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Control of Nutritional
Anaemia in School going
Adolescent Girls
Control of Nutritional
Anaemia in School going
Adolescent Girls
Experiences in JharkhandExperiences in JharkhandExperiences in JharkhandExperiences in JharkhandExperiences in Jharkhand
Directorate of Social WelfareDepartment of Education
Department of Health and Family WelfareGovernment of Jharkhand
Background 4
Project Implementation 9
Training and Capacity Building of Functionaries 14
Local Resource Mobilization 19
Supply and Logistics Management 24
Monitoring and Evaluation 27
A Success Story in the War Against Anaemia 34
Annexures 38
ContentsContents
Control of NutritionalAnaemia in School going
Adolescent Girls
4
CHAPTER 1 BackgroundBackgroundAnaemia is a serious public health problem, which affects the mental andphysical development, as well as health maintenance and work performance.Iron deficiency is by far the most common cause of anaemia worldwide.About 2 billion people suffer from varying degrees of anaemia in developingcountries.
Iron deficiency occurs when insufficient iron is absorbed to meet the body’sneeds. This may be due to inadequate iron intake, poor iron absorption,increased iron need or chronic blood loss. Prolonged iron deficiency leads toiron deficiency anaemia (IDA).
Haemoglobin levels recommendedby WHO
Children 6 month-6 years <11g/ 100ml
Children 6-14 years <12g/ 100ml
Adult male <13g/ 100ml
Adult female <12g/ 100ml
Pregnant woman <11g/ 100ml
Background
5
Anaemia is the most common cause ofmaternal deaths, accounting for a fifth ofall maternal deaths (more than one lakhwomen in India die of pregnancy-relateddeaths, out of which 22,000 are related tonutritional anaemia). Severe anaemiaaccounts for 20.3% of maternal deaths.The risk of dying from haemorrhage andinfection is five to ten times greateramong anaemic women compared withnon-anaemic women. Anaemia amongwomen also compromises infant health bycontributing to intra-uterine growthretardation, low birth weight andultimately perinal mortality, and a higherrisk of irreversible brain damage in infants.
Anaemia in adolescent girlsAdolescence is a critical stage in the lifecycle, when the health of females isaffected due to growth spurt, beginningof menstruation, poor intake of iron dueto poor dietary habits and gender bias.
Iron deficiency anaemia affects over 60per cent of the adolescent girls in India(NFHS 1992). Anaemia in adolescent girlshas far-reaching implications. Theanaemic adolescent girls grow into adultwomen with compromised growth, bothphysical and mental. These women havelow pre-pregnancy weight, and are morelikely to die during childbirth and deliverlow birth weight babies.
Therefore, investing in the adolescentgirls serves a dual purpose, as it helps tooptimise the development of the girls’inherent potential and provides a soundfoundation from which to launch thenext generation. Counteracting theeffects of anaemia can help to further
both the above aims. Efforts to controlanaemia in adolescent girls have adopteda two-pronged approach—a weeklyregimen of iron supplementationsupported by an interpersonal interactionfor behaviour change in dietary practices,along with an intensive IEC campaignthat focuses on sustainable strategies forthe control of anaemia.
Control of nutritional anaemia is an entrypoint under the Dular strategy being
Distribution of IFA tablets during morning assembly.
Control of NutritionalAnaemia in School going
Adolescent Girls
6
iron status of a girl before she is subjectedto the rigours of pregnancy and child-rearing can help to minimise thedeleterious impact of anaemia on theoffspring. Hence, controlling anaemia inadolescent girls is now a national priorityand the government of the erstwhile stateof Bihar, along with UNICEF, took theinitiative in this direction by launching adistrict-based pilot project in the year2000–2001. The Anaemia Control Project(ACP) was launched in three districts ofJharkhand—Ranchi, East Singhbhumand West Singhbhum.
implemented in Jharkhand to focus oncare for children below three under lifecycle approach. Innovative approachesare being developed to plan, implementand monitor the strategy.
Pilot initiative for the controlof anaemiaNutritional anaemia has emerged as amajor limiting factor in the developmentof adolescent girls, as it compromisestheir own growth, and also hasimplications for the future generation. Anintervention that can help to improve
Life cycle approach of Dular strategyCommunity and family empowerment process
Community-based
MIS for below
3 year age group
Control of nutritional
anaemia in adolescent
girls and quality life
education-”Kishori Shakti”
Maternal nutrition and
safe motherhood
through C B MIS
ICDS - Education - RCH
ICDS - RCH
ICDS - RCH
Rest, food, iodised salt, safe delivery
practices, 3 check-ups weight gain, IFA,
TT, care of newborn, prevention of LBW
Infant feeding practices, psycho-social
stimulation, breast-feeding, complementary
feeding, care of girl child, immunisation,
feeding during sickness, ARI, vit A,
growth monitoring and promotion,
safe drinking water, personal
hygiene
Weekly supply of IFA, parents’
counselling, local resources management,
personal hygiene-menstrual period, AIDS education,
delay age at marriage, personality development,
completion of school, food-diet practices, sanitation,
prevention of worms and malaria
Capacity building
and skill upgradation
for better planning and
implementation
Capacity building
and skill upgradation
for better planning and
implementation
Background
7
Key features✦ Phase-wise approach: The project is being
implemented in two phases. Phase I aims to reachschool-going adolescent girls, who compriseapproximately 25 per cent of adolescent girls.Phase II aims to reach the out-of-school girls, whorepresent the majority of adolescent girls. Inaddition to addressing the health needs of these girlsthrough iron supplementation, the programme alsoenvisages educating them about their nutrition anddietary practices.
✦ Monitoring through compliance cards: Monitoringof the intake of iron supplementation is a keyfeature of the project. The girls themselves have tofill compliance cards after taking the iron-folic acid(IFA) tablets.
✦ Girl-to-girl approach: A girl-to-girl approach hasbeen adopted, in which the nodal girls play apivotal part in supporting their friends in school.
✦ Intersectoral convergence: This has been adoptedat every level—state, district, block and grassroots—involving all social sectors, including health, ICDS,education, PHED. This is helping to link theprogramme with other development programmessuch as water and sanitation, malaria control,deworming, etc., whose simultaneous interventioncan help to enhance the impact of anaemia controlmeasures.
✦ Behaviour change strategy: Apart from focusing oncauses, effects and control of anaemia, messages forbehaviour change with regard to dietary practices arealso included in the strategy. These emphasise foodsrich in iron, inhibitors (e.g. tea), and promoters ofiron absorption (e.g. vitamin C).
✦ Social mobilisation and parental counselling: Theprogramme in its initial phase has concentrated onenvironment building and social mobilisation on theissue of anaemia. Parents have been counselled onthe causes and prevention of anaemia. Theirmisconceptions regarding iron supplementationhave been removed through meetings—gramsabhas, mahila mandals, guru goshtis, etc.
Project objectivesShort-term goal: In the short term,the goal is to provide weekly IFAsupplements and ensure reasonablecompliance, thus bringing aboutquick reduction in the prevalence ofanaemia in adolescent girls.
Long-term goal: In the long term,the goal focuses on sustaining thebenefits accrued from the short-term measures, through intensiveIEC campaigns. Identifying localresources (human, agricultural,horticultural) that can mitigate theill effects of anaemia over a longperiod (that is, after thesupplementation phase is over),social mobilisation, and ensuringcommunity participation are someelements of this strategy.
