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

2. 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.

3. 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.

4. 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

5. Prevalence of Anemia by Age Groups, Rajasthan

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

7. 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

8. Top & Bottom five Districts of Rajasthan according to NFHS 4, 2015-16
(Ranked)
Children age 6-59 months who are anemic (%)
Pregnant women age 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%)

9. Interventions to prevent and control Anemia
Source: Iron deficiency anaemia: assessment, prevention and control. A guide for Programme Managers; WHO 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

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

11. 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
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.

12. 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.

13. National Guidelines

15. 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

16. 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.

17. 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).

18. 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

19. 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)

20. 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

21. 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.

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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.

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

31. Poster for WIFS (Distributed in field)

32. 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

33. Programme reporting status

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

35. 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

36. 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

37. 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

38. 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

39. 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.

40. 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

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