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Operational Guidelines on

Nutrition Programmes

through NHM as per the

approval of MoHFW, India

2020-21

Preface

Nutrition is the science of nourishment. It is a fundamental stipulation of life in the

world. Evolutions in technology, transformation in social structure and life style, economic

alteration, globalization are some of the significant dynamics for which the world is facing

with different public health nutrition problems today. Most of the public health nutrition issues

are easily preventable and have great impact of human health and wellbeing. Realising the

benefit of different nutritional welfare programmes on nation’s development, GoI

implemented various nutrition welfare programmes through the MoWD,& MoHFW.

MoHFW implements programmes for prevention and control of anaemia, vitamin A

deficiency, iodine deficiency, fluorosis and protein energy mal nutrition through NHM. These

programmes have optimistic impact on NFHS indicators from 2005 to 2015. Assam is

considered as one of the well performing state on nutrition indictors and it is the result of

continuous, dedicated and comprehensive efforts of all health service providers from field to

district.

The DRoP on Nutrition for the FY 2020-21 is focused smooth on implementation of

Anaemia Mukt Bharat and reduction in anaemia among all age groups by ensuring IFA

availability to beneficiary and compliance. T3 camps are expected to be helpful in this aspect

in DRoP 2020-21. Identification of malnourished children, referral and improved bed

occupancy in each Nutrition Rehabilitation Centre is the second important area of interest in

this year. Approvals for Infant and Young Child feeding practices will definitely help in

reducing incidences of malnutrition, diarrhoea & pneumonia among children under 2 years

and will have positive impact of IMR. Due to COVID -19, other nutrition programmes such

as Intensified Diarrhoea Control Fortnight, National Deworming Days, Mothers Absolute

Affection, etc will be implemented based on the future guidelines received from GoI. But

detailed plan and budget are provided in this guideline for your future reference.

Like previous years all ongoing nutrition programmes will be implemented in 2020-21.

All health officials, programme officers are requested to go through this nutrition operation

guidelines to develop proper block and district specific plans for better outcomes. In this

guideline each programmes are explained comprehensively including different activities such

as orientation, IEC, ASHA incentive, printing etc together. Hence, please do the planning for

programme implementation, monitoring and review in a team.

Dr. Priyakshi Borkotoky

Consultant Nutrition

NHM, Assam

Summary of Approvals

(Rs In Lakhs)

FMR Budget Head Total Amount Approved for

FY 2020-21

State Allocation

District Allocation

1 U.1 Service Delivery-Facility Based 51.35 0.00 51.35

2 U.2 Service Delivery-Community Based 93.82 0.00 93.82

3 U.3 Community Interventions 370.98 0.00 370.98

4 U.4 Untied Fund 0.00 0.00 0.00

5 U.5 Infrastructure 0.00 0.00 0.00

6 U.6 Procurement 1142.53 1142.53 0.00

7 U.7 Referral Transport 0.00 0.00 0.00

8 U.8 Human Resource 0.00 0.00 0.00

9 U.9 Training 314.69 1.18 313.51

10 U.10 Review, Research, Survey and Surveillance 0.00 0.00 0.00

11 U.11 IEC/BCC 611.04 522.42 88.62

12 U.12 Printing 122.14 1.72 120.42

13 U.13 Quality / Assurance 0.00 0.00 0.00

14 U.14 Drug Warehousing and Logistics 0.00 0.00 0.00

15 U.15 PPP 0.00 0.00 0.00

16 U.16 Programme Management 0.00 0.00 0.00

17 U.17 IT Initiatives for Strngthening Service Delivery 0.00 0.00 0.00

18 U.18 Innovations 0.00 0.00 0.00

Grand Total 2706.55 1667.85 1038.70

Content

Sl no Programme Page No

1 Nutrition Rehabilitation Centre 1

2 Mother’s Absolute Affection 15

3 Anemia Mukt Bharat 23

4 Intensified Diarrhoea Control Fortnight 45

5 Vitamin A Biannual Round 70

6 National Deworming Day 83


FMR Particulars/Activity

Related

Progra

mme

Total

Approval

for

2020-21

( In

Lakhs)

