1. WEEKLY IRON & FOLIC ACID SUPPLEMENTATION
WIFS/ NIPI Block level Officers Orientation ​
Dr PREM SINGH, MPH
State Nodal Officer-WIFS

2. And more than that definitely
Concerns of
Hon’ble Health Minister, Govt. of Rajasthan
Chief Secretary of Rajasthan (1, Sept 2016)
Principal Health Secretary
SS & Mission Director, NHM
Secretary to Government-Education
Director, ICDS
UNICEF
And more than that definitely
‘All of us’

3. Anemia
Anemia is manifestation of under nutrition and poor dietary intake of Iron affecting not only a section but entire population
It is a condition in which the body does not have enough healthy red blood cells to bring oxygen to body tissues.

4. Rationale: Evidence Anemia is multi-factoral in etiology
Iron and folate deficiency are common
Iron deficiency is related to nutritional deficiency, intestinal helminthic deficiency and folate deficiency due to poor intake and chronic hemolytic stage
Besides these, Malaria and other chronic diseases like Tuberculosis, HIV and cancers remain as major contributors to anemia.

5. Adolescent Anaemia Reduced physical development
Reduced cognitive development
Adolescent Anaemia
Diminished concentration
Decreased work capacity
Impaired sexual and reproductive development
Decreased work output
Poor learning ability
Disturbance in perception
Irregular menstruation
LBW babies and preterm delivery
Low pre-pregnancy iron stores

6. Rationale: Evidence
Anaemia in pregnant women reduces womens ability to survive bleeding during and after child birth
Risk of maternal mortality decreases by about 20%for each one g/dl increase in Hb
Reduction in severe anemia is evidenced in pregnant women who receive regular malaria prophylaxis in malaria endemic areas
20% maternal deaths are attributable due to anemia in India

7. Micronutrient deficiencies during pregnancy results in spontaneous abortions, Pre term labour, IUGR, LBW babies and maternal deaths.
The cost implications include:
Increased length of hospital stay
Expenses related to referral, transport of cases to hospitals with pediatric care facilities
Cost of incubators and Intensive care
Cost of post maternity care

8. Iron Deficiency Anemia
By the time a person is diagnosed with anemia, the body stores are nil and the RBC Iron is to the minimal level

10. Health Economics of Micronutrient deficiencies in children
Anemia and other key micronutrient deficiencies can directly attribute to
Depressed Cognition
Inferior school performance
Reduced future earnings & productivity
Depressed immunity
Repeated infections

11. Health Economics of Anemia…. cont
Impact on Productivity:
In an anemic individual, the aerobic capacity, endurance and energy efficiency are compromised 10-50%
IDA “reduces the work capacity of individuals and entire populations, bringing serious economic consequences and obstacles to national development’’ (WHO).
Anemia hits hard on productivity with an estimate of 5% deficit among all “blue collar” jobs to additional 17% loss for Heavy manual labor such as agriculture and construction (The Journal of Nutrition, 2002)
India loses 0.9% of its gross domestic product (GDP) due to IDA (Food Policy,2003).
This could mean a loss of up to $20.25 billion (Rs.1.35 lakh crore), according to the World Bank’s estimate of India’s GDP in 2016.

12. Health Economics of Anemia…. cont
Impact on Children
iron-deficiency anaemia severely affects cognitive performance.
It also impacts language skills, motor skills and coordination among infants and young children, and a deficit of 5 to 10 points in intelligence quotient (IQ).
(Iron deficiency in infancy cannot be correct by subsequent iron therapy, according to WHO.)
Anemic children score 0.5 to 1.5 SD lower on Intelligence tests where as iron interventions have similar magnitude of positive impact on cognitive scores.
Global evidences conclude that a 0.25 SD increase in IQ level would lead to 5-10% increase in wages

13. Health Economics of Anemia…. cont
Micronutrient deficiencies during pregnancy results in spontaneous abortions, Pre term labour, IUGR, LBW babies and maternal deaths.
The cost implications include:
Increased length of hospital stay
Expenses related to referral, transport of cases to hospitals with pediatric care facilities
Cost of incubators and Intensive care
Cost of post maternity care
These all result in burden on State Health Budget

