS, this landscape analysis identifies priority research areas for advancing Senegal’s MMS Learning Agenda and roadmap to scale.

For more on the findings and recommendations, view the full report in English and French.

You can also reach out to Jennifer Busch-Hallen, Practice Area Director for Maternal and Neonatal Health and Nutrition, at jbuschhallen@nutritionintl.org or Balla Diedhiou, Senegal Country Director, at bdiedhiou@nutritionintl.org.

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