Implementation of Weekly Iron Folic Acid Supplementation Programme (WIFS) and National Iron Plus Initiatives Program (NIPI) 09-11 January, 2018.

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Presentation transcript:

Implementation of Weekly Iron Folic Acid Supplementation Programme (WIFS) and National Iron Plus Initiatives Program (NIPI) 09-11 January, 2018

Today’s Agenda Status of Anemia in Rajasthan (children and adolescent) and its consequences. Overview of WIFS and NIPI program. Problems in implementation of the program. Problems in supply chain management Reporting issues of WIFS and NIPI program. Discussion on strategies (Roadmap) for effective implementation and improving coverage.

Anemia……..A big challenge Anemia is manifestation of under nutrition and poor dietary intake of Iron affecting not only a section but entire population Anemia among all age group is an important and major public Health Problem in India It is a condition in which the body does not have enough healthy red blood cells to bring oxygen to body tissues. It has assumed the dimensions of Public Health Emergency that warrants and immediate action.

Adding to the Consequences and Impacts…. Anemia Seriously affect Child Survival. Studies suggest that increasing Hb by 1 gm would reduce IMR by 24% among children Associated with high infant mortality and U5MR Renders child susceptible to infections – respiratory and gastrointestinal Associated with undernutrition, poor future growth and development Lowers Scholastic Performance and learning ability Lowers productivity

Prevalence of Anemia by Age Groups, Rajasthan

Spatial Distribution, prevalence of Anemic Children aged 6-59 months, Rajasthan (NFHS –IV, 2015-16)

Prevalence of Anemia among Children aged 6-59 months, Rajasthan, (NFHS –IV, 2015-16) SPHP SDG MPHP Note : SPHP- Severe Public Health Problem , SDG-Sustainable Development Goals , MPHP – Moderate Public Health Problem

Top & Bottom five Districts of Rajasthan according to NFHS 4, 2015-16 (Ranked) Children age 6-59 months who are anemic (%) Pregnant women age 15-49 years who are anemic (%) Top -5 Ganganagar (40.2%) Hanumangarh (20.3%) Churu (42.2%) Jhunjhunu (27.7%) Jaisalmer (42.5%) Dausa (28.6%) Dausa (45.2%) Jaipur (30.0%) Hanumangarh (46.2%) Sawai Madhopur (30.8%)   Bottom-5 Baran (76.3%) Banswara (68.7%) Jhalawar (76.6%) Baran (69.5%) Udaipur (79.1%) Jhalawar (69.6%) Bundi (80.0%) Chittaurgarh (71.6%) Banswara (84.6%) Udaipur (73.5%)

Interventions to prevent and control Anemia Source: Iron deficiency anaemia: assessment, prevention and control. A guide for Programme Managers; WHO 2001- WHO/NHD/01.3 Strategies for prevention and control of iron deficiency and Anemia Food based strategies Supplementation Improved Health Services WIFS NIPI Deworming Dietary diversification Food fortification

Preventive & Curative measures by the government Weekly Iron & Folic Acid Supplementation Programme (WIFS) National Iron Plus Initiative (NIPI) National Deworming Day (NDD) Programme

WIFS Overview Target Groups The MoHFW, Government of India has launched the Weekly Iron and Folic Acid Supplementation (WIFS) Programme to reduce the prevalence and severity of nutritional anemia in adolescent population (10-19 years) in FY 2013-14 In Rajasthan, the programme was launched on July 25th 2013. Target Groups Weekly Iron and Folic Acid supplementation programme has been implemented for the following two target- Adolescent girls and boys enrolled in government/government aided/municipal schools from 6th to 12th classes. Adolescent Girls who are not in school 10 to 19 years through Aganwadi.

Strategies of WIFS (Both Blue & Pink) Administration of free IFA of 100mg elemental iron and 500μg Folic acid to target population. Institutions based Fixed day strategy Annual de-worming • Information & counselling Improving dietary intake • Screening of target groups for moderate/severe anaemia and referring.

National Guidelines

National Iron Plus Initiative (Launched on 2nd Oct, 2015 by Hon’ble HM) Age Group Intervention/Dose Regime Service delivery Coverage / Status 6–60 months IFA syrup Biweekly throughout the period 6–60 months of age Through ASHA/(on AWC platform) In all 33 districts 5–10 years WIFS Junior (Pink) Weekly throughout the period 5–10 years of age In government school (Class 1 - 5) through Teachers, Same as WIFS

Weekly IFA- Benefits Boosts iron levels - energy, concentration, immunity, muscle function, memory Feel energetic, less fatigue, less irritated Fall sick less often – better attendance I.Q & test scores improve - academic success Reduces anemia by 20-30% Contributes to reduce maternal deaths, LBW and neural tube defects causes by deficiency of iron and folic acid.

