Guidelines for WIFS Programme for the Community Based Intervention

Operational Guidelines for Weekly IFA Supplementation Programme for the Community Based Intervention: Rc.No.344, Dated:21.9.2017 :: Sub: NHM - RKSK - WIFS - Implementation of WIFS programme and submission of monthly reports in the prescribed formats - Certain guidelines - Communicated - Regarding. Ref: This office memo Re.Even No. dated 15.03.2017

In continuaion of the reference cited, all the District Medical & Health Officers and District Co-ordinators for RBSK/RKSK are once again informed that the Weekly Iron and Folic Acid Supplementation (WIFS), which aims at reduction of prevalence of iron deficiency anaemia amongst the adolescents (10-19 years girls & boys), has to be implemented in all Government and Aided schools (for both girls and boys) including residential schools, Ashramshalas, Madrasas and municipal schools and Centres (for out of school girls only). Accordingly, the monthly report consolidated at each level in the following formats, a copy of which enclosed herewith.

Therefore, all the DM&HOs & District Co-ordinators for RBSKiRKSK are requested to take necessary action for implementation of the WIFS programme in convergence with the Education and ICDS Departments of concerned districts and streamline the reporting system in the following hierarchy and ensure the submission of the district level monthly report in time:

SCHOOLS: Class Monthly Report - School MonthlyReport - Block Monthly Report
- District Monthly Report
ANGANWADI CENTRES: Anganwadi Centre Monthly Report - Block Monthly
Report - District Monthly Report

A copy of the brief guidelines for implementation of the WIFS programme in schools and Anganwadi Centres is also enclosed herewith.

GUIDELINES FOR TEACHERS AND PRINCIPALS
Goal: To institute a school based weekly IF A supplementation (WIFS) programme for control of anaemia in adolescent boys and girls attending classes 6 to 12th of government/government aided/ municipal schools.

Objectives: 
Ensure that all adolescent boys and girls in 6 to 12th standards of government/government aided/ municipal schools are given a tablet of IF A once a week and Albendazole twice a year for de-worming.
To inform adolescent boys and girls of the correct dietary practices for increasing iron intake.
To inform adolescents of the significance of preventing worm infestation and encourage
adoption of correct hygiene practices, including use of footwear to prevent worm infestation.

Strategy:
Administration of weekly iron-folic acid supplements (WIFS). (IFA tablet containing IOOmg elemental iron and 500ug Folic acid) for 52 weeks in a year, on a fixed day preferably Monday.
Screening of target groups for moderate/severe anaemia and referring these cases to an appropriate health facility.
Biannual Albendazole (400mg), six months apart, for control of worm infestation.
Information and counseling for improving dietary intake and for taking actions for prevention of intestinal worm infestation.

Responsibilities of Head Master/Principal:
Designate two teachers as the WIFS nodal teachers.
Ensure orientation of other class teachers about WIFS programme.
Ensure provision of safe drinking water.
Ensure separate time for NHE session.
Ensure proper storage of IF A and Albendazole tablets
Ensure estimation of IF A and Albendazole tablet requirements for the school.
Proper storage of IF A and Albendazole tablets
Constitute a School WIFS committee to be headed by the Principal /Head Master with participation of the Nodal teachers, Student representatives and ANM for regular monitoring and management of the programme.

The committee will be responsible for monitoring the following:
• 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 IF A and Albendazole distribution

Responsibilities of Nodal Teacher/ Teachers
Estimation of Requirement and storage
Annual supplies of IF A and Albendazole tablets should be stored in a clean, dry and dust free area away from the direct sunlight.
The nodal teacher (s) for each school will estimate annual requirements for IF A and Albendazole tablets.


Estimation of IFA and Albendazole Tablets
IFA tablets for the year = 52 x Total number of children in 6-12th standards + 52 tablets /per teacher /year. An additional 20 % stock as buffer to be added.
Albendazole tablets Requirement for the year= 2 x number of children in 6th-12th standards. An additional 10 % stock as buffer to be added.
After estimating IFA and Albendazole tablets requirements for students and teachers , the schools will forward the requirement to the Block Education Officer in the form prescribed
below:

Name of School:
STOCK REQUIREMENTUNDER WIFS PROGRAMME
Address of School:
Total Number of Adolescent: Boys Girls: Total
Total number of teachers:
Annual requirement is for the year 20 ........
Total IFA tablets required:
Total Albendazole tablets required:
Signature (Nodal Teacher 1) Signature (Nodal Teacher 2)
Signature f Principal)

