Rajasthan
National Deworming Day 2016
An Overview
1
Presentation Outline
Prevalence of Worm Infection
Effects of worms
Complementary Ways of Addressing Worm Infections
National Deworming Day (NDD ) 2015: Key Achievements
Preparations for NDD 2016- At National Level
Rajasthan National Deworming Day 2016 : Objectives
and Targets
Program updates for Rajasthan National Deworming Day
2016
Key Decisions
Potential Challenges
Next Steps
2
Prevalence of Worm Infection
Children aged 1 to 19 years
(preschool and school-age
children) are at-risk of
parasitic intestinal worm
infections, known as Soil
Transmitted Helminths (STH).
Worms can cause anemia and
nutritional impairment, thereby
impairing mental and physical
development.
Round
worm
Whip
worm
Hook
worm
Effects of Worms = Debilitating1
Transmission of worm infections1:
• Ingestion of infected eggs or larvae contaminating food,
hands, or utensils
• Penetration of the skin by infective larvae
contaminating the soil
Common consequences of intestinal worms:
Intestinal bleeding, impaired iron status, anemia
Malnourishment / malabsorption of nutrients, loss of appetite
Stunted growth
Impaired mental and physical development and cognition
Exhaustion and poor concentration
Weakened immune systems
1Source:
“Helminth control in school-age children: A guide for managers of control programes” second edition, World Health Organization 2011
Complementary Ways of Addressing Worm Infections
Short Route
Approach
Objective
Deworming drug
administration via
NDD
Treatment:
• Reduce morbidity
• Reduce individual
worm burden
Long Route
Improved sanitation and
waste management
E.g., improving WASH facilities
in schools
Improved hygiene education and
awareness. Ex, delivered via
public health system, community
or schools
Prevention
• Control transmission
• Reduce reinfection
Long term actions require sustained commitment- financial and human resources, behaviour change and multiple efforts across departments, and therefore short term
actions - ‘Deworming’ are of critical importance
5
School/ Anganwadi based deworming &
fixed day approach
Safe
•
•
The WHO recommends
mass school-based
deworming as a safe
treatment for all preschool
and school-age children
There are no significant
side-effects of treatment
Why fixed day approach?
Cost-effective
•
School-based deworming
costs <50 cents per child per
deworming treatment,
earning it a ‘best-buy’ in
development rating by the
Copenhagen Consensus,
GiveWell, and the Abdul
Jameel Poverty Action Lab at
MIT (JPAL)
Scalable
•
Due to leveraging existing
school infrastructure, schoolbased deworming has the
potential to reach >80% of
pre-school and school-age
children
• An optimal mechanism cost effective way to high coverage
• Campaign style messaging can be leveraged to increase awareness
• Support structures could be in place to easily track and respond to any cases of adverse
events
• Mobilization of stakeholders is easy
• Effective monitoring
6
How to Treat Worm Infection?
• Albendazole syrup 5 ml (Half
Bottle 200 mg)/Half tablet for
children between 1 -2 years
• Albendazole tablet (400mg)
for children > 2 years
Left: Albendazole tablet, Right: Albendazole syrup
Albendazole is a safe drug for both infected and
non infected children and adults and has been
used to treat millions of people across the world
for STH
National Deworming Day-2015: Key Achievements
• Commitment at National level with launch of National
Deworming Day (NDD) 2015 by MoHFW to implement
mass deworming program in Campaign Mode – on
February, 10 followed by Mop Up Day on February, 13.
• 10 States and one UT participated, covering 272 districts
• 10.31 crore children targeted* in the age group of 1-19
years
• National launch by Honb’le Union Minister of Health &
Family Welfare on February 9, 2015 in Jaipur.