FMR Owner Total

District

approval

( In

Lakhs)

State

Approval

( In

Lakhs) At State HQ

At

District

Level

At Block level

1.3.1.4 Operational Cost for NRCs NRC 51.35 Consultant,

Nutrition

Nodal

Officer Dietician 51.35 -

2.3.1.1.1 Outreach camps AMB T3

Camp 93.82

Consultant,

Nutrition

DCM &

Dco BCM & BCo 93.82 -

3.1.1.1.2

ASHA incentive under MAA

programme @ Rs 100 per ASHA

for quarterly mother's meeting

ASHA

Incentive 73.23

SCM/

Consultant,

Nutrition

DCM BCM 73.23 -

3.1.1.1.5

Incentive for referral of SAM cases

to NRC and for follow up of

discharge SAM children from

NRCs

ASHA

Incentive 3.25

SCM/

Consultant,

Nutrition

DCM BCM 3.25 -

3.1.1.1.6

Incentive for National Deworming

Day for mobilising out of school

children

ASHA

Incentive 65.09

SCM/

Consultant,

Nutrition

DCM BCM 65.09 -

3.1.1.1.7

Incentive for IDCF for prophylactic

distribution of ORS to family with

under-five children.

ASHA

Incentive 34.68

SCM/

Consultant,

Nutrition t

DCM BCM 34.68 -

3.1.1.1.8

National Iron Plus Incentive for

mobilizing WRA (non pregnant &

non-lactating Women 20-49 years)

ASHA

Incentive 58.42

SCM/

Consultant,

Nutrition t

DCM BCM 58.42 -

FMR Wise Budget Summery of DRoP –Assam- 2020-21



Related

Progra

mme

Total

Approval

for

2020-21

( In

Lakhs)

FMR Owner Total

District

approval

( In

Lakhs)

State HQ

Approval

( In

Lakhs) At State HQ

At District

Level

At Block

level

3.1.1.1.9

NIPI Incentive for mobilizing

children, ensuring compliance and

reporting (6-59 months)

ASHA

Incentive 136.31

SCM/

Consultant,

Nutrition

DCM BCM 136.31 -

6.2.1.5

IFA tablets for non-pregnant & non-lactating women in Reproductive Age (20-49 years)

AMB 72.77

DSM/

Consultant,

Nutrition

DDSM Block

Pharmacist -

72.77

6.2.1.6

Albendazole Tablets for non-pregnant & non-lactating women in Reproductive Age (20-49 years)

NDD &

AMB 15.39

DSM/

Consultant,

Nutrition

DDSM Block

Pharmacist - 15.39

6.2.2.3

IFA syrups (with auto dispenser) for children (6-60months)

AMB 162.42

DSM/

Consultant,

Nutrition

DDSM Block

Pharmacist - 162.42

6.2.2.4

Albendazole Tablets for children (6-60months)

NDD &

AMB 58.12

DSM/

Consultant,

Nutrition

DDSM Block

Pharmacist - 58.12

6.2.2.5

IFA tablets (IFA WIFS Junior tablets- pink sugar coated) for children (5-10 yrs.)

AMB 205.59

DSM/

Consultant,

Nutrition

DDSM Block

Pharmacist - 205.59

6.2.2.6

Albendazole Tablets for children (5-10 yrs.)