The targets fixed for achievement bythe end of the project are:✦ To create awareness and bring
behavioural change in dailydietary practices.
✦ To ensure 90% weeklyconsumption of IFA tablets inschool-going girls.
✦ To establish regular supply ofIFA tablets to school-going girlsfor a period of 52 weeks in ayear.
✦ To ensure interdepartmentalcoordination for successfulprogramme implementation.
✦ To promote locally availableiron-rich foods.
Anaemia Control Project
Control of NutritionalAnaemia in School going
Adolescent Girls
8
Launching the ACP inJharkhandUnder Dular strategy, the life cycleapproach was started in Jharkhand. Thefocus was on children below three yearsage. Nutritional Anaemia Control Projectunder Dular strategy has a two-prongedapproach – (a) to reduce nutritionalanaemia among adolescent girls andmake this age group the state priorityand (b) to focus on child care issuesthrough adolescent health and nutritioncare.
It was decided by UNICEF and theGovernment of Jharkhand to use theforums of initiating the project forcommunicating it to the community, keyimplementers, policy makers, etc., andlaunch with high profile. All threedistricts organised various activities forlaunching and created a favourableenvironment through folk media, printmedia, orientation of district and block
teams, involvement of district magistratesand all the key officials, conductingcompetitions of different types like,slogan writing, singing, essay, etc., forschool going adolescent girls.
ACP in selected districts ofJharkhandIn Jharkhand, the programme wasformally launched on 6th November2000, in collaboration with theDepartments of Social Welfare, Healthand Education. The districts covered—Ranchi, East Singhbhum and WestSinghbhum—are UNICEF’s Dulardistricts, as well as Border District ClusterSeries (BDCS) districts.
An initiative of the state government andUNICEF, the programme ensures theinvolvement of intersectoral teams suchas ICDS, as well as schools andcommunity, in planning andimplementation.
JharkhandSahibganj
Pakaur
Godda
DumkaDeoghar
Jamtara
Giridih
DhanbadBokaroHazaribag
Kodarma
ChatraPalamauGarhwa
Latehar
Lohardaga
RanchiGumla
Simdega WestSinghbhum
EastSinghbhum
Saraikela-Kharsawan
Districts coveredunder ACP
ProjectImplementation
9
CHAPTER 2
The state nodal agency for the implementation of the programme is theDepartment of Social Welfare, in close collaboration with the HealthDepartment, Jharkhand Education Project, ICDS, and State Institute ofHealth & Family Welfare. In the districts, the Deputy Commissioner (DC)holds the overall responsibility for implementing the project.
District Coordination CommitteeEach district has a District Coordination Committee (DCC), whose membersinclude heads of different sectors like education, welfare, health, agriculture,etc., and representatives of major NGOs active in the district. The DCC meetsregularly under the chairmanship of the DC—in some cases the meetingtakes place once in two months, as in case of Ranchi, while in the otherdistricts, the meeting is held once in three months.
The role of the committee is to ensure smooth implementation of the projectin the district. Since the members include key officials from the Departmentof Health, ICDS, Agriculture, PHED, Education, etc., they ensure thecomplete participation of their respective department in the project. Duringthe DCC meeting, the DM also reviews the progress of the project and thedifficulties being encountered.
Project ImplementationProject Implementation
Control of NutritionalAnaemia in School going
Adolescent Girls
10
Nodal agencyThrough its deliberations, the DCCselected a nodal agency in the district,which is directly responsible forimplementing the Anaemia ControlProgramme in each district. In WestSinghbhum, the District ProgrammeOfficer (DPO) of the Welfare Departmentwas entrusted with the responsibility,while in East Singhbhum, it was theDistrict Superintendent of Education(DSE). In Ranchi, the District EducationOfficer is the nodal officer.
District Support Team (DST)Once the nodal agency and officer weredecided upon, the implementation of theprogramme began. Before the formallaunch in each district, district supportteams (DST) were constituted. DSTmembers were placed on assignmentbasis for project implementation in thedistrict. The DST members oversee theimplementation of the project along withthe District Education Officer (DEO).Their role is to facilitate the properimplementation of the project in therespective districts.
District Nodal Supported by Focal theme
Ranchi DEO Education, health, NGOs, “Intersectoral networking”
banks, horticulture, transport
West DPO Education, health, NGOs, “Integral part of the life
Singhbhum banks, horticulture, transport cycle approach of ECCSGD”
East DSE ICDS, health, NGOs, “Networking with the
Singhbhum corporate sector corporate sector”
Awareness creation by village teams through street play.
ProjectImplementation
11
There are two DST members (a male anda female) in each district. They aregraduates with some experience in arelated field.
District Technical Core GroupThe District Technical Core Groupconsists of representatives from thefollowing departments:✦ Health (CHMO/DY.CHMO)✦ ICDS (DPO)
✦ Education (DEO)✦ District Welfare Officer✦ Representative from PHED✦ Representative from agriculture, etc.
This is based on the individual capacityof people in these departments.
At the block level, the Block CoordinationCommittee has been formed, whosemembers include the Child Development
District Nodal Agency
Block Resource Centre
Cluster Resource Centre
Schools
Nodal teachers
Class monitors
School going
adolescent girls
Through ICDS systems,
community based structure
is AWC village with the
help of LRGs, through
Kishori Shakti Scheme
Non-school going
adolescent girls
Preparatory Activities
✦ Advocacy
✦ Capacity building
✦ Enumeration of target girls
Implementation Phase
✦ Distribution of IFA
✦ Monitoring
✦ Reporting
✦ Continuing advocacy for
diet modification and
positioning anaemia
control as priority for
individual and community
Multi-sectoral
Approach
Depts of
Health, ICDS,
Education, BEP,
DIET, NGOs,
clubs organising
joint activities
at district, block
and grassroots
level
1st Phase 2nd Phase
IFA distribution system
Control of NutritionalAnaemia in School going
Adolescent Girls
12
Mr. Arvind Vijay Bilung took charge as the District
Education Officer, Ranchi, only six months back. He
convenes the District Core Committee meeting every
month. Mr. Bilung describes the intersectoral
convergence and the positive response to the project:
“Various departments and agencies have all come
together in a unique effort to eradicate anaemia from
the district. Apart from government departments
(ICDS, Health, Education, PHED, Social Welfare),
public sector (banks, LIC, etc.), as well as private
sector and local media are involved in the project.
An effort is also being made to involve the Village
Education Committees (VECs).
“The programme has been well received at the
community level. Gram samiti members, people from
block level, community members, government
officials all took part in the launch of the programme.
The community was mobilised through nukkad
nataks, prabhat pheris, puppet shows, cassettes on
anaemia in local language, poster competition, slogan
writing competition, etc. The slogans on anaemia
coined by children were later plastered on the walls
all over the district.
“Among the girls, I personally feel the younger girls
in the middle school are more active and take keener
interest in the project as compared to their
counterparts in high school. We are also working to
bring out a recipe booklet on locally available
vegetables, their nutritional value, composition, and
preparation. As we all know there are 42 varieties
of saag (spinach), which is grown in this region.
“This year result of class X will be better. I expect
around 47.50 per cent result as compared to 35 per
cent last year.”