• The program successfully dewormed 8.98 crore children
across 4.70 lakh schools and 3.67 lakh anganwadi centers
8
*Source-NDD report 2015 released by Ministry of Health and Family Welfare, GOI dated November 27, 2015
Rajasthan National Deworming Day-2015:Key
Achievements
Successful implementation of Round 3 of school and anganwadi based mass deworming on February
10, 2015 with collaborative effort between the Department of Health, Department of Education,
Department of Women and Child Development with technical assistance from Evidence Action –
Deworm the World Initiative and UNICEF
Deworming Coverage-2015
Coverage
No. of school enrolled children dewormed
No of non-enrolled/ out of school children dewormed
No. of AWC registered children dewormed
% Coverage of NDD 2015
Training details
Number of teachers trained
Number of anganwadi functionaries trained
64,63,898
6,83,631
47,11,239
84%
71,985
58,359
*Source: Data submitted by Government of Rajasthan to Ministry of Health and Family Welfare, Government of India dated 15th April, 2015
9
Rajasthan National Deworming Day-2015:Key Achievements
10
National
Deworming Day - 2015
11
National Deworming Day- February 10,
2016
Objective:
To deworm all preschool and school-age children (enrolled and out-of-school) between the
ages of 1-19 years through the platform of government schools, private schools, madarsa and
anganwadi centers with fixed day approach.
New Initiative:
- Engage private schools to ensure coverage of beneficiaries currently being left out
- Standardizing denominator of all target age group
• Children enrolled in government schools
• Children enrolled in private schools
• Preschool children registered at anganwadi centres
• Preschool children not registered (1-5 years) with anganwadi centres
• School age children who are out-of-school (6-19 years)
- Increased reach to all children who are not attending school and anganwadi through greater
engagement of ASHA
*Albendazole 400 mg tablets to be administered to children 2- 19 years.
**Albendazole 200mg syrup to be administered to children 1- 2 years
12
Preparations for National Deworming Day-2016:Updates
so far
Review Meet
NDD 2015
Held on Oct 27, 2015
with participation of
11 states/UT
Revisions in
guideline for
NDD 2016
Learnings and best
practices from state
guided
revisions
under Operational
guidelines
NDD
2016
NDD 2016
Orientation
Meet
Held on Dec 1, with
participation 36 states
and UT’s under the
chairmanship
of,
Joint
Secretary,
MoHFW,
*The revised NDD 2016 guidelines and relevant NDD resource kit available on MoHFW-NHM website
http://nrhm.gov.in/component/content/article.html?layout=edit&id=519
1) Letter from JS,
MoHFW to all states on
NDD dates, and related
preparation
2) Inter-departmental
convergence meeting
(Health, WCD, Education,
PRI) for effective roll out
of program
4) Letter from JS to other
ministries (Education,
WCD,PRI) for greater
collaboration
5) Joint directives from
Secretaries (Heath,
Education and WCD)
issued to all states for
convergence
6) Uploading of the NDD
2016 resource kit on NHM
13
website (link below)
Rajasthan National Deworming Day-2016:Targets
Parameter
Target Institution Beneficiaries
No of Districts
33
No of Blocks
249 (H)/257 (E)
No of government schools
69,269
75,24,294
No of Private schools
34,056
80,73,369
No. of Kendriya Vidhyalaya
70
63,076
No. of Navodaya Vidhyalaya
34
16,325
No. of Madarsas
2359
183825
No. of AWCs in the state
60,163
74,35,569
No. of unregistered children in AWC (1 – 6 years)
246767
No. of out-of-school children (6-16 years)*
16,09,344
Total Target
2,51,52,569
Sources: Data related to department of education is as per DISE 2014-15, Data for KVs and NVs is as per their respective websites, Data of AWCs includes data taken from Aug
2015 MPR of ICDS, number of registered children (1-6 year) is calculated on the basis of 0-6 year population in ICDS MPR Aug 2015 applying a group proportionate to census, number of
unregistered children (1-6 year) is calculated on the basis of census and registered children of 0-6 year in AWCs as per ICDS MPR Aug 2015, number of out-of-school children14
aged 6-16 year
calculated using Annual Status of Education Report (ASER) 2014 and National Survey on Estimation of Out-of-School Children, 2014 as basis
Rajasthan National Deworming Day- February 10,
2016: Overview
Objectives:
• To deworm all children in age group of 1-19 years through schools and anganwadi centers
• Inclusion of centrally affiliated school (Kendriya and Navodaya Vidhyalayas), private schools and madarsas
