A frontline worker in Uttarakhand had visited the same household three times in a single month. The iron syrup from her previous visit sat untouched on a shelf. She explained the benefits again to the mother and the family. She answered the same questions again. She would come back.
What stands out is not her persistence. It is what makes it possible. The training she received, the awareness materials she carries, and the system behind her. This is not one person's effort. This is what delivery actually looks like. And it is the driving force behind one of India's most critical public health priorities.
Anaemia remains one of India's most consequential public health challenges. According to the National Family Health Survey (NFHS-5) 2019-2021, 67% of children under five and 57% of women aged 15 to 49 are anaemic. Anaemia, where the body lacks sufficient healthy red blood cells, leads to impaired cognitive development, reduced physical capacity, poor maternal outcomes, and decreased productivity. Iron deficiency is the most common cause, and it is almost entirely preventable.
In 2018, the Government of India launched the Anaemia Mukt Bharat (AMB) programme to accelerate the reduction of anaemia prevalence across all age groups. At its core is the weekly or biweekly Iron and Folic Acid Supplementation initiative, a school and community-based program targeting children from six to 59 months, adolescents aged 10 to 19 years, pregnant women, and lactating mothers. The AMB Scorecard, which tracks coverage across beneficiary groups using government Health Management Information System (HMIS) data, managed by the ministry of health and family welfare, tells a story of genuine, hard-won progress.
{{/usCountry}}In 2018, the Government of India launched the Anaemia Mukt Bharat (AMB) programme to accelerate the reduction of anaemia prevalence across all age groups. At its core is the weekly or biweekly Iron and Folic Acid Supplementation initiative, a school and community-based program targeting children from six to 59 months, adolescents aged 10 to 19 years, pregnant women, and lactating mothers. The AMB Scorecard, which tracks coverage across beneficiary groups using government Health Management Information System (HMIS) data, managed by the ministry of health and family welfare, tells a story of genuine, hard-won progress.
{{/usCountry}}Health outcomes can be transformed across generations through a simple weekly iron and folic acid (IFA) supplementation. The IFA dosage variants include syrup for children aged 6 to 59 months, supplemented by pink tablets for those aged 5 to 9 years and blue tablets designated for adolescents between 10 and 19 years old. The national AMB Index stood at 38.7% in 2020-21. By 2025-26, it had risen to 71.2%. Adolescent coverage, arguably the hardest group to reach consistently, grew from 19.8% to 72.3% in the same period. Coverage of children aged 5 to 9 rose from 15.2% to 68.5%.
These are not incremental gains. They reflect a government programme that has scaled with real intent, with convergence across health and education departments, with ASHAs and anganwadi workers and school teachers working in coordination. Evidence Action has been privileged to support this effort in five states since 2019 through its technical partner EAII Advisors in India. Evidence Action provides technical assistance across Haryana, Jharkhand, Madhya Pradesh, Rajasthan, and Uttarakhand. This impact is set to grow significantly as we expand our technical assistance into two new states.
Measuring reach has been the programme's first and necessary task. Coverage data tells us how many children received a supplement. It tells us far less about whether that supplement was consumed, whether it was consumed consistently, and whether the household understood why it mattered.
The system is rightly focusing on consumption, consistency, and whether households have the information they need to make supplementation work. For IFA supplementation, that gap between distribution and adherence is where the program's real effectiveness is determined.
Anaemia is a silent condition. Fatigue, weakness, and poor concentration are so often normalised, particularly among women and children in under-resourced households, that they are rarely recognized as symptoms of something treatable. The benefits of supplementation are real but invisible in the short term including improved haemoglobin, better cognition, reduced maternal risk. When people cannot feel a difference week to week, building a consistent habit requires more than access to a tablet. It requires understanding, trust, and ongoing reinforcement.
A big constraint is sustained behaviour change, at scale, across diverse and often hard-to-reach populations. Getting dosage into supply chains, into schools, into anganwadis is genuinely difficult and was the necessary first step. But having watched this program grow, I believe that the next frontier is not supply alone. It is the infrastructure of behaviour.
When I reflect on what has worked in states like Madhya Pradesh, where the AMB Index moved from 64.1% to 92.1%, or Uttarakhand, where it rose from 28.5% to 88.5%, I keep returning to the same insight that no single intervention explains it. We work alongside state governments on policy advocacy, ensuring that evidence shapes decisions. We strengthen real-time monitoring for early identification of supply and service gaps. We support procurement and supply chain management to minimise stock-outs. We do resource planning and build capacity through training, and we help design community sensitization efforts that resonate locally. We support functionality in reaching children aged six months to 19 years with age-appropriate IFA supplementation, including IFA syrup, pink tablets, and blue tablets.
What really works is a layered system, where multiple reinforcing mechanisms are embedded within existing government structures and designed to sustain practice over time.
IEC and SBCC materials put simple, actionable messaging into the hands of communities, not just health workers. Short digital content, YouTube-based learning in Jharkhand, SMS reminders to prompt timely distribution, tele-calling platforms for follow-up: none of these is individually transformative. Together, they create a system of reinforcement that treats behaviour change as requiring repetition, not a single touchpoint.
And then there is the programme's structural continuity. Schools are the primary platform for weekly IFA delivery, with teachers playing a supervised role that normalises supplementation as part of the school day. But when school calendars shift, the programme does not pause. Tablets are distributed in advance before summer/winter breaks by teachers, who also share follow-up reminder messages in parents' WhatsApp groups to reinforce compliance. In addition, ASHAs reiterate the importance of tablet consumption during their household visits, providing another layer of follow-up and encouragement. This convergence between health and education systems means that a child who misses school during vacation does not miss the program. That continuity matters enormously, because adherence is habit-forming or habit-breaking. An interrupted habit is far harder to rebuild.
At its core, the IFA programme is about ensuring that every child and adolescent receives the nutrients they need to grow, learn, and thrive. But ending anaemia is a shared mission of strong government leadership, community participation, and the dedication of frontline workers.
I truly believe our frontline workers are the backbone of this mission. They are the ones who return again and again, raising awareness, delivering dosage, encouraging adherence, and tracking progress. Their work transforms policy into impact and turns intent into action. Without their commitment, even the strongest programmes would struggle to reach those who need them most.
(The views expressed are personal)
This article is authored by Ankur Garg, India country director, EAII Advisors.