Steering the project in the right direction
“Mere distribution of IFA tablets is not enough…”Mrs. Nidhi Khare (IAS), District Commissioner, East
Singhbhum, has been steering the project in the right
direction. As a team leader she has been extremely
supportive and reviews the progress regularly in
the meetings organised in her office. The district
has given full support to the project. There have
been several initiatives undertaken under her
leadership in the district.
She explains, “Besides the distribution of IFA tablets,
there is a need to go into the causes of anaemia. The
rural people have a diet that includes saag and other
vegetables. However, there is still a high level of
anaemia, perhaps because their body is not absorbing
the iron properly. Therefore, I feel that deworming is
very important. Malaria, which is quite common here,
could also be one of the causative factors.
“Another interesting aspect that we found in
Jamshedpur is that girls in public schools are more
anaemic than their counterparts in rural schools,
mainly because urban girls want to look thin. Their
intake of iron-rich foods and fruits is not much, as
compared to the intake of junk or fried foods. This
was clearly demonstrated in a survey commissioned
in the schools of the district.”
She adds, “Mere distribution of IFA tablets is not
enough. Change in dietary practices is equally
important. Also important are health and sanitary
practices, especially in rural areas.
“In order to motivate girls to have higher haemoglobin
levels, we gave prizes to girls who had high
haemoglobin levels. Apart from gifts, we give them
saplings of plants rich in vitamin C such as amla,
lemon, etc.
“Non-school going girls are also being targeted under
the project through the school-going girls, who act
as motivators for these girls. The tablets for these
girls are given through AWCs (anganwadi workers)
and health centres (ANM).”
Control of NutritionalAnaemia in School going
Adolescent Girls
12
ProjectImplementation
13
No. of school going and out-of-schooladolescent girls in Jharkhand
Ranchi East Singhbhum West Singhbhum
No. of school going 59,037 44,000 20,048adolescent girls
No. of non-school going 20,500 — 18,780adolescent girls
Programme Officer, Block DevelopmentOfficer, Block Medical Officer and BEEO.
Preparatory activitiesAfter the constitution of the committees,each district developed its own IECmaterial like pamphlets, posters, banners,wall paintings, etc., to generateawareness. All efforts were made toinclude Anaemia Control Programme foradolescent girls in the regular meetings ofgovernment sector, NGOs, EducationDepartment, and village and communitylevel meetings to generate awareness.Simultaneously, the process ofenumeration of adolescent girls in andout of school was begun.
After a preliminary level of awarenesshad been generated, capacity building
activities were started. These includedorientation and training of district corecommittees, block core committees, andidentification of master trainers for thedistricts. Training of trainers was done,after which the districts were ready toenter the direct implementation phase.
Implementation strategyThe implementation strategy laysemphasis on involving girls to monitorthe programme. For this, a nodal girl hasbeen selected from each class of theschool, who helps in distribution of IFAtablets to her classmates and maintains arecord of compliance under the guidanceof the nodal teacher. The girl-to-girlapproach has been adopted as a specialstrategy to reach the out-of-schooladolescent girls.
Control of NutritionalAnaemia in School going
Adolescent Girls
14
CHAPTER 3
Training is an essential component for the successful implementation of anyprogramme. Once a preliminary level of awareness had been generated,capacity building activities were started. These included orientation andtraining of district core committees, block core committees and identificationof master trainers for the district. Training of trainers (2 days) was conductedand the districts were then ready to enter the direct implementation phase(that is, reach the actual implementers like school teachers, those involved indistribution of IFA tablets and finally, the school-going girls). Training ofnodal teachers was also conducted at the block level. In each school, onenodal teacher holds special responsibility to oversee the implementation ofthe programme.
The training content included the objectives of the Anaemia ControlProgramme, the implementation process, the activities to be organised atdifferent levels and the interventions planned.
Key features of the training strategyA key feature of the training strategy was that all trainings were conductedin a participatory manner. All trainings such as the training of nodalteachers, block level functionaries, motivator girls’ training and communitylevel training programmes were conducted locally in a participatory manner
Training and CapacityBuilding of FunctionariesTraining and CapacityBuilding of Functionaries
Trianing andCapacity Building of
Functionaries
15
through group exercises, presentations,etc. The trainees were informed aboutanaemia and its prevalence, developing acommon strategy for implementing theprogramme in their area and orientingthem about the project so that they couldactively participate in it and help run theproject successfully.
Training manualThe Directorate of Social Welfare, Bihar,in collaboration with UNICEF, hasdeveloped a training manual, which hasbeen used by the project districts to trainthe functionaries. The manual is made upof modular units, focusing on six types oftraining targeted at different levels offunctionaries and groups involved inprogramme implementation. Eachmodule includes the training curriculumand design. The curriculum content,duration and design are based on thetraining requirement of the group to betrained. Each module is a complete unit,defining its objectives, target group,duration, methodology and possibleresource group/person.
Training module unitsThe units of the training module are:✦ Module 1—Orientation of district-
level heads of various departments.✦ Module 2—District level training of
block-level functionaries.✦ Module 3—Training of master
trainers.✦ Module 4—Training of school-level
functionaries (nodal teachers)✦ Module 5—School-level orientation of
school-going adolescent girls.✦ Module 6—Orientation and two-day
IEC material development workshop
at the district level (for village/community level communicators)
Training at various levelsThe training was carried out at the state,district, block, school and communitylevels.
A workshop on the Anaemia ControlProject was organised by UNICEF inPatna, which was attended by the top-level functionaries of the project. Thecauses, symptoms, prevention andcontrol of anaemia were discussed andthe concept of the programme wasexplained.
Training and Orientation of Stateand District teamsA five-day training-cum-workshop onthe programme was organised at XavierInstitute of Social Service (XISS), Ranchi,from 5-9 July 2000 by UNICEF andChetna (Ahmedabad). A total of 30
Training of district team members.
Control of NutritionalAnaemia in School going
Adolescent Girls
16
These block-level people trained people atthe community level, including villagemukhiyas, sarpanch, local village doctors,leaders of Mahila Samakhyas, villagelevel NGO representatives, etc.
While the main features of the trainingwere common in all districts, the trainingprogrammes were designed to suit localneeds. In Ranchi, a series of threetraining programmes was held for urban
project staff from all five districts (Bihar& Jharkhand) attended.
A three-day workshop was organisedfrom 15-17 December 2000, by UNICEFat Bodh Gaya, in which staff from all fiveproject districts (Bihar & Jharkhand)attended. In this programme, discussionswere held on the training modules of theproject, distribution of IFA tablets andpreparation of annual workplans.
Keeping anaemia at bay
At Doranda Girls High School, Ranchi, Soni Gardi is a nodal girl of the
Anaemia Control Project, who acts as a motivator. She and her nodal
girl colleague fill the compliance card of each student. Soni is a student
of class X. She is a keen participant in extra-curricular activities and
has taken part and won prizes in various quiz competitions organised as
part of the project. She narrates one of the several slogans penned by
the girls themselves.
“Kishori Balikaon Ki Yahi Pukar
Nahin Honge Anaemia Ke Shikar”
Soni’s colleague Deepika Kumari echoes the same feeling. “I missed
several months of school due to a regular stomach ailment. I was referred
to Delhi, where the doctor told me that my haemoglobin level was low.
She advised me to take IFA tablets and iron-rich foods in my diet. I took
her advice and adopted our school programme and consume IFA regularly.
Now I feel much better.”