Success is possible (Evidence) Improvements in the prevalence of anaemia among women of reproductive age have been seen in countries around the world*: e.g., Burundi (64.4% to 28% in 20 years); China (50.0% to 19.9% in 19 years); Nicaragua (36.3% to 16.0% in 10 years); Sri Lanka (59.8% to 31.9% in 13 years); and Viet Nam (40.0% to 24.3% in 14 years). *Resolution WHA65.6. Comprehensive implementation plan on maternal, infant and young child nutrition. In: Sixty-fifth World Health Assembly Geneva, 21–26 May 2012. Resolutions and decisions, annexes. Geneva: World Health Organization; 2012:12–13 (http://www.who.int/nutrition/topics/WHA65.6_resolution_en.pdf?ua=1, accessed 6 October 2014).

Education System Approaches Weekly Supplementation of IFA tablets on fixed day approach to school going girls and boys in the age group of 10-19 years. Supervised consumption of IFA School based Deworming program Nutrition education to increase consumption of iron rich food

ICDS Approaches Information, counseling and support to adolescent girls on: How to improve their diets, especially iron intake, How to prevent anemia and How to minimize the potential undesirable effects of WIFS Referral services for adolescent girls suffering from moderate and severe anemia At AWCs these tablets are distributed free of cost to adolescent girls who is out of school. For Adolescent girls-Married /Unmarried Weekly IFA for 52 weeks in a year (Weekly fixed day)

District Education and ICDS Dept As per WIFS operational framework Ensure monitoring of programme with monthly data collection from block level Ensure uninterrupted supply of IFA tablets at block level (school and AWC) Ensure completion of training/orientation sessions of block officers, teachers, ICDS supervisors, ANM, AWW, ASHA and MO-PHC Ensure IEC material displayed at school and AWC

PEOs at Gram Panchayat level Block Education Officer and CDPO/ICDS Officer As per WIFS operational framework Consolidated requirements from schools and ICDS projects for block supply and share with district level Set up distribution system for schools and AWC Ensure uninterrupted supply of IFA Consolidated monitoring data and share with dist. Conduct quarterly meeting to review the programme Ensure display of IEC PEOs at Gram Panchayat level Regular Monitoring of WIFS Blue & Pink Programme, Ensure Supply of IFA, Consumptions and Reporting IEC and Community awareness etc.

WIFS Supply System Demand from School and AWWs INSTITUTE Demand from School and AWWs PAM CHAYT PEOs & LS will receive demand from covered institutions BLOCK Compilation at Block level (Edu & ICDS) A Copy to BCMOs with name and demand of institutions DISTRICT Compilation at DEOs /DD ICDS offices DEOs /DD ICDS officer to RCHO office of health Dept. STATE All RCHO to State office State Office to RMSCL for Procurement RMSC RMSC Supply WIFS tab/ to DDW at Districts District RCHO receive supply from DDWs; will ensure Supply upto Block level BLOCK BCMO will receive Supply from Dist; and Demand from BEOs/ CDPOs BCMO will ensure supply upto institutions with coordination of BEOs/Nodal/ CDPOs In Education on Panchayt level, PEOs will ensure. Pan chyat In Education PEOs will ensure supply and demands of covered School, and similarly in ICDS LS is responsible INSTITUTE Receive supply; ensure proper storage, consumption, recording and reporting

Monitoring Of Programme School Level Monitoring Individual Class - Monitoring register by class teacher School -Nodal teacher, format (Annexure-3) School WIFS committee (headed by the Principal /Head Master , Nodal teachers, student representatives and ANM for regular monitoring and management of the programme) Compliance in consumption of the tablets Regular IEC and Nutrition and Health Education session Record keeping at class level Transfer of correct information from recording registers to the reporting format Timeliness of the submission of monthly reports Ensuring timely IFA and Albendazole distribution Proper storage of IFA and Albendazole tablets

Monitoring Of Programme Block Level Monitoring The Block Education Officer will review the monthly report from each school and consolidate the reports for all schools in the block and submit it to the District Education Officer as per Annexure 4. District Level Monitoring (District Health Society) Status of implementation of the programme and timeliness of the submission of monthly reports Facilitate convergence and ensure use of community based platform like VHSCs for community mobilization and awareness Training Timely and adequate supply and distribution of IFA and Albendazole tablets Provision and usage of IEC materials

Monitoring Of Programme State Level Monitoring (State WIFS Advisory Committee) Status of implementation of the programme and timeliness of the submission of monthly reports Facilitate convergence Training Timely and adequate supply and distribution of IFA and Albendazole tablets Provision and use of IEC and counseling materials Ensuring quality control

