Where	National level
When	Intervention started on a national scale in 2006 and is ongoing
Partners	The Bolivian MSD leveraged an existing public health care system already distributing iron syrup, to transition to MNP in 2006.
Objectives	To integrate MNP (branded as Chispitas) into the country's Zero Malnutrition Program, a multisectoral programme implemented by the Government of Bolivia and its partners to eradicate malnutrition in children under 2 and to decrease malnutrition in children under 5.
Target population	The MNP intervention initially targeted all children 6–23 months. In 2013, the intervention was expanded to all children under 5.
Coordination	Multiple ministries, including the MSD, formed the National Committee on Food and Nutrition in support of implementing Zero Malnutrition Program. Their mandate was to plan and implement multisectoral strategies and mobilize funding and technical assistance from national and international stakeholders.
Enabling environment	In 2003, the Bolivian national demographic and health survey showed that 60% of children under 5 and 72% of children under 2 were anaemic. In 2005, a collaborative group (e.g., MI, PAHO, UNICEF, and WFP, working with MSD) reviewed possible options for anaemia control. With their findings, the MSD decided to replace iron syrup with MNP for all children 6–23 months. MNP was included as a benefit within Bolivia's social protection package, the universal maternal‐child insurance fund (SUMI). This ensured that procurement and basic distribution and delivery costs were absorbed and embedded within SUMI.
Evidence generated	A randomized controlled trial was conducted by Bolivian researchers under similar circumstances to those of the former intervention for the prevention and control of anaemia in children 6–23 months. From this study, the researchers concluded that the use of MNP increased adherence to treatment and significantly reduced rates of anaemia compared to ferrous sulfate syrup (Urquidi, Mejía, & Vera, 2009).
Supply issues	MNP was registered with the MSD as a supplementary food. The MI donated the initial 6 million sachets (for 100,000 children).
	In 2008, MSD issued a request for tender to Bolivian pharmaceutical manufacturers to provide a national supply of Chispitas. Stock‐outs were frequently experienced and due primarily to factors including inaccurate forecasting, order delays due to limited supplier capacity, and delays receiving SUMI funds for MNP procurement.
Outcomes	By 2013, MNP coverage reached 72% of approximately 536,000 children 6–23 months of age. A nationally representative survey found 74% of urban caregivers and 82% of rural caregivers demonstrated adequate preparation of MNP. As a measure of adherence, 45% of urban and 52% of rural caregivers reported that children consumed all 60 sachets.
Lessons learned	The integration of MNP into existing public health and nutrition programmes is a feasible approach to enable large‐scale distribution. Support for the scale‐up process can be enhanced by government agencies and policymakers who include MNP within national development plans and give prioritization to multisectoral coordination, engagement of the private sector, and resource mobilization.
	Once a programme can generate sufficient orders, and demand for the product is steady, local manufacturing can be a reliable and cost‐efficient approach to maintaining a quality supply.

MNP, micronutrient powders; MI, Micronutrient Initiative; MSD, Bolivian Ministry of Health and Sports; PAHO, Pan‐American Health Organization; SUMI, Universal Maternal‐Child Insurance Fund; UNICEF, United Nations Children's Fund; WFP World Food Programme.

Based on information from key informant 20