{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:44:05Z","timestamp":1792086245811,"version":"4.4.0"},"reference-count":33,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kirk Humanitarian"},{"name":"MMS"},{"name":"Vitamin Angel Alliance"},{"DOI":"10.13039\/501100017022","name":"Ministry of Health of the Republic of Indonesia","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100017022","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00fqjrd79","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The United Nations International Multiple Micronutrient Antenatal Preparation of a multiple micronutrient supplement (UNIMMAP MMS or MMS) is replacing iron and folic acid supplementation (IFAS) in antenatal care (ANC) in low- and middle-income countries (LMICs). An investigation into determining how to secure a sustainable supply of MMS began in response to the Indonesian Ministry of Health (MOH)\u2019s decision to introduce MMS into its national health services. Objective: We aimed to identify and test sustainable strategies for securing MMS supplies. Methods: A three-phase implementation science framework was applied to (1) foster an enabling environment for securing MMS supplies, (2) undertake implementation research (IR) to compare sourcing strategy options, and (3) plan and execute actions to scale MMS supply availability and distribution. The MOH assumed ownership of the initiative and guided policy, procurement, and program decisions. Results: (1) Landscaping resulted in recommendations that triggered supply-related policies, an accommodating regulatory framework, integration of MMS into key government support systems (i.e., budget, finance, procurement, and distribution), and identification of supply strategy options. (2) IR resulted in the selection of a local manufacturing and sourcing strategy for acquiring a sustainable supply of high-quality MMS product while retaining an option to import a limited supply of MMS during scaling. (3) A multi-year plan was developed to scale MMSs within ANC services. Conclusions: Applying implementation science provided an evidence-based framework with which to identify, establish, and test a sustainable strategy for securing MMS supplies and yielded insights useful for other countries introducing MMS into their national health systems.<\/jats:p>","DOI":"10.3390\/nu18132162","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T09:34:11Z","timestamp":1783071251000},"page":"2162","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Applying Implementation Science to Secure a Sustainable Supply of UNIMMAP MMS for National Antenatal Care Services in Indonesia"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1303-8812","authenticated-orcid":false,"given":"Holis Abdul","family":"Holik","sequence":"first","affiliation":[{"name":"Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Faculty of Pharmacy, Padjadjaran University, Jl. Ir Soekarno KM 21, Jatinangor Sub-District, Sumedang Regency 45363, West Java Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otte","family":"Santika","sequence":"additional","affiliation":[{"name":"The Vitamin Angel Alliance, Indonesia, Ruko Sentul Tower Apartment (STA) Niaga Blok B No. 2, Citaringgul, Babakan Madang, Bogor Regency 16810, West Java Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8671-2065","authenticated-orcid":false,"given":"Auliya","family":"Suwantika","sequence":"additional","affiliation":[{"name":"Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Faculty of Pharmacy, Padjadjaran University, Jl. Ir Soekarno KM 21, Jatinangor Sub-District, Sumedang Regency 45363, West Java Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Atwater","sequence":"additional","affiliation":[{"name":"Ataqua Regulatory Services, 20878 Blue Ridge Mountain Road, Paris, VA 20130, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarno","family":"de Lange","sequence":"additional","affiliation":[{"name":"The Vitamin Angel Alliance, 6500 Hollister Ave Suite 130, Goleta, CA 93117, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Razak","family":"Thaha","sequence":"additional","affiliation":[{"name":"Indonesian MMS-TAG, Indonesian Nutrition Initiative (IGI), Kompleks Bappenas A1 Jl. Siaga Raya Pejaten, Jakarta Selatan City 12510, Jakarta