Understanding Anemia: Guidance for Conducting a Landscape Analysis

Step 3: Review Anemia Policies

Effective anemia prevention and control activities require a strong policy environment. When policies do not exist, or are not used for programming, it can be difficult to create broad-based stakeholder support for long-term implementation. Conducting a review of anemia-related policies in your country will enable you to identify gaps in the anemia-related policies and will highlight key areas for stakeholder action. Keep the policy lifecycle in your country in mind so you can determine whether new policies, strategies, or implementation plans should be developed or existing ones updated. Sometimes, a country does not have a policy, but they do have a strategy or implementation plan, so identify these, as well.

You may want to go beyond simply identifying existing policies, strategies, or implementation plans. Outlining the content of these documents can help you understand how your country is implementing or intending to implement interventions. For example, when reviewing documents, identify the target groups, type of treatment (including dose and duration), clinical guidelines, and delivery platforms. Also, sometimes, you can examine progress reports on implementation plans.

Your country may not have a specific anemia-related policy, but look for policies that address anemia causes, prevention activities, and control measures. Remember that anemia-related policies are often found within larger policy documents; for instance, a national agriculture policy document may include a policy on biofortification. While the following list is not exhaustive, it is a place to start:

  • agriculture and food security policy/strategy
  • anemia policy/strategy
  • biofortification
  • delayed cord clamping
  • deworming for children and/or pregnant women
  • dietary diversity and/or modification
  • family planning
  • food safety
  • indoor residual spraying
  • infant and young child feeding
  • industrial fortification legislation
  • iron–folic acid for pregnant women and/or women of reproductive age, including adolescents
  • intermittent preventative treatment in pregnancy for pregnant women
  • long-lasting insecticide-treated bed nets for household use
  • malaria diagnosis and treatment
  • micronutrient supplementation
  • nutrition policy/strategy
  • screening, counseling, and/or management of genetic disorders
  • water, sanitation, and hygiene national policy/strategy

Outlined here are three options for reviewing anemia-related policies. Depending on the resources available for this work, you may only be able to complete one or two types of policy review. The key is to have a picture of the policy landscape—you and your colleagues can continue to fill in the details and learn more as you put the findings from this landscape analysis into practice.

1. Conduct key informant interviews with anemia stakeholders

Reaching out to policymakers and implementers can help identify relevant policies, even those that are not available online. This step is particularly useful in countries where government documents are not readily available online. Informants can identify relevant documents, but consider including these prompts in your questionnaire:

  1. What policy documents do you consult when considering anemia-related programs?
  2. What policies do your colleagues consult when developing anemia-related programs?
  3. What policies are still needed to improve the support for anemia-related programming?
  4. If a policy is in place, is it being implemented?
  5. What are the challenges/constraints to implementing the existing policies?
  6. [For policies you identified as missing:] Why isn't [POLICY] a policy in this country?
  7. Can you share a copy of the [POLICY]?

2. Consult the websites of relevant government agencies.

Many ministries or departments have policy sections on their websites where you can download relevant documents. Start by searching the Ministry of Health (or similar) website; focus on ministry-wide policy pages, as well as anemia-related units, if they have their own pages. Expand your search to include other anemia-relevant ministries or sectors, such as agriculture, education, gender, etc. Finally, look for government-wide policy documents relevant to nutrition. They may be available through websites for the office of the prime minister or president, and any national development bodies or the Ministry of Finance.

3. Search for relevant policies on online databases.

  1. The World Health Organization’s (WHO) Global database on the Implementation of Nutrition Actions collects a variety of standardized data about nutrition actions across the globe, including policy data. You can search for policies by country (extranet.who.int/nutrition/gina/en/policies/summary) to see what is available for your country. Most policy pages include information on the timeline, adoption status, goals, monitoring and evaluation indicators, and links to full-text versions of the policy. Note that this database relies on registered users to submit data. Even if a policy is not included in this database, it may exist; it may be new enough that no one has uploaded it to the site.
  2. The Scaling Up Nutrition (SUN) website aggregates a significant amount of information on member states. If your country is a member of SUN, visit the “Coherent Policy and Legal Framework” section of the country page (www.scalingupnutrition.org/sun-countries) for a list of key documents from a range of nutrition-related sectors. This section lists responsible bodies for policy documents and often includes a short description of the policy or legislation. When available, a link will let you download the document. Because the WHO website documents may not be available immediately, check the “Last updated” data on the page.

How to include this information in your landscape analysis

In the methods section of your landscape analysis, document the search methods you used to identify policies. If you conducted interviews, include a list of respondents as an appendix to your final report. Include the full list of identified policies, with a discussion of any gaps your review uncovers. If possible, include the presence or absence of a supportive policy in your discussion of interventions.