14. Global picture

15. Adolescent Anemia: problem scale by States

16. Rajasthan : Prevalence of Anaemia among Adolescents and Adults

17. Intergenerational cycle of Anemia
Adolescent enters reproductive age group with low iron stores
Pregnant women with Anemia
Baby with low iron and hemoglobin levels
Uncorrected anemia in infancy and childhood
Adolescent with low iron and hemoglobin levels + Menstrual blood loss

18. Anemia & Malnutrition Height-for-age (stunting)
MILD ANAEMIA
MODERATE ANEMIA
SEVERE ANEMIA
ANY ANAEMIA
g/dl
g/dl
<7.0g/dl
<11.0g/dl
Three standard indices of physical growth that describe the nutritional status of children
Height-for-age (stunting)
Weight-for-height (wasting)
Weight-for-age (underweight)

19. Strategies for prevention of IDA
Dietary Diversification
Food Fortification
IFA Supplementation with Biannual deworming
Provide Improved Health Services

20. 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 Resolutions and decisions, annexes. Geneva: World Health Organization; 2012:12–13 ( accessed 6 October 2014).

21. Weekly Iron Folic Acid Supplements ( Launched on July 25th,2013 )

22. 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/(AWC
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

23. Objective
The Ministry of Health and Family Welfare, Government of India has launched the Weekly Iron and Folic Acid Supplementation (WIFS) Programme to reduce the prevalence and severity of nutritional anaemia in adolescent population (10-19 years) and NIPI for age group 6 month to 10 years.

24. Target groups
Weekly Iron and Folic Acid supplementation (WIFS) programme will be planned and implemented for the following two target groups in both rural and urban areas:
Adolescent girls and boys enrolled in government/government aided/municipal schools from 6th to 12th classes.
Adolescent Girls who are not in school through AWCs.
National Iron Plus Initiatives
Girls and boys enrolled in government/government aided/municipal schools from 1st to 5th classes.
6 month to 60 month children through AWCs

25. Targets Group WIFS All 33 districts No. of in-school adolescents
36,25,691 (As per DISE 2015)
43,47,720
All
33 districts
No. of out-of-school girls
7,22,029*
National Iron Plus Initiatives
Government Schools class-1st to 5th
41.02 lakh
lakh
6 Month to 60 month (out of school)
63.16 lakh

27. Strategy for Prevention of Anaemia in Adolescents
Fixed day,
Institution Based,
Supervised consumption,
Educating correct dietary practices & increasing iron intake,
Screening for moderate/severe anemia & referring,
Annual / biannual deworming.

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

30. ICDS Approaches
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
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

31. 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

32. 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

33. Estimation of IFA Education ICDS
IFA tablets for the year = (52 x Total number of children in 6 to 12th standards) + (52 tablets /per teacher /year). An additional 20 % stock as buffer will be added.
ICDS
Estimating IFA tablet Supply = (Number of adolescent girls registered with ICDS x 52 tablets) + (52 tablets/ year for each AWW + 52 tablets/ year for ASHA). An additional 20% is to be added for ensuring adequate stock supply.

34. WIFS Supply System RMSC Supply WIFS tab/ to DDW at Districts
INSTITUTE
Demand from School and AWWs
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
INSTITUTE
Receive supply; ensure proper storage, consumption, recording and reporting

35. WIFS-IFA DRUGS (Storage)
STORAGE – WIFS-IFA Drugs should be kept in a cool & dry place. (AVOID EXPOSURE OF DIRECT SUNLIGHT & WATER)
Selection of proper place
Locke and key room
Limited access to the store
Keep store in good condition
Control the temperature in the store
Control the light in the store
Prevent water damage and control humidity
Keep the store free of pests
Keep your store clean and organized
Clean the store and keep it tidy
Store supplies on shelves
WIFS Blue TAB
Exp:…..
WIFS Pink TAB
Exp:…..

