SMART-MMS Stakeholder Advisory Board: An Initiative to Strengthen Monitoring of MMS Consumption Compliance Among Pregnant Women in Lombok
- SID Developer
- May 7
- 4 min read
Iron and Folic Acid Supplementation Remains a Key Challenge in Indonesia
The consumption of iron and folic acid supplements (Iron-Folic Acid Supplementation/IFAS) remains a major challenge in Indonesia, particularly in Lombok Island. This is reflected in the relatively high prevalence of anemia among pregnant women, ranging from 5–14% in 2024. National data show that around half of pregnant women who consume IFAS for at least 90 days demonstrate higher adherence in urban areas (59.0%) compared to rural areas (47.8%).
In 2024, the Ministry of Health of the Republic of Indonesia launched the Multiple Micronutrient Supplementation (MMS) program for pregnant women to meet maternal nutritional needs during pregnancy and prevent anemia. However, adherence to MMS remains a challenge, with reported compliance rates ranging from 23–50%. This highlights the need for more effective strategies to improve supplement adherence.
The use of digital technology offers an opportunity to enhance and monitor supplement adherence. However, scientific evidence regarding its effectiveness among pregnant women remains limited. This study aims to address this gap by evaluating the use of digital technology in supporting adherence to MMS and calcium supplementation.
SMART-MMS: A Digital Innovation to Support MMS Consumption Among Pregnant Women
The Summit Institute for Development, with funding support from the Children’s Investment Fund Foundation (CIFF) through Sight and Life (SAL), has initiated the SMART MMS (Study of Monitoring, Adherence, and Response to Technology in Multiple Micronutrient Supplementation) program in Lombok Island.
SMART-MMS is a study focused on monitoring pregnant women’s adherence to MMS consumption using digital innovation. The study employs a cluster randomized controlled trial (RCT) design, with primary healthcare centers (puskesmas) serving as the unit of randomization. The program targets 12,000 pregnant women across 60 puskesmas throughout Lombok Island.
The selected puskesmas are divided into a digital intervention group and a standard care group. This distinction aims to assess the impact of digitalization on MMS adherence. The standard intervention group receives antenatal and postnatal care services, home visits for monitoring supplement intake, and real-time education on MMS and calcium. Meanwhile, the digital intervention group receives the same standard services, supplemented with digital features such as:
Routine MMS intake reminders and consultation via WhatsApp automation
Gamification through self-reported consumption tracking linked to WhatsApp reminder automation, where women with the highest reporting performance receive points and rewards
AI Pill Counting, a feature designed to automatically monitor MMS consumption
All field monitoring data on MMS intake are automatically aggregated into the SMART-MMS dashboard. Through this dashboard, adherence levels among pregnant women can be tracked. For those with low adherence, follow-up actions are conducted in the field through automatically scheduled visits using Dynamic Worker Support (DWS). The dashboard can also be accessed by district health offices and puskesmas to monitor program progress within their respective areas.
Establishment of the Stakeholder Advisory Board
To ensure optimal implementation of the study, a strong foundation and support from multiple stakeholders are required. Therefore, a Stakeholder Advisory Board was established to conduct expert review processes and obtain endorsements from experts related to digital-based MMS and calcium supplementation interventions. In addition, this initiative aims to ensure alignment between the SMART-MMS program and ongoing health programs in Lombok.
The establishment event of the Stakeholder Advisory Board was held on Tuesday, May 5, 2026, attended by the Head of the Provincial Health Office of West Nusa Tenggara, Dr. dr. H. Lalu Hamzi Fikri, MM., MARS, as well as heads of Health Offices from five districts/cities along with their respective division heads and working teams from Primary Health Services and Environmental Health (PKPKL) and Health Resources (SDK).
The event was also attended by representatives from BRIDA NTB, BAPPEDA NTB, KOMINFOTIK NTB, and representatives from Sight and Life, including Dr. Sulistyo Sigit, MPH, Country Program Manager of Sight and Life Indonesia.
The activities were divided into two parts: the main session and the workshop session. The main session consisted of a general presentation of the SMART-MMS program, as well as the roles and responsibilities of the Stakeholder Advisory Board. The Chair of the Indonesian Society of Obstetrics and Gynecology (POGI) West Nusa Tenggara Branch, Dr. A. Rusdhy H. Hamid, Sp.O.G., Subsp. KFm., MARS, as a member of the SMART-MMS Scientific Advisory Board, also delivered a presentation on SMART-MMS from an obstetrics and gynecology perspective. In addition, Dr. Nurhandini Eka Dewi, Sp.A., MPH (Chair of the Medical Committee of Mandalika Hospital, West Nusa Tenggara Province), also representing the Scientific Advisory Board, presented on SMART-MMS from a child health perspective. The main session concluded with the signing of a joint commitment by all members of the Stakeholder Advisory Board.
The workshop session was divided into two separate groups, each focusing on different topics. The pharmacy working group discussed logistics and the distribution flow of MMS, while the program working group focused on the implementation scheme of the SMART-MMS program in the field. Each group discussed and determined the most suitable implementation approach for field conditions.
The Provincial Health Office also provided guidance regarding the SMART-MMS program, particularly emphasizing the transition protocol from iron tablets (TTD) to MMS, including considerations related to the expiration date of TTD and the distribution scheme of TTD and MMS for anemic pregnant women.
“Pregnant women who still have TTD at home should keep it and consume it after delivery. The MMS program team must pay attention to the expiration date of the TTD. For pregnant women suffering from anemia, both TTD and MMS should be given simultaneously in accordance with the Ministry of Health’s technical guidelines on MMS,” commented Lutfiatun Akhiriah from the PKPKL Program Team, who attended the session.
Rizal Huraeni, representing BAPPEDA, expressed hope that the SMART-MMS program would be successful, as it is a local innovation that can be scaled up to other programs.
“I hope this SMART-MMS program will succeed, as I believe this digital innovation can also be applied to other programs such as iron tablet consumption among adolescents. This is a local innovation that can be adapted and implemented in other programs,” he said.
This activity produced recommendations for field implementation readiness at the provincial, district, and primary healthcare center levels. Through the establishment of the Stakeholder Advisory Board, it is expected that strategic direction and shared understanding among stakeholders will be strengthened to support effective, context-specific, and sustainable implementation of the program in Lombok Island.
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