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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.


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


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


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.


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


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).”


Adolescent Girls

12


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.


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.


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.


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


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.


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)


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.”


Adolescent Girls

22


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.


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


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


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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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.


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.


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:


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:


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.”


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


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.


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

Documentation and Design

New Concept Information Systems Pvt. Ltd.Tel. 91-11-26972748

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