36. WIFS-IFA DRUGS (Administration) etcl
ADMINISTRATION – IFA Drugs should be administered WEEKLY ; Schools – Monday; AWCs - Thursday) to adolescents (10-19 years) School going adolescents & Out-of-school adolescent girls after Mid Day Meal / Poshahaar ( NOT EMPTY STOMACH)
FEFO (First Expiry First Out)
Check Expiry in routin

37. Monitoring of Programme
School Level Monitoring
Individual through ICC
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

38. 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 WIFS Advisory Committee)
{it is merged in District Health Society at district level}
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

39. 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

40. Samblambn Monitoring Report A initaive of education dept
क्रमांक
जिला
कुल अवलोकित विधालय
विदयालय में पेयजल सुविधा उपलब्ध है
बालकों /बालिकाओं के लिए अलग -अलग शौचालय सुविधा उपलब्ध है
बच्चों द्वारा शौचालय का उपयोग किया जा रहा है
शौचालय में नियमित जल आपूर्ति की व्यवस्था है
शाला स्वछता हेतु उपलव्ध कराई गयी राशि (500 रु प्रतिमाह )प्राप्त हो गयी ?
बच्चों के साबुन से हाथ धोने के लिए अलग से सुविधा उपलब्ध है
पोषाहार (मिड डे मील)से पहले बच्चे साबुन से हाथ धोते हैं ?
राष्टीय बाल शाला स्वास्थ्य कार्यक्रम के अंतर्गत बच्चों का स्वास्थ्य परिक्षण कर लिया गया है?
बालक बालिकाओं को साप्ताहिक आयरन गोली दी जा रही है ? 2
ALWAR
283
230
268
278
222
252
275
276
207
226 4
BARAN
158
134
151
143 84
139
147
150
100
142 6
BHARATPUR
195
141
187
186
130
181
175
144
168 7
BHILWARA
188
183
184
152
171
166
182 8
BIKANER
170
165
116
127 11
CHURU
246
240
234
215
232
189
228 12
DAUSA
122 90
119
120 69
109
117 58
115 15
GANGANAGAR
185 16
HANUMANGARH
113
102
118 88
110 17
JAIPUR
443
390
424
434
350
364
423
428
221
379 20
JHALAWAR
157
149
148
154
124 21
JHUNJHUNUN
178
162 23
KARAULI 86 67
114 66
103 24
KOTA
160
155
126
132
159 29
SAWAI MADHOPUR
161 30
SIKAR
295
261
274
286
227
285
290
214
263 31
SIROHI
125
123 92 75
105 32
TONK
156
Total
6057
5498
5805
5863
4579
5496
5759
5859
4214
5205

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

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

43. Individual Compliance Card

49. NIPI Reporting format (IFA Syrup)

50. WIFS Junior Reporting Format

51. On Web http://rajswasthya.nic.in/

52. Issues in Reporting Data Quality Non Reporting Irregular Reporting
Time of reporting
Old formats
Change denominator
Over Reporting

53. Summry Public Health Challenge of our Country.
Find the gap in implementation of prog and resolve it immediately
Include in Health Education (Anemia) in school routine system.
Priorities and Increase focus and visibility in community.
Regular availability/supply of supplements in inst.
Regular Reporting (it is reflection of your dist)
Regular agenda of DHS & BHS.
Increase convergence among inter and intra depts.
Use innovation for implement and increase reliance of public.
Adverse event
Media management
Remember 3 mantra to OVERCOME from anemia -
WIFS
Nutrition education (Ion Reach Source)
Deworming (National Deworming Day)

54. Take Care of Adolescent, They will take care of Country
I want to thank you for your patience, kind heart, and loving attitude.

55. Action Plan District wiseSN
Issues
Action Point
Time line 1.
Cover those schools /AWCs (if) where prog is not implemented 2.
Regular Reporting 3.
Submission of remaining reports 4.
Maintain data quality of reports 5.
Ensuring continuous drug supply in institutions 6.
Awareness /Sensitization among students & Parents 7.
Convergence issue 8.
IEC 9.
10.

56. Contact details: At State- At Districts- At Block-
Dr Prem Singh
SNO- Adolescent Health-WIFS
Mobile no:
At Districts-
Reproductive & Child Health Officers
At Block-
Block Chief Medical & Health Officers