Province, Indonesia"},{"name":"Indonesian Center for Nutrition Studies, Faculty of Public Health, Hasanuddin University, Jl. Perintis Kemerdekaan No. KM.10, Tamalanrea Indah, Kec. Tamalanrea, Makassar City 90245, South Sulawesi Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Endang Laksminingsih","family":"Achadi","sequence":"additional","affiliation":[{"name":"Center for Family Welfare Research (PUSKA), Faculty of Public Health, Universitas Indonesia, Building G No. 210, Depok City 16424, West Java Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hera","family":"Nurlita","sequence":"additional","affiliation":[{"name":"Directorate of Family Health Service, Ministry of Health, H.R. Rasuna Said Road Blok X-5 Kavling 4-9, Jakarta Selatan City 12950, Jakarta Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erni","family":"Rahmawati","sequence":"additional","affiliation":[{"name":"Directorate of Traditional Medicine, Health Supplement and Cosmetic Standardization, The Indonesian Food and Drug Authority of The Republic of Indonesia (BPOM), Bhinneka Tunggal Ika Building, 2nd Floor, Jl. Percetakan Negara No. 23, Jakarta 10560, Jakarta Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2421-5933","authenticated-orcid":false,"family":"Rimbawan","sequence":"additional","affiliation":[{"name":"Department of Community Nutrition, Faculty of Human Ecology, IPB University, FEMA Building W1\u2013L2, Jl. Kamper, IPB Dramaga Campus, Bogor Regency 16680, West Java Province, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7462-9548","authenticated-orcid":false,"given":"Clayton","family":"Ajello","sequence":"additional","affiliation":[{"name":"Kirk Humanitarian, 2755 E. Cottonwood Parkway, Suite 450, Salt Lake City, UT 84121, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","unstructured":"Bill&Melinda Gates Foundation, Children\u2019s Investment Fund Foundation, and the Eleanor Cook Foundation and Kirk Humanitarian (2026, January 12). Healthier Pregnancies and Brighter Futures for Mothers and Babies: A Global Investment Roadmap for Multiple Micronutrient Supplementation. A Joint Technical Report 2024. Available online: https:\/\/hmhb.micronutrientforum.org\/wp-content\/uploads\/2024\/05\/MMS-Investment-Roadmap-Digital-B-9-July.pdf."},{"key":"ref_2","unstructured":"World Health Organization, United Nations Children\u2019s Fund, and United Nations University (1999). Composition of a Multi-Micronutrient Supplement to Be Used in Pilot Programmes Among Pregnant Women in Developing Countries, United Nations University. Available online: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/efd01196-bf5b-4faa-9a49-984e6cb1c507\/content."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1090","DOI":"10.1016\/S2214-109X(17)30371-6","article-title":"Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: A meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries","volume":"5","author":"Smith","year":"2017","journal-title":"Lancet Glob. Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Keats, E.C., Haider, B.A., Tam, E., and Bhutta, Z.A. (2019). Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst. Rev., CD004905.","DOI":"10.1002\/14651858.CD004905.pub6"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e13509","DOI":"10.1111\/mcn.13509","article-title":"Antenatal multiple micronutrient supplements versus iron-folic acid supplements and birth outcomes: Analysis by gestational age assessment method","volume":"19","author":"Gomes","year":"2023","journal-title":"Matern Child Nutr."},{"key":"ref_6","unstructured":"World Health Organization (2020). Antenatal care recommendations for a positive pregnancy experience. Nutritional Interventions Update: Multiple Micronutrient Supplements During Pregnancy, World Health Organization."},{"key":"ref_7","unstructured":"World Health Organization (2021). Model List of Essential Medicines, World Health Organization. [22nd ed.]."},{"key":"ref_8","unstructured":"Ministry of Health Republic of Indonesia and United Nation Children\u2019s Fund (2023). Maternal Nutrition in Indonesia: Landscape Analysis and Recommendations, UNICEF."},{"key":"ref_9","unstructured":"Ministry of Health Republic Indonesia (2026, January 12). Riset Kesehatan Dasar (Riskesdas) 2018. Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan, Republik Indonesia. Available online: https:\/\/repository.badankebijakan.kemkes.go.id\/id\/eprint\/3514\/1\/Laporan%20Riskesdas%202018%20Nasional.pdf."},{"key":"ref_10","first-page":"25","article-title":"Update on evidence, policy, and practice: Multiple micronutrient supplementation (MMS) for pregnant women","volume":"75","author":"Hurley","year":"2019","journal-title":"Ann. Nutr. Metab."},{"key":"ref_11","unstructured":"(2020, January 13). Indonesian Nutrition Initiative (Inisiatif Gizi Indonesia, IGI) in collaboration with Johns Hopkins Bloomberg School of Public Health and Kirk Humanitarian. Proceedings of the Researchers and Experts Discussion on Multiple Micronutrient Supplementation for Pregnant Women as a Measure for Stunting Prevention, Jakarta, Indonesia."},{"key":"ref_12","unstructured":"Kraemer, K., and Olsen, R. (2023). Enabling the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) to Implement and Evaluate Antenatal Multiple Micronutrient Supplementation in Jordan. Sight and Life\u2014Special Report: Focusing on Multiple Micronutrient Supplements in Pregnancy, Sight and Life Foundation. [2nd ed.]."},{"key":"ref_13","unstructured":"Kraemer, K., and Bajoria, M. (2020). Procurement and Production of Multiple Micronutrient Supplements for Pregnant Women\u2014A Country Assessment Toolkit. Sight and Life\u2014Special Report: Focusing on Multiple Micronutrient Supplements in Pregnancy, Sight and Life Foundation. [1st ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"809","DOI":"10.2147\/CEOR.S549589","article-title":"Cost-Effectiveness Analysis and Priority Setting in the Transition from Iron-Folic Acid (IFA) to Multiple Micronutrient Supplementation (MMS) for Pregnant Women in Indonesia","volume":"17","author":"Alfiani","year":"2025","journal-title":"Clin. Outcomes Res."},{"key":"ref_15","unstructured":"Nutrition International (2026, January 12). The MMS Cost-Benefit Tool: User Interface and Interpretation Guide. Available online: https:\/\/www.nutritionintl.org\/wp-content\/uploads\/2021\/01\/MMS-Cost-Benefit-Tool-User-Guide-Update-Final-2020-03-31.pdf."},{"key":"ref_16","unstructured":"UNICEF Supply Division (2026, April 10). Requirements for Pharmaceutical and Nutrition Products. Interagency Pharmaceutical Product Questionnaire. Available online: https:\/\/www.unicef.org\/supply\/requirements-pharmaceutical-and-nutrition-products."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Multiple Micronutrient Supplementation Technical Advisory Group (2020). Expert consensus on an open-access United Nations International Multiple Micronutrient Antenatal Preparation\u2013multiple micronutrient supplement product specification. Ann. N. Y. Acad. Sci., 1470, 3\u201313.","DOI":"10.1111\/nyas.14322"},{"key":"ref_18","first-page":"1","article-title":"Expert consensus on an open-access United Nations International Multiple Micronutrient Antenatal Preparation\u2013multiple micronutrient supplement product specification\u20142024 version","volume":"1540","author":"Ajello","year":"2024","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_19","unstructured":"UNICEF (2026, May 15). UNIMMAP MMS Product Specification Sheet, Micronutrients Tabs, Pregnancy\/BOT-180. Available online: https:\/\/www.unicef.org\/supply\/media\/25216\/file."},{"key":"ref_20","unstructured":"(2026, January 26). Decree of the Minister of Health (KMK) No. HK.01.07-MENKES-1092-2024, Regulating the Standards for Micronutrient Supplements for Pregnant Women, Known as MMS (Multiple Micronutrient Supplement). Available online: https:\/\/klinikhukumkesehatan.id\/wp-content\/uploads\/2024\/08\/KMK-No.-HK.01.07-MENKES-1092-2024-ttg-Standar-Suplemen-Zat-Gizi-Mikro-Untuk-Ibu-Hamil-signed.pdf."},{"key":"ref_21","unstructured":"(2026, January 26). Decree of the Director General of Primary and Community Health Number HK.02.02\/B\/1196\/2025 concerning the Technical Specifications of Micronutrient Supplements for Pregnant Women Under the Special Program. Available online: https:\/\/www.hukumonline.com\/pusatdata\/detail\/lt6847ef3bd4be7\/keputusan-direktur-jenderal-kesehatan-primer-dan-komunitas-nomor-hk0202-b-1196-2025-tahun-2025\/."