Ranchi East West
Singhbhum Singhbhum
No. of trainers trained 40 30 60
No. of functionaries trained 185 46 63
No. of teachers trained 1248 473 242
No. of motivator girls trained 1248 311 242
Trianing andCapacity Building of
Functionaries
17
schools between 23rd June 2001 and16 July 2001, in which headmasters,nodal teachers and nodal students weretrained. Overall, 89 schools in threeurban blocks of Ranchi and more than16,000 girls were covered.
Special plans were devised for ruralareas. The training of headmasters, nodalteachers and two nodal girls was heldjointly, as nodal girls were not permittedby the families to go to distant places fortraining. One-day joint trainingprogrammes were held blockwise in aseries, from 18 July to 16 October 2001,covering 535 schools and over 42,000girls. These were conducted either at theschool or at the Block Resource Centre.
The training focused on the followingaspects:✦ Anaemia, its causes, effects, the life
cycle approach.✦ Prevention and control by bringing
about change in dietary practices,behavioural change, supplementationand intake of iron-rich food.
✦ Role and responsibility of nodalteachers and girls in programmeimplementation; proper storage anddistribution of IFA tablets, andensuring intake of these by adolescentgirls.
✦ Review and monitoring—filling ofcompliance cards by girls, regularmaintenance of registers.
The training has helped in building up ateam of four trainers and implementers inevery school. The training process wasparticipatory and well received by theparticipants. In all the training
programmes, it was ensured that theblock level functionaries, i.e., BDO, MO,CDPO, BEEO, supervisory staff (LS, LHVand ANM) participated actively.
In East Singhbhum, a training of trainersprogramme was conducted from1-3 December 2000 at the Block ResourceCentre, Sakchi, Jamshedpur. A total of 30individuals from NGOs took the training,which followed the training moduleprovided by UNICEF. Resource personsfrom Tata Steel, MGM Medical College,and from voluntary organisations such asShadeva Parivar Kalyan Sansthan, GramVikas Kendra, Alternative for IndiaDevelopment (AID) and Centre forFamily Initiatives conducted the training.
The list of nodal teachers from middleand high schools was collected and theirtraining has been conducted. Schoolnodal girls have been selected andprovided training to form Kishori
Training of headmasters, nodal teachers in Ranchi.
Control of NutritionalAnaemia in School going
Adolescent Girls
18
Mandals and to assist their nodalteachers in distributing and maintainingrecords of IFA consumption.
In West Singhbhum also, training tookplace at various levels:✦ Orientation of senior district officials✦ Orientation of lady supervisors✦ Training of trainers
A programme that reaches all
Mr. D. Oraon, District Programme Officer,
highlights some of the notable features of the
Anaemia Control Programme in Ranchi district:
“There is convergence with Mahila Samakhya
of Jharkhand Education Project (JEP). We
have formed Kishori Manch at village level.
This is a forum of adolescent girls, which is
effectively used for the Anaemia Control
Project. The Kishori Manch has been formed
in six blocks in the district. Now we are also
going to open alternative schools all over the
district, where this project will also be
launched. This is being done in coordination
with the Education Department.
“Local Resource Groups (LRGs) have been
formed at the village level. In each LRG, 4-5
influential women are members, who
coordinate the various activities. They are
grassroot workers and our link with the
community. The chain is as follows:
LRG ---- AWC---- CRC----CDPO---- District
level
“We had a village contact drive, where a
village map was drawn through PRA. The
village map contained all information about
the village such as number of pregnant/
lactating women, adolescent girls, etc. In the
village map, houses were marked in four
colours. The map is kept at the AWC in each
village and we try and update the map
regularly. Each programme or project
becomes supply oriented, but in this project
we are working towards behaviour change,”
adds Mr. Oraon.
✦ Training of newly recruited ChildDevelopment Project officials
✦ Orientation of NGO representatives✦ Training of headmasters from
Chaibasa Sadar✦ Training of nodal teachers and
motivator girls from all 21 blocks ofWest Singhbhum
Local ResourceMobilisation
19
CHAPTER 4
Each district has developed its own IEC materials like pamphlets, posters,banners, wall paintings, etc., to create mass awareness. One of the notablefeatures of the project has been the local mobilization of resources. Banks,insurance companies, educational institutions and private individuals cameforward to sponsor activities, including the printing of IEC materials andcompliance cards.
Activities for community awarenessFor sustainability, it was essential to create awareness, bring aboutcommunity ownership of the programme, and bring about change in dietarypractices of families.
UNICEF developed two booklets on anaemia. One of them was circulatedamong school-going adolescent girls, giving details about anaemia, itssymptoms, causes, prevention, dietary practices, IFA tablets and the role ofschool girls in controlling anaemia. The second booklet was meant for
creating awareness among schoolteachers, emphasising their role inthe prevention of anaemia. Thisbooklet explains the reasons for theeducational and nutritionalprogrammes for adolescent girls.Besides these, many pamphlets,leaflets, brochures and posters wereprinted in each of the districts.
Local Resource MobilisationLocal Resource Mobilisation
Control of NutritionalAnaemia in School going
Adolescent Girls
20
Programmes were broadcast on TV andradio, and newspaper advertisementswere brought out. Apart from utilisingthe electronic and print media forawareness generation, traditionalmethods such as wall writing/painting,
folk dance and drama, prabhat pheris,etc., were effectively used. Wall writingswere done on roads leading to importantpublic places, including schools. Folkartists presented dance dramas in locallanguages such as Sadri and Mundari.
Wall painting on anaemia control.
Lending a helping handMost of the IEC activities in Ranchi were supported by different sources such as
public sector (CCL and MECON), media, corporate institutions, voluntary
organisations (Lions Club, Rotary Club, Red Cross, and AROX), Directorate of Field
Publicity, etc. Some examples of their contributions:
✦ Tata Steel, Lions Club and CARE, Jharkhand, sponsored the printing of 20,000
compliance cards.
✦ Directorate of Field Publicity organised extensive publicity campaigns,
exhibitions, and sponsored prizes for competitions.
✦ Food and Nutrition Board provided demonstrations with recipes on iron-rich
food is the school.
✦ The All Ranchi Old Xaverians (AROX) sponsored the printing of 2000 posters,
as well as cinema slides about the programme all over the district.
Local ResourceMobilisation
21
School girls were motivated to organisedance and drama on the theme ofanaemia on different occasions in schools,block and villages. From time to timeessay, slogan writing, poem writing,painting and quiz competitions based onthe theme of anaemia were organised andprizes awarded to the girls.
The District Support Team (DST) members,Anaemia Control Programme, Ranchi,have taken every opportunity to organiseand participate in seminars, workshopsand other events. They have used theseforums to disseminate information aboutthe Anaemia Control Programme.
To mobilise support for the programme,the DST members, Ranchi, participate in:✦ Planning and advocacy meetings at
the state level✦ Monthly meetings of BEEOs at the
district level✦ Monthly meetings of headmasters
(guru goshtis) at block level
✦ Meetings of BEEOs at the JharkhandEducation Project office.
At the end of every month, the DSTmembers participate in the meeting of theCore Committee in the chamber of theDEO, Ranchi, to share their experiencesand to seek advice.
In East Singhbhum, the district planningand advocacy meetings are heldquarterly. The District CoordinationCommittee (core group members) meetsmonthly, to review the progress anddevelop strategy. In order to reach thetarget at the grassroots level, localresource persons are to be identified andtrained. These will form local resourcegroups. Village contact drives will beundertaken in which resource mappingand family coding will be done.