in all districts
• To align integrated distribution of program resources with training for program outreach
• To increase coverage of all children especially those not attending schools and anganwadi centers through
active engagement of ASHAs
• To increase ownership at district level towards the program with regular review of program preparedness
through District Coordination Committee Meeting
• To sustain and strengthen inter-departmental convergence within stakeholder departments to maximize reach
to schools and anganwadi centers
15
Rajasthan National Deworming Day-2016:
Roles and Responsibilities of Department of Medical,
Health and Family Welfare
•
•
•
•
•
•
•
•
•
Target of children (1-19 years) finalized
Lead NDD coordination committee meetings at all levels
Ensure procurement, transportation and distribution of drugs at all levels
Plan cascade model of training in coordination with other stakeholder across all levels
Print training and IEC material and provide budgetary allocations for further dissemination to blocks
Integrated distribution of NDD kits with training
Implementation of the mix mass media strategies at all level for greater community awareness
Facilitate involvement of ASHAs for greater reach to all children especially out of school children
Adverse Event Management protocols to state’s requirements and dissemination at various levels to
ensure preparedness
• Depute monitors for checking preparedness on and before National Deworming Day Feb 10 and
Mop Up Day, Feb 15, 2016
• Ensure timely reporting of coverage and compile the same for sharing with GoI
16
Rajasthan National Deworming Day-2016:
Roles and Responsibilities of Department of Education
• Support Department of Health in implementation of NDD for extending program to
private schools
• Effective program implementation by teachers and schools through safe drug
administration to school age children (including out-of-school) on NDD and Mop up
Day
• Block officials (BEO/BRPs) to attend district level training
• Train headmasters/teachers at block level trainings
• Integrated distribution of NDD kits in block level trainings to all schools
• Community mobilization through School Management Committees and other
activities
• Monitoring visits by officials on National Deworming Day and Mop Up Day
• Report accurate coverage data to Department of Health in standardized reporting
formats within specified timelines
17
Rajasthan National Deworming Day-2016:
Roles and Responsibilities of stakeholder
Department of Women and Child Development (ICDS):
• CDPOs to attend district level trainings
• Train lady supervisors and anganwadi workers using platform of monthly meeting on
deworming program
• Integrated distribution of NDD kits in block/sector level trainings to all AWC
• Effective program implementation by anganwadi workers through supervised & safe
drug administration on NDD and Mop up Day
• Ensure community mobilization through anganwadi workers using existing
platforms like VHSC
• Monitoring visits by ICDS officials on National Deworming Day and Mop Up Day
• Report accurate coverage data to Department of Health in standardized reporting
formats within specified timelines in the cascade
18
Support expected from partners
• Panchayati Raj Department
• Support in community mobilization and awareness generation through PRIs
• Include deworming as an agenda in the meetings of PRIs to be held in January / February
2016
• Local Self Government Department
• Support in community mobilization and awareness generation through Urban Local
Bodies
• Include deworming as an agenda in the meetings of Urban Local Bodies to be held in
January / February 2016
• Public Health Engineering Department
• Support in community mobilization and awareness generation through the various
programs/ meetings organized by the department by including deworming as an agenda
item
19
Preparations for NDD 2016Policy Advocacy
Progress so far:
• NDD operations plan for better clarity on roles of partners and timely execution of program
• Following letters released
 Letter released from Department of Health to Kendriya Vidhyalaya and Navodaya
Vidhyalaya for engagement during NDD
 Joint Directives signed by all four department
• Freezing of target(denominator) for NDD 2016 for estimating coverage finalized and
shared with GoI
• Meeting of nodal officers of Health, Education and ICDS conducted in September and
December
