Feasibility and Readiness for Scaling-Up Multiple Micronutrient Supplements in Nepal: A Qualitative Study Using the Expandnet Scaling-Up Framework

Micronutrient deficiencies in pregnancy remain a critical public health issue in Nepal, where iron–folic acid (IFA) supplementation alone has not fully addressed maternal and neonatal risks. Multiple micronutrient supplements (MMS) promise broader nutritional benefits; however, real-world guidance for their effective and equitable integration into routine maternal care is lacking. This study, guided by the ExpandNet scaling-up framework, was conducted to establish the feasibility and readiness of Nepal to scale-up MMS and concluded that Nepal’s transition from IFA to MMS in routine ANC is timely and broadly supported, but its success will depend on closing critical gaps in financing, supply, and frontline counseling. Our findings point to four cross-cutting priorities for institutionalizing MMS at scale: securing sustainable funding, integrating MMS within existing ANC platforms, strengthening and recognizing frontline workers, and engaging communities in ways that respond to local beliefs and constraints. Addressing these priorities in a coordinated way can help ensure that MMS reaches pregnant women consistently and equitably across Nepal’s decentralized health system.