2. IFA tablet distributionand screening

  1. Implement programme in school children from 6th to 12th standard, both boys and girls
  2. Nodal teachers will orient other teachers regarding WIFS programme.
  3. The programme could be initiated preferably in the month of April or after beginning of new session in all schools.
  4. Teachers will orient students on how to fill Individual Compliance cards.
  5. Nodal teachers with involvement of class teachers will ensure supervised ingestion of IFA
  6. tablets by adolescents enrolled in classes 6th to 12th
  7. IFA tablet to be given on a fixed day preferably Monday at a fixed time after Mid-Day Meal (where applicable )/I unch.
  8. IFA tablet to be consumed after meals only ( half hour to one hour gap)
  9. Teachers should ensure provision of sage drinking water for IFA tablet consumption
  10. Teachers should ensure student consume IF A tablets in their presence.
  11. Teachers to consume IFA tablets themselves
  12. If the child is absent on a Monday or misses out on the consumption of the !FA tablet, give IFA tablet on subsequent contact within that week. The next week tablet will be given on fixed day only.
  13. Teachers will screen adolescents for presence of moderate/severe anaemia by assessing nail bed, palmar, conjunctiva! and tongue pallor. ( Continue weekly !FA supplementation in an adolescent with significant anaemia till the time he/she is tested for haemoglobin level in health facility and started on treatment of anaemia)
  14. Students with significant pallor should be referred to appropriate nearby health facility for
  15. management of anaemia.
  16. Before the school closes for vacations, the students should be given the requisite number of IFA tablets for consumption during the holidays under parental supervision. After vacations, teachers will check empty IFA tablet strips to confirm intake.
  17. Minor side effects such as black stools, nausea and vomiting can occur in few cases, but side effects are often transitory and the frequency of side-effects of WIFS is much lower than with daily doses. Also side effects decrease over time
  18. In case a girl complains of uneasiness /any side effects, the teacher will refer her to the ANM.
  19. Teachers should inform girls and boys about benefits of IF A supplementation such as:
  20. Improved concentration in school, and school performance
  21. Feeling stronger and less tired,
  22. Increased energy levels and output in day to day work,
  23. Increased appetite,
  24. Improved overall capacity to work and earn
  25. Better sleep
  26. Improved skin appearance,
  27. Regularization of menstruation
  28. Building pre-pregnancy health

NOTE: Pregnant adolescent girls should be referred to nearest health facility and given lFA tablets as per ANC guidelines.

3. Albendazole Tablet distribution
a. Give first dose of Albendazole ( 400 mg) tablet in month of August or as decided by state and the second dose should be given by February /six months after the first dose.
b. Inform MO-PHC prior to initiating Albendazole tablet distribution
NOTE: The state must ensure that the Emergency response system is activated during the time that deworming tablets are being given.

4. Nutrition and Health Education

  1. Separate time should also be allotted during the school year to provide Nutrition and Health Education (NHE) to the adolescents.
  2. The nodal teacher should conduct monthly NHE session(s).
  3. Parents should also be oriented on WIFS and NHE during Parent Teacher Association Meetings.


5. Monitoring (Class teacher, Nodal teacher, Principal/Head Master)

  1. The nodal teacher and class teachers will be responsible for overseeing that the compliance card is filled correctly
  2. The class teacher will use monitoring register at school/class level as per (Annexure 2).
  3. Information will be entered each week in this register by class teachers
  4. At the end of the month, the class teacher will need to compile the information on the number of girls and boys who have taken 4/5 IF A tablets per month (5 tablets in case of 5 weeks in a month) .
  5. Similar exercise would also need to be carried out for Albendazole tablets during de-worming months.
  6. In case of girls and boys who are not able to consume 4 IFA tablets in a month the reason for
  7. non-compliance is to be mentioned in the remarks column of the format and will be compiled in school report
  8. The nodal teachers would consolidate all the information from the class reporting formats on
  9. the monthly school-reporting format (Annexure- 3) and submit it to the school principal
  10. School principal will review the information in the monthly school reporting format, counter sign it and submit it to the block level officials on a monthly basis.
  11. The school principal will also send a copy of this monthly school report to the ANM.


KEY ACTIVITIES
~ Both boys and girls to be given IFA and Albendazole Tablets
~ 6th to12th class students to be covered
~ Weekly Fixed day approach
~ Supervised consumption of weelcly IFA tablet to be ensured
~ IFA tablet to be given after meals ( Mid-Day Meal or Lunch)
~ Screen students for pallor and refer
~ Bi-annual ( six months apart) distribution of Albendazole tablets
~ NHE sessions to be conducted regularly
~ Filling of Individual compliance cards

Guidelines for Anganwadi Workers.
Guidelines for ICDS Supervisor/CDPO.
Guidelines for District ICDS Officer.



GUIDELINES FOR ANGANWADI WORKER:
Goals:
To institute a community based Weekly IFA Supplementation (WIFS) programme forcontrol of anaemia among out-of-school adolescent girls in a given ICDS area.

Objectives:

  • Ensure that all adolescent girls (including married girls) in age group 10-19 years are given a tablet of IFA once a week and six monthly dose of Albendazole (400mg) tablet for de-worming.
  • To inform adolescent girls of the correct dietary practices for increasing iron intake.
  • To inform adolescents girls of the significance of preventing worm infestation and encourage adoption of correct hygiene practices, including use of footwear to prevent worm infestation.


Strategy:

  • Administration of weekly iron-folic acid supplements (WIFS). (IFA tablet containing 100mg elemental iron and 500 microgram Folic acid) for 52 weeks in a year, on a fixed day preferably Monday.
  • Screening of target groups for moderate/severe anaemia and referring these cases to an appropriate health facility for management of anaemia.
  • Biannual Albendazole (400mg), six months apart, for control of worm infestation.
  • Information and counseling for improving dietary intake and for taking actions for prevention of intestinal worm infestation.