},{"key":"ref_22","unstructured":"(2026, January 29). BPOM Regulation (Peraturan BPOM No. 15 Tahun 2024) Concerning the Amendment to BPOM Regulation Number 32 of 2022 on the Criteria and Procedures for the Registration of Health Supplements. Available online: https:\/\/standar-otskk.pom.go.id\/storage\/uploads\/2b63ffda-4da5-4464-babc-99ae454756d8\/PerBPOM-No.-15-tahun-2024.pdf."},{"key":"ref_23","unstructured":"(2026, June 19). BPOM Regulation No. 24 of 2023 Concerning Safety and Quality Requirements for Health Supplements. Available online: https:\/\/peraturan.bpk.go.id\/Details\/284992\/peraturan-bpom-no-24-tahun-2023."},{"key":"ref_24","unstructured":"Holik, H., Ajello, C., and Atwater, J. (2024). Study of Recommendations on Standard Specification of Multiple Micronutrient Supplement for Pregnant Women in Indonesia based on United Nations International Multiple Micronutrient Antenatal Preparation for a Multiple Micronutrient Supplement. A Technical Report of the Center of Excellence for Pharmaceutical Care Innovation (PHARCI) Universitas Padjajaran, PHARCI Universitas Padjadjaran."},{"key":"ref_25","unstructured":"(2026, April 03). Unicef Supply Catalogue. Available online: https:\/\/app.powerbi.com\/view?r=eyJrIjoiYzM0Y2ZjYzMtOGNmZC00NmEwLWFjYmQtYmUwYzgyYzEzNjlkIiwidCI6Ijc3NDEwMTk1LTE0ZTEtNGZiOC05MDRiLWFiMTg5MjAyMzY2NyIsImMiOjh9."},{"key":"ref_26","unstructured":"Suwantika, A. (Center of Excellence for Pharmaceutical Care Innovation (PHARCI) Universitas Padjajaran, Bandung, Indonesia). Personal communication, 2023."},{"key":"ref_27","unstructured":"Suwantika, A., and with Nutrition International (2019). Policy Brief: Indonesia: Cost-effectiveness of Transitioning from Iron and Folic Acid to Multiple Micronutrient Supplementation for Pregnancy. A Joint Technical Report of Nutrition International and Center of Excellence for Pharmaceutical Care Innovation (PHARCI) Universitas Padjajaran, PHARCI Universitas Padjadjaran."},{"key":"ref_28","unstructured":"(2026, January 26). Regulation of the Minister of Health (Permenkes) of The Republic of Indonesia, Number 12 of 2025, Concerning the Strategic Plan of The Ministry of Health for 2025\u20132029. Available online: https:\/\/kemkes.go.id\/id\/permenkes-ri-no-12-tahun-2025-tentang-rencana-strategis-kementerian-kesehatan-tahun-2025-2029."},{"key":"ref_29","unstructured":"(2026, February 12). MMS-TAG Stakeholders\u2019 Meeting. Reviewing the Five-Year Journey to Introduction and Scale-up of MMS. Conference Proceedings Report, Bogor, Indonesia. Available online: https:\/\/www.prnewswire.com\/news-releases\/vitamin-angels-and-the-ministry-of-health-of-indonesia-host--mms-meeting-with-leading-national-and-global-experts-to-review-progress-on-indonesias-national-mms-antenatal-program-302458778.html."},{"key":"ref_30","unstructured":"UNICEF (2026, April 21). The Child Nutrition Fund: Scaling up Policies, Programmes and Supplies to End Child Undernutrition. Available online: https:\/\/www.unicef.org\/documents\/child-nutrition-fund."},{"key":"ref_31","unstructured":"World Bank (2026, April 21). Investment Framework for Nutrition 2024. Available online: https:\/\/www.worldbank.org\/en\/topic\/nutrition\/publication\/investment-framework-nutrition."},{"key":"ref_32","unstructured":"Sifri, Z. (Gates Foundation, Washington, DC, USA); Kirk, S.; Ajello, C.; Jenkins, J. (Kirk Humanitarian, Salt Lake City, UT, USA). Joint Analysis to Determine a Benchmark Price for MMS Based on Examination of Optimized MMS Pricing Derived from 10 Years of High Volume Purchasing by Kirk Humanitarian combined with a Cost of Goods Study commissioned by the Gates Foundation. Personal communication, 2025."},{"key":"ref_33","unstructured":"Zifri, Z. (2026, January 8\u201310). UNIMMAP MMS-Cost of Goods Sold. Proceedings of the Presented at the United Nations International Multiple Micronutrient Antenatal Preparation (UNIMMAP) Multiple Micronutrient Supplement (MMS) Manufacturer\u2019s Technical Meeting, London, UK."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2162\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T04:23:21Z","timestamp":1783225401000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2162"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":33,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nu18132162"],"URL":"https:\/\/doi.org\/10.3390\/nu18132162","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}