• Inclusion of private schools in NDD 2016
20
Status Update on preparations for NDD 2016Policy Advocacy
Parameters
Target*
Total number of private schools
34,056
Children enrolled in private aided schools (6-19
years)
80,73,369
% children in private schools
32%
Strategy for Private Schools
• All private schools in all districts across state would be covered
• Training and distribution of all program resources i.e drugs, IEC training handouts to private schools aligned
with block level trainings
*(Source: DISE 2014)
21
Preparations for NDD 2016Drug Procurement and Logistics
• Drugs are sufficient for all children in the age group of 1-19 years in the state
Cascade for Drugs of school age children
Cascade for drugs of pre school age children
At State level:
- 30.8 million drugs received from WHO
- Transportation of drugs from state to all districts
completed
At District Level
- Sufficient drugs received in 31 districts
- Transportation of drugs from districts to blocks by
January 15
At Block level
– Drugs received by the BCMHO
- Received in 85 blocks as on Jan 12, 2016
- Drugs to be distributed to BEEO
- Distribution of drugs to all schools in block
level training (19- 29 January, 2016)
At State level- Requisition and procurement of drugs for pre
school age children
- Supplied by RMSC to district warehouses
- Status: completed for all 33 districts
At District level –
- Drugs available at district drug warehouse
- RCHO would coordinate with the Deputy Director
ICDS and send drugs to BCMHO - Transportation of
drugs from districts to blocks (BCHMO) by January
15
At Block Level
– Drugs received by BCMHOs
- Received in 66 Blocks as on Jan 12, 2016
- Drugs to be distributed to CDPOs at for sending the
drugs for further dissemination in trainings (by 19-29
January, 2016)
22
Plan on preparations for NDD 2016Adverse Event Management
Progress so far:
• Effective adverse event management in place at all level state, district and below
• Coordination with RBSK team and 108 team to respond to any adverse event reported on
NDD
• Letter issued for district level preparations involving constitution of block level emergency
response teams to CHMOs
• Block level emergency response team: A doctor, nurse and ANM
• Sharing of contact no. of health officials at all health institutions
• Cover key messages of adverse event management in the training of front line workers of
the department of Education and ICDS
23
Preparations for NDD 2016Training Cascade
State Level
Training of
Trainers
• Training conducted on Jan
8
• 169 Participation of Health,
Education and ICDS district
level officials.
District Level
Training
• Training to be conducted
by RCHOs on January 1113
• Completed in 16 Districts
as on Jan 12)
• Participants to include
• BCMHO, BRPs
Elementary Education
and CDPO
Block level Training
• Training to be conducted by BCMHO, BRPs and
CDPO from January 19 to 29, 2016
• Participants to include
• ANMs, ASHAs of Health Department to be
trained by BCMHO in batches
• Representative from each School - Elementary,
Secondary, Private, KGBVs, Kendriya and
Navodaya Vidhyalayas and Madarsa to be trained
by BRPs of the Education Department in batches
• LS trained by CDPO. Further, AWWs to be
trained by LS during specific meetings for
deworming.
24
Glimps of State Training for NDD 2016
25
Preparations for NDD 2016Integrated Distribution Timeline (Schools and
Anganwadis )
Timeline
Program Activities
Jan
Remarks
Drugs
Transportation of drugs from districts to
Block wise distribution would be made as per the list
Jan 5 to Jan
blocks (BCMHO ) for school age
provided to Health department, in process
15
children
Drug present at district drug warehouse.
Jan 8 to Jan Drugs to be sent to block BCMHO offices
Bundling and transportation of drugs
15
from districts to blocks
26
Preparations for NDD 2016Integrated Distribution Timeline (Schools and
Anganwadis)
Program Activities
Timeline
Remarks
IEC, Reporting formats, training material (Hand-outs and flip chart), monitoring formats, adverse event
forms
Printing at state
Transportation up to district level
Transportation up to block level
Jan 8-11
Jan 14-15
Jan -16-17
Distribution of NDD kits during block/ sector
level trainings
Jan 19 – Jan 29
Received on January 11
Transportation from state to district as per the listing
Transportation from district to block as per the listing
As per the listing of number of schools bundling to
include the drug in the NDD kit final distribution to
front line workers in sector level trainings.
