Bottlenecks in the Coverage of the Anemia Mukt Bharat Programme in Rural Jharkhand and the Way Forward: A Qualitative Research.

Background Exorbitant prevalence of anaemia is a major public health perturbation in India. The objectives of this study are to explore the reasons behind the non-acceptability of the interventions among pregnant and lactating females, provided under the Anemia Mukt Bharat (AMB) programme, including the beneficiaries' perceptions, systemic issues, and cultural factors, and to describe the challenges faced by service providers in delivering the services. Methods A qualitative study was conducted to explore the reasons behind the non-acceptability of the interventions provided under the AMB programme, from July 2023 to June 2024, in the Ormanjhi block of Ranchi district in Jharkhand. An in-depth Interview was performed with 95 pregnant and lactating females above 18 years of age, recruited by stratified non-random purposive sampling. Two focus group discussions were done separately with auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs) of the area, and two key informant interviews were done with the medical officer in charge (MOIC) and child development project officer (CDPO) of the block. Results Thematic analysis revealed four major themes with 10 sub-themes, reflecting the various behavioural, infrastructural, and systemic impedances to the effective implementation of the program. These primarily included irregular supply and frequent stockouts of the supplements at the healthcare facility, poor compliance due to side effects associated with the supplements, lack of awareness among the beneficiaries, lack of availability of the information, education, and communication (IEC) materials, existing cultural beliefs and barriers, and the educational qualifications of the beneficiaries. The main challenges faced by the service providers under the programme were a shortage of manpower and increased workload, frequent stockouts of the supplements and IEC materials, inadequate periodic training provided to the ground-level workers on the functioning mechanism of the programme, lack of advocacy from local leaders, and a meagre pay scale of frontline workers. Conclusion The present study reveals critical insights into the programme's reach and effectiveness, indicating a substantial gap between the programme's objectives and its actual implementation on the ground. Despite the programme's well-intentioned efforts to combat anaemia, the coverage remains inconsistent and limited. Several factors contribute to this shortfall.