Introduction of Multiple Micronutrient Supplements in Pakistan through the National Health System: A Pilot Study

Abstract Multiple micronutrient supplements (MMS) are more effective than iron-folic acid (IFA), reducing the risk of preterm and small-for-gestational-age (SGA) births by 29%. In Pakistan, where 39% of women of reproductive age are anemic and one-third of infants are born SGA, contributing to 26% of neonatal deaths, MMS offers a critical intervention. Following the World Health Organization’s 2021 inclusion of MMS in the Essential Medicines List, the Junaid Family Foundation (JFF) partnered with Pakistan’s Ministry of National Health Services from 2019–2023 to pilot the introduction of the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) MMS within the public health system. The initiative secured Planning Commission (PC-1) approval from Pakistan’s Ministry of Planning, Development & Special Initiatives, for national implementation through the existing IFA network. Across seven districts, JFF organized cascade trainings for 762 community health workers, more commonly known as Lady Health Workers (LHWs) in Pakistan, and distributed 129,600 MMS bottles through the LHWs and public health facilities. Of the 108,727 verified bottles, 98.6% were successfully delivered, with an additional 20,873 bottles distributed but pending verification. Continuation rates exceeded 98% in all districts. Key challenges included limited awareness, cultural barriers requiring family consent, and weak reporting systems. Overall, the pilot proved the feasibility of integrating MMS into Pakistan’s public health delivery model, paving the way for scale-up and further evaluation of effectiveness and cost. Information © The Authors 2026