Post on 23-Jan-2018
The Adolescent Girls' Anaemia Control Programme : A decade of programming experience to break the inter-generational cycle of malnutrition in India
The journey from Pilot to Scale
Implications of Anaemia
Becomes anaemic during
pregnancy
Baby born with low iron stores and
haemoglobin level. Increased risk of
childhood stunted.
Uncorrected anaemia in infancy and childhood
Enters adolescence with low iron stores &
haemoglobin level
Adolescent enters reproductive cycle
with low iron stores & haemoglobin
level
Intergenerational Impact
Negative Consequences of
Anaemia
Impaired physical growth & cognitive
development
Poor reproductive outcomes
Reduced work productivity &
income earning capacity
20 % of Adolescents (10-19 years) : in world are from India
48% of Indian adolescents are GIRLS !!!
1 out of 2 Adolescent girls -
anaemic
• 56% anaemic*
• 20% moderate to severe anaemia
• 16 % begun child bearing
• Dietary iron intake <50% of
Recommended Dietary Allowance
(NNMB 2012)**
*DLHS 2 and NFHS 3Source : World Population Prospects : The 2012 Revision
Knowledge centered program cycle : from Innovation to Universalization
EVIDENCE
Using national and global research and
findings
INNOVATION
Pilot testing an innovation with
scale
EVALUATION
Documenting the effectiveness of an
innovation
REPLICATION
Expanding an effective
intervention
UNIVERSALIZATION
Scaling up and mainstreaming Knowledge
generation and
dissemination
VM Aguayo et. al. 2013
Global research seemed to indicate Weekly
schedule of Iron and Folic Acid Supplementation could be practical, safe and effective strategy in
reducing anaemia prevalence
UNICEF initiated a Pilot to control Adolescent Anaemia among girls
Starting: Year 2000 (20 districts in 5 states)
Platform: Govt. schools,Anganwadi centres
Target group
School-going adolescent girls (grade 6th to 12th)Out of School Adolescent Girls
Channel: Nodal teachers (responsible for providing interventions to students), field level anganwadi workers (for out of school girls)
Programme Elements
Three interventions
Every week One Iron Folic Acid tablet (100 mg elemental iron and 0.5 mg folic acid)
Biannual deworming (Albendazole 400 mg)
Monthly Nutrition Education
Strategy: Fixed day, Fixed site, fixed responsibility
UNICEF : technical and financial lead for programme design, capacity building, IEC, supply gap filling, monitoring and evaluation, documentation
Health and Family
Welfare
Women
and Child
Development
Human
Resource
Department
Convergence of Three Ministries
• UNICEF initiated a pilot in 20 districts of 5 states
• Expanded to 52 districts of 13 States* by end of 2005
• Covering 8.8 million adolescent girls
• Expanded to all districts of 13 states* by 2011
• Covering 27.6 million adolescent girls
• Government of India launched the Nation-wide ‘ WIFS’ Programme in 2012
• Targeting 108 million adolescent girls and boys both
2000 – 05 Innovation Phase
2006 – 11 Evaluation -
Consolidation Phase
2012 onwards Universalization Phase
Phase-wise Progress
* UNICEF supported
Aimed to document cost and effectiveness
Scaling up by the Government
Reduction in prevalence of overall anaemia (HB <120g/l) in adolescent girls after 1 year of implementation
8175
88
6573
78
40
53
80
54
39
54
AndhraPradesh
Gujarat MadhyaPradesh
Maharashtra UttarPradesh
Pooled
Baseline Endline
Over all anaemia : Statistically significant 24 %age point reduction (30.6% decrease)
Moderate to severe anaemia : Average 8.4%age point reduction (43.1 % decrease)
For both girls & boys
Launched in 2012
Program Coverage: From Pilot to Universalization (2000 to 2015) : A decade of programming experience
2000-2001 2002-2005 2006-2010 2011 2012-2015
20 districts/5 states
52 districts /13 states
State-wide/13 states (Govt. funds)
All States and UTs (Government funds)
Pilot Expansion Universalization
14.5 million
8.8 million
108million
27.6million
State-wide/13 states
Girls only Girls and boys both
INR 21 – 62 per adolescent girl per annum(supplies, training, communication, monitoring and assessment)
INDIA WIFS : The ten make-
or break elements
10 1 23
45
67
8
9
Techno-managerial unit at state level
Partnership with academic/training institutes to capacity building
Preventing supply stock outs
Emergency Response System for managing adverse effects
Sustained positive engagement with media
Branding andcelebrities
Basket of services
On fixed day
Reinventing strategies for
unreached
Convergence needs highest authority’s
leadership
Use of evidence and partner’
coalitions
Acknowledgements
Government of IndiaVictor M. AguayoKajali PaintalGayatri Singh Jee Hyun Rah Vani Sethi