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Rajasthan National Deworming Day 2016 An Overview

Rajasthan National Deworming Day 2016 An Overview. 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

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Rajasthan National Deworming Day 2016 An Overview

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  1. Rajasthan National Deworming Day 2016 An Overview

  2. 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 • About Evidence Action’s technical assistance

  3. 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. Whip worm Hook worm Round worm

  4. 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

  5. Complementary Ways of Addressing Worm Infections Short Route Long Route Improved sanitation and waste management E.g., improving WASH facilities in schools Approach Deworming drug administration via NDD Improved hygiene education and awareness. Ex, delivered via public health system, community or schools Objective • Treatment: • Reduce morbidity • Reduce individual worm burden 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

  6. School/ Anganwadi based deworming & fixed day approach Safe Cost-effective Scalable Why fixed day approach? • 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 • 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 • 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) • Due to leveraging existing school infrastructure, school-based deworming has the potential to reach >80% of pre-school and school-age children

  7. How to Treat Worm Infection? 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 Albendazolesyrup 5 ml (Half Bottle 200 mg)/Half tablet for children between 1 -2 years Albendazole tablet (400mg) for children > 2 years

  8. 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 *Source-NDD report 2015 released by Ministry of Health and Family Welfare, GOI dated November 27, 2015

  9. 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 *Source: Data submitted by Government of Rajasthan to Ministry of Health and Family Welfare, Government of India dated 15th April, 2015

  10. Rajasthan National Deworming Day-2015:Key Achievements

  11. National Deworming Day - 2015

  12. 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 governmentschools, private schools, madarsaand anganwadicenters 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 anganwadicentres • 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

  13. Preparations for National Deworming Day-2016:Updates so far NDD 2016 Orientation Meet Revisions in guideline for NDD 2016 Review Meet NDD 2015 *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

  14. Rajasthan National Deworming Day-2016:Targets • 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 children 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

  15. Rajasthan National Deworming Day- February 10, 2016: Overview • Objectives: • To deworm all children in age group of 1-19 years through schools and anganwadicenters • Inclusion of centrally affiliated school (Kendriya and NavodayaVidhyalayas), 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

  16. 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

  17. 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

  18. 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 anganwadiworkers 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 anganwadiworkers through supervised & safe drug administration on NDD and Mop up Day • Ensure community mobilization through anganwadiworkers 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

  19. 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

  20. Preparations for NDD 2016-Policy 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 KendriyaVidhyalayaand NavodayaVidhyalayafor 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

  21. Status Update on preparations for NDD 2016-Policy Advocacy • 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)

  22. Preparationsfor NDD 2016-Drug Procurement and Logistics • Drugs are sufficient for all children in the age group of 1-19 years in the state

  23. Plan on preparations for NDD 2016-Adverse 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

  24. Preparations for NDD 2016-Training Cascade

  25. Glimps of State Training for NDD 2016

  26. Preparations for NDD 2016-Integrated Distribution Timeline (Schools and Anganwadis)

  27. Preparations for NDD 2016-Integrated Distribution Timeline (Schools and Anganwadis)

  28. Preparations for NDD 2016-Community Awareness and Mobilization

  29. Preparations for NDD 2016-Reporting Cascade For the Department of Education For ICDS

  30. Preparations for NDD 2016-

  31. Preparations for NDD 2016-

  32. 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 Coordinatorsto support on-ground program coordination with stakeholders, field monitoring for 3 months around deworming (December 2015-March 2016) • 4 Tele-Callersto track preparedness of districts and below through calls conducted (December 2015-March 2016) and 1 Tele-Callerfocussed 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 reporting for timely corrective actions

  33. THANK YOU

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