GUIDELINES FOR AWW / ASHA /ANM:
Distribution of IFA through ICDS platforms: Role of AWW / ASHA /ANM

  • The platform of Kishori Samooh will be utilized for mobilizing adolescent girls in the districts implementing SABLA scheme. In other districts AWW with the help of ASHA will mobilize adolescent girls at the AWC on a fixed day (preferably a Monday) at a fixed time preferably after the noon meal.
  • One IFA tablet will be provided to each girl by AWW and she will ensure direct consumption of IFA tablet by adolescent girls. AWW will advise the girls that IFA tablets are not taken on an empty stomach and to the extent possible ensure that the girls have eaten a meal prior to taking the IFA tablet.
  • AWW will screen adolescent girls for presence of moderate/severe anaemia by examining the nail bed and tongue pallor.
  • Adolescent girls with moderate/severe anaemia will be referred to a nearby health facility.
  • In case a girl complains of uneasiness /any side effects, the AWW will refer her to the ANM.
  • Each girl will be guided to maintain individual compliance cards by the AWW. The
  • AWW will be trained on maintenance of the Individual Compliance Card.
  • Two fixed months- August and February in year will be allocated for administering Albendazole to all adolescent girls on ‘WIFS Day”.
  • ANM will undertake quarterly Nutrition and Health Education session on “Anaemia in
  • adolescent and benefits of IFA supplements” in convergence with SABLA /ICDS and will record date and attendance in monthly format. ANM will also receive copy of consolidated monthly report from AWW as per Annexure 7A.
  • AWW, ICDS helper and ASHA will also be supplied IFA tablets for weekly consumption; these frontline workers will be encouraged to consume the supplement in the presence of the girls.
  • AWW will encourage all adolescent girls to be tested for anaemia at appropriate health facility.


Estimation of IFA and Albendazole
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
Estimating De-worming tablet supply = (Number of adolescent girls registered with
ICDS x 2 tablets of Albendazole) + 10% as buffer stock
Name and address of Anganwadi Centre: …………………..
Total Number of Adolescent Girls: ……………………….
Total IFA tablets required : …………………………
Total Albendazole tablets required :…………………………


Monitoring by AWWs

  • The AWW will be responsible for maintenance of Individual Compliance Card/ Kishori Card. Annex 1.
  • At the Anganwadi Center (AWC) level: the Anganwadi Worker (AWW) will compile the monthly data of IFA consumption by adolescent girls for their Anganwadi Center as perAnnexure 7A and will forward it to Sector Supervisor. A copy of the monthly report will be shared with ANM. The monitoring report for the WIFS programme will be integrated with the ICDS monthly progress reports.
  • AWW will maintain a supply-compliance register.


Guidelines for ICDS supervisor/CDPO:
Key functions

  • Consolidate requirements from ICDS projects for block supply and share with district level.
  • Set up distribution system for AWC & ensure uninterrupted supply & storage of IFA and de-worming tablets to AWC.
  • Consolidate monitoring data received from AWC and share with district on monthly basis.
  • Conduct quarterly meeting to review the programme.
  • Ensure display of IEC material in schools and AWC.


Monitoring:
The supervisor will compile the information from all the AWCs (received in Annexure 7A) in the monthly reporting (Annexure 7B) format and submit it to the CDPO.

Guidelines for District ICDS Officer:
Key functions:

  • Ensure uninterrupted supply of IFA and Albendazole tablets to the AWCs on an annual basis.
  • Stock request process: The supply request for the district will be submitted by the District ICDS Officer to the District Health Officer annually.
  • The District Health Department will send the request to State HFW Department who will supply the IFA and Albendazole tablets as per the requirements of the districts.
  • The District Health Officer will co-ordinate and forward annual supplies to District ICDS Officer.
  • At the district level, the ICDS Department will be in-charge of forwarding the annual supply stock to the CDPO. CDPO will help ensure uninterrupted supply of IFA and Albendazole tablets to AWC.


Monitoring:

  • District ICDS Officer will be responsible for monitoring the programme and compiling the monthly data using the district level reporting formats which will then be shared with District RCH/Health Officer (Annexure 5). The District ICDS will forward the report of their districts to District RCH /Health Officer with a copy to the State Director ICDS, Department of Women and Child Development.


District WIFS Advisory Committee:
At the district level, the District WIFS Advisory Committee will be formed with participation from Health, Education and Women and Child Development Departments. The function of the committee will be to monitor the progress of the programme and resolve programmatic issues. The Committee would need to meet every quarter with the participation of Health, Women and Child Development and Education block officials. Yearly meeting with nodal teachers could be organized to further streamline the implementation of project. Committee would monitor the following:


  • Status of implementation of the programme and timeliness of the submission of monthly reports.
  • Facilitate convergence and ensure use of community based platform like VHNDs for community mobilization and awareness.
  • Training.
  • Timely and adequate supply and distribution of IFA and Albendazole tablets.
  • Provision and use of IEC and use of counseling materials.
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