Reporting Schedule (Education) S.No From Form To Dead Line 1 School Principal Annex 3 BEO 5th of every month 2 Block Education Officer Annex 4 District Education Officer Copy to BCMO 7thof every month 3 Annex 5 Dist RCHO office Copy to State Education Dept 10th of every month 4 State Nodal Officer 15th of every month

Reporting Schedule (ICDS) S.No From Form To Dead Line 1 AWW Annex 7A LS 5th of every month 2 Annex 7B CDPO 7thof every month 3 Annex 4 DD,ICDS Copy to BCMO 9th of every month 4 Annex 5 RCHOs Copy to Dir, ICDS 12th of every month Dist RCHO office State Nodal Officer 15th of every month

Inter-departmental Convergence एनीमिया भगाओ, खून बढ़ाओ, तीन नीति अपनाओ Inter-departmental Convergence तीन कार्यक्रम तीन विभाग तीन मन्त्र एनीमिया MEDICAL DEPARTMENT ICDS DEPARTMENT EDUCATION DEPARTMENT

Steps Taken To Promote Inter-departmental Convergence (Administrative) Letter from MD,NHM to all DCs to include WIFS in DHS meetings Monthly reminders, notices to RCHOs to send reports on time Joint letter from the all three departments for organize review meetings on all divisions DO letter from Principal Secretary (Health) to Addl Chief Secretary (Education) & Addl Chief Secretary (ICDS) to bring up the issue of poor reporting in WIFS Appointment of Nodal Officers in Education & Health Dept . Letter from education dept to all district officials Issued discussed in GB meeting (2016)of NHM and decision taken for online reporting through Shala darshan and Shala darpan.

Trainings of block level officers and field functionaries Done in: Bharatpur, Banswara, Dungarpur, Barmer, Jalore, Dausa, Dholpur At District level Block officials Field Functionaries

Poster for WIFS (Distributed in field)

WIFS/ NIPI – CHALLENGES Timely provision of adequate drugs at the schools & AWCs (Both side Health and Education/ICDS) at down side… Timely Reporting of Programme from education and ICDS dept IEC & Community Participation Quality training of teachers & AWWs Information symmetry at various levels (freq change of Dist and block officials) Monitoring by all three department Lack of coordination at down side amongst departments Lack of awareness amongst stakeholders

Programme reporting status

WIFS Annual Coverage (Reporting) Divisional Meeting 2016 Divisional Meeting 2014

WIFS program Coverage (April to November 2017) Month ICDS data reporting districts Education data reporting districts April 24 22 May 20 June July 19 August September 18 15 October 13 November 10 11

WIFS Coverage in % (April to Nov. 2017) Categories April'17 May'17 June'17 July'17 Aug'17 Sept’17 Oct’17 Nov’17 Average Coverage (%) Out of School (ICDS) 20.45 14.99 19.56 13.13 14.52 4.19 6.8 2.48 12.02 In school (Education) 35.24 23.21 28.93 28.03 28.14 12.17 17.44 10.11 22.91 Total Avg. Coverage 17.46

NIPI program Coverage (April to November 2017) Month No. of IFA Syrup reporting districts No. of WIFS Junior reporting districts (Education) April 23 18 May 17 June July 15 August 12 September 11 October 14 09 November

NIPI coverage in % (April to Nov,17)   April,17 May,17 June,17 July,17 Aug,17 Sept,17 Oct,17 Nov,17 Avg. Coverag e in % IFA Syrup 11.31 12.9 11.67 12.82 4.5 0.13 0.09 0.05 6.68 WIFS Junior 14 10.45 9.62 15.64 10.75 6.34 5.82 10.68 Total Avg. Coverage 8.68

Problems faced by the districts in the proper implementation of WIFS/NIPI program (reported by 20 districts)- RCHO’s are not got the reports on time even after regirous followup (Sikar, Chittaurgarh, Nagaur, Rajsamand and Barmer districts). Some DEOs and the officers of ICDS Department don’t take part into the District Health Society meetings, (Rajsamand, Jodhpur and Kota districts). Reports are obtained from both the departments after too much of delay and with rigorous follow ups. (Karauli, Jodhpur and Jhalawad districts) Education department officials not attended recent district level training of block level officials of Education and Health (Bundi) Schools and ASHA’s at AW Centers don’t report the shortage, Jaisalmer Health Dept Officials (BCMO) are not asking to school for supplies (Education dept officilas) No proper monitoring of the program by the district officers of Health, Education and ICDS Departments.

Status of Online Reporting Through Shala Drashan & Shala Darpan Portal 1- WIFS Blue 2- WIFS Pink Status: - Will be live in this month Through ANM form no 6A PCTS 1- IFA Syurp 2- WIFS Blue (out of school girls on AWCs ) Status: - Now Live in PCTS

Call for discussion on effective implementations of WIFS/NIPI THANK YOU