In West Singhbhum, special awarenesscamps were held in each block in order totake the message of anaemia control to
Anaemia control: Everybody chips in…
In West Singhbhum, the following organisations contributed to the IEC
activities by sponsoring the printing of posters, stickers, wall writings,
messages and banners:
✦ Rotary Club (Chaibasa)
✦ New India Insurance Company
✦ Allahabad Bank, Central Bank, Punjab National Bank
✦ Sudha Dairy
✦ Production, Postal, and Forest & Horticulture departments
✦ Bookstores
✦ Private individuals
✦ NIIT
✦ Pathological labs (free Hb tests for adolescent girls)
Control of NutritionalAnaemia in School going
Adolescent Girls
22
Taking charge
Government Middle School, Getalsud (Angarha block,
Ranchi) is a coeducational school, with 755 students
in its middle school section and 265 students in its
high school section. The students of this school are
a motivated lot. Savitri Kumari of class X is an
example. Savitri says that she had no clue as to what
anaemia was, why the intake of IFA tablets was
necessary, and why one should consume iron-rich
foods, until the Anaemia Control
Project was launched in her school
two years ago.
Savitri says, “Under the project,
an orientation was given to the
teachers and later the didis (DST
members) came to our school to
tell us about anaemia and its
causes. Before I started taking the
IFA tablets each week (Monday),
I used to feel lethargic and weak.
Many of my classmates used to feel weak and some
of them even collapsed during prayers. At first we
were very hesitant in taking the tablets but our
teachers motivated us. They told us that it was
necessary to increase our haemoglobin levels. I have
been taking the tablets regularly since then and I have
also motivated my family members, especially my
elder sister, to consume iron-rich foods such as fruits
and vegetables.”
Savitri is proud of her
achievements and says, “I have
started taking part in sports such
as football and kabaddi. I have
also won first prize in the
athletics meet held in our school.
I want to motivate the non-school
going girls in my village about the
ill effects of anaemia.”
A motivated student spreads the word about anaemia
Mrs. Poonam Singh, District Superintendent of
Education (DSE), East Singhbhum is in charge of
school-going girls, while the Civil Surgeon is in charge
of the non-school-going girls in the project.
Mrs. Singh elaborates her plans, “We are planning
to organise an orientation programme for all principals
of government schools for their greater involvement
and to get their feedback on the project. We also
plan to organise haemoglobin tests in all government
schools. Public schools can also be involved if
interested.
“It has been found that more girls from public schools
are anaemic than their counterparts in government
schools and those studying in villages. For public
schools and intermediate colleges (to target girls in
the higher age group 16-19 years) we have a different
strategy. We are going to send a letter to all
principals of the schools and colleges, requesting
them to ask parents to get their wards’ haemoglobin
level tested. This can be done at the level of the
parents or at the school level. After the test if the
schools agree we can provide them with IFA tablets.”
Mrs Singh dwells upon the difficulties faced in the
district, which has a high concentration of tribals and
backward communities. “The greatest challenge is
working with the tribals. In Patamada block there is
a primitive tribe called Sabar, among whom there is
a practice that once a person is sick, he/she is left
alone in the deep forest. In case the sick person
returns from the forest, it is believed that the devi
(goddess) has cured the person of all illnesses. We
have to deal with these communities, which is not
easy.
“It has been found that anaemia in the district is
more due to worm infestation, which is common
because the adolescents, particularly in rural areas,
do not wear chappals (slippers). We are also
conveying the message that girls should wear slippers
and have plans for deworming as soon as the
examinations will start.”
Control of NutritionalAnaemia in School going
Adolescent Girls
22
Local ResourceMobilisation
23
the grassroots. Each of these camps wasattended by 500-600 people, 90% of thembeing adolescent girls and women. Thesecamps were attended by district andblock level officials, NGOs, teachers,headmasters of schools and influentialpeople of society. Various departments aswell as NGOs involved in the programmeheld exhibitions at the camp todemonstrate the activities for anaemiacontrol, stressing on the theme of“convergence of services.”
Competitions were held such as quiz,debate, painting, etc., at the camps. The
one-month long campaign in the blockswas given extensive coverage in themedia, including newspapers and localTV networks.
The project was unique in the sense thatit set an example for local resourcemobilisation. All compliance cards andother materials such as banners, wallpaintings, stickers, ads on TV and printmedia were sponsored by variouscorporate houses and governmentagencies such as LIC, GIC, TransportDepartment, banks, SAIL, Tata Steel,MECON, etc.
Slogans developed at community level are displayed on walls in the village.
Control of NutritionalAnaemia in School going
Adolescent Girls
24
CHAPTER 5
In Jharkhand, UNICEF is responsible for the supply of IFA tablets as perrequirement, for distribution. Purchase of IFA tablets is done by UNICEF andsupplied to the Directorate of Social Welfare for distribution. The Directoratein Ranchi supplies the IFA to the respective districts and the nodal agency inturn supplies the same to the schools for distribution.
Each girl in the school is given a tablet of IFA every week in the school. Thesetablets are stored with the nodal teacher in the school. Each girl receiving theIFA supplementation is oriented by the nodal teacher to fill up the self-compliance card.
The training programmes have also covered the intake of IFA tablets. Theparticipants, including nodal teachers and the adolescent girls, were briefedabout the utility of weekly intake of IFA tablets. They were also informedthat these tablets should not be taken on an empty stomach. In a few cases,there might be symptoms of nausea, constipation and change in colour ofstools, but these should not cause concern. These problems will go away afterregular intake of the tablets.
Supply and LogisticsManagementSupply and LogisticsManagement
Supply and LogisticsManagement
25
Every effort was made to remove thegirls’ fears and misconceptions regardingthe IFA tablets. On many occasions, theDPO, CDPO or nodal teachersthemselves took the tablets to encouragethe girls.
Manju Kumari is a student of class IX at Jawaharlal
Nehru Girls High School, Getalsud, Angarha block,
Ranchi. Manju is a changed girl after the initiation
of the Anaemia Control Project (ACP) in her school.
She used to feel weak and did not take interest in
studies or sports. She says, “I could not
comprehend easily what was being taught in class
and for this I used to get scolded by the teachers,
as well as my parents. I also had to attend to daily
household chores after returning home from school.
I did not feel like doing
anything. My eyes were dull
and my nails had become
yellow. I had never
undergone a haemoglobin
test, as there was no such
facility in our village.
“Now, after having known
about anaemia and the risks
due to the low haemoglobin
level, I have started taking
IFA tablets regularly. Many
of my classmates used to
remain absent on Monday,
when the tablets were
administered, as they did not want to take the
tablets. Initially, I too felt like vomiting after
consuming the tablets. But our nodal teacher,
Mrs. Imiliyana Surin, was very helpful. She told us
that we should not worry, as these tablets are safe
and have no side effects. I do not feel weak any
more and I am an active participant in the games.
Last year, I could not take part in the annual sports
meet but this year I stood first in the sports meet.
I also do most of the daily chores at homes and my
mother feels I have become
more responsible now.”
Manju adds, “ Now, even if the
distribution of IFA tablets is
discontinued, we will have no
problem, as we know that we
can maintain the haemoglobin
levels by regular intake of iron-
rich foods such as fruits and
vegetables in our diet.” She says
smilingly, “The boys in our
school are jealous because only
the girls get the IFA tablets.
