Examining the Implementation of Blood Supplement Tablet Policy as a Strategy for Stunting Prevention: Insights from High and Low Coverage Health Centers in Medan City

The program to provide and ensure a minimum of 90 blood supplement tablets (BSTs) during pregnancy has been successful in preventing and treating iron deficiency anemia among pregnant women.

This study offers critical insights into the implementation of the BST policy in Medan City as part of a broader strategy to combat stunting among pregnant women.

Through qualitative methods, including in-depth interviews, focus group discussions, and document analysis, the study identified key factors influencing policy execution: communication, resources, disposition, bureaucratic structure, and the socio-economic environment. Notably, effective communication across multiple channels emerged as a cornerstone, ensuring that stakeholders, community health workers, and pregnant women were well-informed about BST availability and usage.

The research highlights the adequacy of resources, including human resources and infrastructure, but notes challenges, such as dual roles for staff and short BST expiration periods, which complicate distribution. A lack of specific standard operating procedures (SOPs) for BSTs was identified as a gap, with existing guidelines embedded within broader antenatal care frameworks.

Additionally, while coordination among sectors is ongoing, data integration and reporting mechanisms remain fragmented, hampering program monitoring and evaluation. Community involvement, particularly through health cadres and field assistance, significantly influenced pregnant women’s compliance with BST consumption. However, economic disparities were found to affect access, with middle-to-upper-class women often bypassing public health centers in favor of private providers, creating data collection challenges.

These findings underscore the need for targeted improvements, including an integrated reporting system, enhanced SOPs, and more robust coordination mechanisms. By addressing these gaps, this study provides a framework for refining health interventions, demonstrating the critical interplay between communication, resources, and community engagement in achieving sustainable policy outcomes.