Objective="Increase Iron, Folic Acid (IFA), and Vitamin A supplementation among women."
Details for Reform Option "Awareness Generation on Vitamin A and Anaemia, Jharkhand"
Jharkhand is a tribal dominated state with poor irrigation; almost 75% of the districts have been classified as being deprived of water. This, combined with other socio-economic factors, has led to extreme food insecurity in the state especially among people living Below Poverty Line (BPL). The government runs several micronutrient supplementation programmes in IFA and Vitamin A; nutrition programmes are also conducted through Anganwadi and Sub Centres for pregnant and lactating women, adolescent girls and children below the age of 6 years. Despite that, the Rapid Household Survey (1998) found that coverage of IFA tablets was very low, ranging from 1.9% to 32.5%; regular consumption of these tablets was even lower at 14.6%. The reason for such low compliance was lack of awareness of the importance of IFA in foetal growth.
In June 2004, Government of Jharkhand launched an anaemia control project in coordination with Vikas Bharati, a local Non-Government Organisation (NGO) and MOST, a USAID funded micronutrient initiative. This pilot project was started in 5 blocks of the Gumla district, covering a population of 400,000. Government of Jharkhand provided consumables and logistical support while Vikas Bharti focussed on community mobilisation. Technical support to the project was extended by USAID-MOST. The main thrust of the project was to raise awareness among women and adolescent girls of IFA supplementation and its regular consumption.In each village, a central location was selected for the activities, like the Anganwadi centres, Panchayat Bhawan, Sub Centre or the local clubhouse. Anganwadi Workers were chosen as service delivery persons in the villages which had an Anganwadi Centre (AWC); villages which did not have an AWC, a Vikas Bharti Worker (VBW) was selected as the delivery person. A Cluster Resource Person (CRP) was chosen with the help of the Panchayat, whose task was to monitor the activities. The CRP also served as a link between frontline workers and Vikas Bharti.The main responsibility of frontline workers was to raise local support from teachers, village elders, both male and female, Self Help Groups, Mahila Mandals, and the like. With their group effort they then mobilised the target segment. Three-day training was given to health service providers and frontline workers on how to counsel for raising awareness and motivation among the target group. The focus of the training was to emphasise the importance of IFA tablets and symptoms and consequences of anaemia. Songs were also composed in local dialects so that IFA gained common currency.
Results:The average consumption of iron tablets in the 5 blocks increased from 35% in March 2005 to 85% in September 2005 and has consistently remained at that level.
Low-cost. Since it is a joint project of the State government and USAID-MOST it is difficult to get exact information on the cost.
5 blocks in Gumla district in June 2004.
From planning to implementation it took almost 18 months.
Increased awareness: Raising awareness has led to increased compliance with regular consumption of IFA tablets.
Health seeking behaviour: Increased awareness led to increased health-seeking behaviour in the community.
Mobilisation of women: Difficult to mobilise women out of their busy everyday schedule.
Monitoring mechanism: Difficult to devise simple and effective monitoring mechanism for regular consumption of the IFA tablets.
Logistics: A lot of planning and effort are required to maintain continuum of services.
Well trained service providers.
Easy- to-understand IEC material.
Committed field staff.
Effective NGO partners.
Who needs to be consulted
It is an awareness generation programme, which makes the activities self-sustainable.
Chances of Replication
Since the reform is of low cost and since majority of Indian women are anaemic it should be replicated widely.
Simply diagnosing women as anaemic would not alter their health condition unless their compliance with the standard treatment for anaemia is maintained. This can be achieved only through raising their knowledge about complications related to anaemia and other micro nutrient deficiency.
Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics, May, 2006.