They feel they too should be
given the tablets!”
The magic of IFA works on Manju
Source: District Administration Report, Jamshedpur
Control of NutritionalAnaemia in School going
Adolescent Girls
26
Progress despite all odds
Up-to-date distribution of IFA in 3 districts,including enrolled & out-of-school girls
The Anaemia Control Project is making good
headway in West Singhbhum despite a number of
constraints, in terms of poverty, poor infrastructure,
and high concentration of backward and tribal
communities. The District Programme Officer,
Mr R.N. Jha, outlines the special interventions that
have been taken to make the programme a success:
Health days (every Wednesday) are being observed
in the district. On this day a comprehensive package
of health services is being provided at the AWC,
including immunisation, health check-up, sanitation
and hygiene education. There are 2,25,000
adolescent girls in the district, out of which
1,85,000 are non-school going girls. These are being
reached through the 1393 Anganwadi centres
(AWCs) in the district.
For one full year after the launch of the project in
2000, the district administration carried out
intensive awareness building. Apart from prabhat
pheris and other campaigns, the District Support
Team members used to visit schools to create
awareness among students and teachers. Only in
the second year was the distribution of IFA tablets
in schools started.
The tribal community has been reached through
Mundas, who are locals with great influence over
the community. They are a kind of link to the tribal
community and have played a crucial role in
motivating the tribals.
All IEC materials related to the project have been
developed by mobilising local resources, such as
banks, LIC, computer institutes, etc. A convergence
cell has been created at the district level, which
has members from the health, education & ICDS
departments. Monitoring of the project, as well as
all other activities under ICDS, is being carried out
very closely.
Ranchi East Singhbhum West Singhbhum
Distribution of IFA
School going girls 34,02,000 14,68,540 9,62,060Round I (up to Sept. 2002)
6,57,000Round II (from Oct. 2002)
Non-school going girls 5,33,000 — 9,01,000
Monitoring andEvaluation
27
Monitoring is an essential and integral part of the project, which helps toensure progress and identify gaps. It enables programme managers andfunctionaries to analyse and take corrective action. In the Anaemia ControlProject, monitoring is carried out at four levels—at the school, block, districtand state level.
Monitoring at different levelsSchool level
(Nodal girls, nodal teacher, School Principal)
Block level
(BEEOs, and Cluster Heads)
District level
(DEO, District Coordination Committee, District Core
Committee, Civil Surgeon, DPO-ICDS)
State level
(UNICEF, Directorate of Social Welfare)
CHAPTER 6 Monitoring and EvaluationMonitoring and Evaluation
Control of NutritionalAnaemia in School going
Adolescent Girls
28
School levelAt the school level, monitoring of intakeof IFA tablets is done at three levels:✦ Self-monitoring is done by the
adolescent girl, who has to fill theindividual compliance card aftertaking the tablets every week.
✦ The nodal girl helps in thedistribution of IFA tablets andensures that girls in her group takethe tablets regularly.
✦ The nodal teacher observes the intakeof IFA consumption and maintains aweekly record in the register.
A monitoring form supplied by theDistrict Education Office has to be filledby the school, and signed by theheadmaster, nodal teacher and nodalgirls. This form contains informationregarding the number of tablets receivedby the school, number of girls whoreceived the tablets, requirement of IFAtablets, and the number of girls whohave taken the tablets for one, two,three, four and five weeks (Annexure 1).
Occasionally, the District Support Teammembers also visit schools to monitor theintake of IFA tablets. They also monitorthe level of awareness and change indietary practices.
Block levelThe forms containing informationregarding the distribution andconsumption of IFA tablets in schools arecollected at the block level. To know thelevel of utilisation of IFA tablets in theblock, the Block Extension EducationOfficer (BEEO) also fills a form detailingthe total number of schools in the block,Monitoring of records at district level.
Weekly consumption calendar.
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Monitoring andEvaluation
29
number of girl students, number oftablets distributed and number consumedin a month (Annexure 2).
Monthly monitoring meetings are held atblock level, which are attended by theheadmasters, nodal teachers and nodalgirls of all the schools in the block.Besides the monitoring form, theheadmasters are required to bring theregisters, compliance cards and emptywrappers of the IFA tablets consumed.These meetings are also attended by theBEEOs.
Meetings of the Block CoordinationCommittee are also held every month atdistrict level, in which BDO, MO, BEEOand members of active NGOs participate.
District levelMonitoring at the district level is carriedout at three levels:✦ A monthly meeting is organised by
the District Education Officer, inwhich all the BEEOs participate. Theybring with them the filled-uputilisation forms. Blockwise review ofthe progress is done by the DEO andDST members.
✦ A meeting of the Core Committee isalso held, in which the DST membersapprise the committee about theprogress and present their quarterlyworkplans, which are discussed indetail.
✦ The District Coordination Committeealso holds monthly meetings, inwhich the Deputy Commissioner
Review meeting of nutritional anaemia control project.
Control of NutritionalAnaemia in School going
Adolescent Girls
30
(DC) reviews the progress andprovides necessary instructions andguidelines for better coordination andimplementation of the programme.
State levelAt the state level, the Directorate ofSocial Welfare is overall in charge ofmonitoring and implementation.Representatives from the Directorateparticipate in the meeting of the District
Coordination Committee, as well as ofthe Core Committee, to review the statusof interdepartmental coordination in theprogramme.
The quarterly progress reports andworkplans submitted by the district officeare reviewed at the Directorate level andforwarded to UNICEF, Patna, regularly.Continuous support and guidance is alsoprovided by UNICEF, Patna.
Changing diets, changing livesThere is a high level of awareness about anaemia
among the girls at Scott Hindi Girls High School
(Chaibasa), where a number of programmes were
organised on nutritional anaemia by the DST
members. Some of the girls narrated their
experiences with the Anaemia Control Project:
Anita Sharma is a student of class X, who feels
that the intake of IFA tablets has made a big
difference to her health. Anita is now a peer
educator to other girls. According to Anita, ”Initially,
we were apprehensive about the intake of IFA
tablets. Every Saturday was nominated as IFA
distribution day and most girls used to bunk classes
that day to avoid taking the tablets. However, my
nodal teacher and the DST members convinced us.
After some initial vomiting tendency I did not
experience any problem and used to take IFA
regularly.
“I feel more energetic and confident now, and I
have started taking active part in other co-curricular
activities and sports in the school. My parents too
support me now after seeing the change in me. My
younger sister also looked anaemic and I took IFA
tablets for her too. She is much better now.“
Anita feels the best outcome of the project has
been the change in dietary practices. “Now we know
that we can avoid anaemia by regular intake of foods
rich in iron and vitamin C. I have been told that we
should not consume tea for at least 1-2 hours after
intake of food. I have also been told to pass on this
information to our less fortunate sisters in villages
who do not go to schools. I have a couple of friends
in the villages who have either dropped out or do
not go to school.”
Juhi Kumari, a student of class IX, echoes the same
feelings. Juhi used to feel weak and did not show
complete interest in studies. She used to get scolded
by her teacher, due to which she used to miss
classes often. After taking IFA tablets, she feels
more energetic, and has become attentive and
regular. Juhi adds, “With adequate knowledge I have
changed my dietary habits also. Unlike in the past,
when I avoided saag and other leafy vegetables,
now I myself ask my mother to prepare saag
regularly.”
