ADOLESCENT GIRLS ANAEMIA CONTROL PROGRAM

ADOLESCENT GIRLS ANAEMIA CONTROL PROGRAM-Karunya Vinukonda

1INDEXIntroductionAnaemia & consequencesStatisticsObjectiveStrategyInitial phase, consolidation phase, expansion phaseSample sheetLessons learntConclusionReferences

INTRODUCTIONAdolescence: transition phaseRapid growth phase: 45% skeletal growth- 15 to 25% adult height achievedIncrease in lean body mass, expansion of blood volume, onset of menstruation- iron requirement

ADOLESCENT ANAEMIAAffects growth and development concentration learning ability appetite irregular menstrual cycles physical fitness work productivity lower pregnancy iron stores LBW, Preterm new borns or still births.

STATISTICSIndia 113 million adolescent girls between ages 11 to 18 years56% - anaemic [64 mn girls]

OBJECTIVEMain objectiveTo reduce the prevalence and severity of anaemia in school-going adolescent girls using schools as delivery channels and in out-of-school adolescent girls using the community anganwadi centre of Indias ICDS programme as the delivery platform.

STRATEGYGlobally, 3 pronged strategy1) Dietary diversification and improvement2) Food fortification with iron and other essential micronutrients (vitamins and minerals)3)Regular consumption of IFA supplements.Relevance to India

PROGRAM STRATEGY3 interventionsWIFS supplementation comprising 100 mg of elemental iron and 500g of folic acid 52 weeks a year for the prevention of nutritional anaemia

Why?

PROGRAM STRATEGYBi-annual deworming prophylaxis (400 g of albendazole) six months apart for the prevention of helminth infestations

PROGRAM STRATEGYInformation, counselling and support to adolescent girls on how to improve their diets, especially iron intake, how to prevent anaemia and how to minimise the potential undesirable effects of WIFS and deworming.

INITIAL PHASE (2000-2005)Departments of Health and Family Welfare, Women and Child development, and Education played a key roleHow?Innovative phase

INITIAL/INNOVATIVE PHASEThe initial phase of the programme was launched in 2000-2001 across 20 districts in five states, namely Andhra Pradesh, Bihar, Gujarat, Rajasthan and Tamil Nadu. In 2001-2002, six additional states (Jharkhand, Madhya Pradesh, Maharashtra, Odisha, Uttar Pradesh and West Bengal) initiated the programme in 12 districts.

INITIAL/INNOVATIVE PHASESchool-going girls: The Department of Education was the nodal department responsible for expanding the coverage Principals and teachers associations parent-teacher associationsThe district inspectors of the Department of Education were responsible for monitoring

INITIAL/INNOVATIVE PHASEOut-of-school girls: The Department of Women and Child DevelopmentA community-based approach was adopted comprising supervised IFA consumption at the anganwadi centre using a girl-to-girl approach.

EVALUATION PHASEResultsEvaluation in 7 states Andhra Pradesh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Uttar Pradesh and West Bengal. 8.8 million adolescent girls were reached during this phase.Adherence

EVALUATION PHASESupervised WIFS consumption and recording of programme adherence in school registers anganwadi centre registers and girls self-reporting cardsEnhancing overall awareness about the programme by covering the launch of the programme through radio and televisionDispelling potential misconceptions

EVALUATION PHASEInvolvementUse of IFA stock registers in schools and reporting formats at different levelsDesignation of a nodal person at every level for regular reporting and tracking of girls adherence to the programme;Capacity building of ICDS workers

EVALUATION PHASE

EVALUATION PHASE

EVALUATION PHASE

CONSOLIDATION PHASE (2006-2010)Garnering political commitmentPlanning and convergenceEffective programme implementationStrategic gap fillingProgramme communicationMonitoring and evaluation

CONSOLIDATION/ REPLICATION PHASE

CONSOLIDATION/ REPLICATION PHASE

CONSOLIDATION/ REPLICATION PHASE

EXPANSION PHASE (2011 & BEYOND)2011 GOI- SABLA RG scheme for empowerment of adolescent girlsNutrition and non-nutrition servicesACP + Hot cooked meal + education & counselling on reproductive and sexual health+ FP + Prevention of early pregnancy & HIV + menstrual hygiene management

EXPANSION/ UNIVERSALISATION PHASE

STRATEGIES

SAMPLE

SAMPLE

LESSONS LEARNTEvidence-based advocacyData on effectiveness and costSynergy among state departmentsInvolvement of stakeholders : at all levelsTimely and quality communicationTimely availability of supplies

LESSONS LEARNTAn integrated package of interventionsUse existing delivery platforms: today while creating new policies and program opportunities for tomorrowGirls are the best advocates :peer to peer and girl to girl education

Figure 4: A continuum of care for the nutrition, development and empowerment of adolescentgirls Adolescent Girls Anaemia Control Programme, India 2011 and beyond

CONCLUSIONThe lessons learnt suggest that the AGACP has the potential to become an important platform for intersectoral convergence to empower adolescent girls, reduce gender and social inequities and break the inter-generational cycle of undernutrition and deprivation in India

REFERENCESThe Adolescent Girls' Anaemia Control Programme: a decade of programming experience to break the inter-generational cycle of malnutrition in India by guayo VM , Paintal K, Singh G.Adolescent girls anaemia control programme, Gujarat, India by P.V. Kotecha, S. Nirupam & P.D. KarkarAnaemia Control Programme for Adolescent Girls (11 - 18 Years) in OrissaPrevention of deficiency anaemia in adolescents: role of weekly iron and folic acid supplementation. World Health Organization, 2011.Weekly iron and folic acid supplementation programmes for women of reproductive age: an analysis of best programme practices. World Health Organization, 2011.Adolescent Girls Anaemia control program by the UNICEF

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