27
Preparations for NDD 2016Community Awareness and Mobilization
Community mobilization and awareness
Medium
Radio jingles
TV Spot (Scrolls)
Newspaper Advertisement
Posters
for
schools
and
anganwadis
Press sensitization meet at state
Inauguration events at state,
district and block level
Community handbill
Miking
Timeline for Implementation
February 8-15, 2016
February 8-15, 2016
10 & 14 Feb 2016
Integrated distribution at trainings: block / sector level, display at school
and anagwanwadi centers at least a week prior to NDD
With the launch event one day before NDD
State level-One day before NDD , District & block- on NDD
January- February, by ASHAs
February 1-10, 2016, discussion on NDD using platforms like VHSND,
panchayat meetings
IVR (Health mister voice to First week of February
health functionaries)
28
Inclusion of Volenteers
Letters to NYKS and Bharat Scouts & Guides for involvement
Preparations for NDD 2016Reporting Cascade
For the Department of Education
School level
Nodal Head Master
BRP
ADPC
Nodal officer RCEE
• All government schools to report
by February 19 to Nodal HM,
Private school, KVs, NVs and
Madrasas to report to BRP
• Compile all reports and share with
BRP by February 26
• Compile reporting forms and
monitoring form and share with
ADPC by March 10
• Compile and share reporting and
monitoring forms with Nodal
officer RCEE at State by March 17
• To share compiled report with
Nodal officer at Health by March
20
For ICDS
Anganwadi Worler
(AWW)
• Report by February 17, 2015 of
deworming week
ASHA
• To share with ANM by February
19, 2015
ANM
• ANM to share at block level by
February 26
BCMHO
• Compile reporting and
monitoring forms and share with
RCHO by March 10
RCHO
• Compile and share forms with
Nodal officer of Health
department (state level) by
March 17
29
Preparations for NDD 2016Action point
Responsibility
Issuance of joint directives from state to all districts and blocks
Department of Health
• Letters to all districts for District Stake Holder Meeting
Department of Health
• District Level Stake Holder’s Meeting to be conducted in January and first week February to
review preparedness in all districts.
• Share minutes of meeting with department of Health
Video Conference with districts between all stakeholders-Health, Education and ICDS to assess Department of Health
program preparedness closer to NDD
Private school inclusion:
• Letter from NHM to the District Collectors for strengthening private school engagement in
NDD
• Letter to be issued from NHM to private school unions with copy to Education department
officials to private schools to ensure their engagement for NDD
• Letter from Education department (DEO) to write to all private schools in the district for
exact details of training, monitoring, reporting, drugs, preparedness and management of
adverse events, etc.
Department of Health,
Department of Education
30
Preparations for NDD 2016Action point
Responsibility
Training cascade and integrated distribution
• Education department to issue directive to districts and blocks to organize block level trainings of
teachers between January 19-29
• WCD to issue directive to districts and blocks to organize block level training of CDPOs/LS/AWWs
between January 19-29
• Ensure timely trainings at district and block level and increased participation
• Integrated distribution of NDD kits at all levels
Department of Health,
Education, WCD
Training reinforcement:
• Provisions for using existing platform, departmental portals (Health and WCD) for sending SMS to
all field level functionaries
Department of Health,
Education, WCD
Adverse event management:
Department of Health
• State adaptation of adverse event protocol, dissemination to Education and WCD for further sharing
with respective officials and functionaries
• Dissemination of protocols to all CMHOs, BMHOs and other officials and orientation for block level
officials and functionaries on standard procedures
Community awareness and mobilization
• Letter from NHM to ASHAs for sensitizing children, families during community meetings
• Letter from Education department to teachers/head masters for community sensitization during
Parent Teachers meeting
• Letter from ICDS to AWW and head master for community sensitization during VHSC
Department of Health,
Department of Education,
WCD
31
Support from Development Partners
UNICEF
 Technical and Financial Support
 Financial Support for drug transportation from State to Block level
 IEC (Letter from Hon’ble Health Minister to ASHA)
Evidence Action-Program Support for NDD 2016
Technical support to program extended through human resources to facilitate preparedness in all program areas such
adequacy of drugs, availability of IEC, training status, monitoring on field.
 Full time engagement through state team of 4 members
 3 Regional Coordinators at district/regional level to support institutionalization efforts
 33 District Coordinators to support on-ground program coordination with stakeholders, field monitoring
for 3 months around deworming (December 2015-March 2016)
 4 Tele-Callers to track preparedness of districts and below through calls conducted (December 2015-March
2016) and 1 Tele-Caller focussed for tracking progress of private schools
 125 Independent Monitors hired for monitoring in field on NDD, Mop Up Day and Coverage Validation.
 Support from National Office at Delhi across all areas as required
 Quality Assurance of trainings through support in the Training pre-post and monitoring
 Sharing of regular updates with three department on daily basis based on tracking of drugs, trainings and
32
reporting for timely corrective actions
THANK YOU