The interest shown by the girls in the project is
evident from the number of questions they put to
the DST members & the DPO. Some of the questions
raised by the girls are very relevant and interesting.
Monitoring andEvaluation
31
For monitoring purpose, a two-day jointstate level review-cum-strategy planningworkshop is organised every alternatemonth at the state headquarters, underthe guidance of UNICEF, Patna.Representatives from the Directorate ofSocial Welfare, DPOs, CDPOs, DEOs, DSTmembers, and selected lady supervisors ofthe three districts participate in theworkshop. In the workshop, DSTmembers of each district present their
reports and plan of action for their district.Future plan of action is developed andtarget of achievement is fixed.
Monitoring at the state level is done notonly through meetings, workshops andreports, but also at the field level. StateCoordinator, Directorate of SocialWelfare, visits schools and participates inthe different training programmes anddistribution of IFA tablets in schools.
Reviewing progress
A mid-term review of the Anaemia Control Project was carried out in East Singhbhum, in
order to study the impact of IFA supplementation, as well as knowledge, attitudes and practices
on iron-rich diet among school-going adolescent girls. The study was carried out by Parivar
Kalyan Sansthan in the schools of three selected blocks—Dumaria, Patamda and Jamshedpur.
Some of the findings are given below:
Control of NutritionalAnaemia in School going
Adolescent Girls
32
Using the specified format, the nodalteacher indents the IFA tabletrequirement, prepares monthly reports ofnumber of tablets received, numberconsumed and the number required inthe following month. This becomes amonitoring tool for the nodal teacher atthe school level, and when consolidated,for the block and district level. At thedistrict level, the Project Coordinatorensures the supply of IFA tablets andtheir regular distribution.
Compliance cardA compliance card has been supplied foreach beneficiary, i.e., the adolescent girl,which has to be filled by the girl herself.The girls have been imparted training on
how to fill the cards. Those havingdifficulties are helped by the motivatorgirls in filling the cards.
Reaching the unreachedThe Anaemia Control Project has aspecial strategy to reach the large numberof adolescent girls who have dropped outof school or who never enrolled. Theseare reached through the girl-to-girlapproach, in which the selectedmotivator girls in each school have beenassigned the responsibility of reaching theout-of-school adolescent girls in theirrespective localities and ensuring thatthey participate in the weeklyconsumption of IFA tablets.
IFA distributionIn Ranchi, up till October 2001, UNICEFPatna has supplied 176 cartonscontaining 26,00,400 IFA tablets. Out ofthese, 17,47,012 tablets were distributedamong 624 schools, covering 59,037 girls.
Targeting out-of-school girlsUnder phase II of the project, non-schoolgoing girls are being targeted throughpeer educators (the school going girls)and through the platform of ICDS, whichhas a reach in almost all villages. KishoriMandals are being formed in villages.Each Kishori Mandal has 12-15 members,most of them school-going girls. Theformation of Kishori Mandals ismonitored by the CDPOs, with the helpof AWWs.
Under the Kishori Shakti Yojana bothschool-going and non-school going girlsare being targeted through KishoriMandals, whose members are being
1. Name of school
2. Month……… Class……… Section………
3. Sl. No……… Name of girls………. Age……
1st week—2nd week—3rd week—4th week—5th week—Remarks
4. Total no. of tablets consumed………
5. Signature of class teacher…………..
6. Signature of nodal teacher………….
Maintaining recordsAt the time of distribution of IFA tablets,a register is supplied to the nodal teacherof each school for maintenance of recordsof distribution and intake. The registercontains the following information to befilled by the nodal teacher:
Monitoring andEvaluation
33
trained. In the villages, Mahila Mandalshave also been constituted. There hasbeen convergence with PHED, Health,ICDS & Education departments. There is
a need to open more ICDS centres in thedistrict, as the Anganwadi worker is notable to cover all localities.
Kishori Shakti Yojana: Towards a better quality of life
Kishori Shakti Yojana is a means to
empower adolescent girls, so as to enable
them to take charge of their lives. It is a
holistic initiative for the development of
adolescent girls, by improving their
nutritional and health status, and
promoting self-development, awareness
of health, hygiene, nutrition, family life
and child care. The programme also
fosters convergence with
other sectoral
programmes, addressing
the interrelated needs of
adolescent girls and
women.
KSY utilises the platform
of the Anaemia Control
Project for adolescent
girls, to provide diverse
inputs such as quality of
life education to
adolescent girls. The
expected outcome of the intervention is
a better quality of life for the adolescents
and also the next generation.
KSY’s initiatives have resulted in better
understanding of anaemia, its causes and
prevention. Bela Mandal, mother of
12-year-old Uma, in Chanho block, Ranchi,
says, “Uma’s birth weight was below
2.5 kg. She had always
been a weak child. Now,
she has been taking IFA
tablets for the past eight
months and we can see
a marked improvement in
her health. Her teachers
feel that her
performance in school
has also improved. Now,
I also make it a point to
prepare iron-rich food
items such as saag in the
meals.”
Control of NutritionalAnaemia in School going
Adolescent Girls
34
CHAPTER 7
The Anaemia Control Project aims to have a major impact on the health,nutrition status and well-being of the adolescent girls in the project area. It isexpected that the prevalence of anaemia will reduce by 50% among theadolescent girls, improving their work productivity and school performance,as well as reducing absenteeism in schools. In the married adolescent girls,increased pre-pregnancy stores of iron will result in reduced maternalmortality, maternal morbidity and reduce the risk of low birth weight. Otherbenefits include increased awareness of diet and improved dietary practices,thus leading to better learning capacity, confidence and self-esteem.
The programme has inspired the girls of Jharkhand to launch a war againstanaemia, which is perceived to be the biggest killer disease of women andinfants. The real impact of the programme will be gauged only in the longrun, when the present-day beneficiaries, i.e., the adolescent girls, becomemothers.
However, the coverage of the programme and the level of awarenessgenerated in the community are encouraging trends. Already, a change inattitudes is being perceived both in the adolescent girls and in the parentstowards the consumption of IFA tablets, as well as towards dietary practices.Monitoring has revealed that girls are aware of the various causes of
A Success Story in the Waragainst AnaemiaA Success Story in theWar against Anaemia
A Success Story inthe War against
Anaemia
35
anaemia and are receptive toconsumption of IFA tablets regularly.
CoverageIn Ranchi, the percentage ofconsumption of IFA tablets was found tobe more than 83%.
The programme has provided ironsupplements to all school girls of thedistrict for one year now. A mid termevaluation of the Ranchi AnaemiaControl Programme for adolescent girlswas carried out between December 2002and February 2003, by Dr SubadraSeshadri, former Head, Department ofFoods and Nutrition, MS University ofBaroda. The study sample included 605girls from 35 schools in 8 blocks ofRanchi. Teachers, principals, nodal girls,as well as the District Education Officers,were also interviewed. Data wascollected on these aspects:✦ Programme planning, advocacy,
implementation and monitoring.
Success storiesRanchi has a sizeable population of Muslims, who fast during the holy month of
Ramzan. The DEO, Ranchi, received a number of queries during the month from the
school authorities and girls about the intake of IFA tablets in school, as they were
fasting. It was suggested that they could take the tablet after iftar (evening breaking
of fast) or during sahri (early morning meal). This solved the problem and the
school authorities reported that by regular consumption of IFA tablet, the health of
the girls had improved and they were also able to fast during Ramzan.
