Dr Rakesh Kumar Joint Secretary (RCH)

Ministry of Health & Family Welfare 31st October 2012

ADOLESCENT HEALTH

Weekly Iron and folic acid supplementation

School Health Programme

Adolescent Reproductive and Sexual Health

Menstrual Hygiene Scheme

Adolescent health: an emerging programmatic priority with enhanced scope to include…

MoHFW currently working on a National Framework for Adolescent Health to further strengthen the programme so that information, commodities and services are available at the community level itself

However, AH at the implementation levels remains a sub-critical programme priority. Evidence = financial allocation and expenditure by states

5904.44

8314

167.65 568.59

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2011-12 2012-13

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FINANCIAL YEAR

RCH

AH

6.8% 2.8%

Expenditure by states 2011-12 and 2012 -13

167.65

568.59

104.37

11.67 0

100

200

300

400

500

600

2011-12 2012-13

RS

IN

CR

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ES

FINANCIAL YEAR

AH allocation

AH expenditure 62.2 %

2.0% in 1st quarter

WEEKLY IRON AND FOLIC ACID SUPPLEMENTATION

WIFS Programme Details

Objective To address nutritional anaemia among adolescents

Intervention • Weekly IFA supplementation and biannual De-worming

• Screening for anaemia and referral

• Nutrition counselling and health education

Target population

• 12.72 crores Adolescents ( 10-19 years) –

• 5.74 crores in -school boys and girls

• 6.92 crores out-of-school girls

Implementation strategy

Convergence :

• HRD ministry - Mid Day Meal (SSA) and RMSA

• WCD ministry - ICDS and SABLA platform

• Process initiated in all states

• In most states -supply to reach beneficiary by November 2012

Procurement

• National training completed for all states • 24 states will complete training across level

by end of November Training

• Orissa, Tripura, Andhra Pradesh, West Bengal -already launched WIFS

• Maharashtra, Chandigarh, D&N Haveli, Uttrakhand, Arunachal Pradesh, Mizoram, Sikkim, Haryana, Tamil Nadu, Andaman Nicobar, Daman and Diu – November launch

Launch

• 130 crores approved in PIP 2012-13 Budget approved

WIFS page: http://www.mohfw.nic.in/NRHM/AH/WIFS.htm

Issues Dedicated Nodal Officer for AH is not a ground reality eg. Chattisgarh,

Lakshadweep; programme unstable due to frequent change or multiple portfolio/task shifting eg. Punjab, Rajasthan, MP & Bihar

Andra Pradesh, Chhattisgarh, Karnataka, HP, Rajasthan and MP not present in the review meeting held on 19.10 12

Preparedness of rolling out of WIFS: States lagging behind in most areas vis a vis timelines committed during the

National ToTs, particularly procurement - J&K, MP, Maharashtra, NE and Kerala

Quality Assurance Committees to ensure homogenous quality of IFA still to be established across all states

States yet to organise media plans capacity building workshop in the 2nd week – representations from all states and UTs a must

SCHOOL HEALTH PROGRAMME

School Health Programme: Status 2012-2013

Dedicated school health teams

– 2642 teams proposed and agreed to in 16 states – Dedicated teams Status (as on 26th October, 2012)

• Teams in place - Uttarakhand, Delhi and Maharashtra (Existing) • In 13 States recruitment is under process • Expected date of positioning of teams in most States is by November • Jharkhand and Bihar - December • UP, Meghalaya, Chandigarh need to prioritize recruitment – process has stalled

Poor utilization of resources approved – 48.63% in 2010-’11, 57.4 % in 2011-’12 – 399 Crores INR allocated for the FY 12-13 – Expenditure in first quarter 2012-13 is 2.62 % of total allocation

• HF States - 0.57%, • NE - 0.34%, • Non HF States – 6.77%, • Small States & UTs – 2.62 %

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SHP: Status of Programme 2012-2013 • Quarterly reports are available

from 13 States only

• Reports are not available for – Bihar, Chhattisgarh, Himachal Pradesh,

Rajasthan, Uttar Pradesh, Aruachal Pradesh, Assam, Manipur, Mizoram, Andhra Pradesh, Gujarat (Campaign to start), Karnataka, Punjab, West Bengal, Andaman & Nicobar, Dam and Diu, Delhi, Lakshadweep, Pondicherry

– Analyses of the QPR reveals that Wide difference in percentage

coverage of School and Students targeted

Under Biannual Screening protocol

by second quarter the first round of screening should have been over , this is rarely the case. 11

State % School covered of target

% Students covered of target

Jharkhand 69.30 36.02

Uttarakhand 22.87 78.73

Sikkim 53.92 23.79

Chandigarh 26.79 73.29

Dadra & Nagar Haveli

26.67 91.35

Jammu & Kashmir

29.41

Kerala 28.33 29.12

Nagaland 21.19 5.45

Meghalaya 16.12 16.94

Orissa 7.21 4.23

Tamilnadu 6.07 9.91

Goa 12.98

Haryana 1.13 1.64

School Health Programme 2012-2013

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• Recruitment of dedicated teams in States where teams were approved in the current year 2012-13.

• Monitoring of progress both Financial and Physical

• Linkages with other Adolescent Health component

• Pooling of resource – financial, IEC and Human across National Disease control programmes

Immediate action required:

ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH (ARSH)

ARSH Clinics: Issues • Out of total 3493 clinics 3348 (95%) AFHC are functional. However,

Rajasthan, UP and Bihar need to operationalize the clinics at the earliest

• Client load at all functional clinics is low, which needs to be addressed through recruitment of counsellors, training and sensitisation of health service providers.

• Community mobilisation and out-reach services need to be strengthened

• States and UT like Arunachal Pradesh, Andaman and Nicobar, Chattisgarh, Daman and Diu, Dadar and Nagar Haveli, Himachal Pradesh, Lakshwadeep, Uttar Pradesh, Mizoram and Manipur have reported NIL performance.

• States need to strengthen monitoring and reporting for instance ARSH Reports have not been received from Chattisgarh, Haryana, Lakshwadeep, Mizoram, Madhya Pradesh, Puducherry, Uttar Pradesh for 1st quarter

MENSTRUAL HYGIENE SCHEME

Menstrual Hygiene Scheme

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Total Dispatch 322 lakh packs of sanitary napkins Total Uptake (End Sept. 2012) 112.53 lakh(34.95%) packs of sanitary napkins -

State – wise Uptake

Less than 20% U.P., Chhattisgarh

20 – 40% Bihar, Gujarat, Karnataka, Uttarakhand

40 – 60 % Assam, J&K, Jharkhand, Madhya Pradesh, Maharashtra, Punjab, Rajasthan

60 – 80 % Andhra Pradesh, Odisha

More than 80% Himachal Pradesh, Kerala

• Regular to reporting to MoHFW and monitoring to be strengthened

• Re-orientation / re-training of ASHAs required on promotion of sanitary napkins for improved uptake of product among adolescent girls

• State need to focus more on new users i.e. Girls who have not had access to any such product prior to launch of scheme

• Proper record maintenance i.e. reconciliation of delivery / receipt by State and sale of packs vis-à-vis amount of incentive paid to ASHA

• Convergence required with Total Sanitation Campaign for appropriate disposal mechanisms

Issues: MHP

Thank you