Multiple Micronutrient Supplementation (MMS) for pregnant women: A Value Chain Situational Analysis to explore implementation in South Africa
1
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2258
ABSTRACT
BACKGROUND:
In South Africa (SA), iron and folic acid (IFA) are standard of care for pregnant women. In settings with prevalent micronutrient deficiencies, WHO recommends antenatal multiple micronutrient supplements (MMS) – containing 15 micronutrients including IFA – subject to research ensuring country-specific appropriateness. Compared to IFA alone, MMS significantly reduces adverse perinatal outcomes. MMS formulations aligned with WHO dosing recommendations are non-inferior and may be safer and better tolerated than higher doses recommended in SA. This study explored the feasibility of introducing MMS in SA.
METHODS:
From August-December 2025 we conducted a value chain situational analysis (VCSA) comprising a desktop literature review and in-depth interviews with 15 purposively selected key informants. Rapid analysis included thematic organisation of interview data alongside available literature according to the VCSA domains – policy and planning, financing, supply chain, service delivery, demand and uptake, and monitoring and surveillance.
RESULTS:
MMS introduction in SA requires successful local product registration, including clarity on classification as complementary or conventional. Progress toward national scale-up would be led by the National Department of Health (NDoH) through established regulatory, and Essential Medicines List (EML) review processes, supported by engagement across key stakeholders, including finance and information system directorates, professional councils, provincial departments, and development partners. National prioritisation requires consideration of comparative costs and system readiness within a constrained fiscal environment. Applications submitted by NDoH may support prioritisation of MMS review for potential inclusion on the EML. Domestic manufacturing capacity may be relevant to long-term supply sustainability and stakeholder confidence. Implementation research addressing supply chains, nutritional counselling, and maternal adherence would strengthen local evidence to inform decision-making and maximise potential benefits of MMS.
CONCLUSIONS:
The feasibility of transitioning to MMS in SA rests on NDoH leadership, alongside budget prioritisation, supply security of a registered product, and targeted implementation research to inform scale-up.
In South Africa (SA), iron and folic acid (IFA) are standard of care for pregnant women. In settings with prevalent micronutrient deficiencies, WHO recommends antenatal multiple micronutrient supplements (MMS) – containing 15 micronutrients including IFA – subject to research ensuring country-specific appropriateness. Compared to IFA alone, MMS significantly reduces adverse perinatal outcomes. MMS formulations aligned with WHO dosing recommendations are non-inferior and may be safer and better tolerated than higher doses recommended in SA. This study explored the feasibility of introducing MMS in SA.
METHODS:
From August-December 2025 we conducted a value chain situational analysis (VCSA) comprising a desktop literature review and in-depth interviews with 15 purposively selected key informants. Rapid analysis included thematic organisation of interview data alongside available literature according to the VCSA domains – policy and planning, financing, supply chain, service delivery, demand and uptake, and monitoring and surveillance.
RESULTS:
MMS introduction in SA requires successful local product registration, including clarity on classification as complementary or conventional. Progress toward national scale-up would be led by the National Department of Health (NDoH) through established regulatory, and Essential Medicines List (EML) review processes, supported by engagement across key stakeholders, including finance and information system directorates, professional councils, provincial departments, and development partners. National prioritisation requires consideration of comparative costs and system readiness within a constrained fiscal environment. Applications submitted by NDoH may support prioritisation of MMS review for potential inclusion on the EML. Domestic manufacturing capacity may be relevant to long-term supply sustainability and stakeholder confidence. Implementation research addressing supply chains, nutritional counselling, and maternal adherence would strengthen local evidence to inform decision-making and maximise potential benefits of MMS.
CONCLUSIONS:
The feasibility of transitioning to MMS in SA rests on NDoH leadership, alongside budget prioritisation, supply security of a registered product, and targeted implementation research to inform scale-up.
| eISSN: | 2654-1459 |
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