Kammo Kumari was anaemic and used to faint frequently. After taking the IFA
tablets, she seldom faints. Her brother, Ashok, a student of class III, was excited
to see the change in his sister’s health. He told his teacher, “My sister says that
IFA tablets will make her strong, like Shaktiman. I too want to have those tablets!”
In most coeducational schools, boys are demanding that they too should be provided
IFA tablets, and not just the girls!
Anaemia Control Project, East Singhbhum1. No. of Blocks 9
2. Total No. of Schools 366
3. No. of Schools covered under 341
Anaemia Control Project
4. No. of Schools covered in % 92.62%
5. No. of Schools going girls covered 44000
6. No. of IFA distributed
Round 1 1468540
(2001-up to Sept. 2002)
Round 2 657000
(From Sept. 2002)
7. No. of Trained HMs 137
8. No. of Trained Teachers 473
9. No. of Trained workers of various NGOs 90
10. No. of Motivator Girls 311
11. No. of trained district and block level 46
functionaries
12. No. of Master trainers 30
13. No. of Trainings — 1st Round 13
2nd Round 6
Re-orientation 7
14. % of IFA consumption 94.25%
Source: District Admn. East Singhbhum, Anaemia Control Project, East
Singhbhum, Survey of Parivar Kalyan Sansthan, East Singhbhum
Control of NutritionalAnaemia in School going
Adolescent Girls
36
Gaining strength from IFA
✦ Awareness regarding anaemia andthe programme.
✦ Consumption of IFA, benefits andside effects.
✦ Use of IEC materials.✦ Hb levels among the girls.
The notable findings of the Ranchi studyinclude:✦ Improved concentration in class by
the girls.✦ High level of awareness regarding
anaemia.✦ Regular consumption of IFA tablets
by 99.9% of the girls under teachers’supervision.
✦ Changes in dietary habits, in favourof iron-rich food.
✦ 1% severe anaemia and 20%moderate anaemia reported amongadolescent girls by the Ranchi study,compared to 7.1% severe anaemiaand 51% moderate anaemia amongadolescent girls in 16 districts of Indiain the most recent ICMR survey.
Removing misconceptionsMany of the girls were avoiding theconsumption of IFA tablets by stayingaway from the school on the particularday or by saying that they were fasting. Itwas found that many of the parentsthought that the girls were being givenbirth control pills. Another reason for nottaking of IFA tablets given by the girlshas been that after taking the pills, theysuffer from nausea and giddiness.
The teachers have held meetings withparents, in which they have explainedthe causes and ill effects of anaemia, andthe role of IFA tablets in controllinganaemia. The girls have also been advisednot to take the tablets on empty stomach,to avoid nausea and giddiness.
Damyanty Samar is a student of class IX at SPG Mission Girls’ High School, situated
in the heart of Chaibasa town. Damyanti lives in Badgor village, which is 18 km
away from Chaibasa town. Her parents are agriculture labourers, who want their
daughter to study despite all odds.
“My parents bought me a bicycle, on which I ride around 18–20 km to reach my
school. I used to feel very weak and tired, especially as the road from my village to
school is bad. However, once I started taking the IFA tablets I stopped feeling
weak. Even after attending school and commuting for such a long distance, I am
able to assist my mother in cooking and other household chores.”
A Success Story inthe War against
Anaemia
37
Distribution of IFA tablets among school going adolescent girls.
An officer and a role model
Lessons learnt✦ Controlling anaemia in adolescent
girls is a priority and the project hasdemonstrated that the school systemcan contribute significantly to thelives of the students. The girl-to-girlapproach has also been an effectivestrategy to reach the large number ofout-of-school girls.
✦ The partnership between the schoolsand the community, and between thesocial sectors has been crucial for thesuccess of the programme.
✦ Availability of IEC materials, timelyprocurement and supply of IFAtablets are also key factors inprogramme implementation.
✦ Ensuring the support of senior policymakers and district managers in thisinitiative has been an importantfeature of the project.
✦ Mobilisation of the community,government sectors, NGOs andpanchayat members has been integralto the success of the programme.Without the support of these, few ofthe targets would have beenachieved. For example, in West
Ms. Sandhya Rani Mehta, Dy. Superintendent of Police (DSP), Chaibasa, has become
a role model for girls in the district. Ms. Mehta’s association with the Anaemia
Control Project began after she was invited to attend the launch of the project in
Scott Hindi Girls High School. The lady officer left a lasting impression on the girls
as she came clad in her official uniform with a host of subordinates. She adds
smilingly, “When one of the girls in Scott High School was asked what she would
like to become when she grew up, she said that she wanted to become like the
‘DSP Madam’.”
Despite her busy schedule, Ms Mehta has become a keen advocate of the project.
She is working with the Police Officers’ Association and promotes the project
wherever she goes. She says, “The project has been very successful in creating
awareness about anaemia in the district.”
Singhbhum, which has a highconcentration of tribals, the Mundashave been effectively used to mobilisethe communities.
Looking aheadThe coverage, level of awareness andacceptance of the programme in all thethree districts indicate that theprogramme is moving ahead in the rightdirection and the targets set in thebeginning will be achieved.
Control of NutritionalAnaemia in School going
Adolescent Girls
38
Anaemia ContrAnaemia ContrAnaemia ContrAnaemia ContrAnaemia Control Pol Pol Pol Pol Prrrrroject, Ranchioject, Ranchioject, Ranchioject, Ranchioject, Ranchi(Weekly IFA tablet consumption related information)
Name of school :
Block : District : Ranchi (Jharkhand)
1. In year 2001 the number of girls 11 to 18 years of agewho were given IFA tablets :
2. Total number of tablets received by school for distribution :3. Number of girls 11 to 18 years of age presently studying in
school who did not receive IFA tablets earlier and to whomIFA tablets need to be distributed:
4. Weekly information related to the number of girls consumingIFA tablets needs to be submitted in the following format:
Sl Name of 5 weeks 4 weeks 3 weeks 2 weeks 1 week Tablets TotalNo. Month tablets tablets tablets tablets tablets not
consumed consumed consumed consumed consumed consumed
1. June, 2001
2. July, 2001
3. August, 2001
4. September, 2001
5. October, 2001
6. November, 2001
7. December, 2001
8. January, 2001
9. February, 2001
10. March, 2001
11. Apirl, 2001
12. May, 2001
Total
Note: 1. Fill in the format from the same month in which tablets were distributed in school2. The months, in which “5 weeks tablets” were distributed, in the same month “5 weeks”
column should be filled.
Name of the H.M : Name of nodal teacher :
Name of motivator girl-1 : Name of motivator girl-2 :
Dated : ---------------------------------- Signature of H.M & Seal
Annexure 1
39
Annexure
Anaemia ContrAnaemia ContrAnaemia ContrAnaemia ContrAnaemia Control Pol Pol Pol Pol Prrrrroject, Ranchioject, Ranchioject, Ranchioject, Ranchioject, RanchiConsumption details
Block District Ranchi
Month Year
Annexure 2
Sl. Name of School Number of Number Number Number ofNo. 11-18 year of tablets of tablets tablets left
old girls distributed consumed
Numer of Schools Numer of girls
Total number of tablets consumed in a month Total number of tablets left
Block Education and Extension OfficerSignature and Seal
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