NDD &

AMB 68.18

DSM/

Consultant,

Nutrition

DDSM Block

Pharmacist - 68.18



Related

Progra

mme

Total

Approval

for

2020-21

( In

Lakhs)

FMR Owner Total

District

approval

( In

Lakhs)

State HQ

Approval

( In

Lakhs) At State HQ

At

District

Level

At Block

level

6.2.2.7

Vitamin A syrup

Vitamin

A round 72.16

DSM/ Consultant,

Nutrition DDSM

Block

Pharmacist - 72.16

6.2.2.8.1

ORS

IDCF 144.82 DSM/ Consultant,

Nutrition DDSM

Block

Pharmacist - 144.82

6.2.2.8.2

Zinc

IDCF 9.64 DSM/ Consultant,

Nutrition DDSM

Block

Pharmacist - 9.64

6.2.4.1

IFA tablets under WIFS (10-19 yrs.)

AMB 177.81 DSM/ Consultant,

Nutrition DDSM

Block

Pharmacist - 177.81

6.2.4.2

Albendazole Tablets under WIFS (10-19 yrs.)

NDD &

AMB 155.63

DSM/ Consultant,

Nutrition DDSM

Block

Pharmacist - 155.63

9.5.2.2 Orientation on Intensified

Diarrhoea Control Fortnight IDCF 24.89

Consultant,

Nutrition DCM BCM 24.89 -

9.5.2.11 Training on facility based

management of SAM NRC 0.61

Consultant,

Nutrition - - _ 0.61

9.5.2.19 Orientation on National

Deworming Day NDD 101.18

Consultant,

Nutrition

DME

,DCM &

DCo

BCM 101.18 -

9.5.2.23

One day Orientation on AMB. As per

RCH training norms AMB 188.01 Consultant

Nutrition

DCM &

DCo

BCM

&BCo 187.44 0.57



Related

Progra

mme

Total

Approval

for

2020-21

( In

Lakhs)

FMR Owner Total

District

approval

(In

Lakhs)

State HQ

Approval

(In

Lakhs) State District Block

11.5.1 Mid / Mass Media

IEC on

Nutrition

program

mes

611.04

SME/

Nutrition

Consultant

DME/

DCO/ DCM BCM/Bco 88.62 522.42

12.1.4 Printing cost for MAA programme

World

Breast

Feeding

Week

12.56

SPM/

Consultant

Nutrition

DME Counsellor /

SN 10.8393 1.7207

12.2.3

Printing for Micronutrient

Supplementation Programme

including IEC materials, reporting

formats, guidelines / training

materials etc. (For AMB and

Vitamin A supplementation

programmes)

Vitamin

A 28.93

SPM/

Consultant

Nutrition) &

PE (CH)

DME _ 28.93 -

12.2.6

Printing of IEC materials and

reporting formats etc. for National

Deworming Day

NDD 67.80

SPM/

Consultant

Nutrition)

DME _ 67.8 -

12.2.7 Printing of IEC Materials and

monitoring formats for IDCF IDCF 12.85

SPM/

Consultant

Nutrition)

DME _ 12.85 -

Total 2706.55

1038.7 1667.85

dffggggg

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Nutrition Rehabilitation Centre

Activity F.M.R. F.M.R. Owner

State District Block/ HI

Operational Cost 1.3.1.4 Consultant Nutrition Nodal Officer Dietician

ASHA Incentive 3.1.1.1.5 SCM DCM BCM

Nutrition Rehabilitation Centers (NRC) are established in Health Facilities to provide

appropriate and facility based case management to children with SAM for all under 5 children.

Guideline for utilization of Operational Cost

1. Kitchen supplies: - Every essential food items required for preparing all categories of diet for the admitted SAM

children must be available at all the time.

Supply for making Starter and Catch up Diet:

• Fresh whole milk/ Dried skimmed milk powder. • Puffed rice. • Vegetable Oil. • Food Similar to those used in home ( for teaching /use in transition to home/complementary

feed)

2. Pharmacy supplies and consumables : -

The parent health institution where NRC is located should provide all drugs & consumables which are available in the Essential Drug List (EDL) and any other

supplied by the government.

Most essential medicines as per treatment protocol under Facility Based management of SAM children may to be procured when those are not available at NRC/ Health

Facility. District Drug Store Manager should ensure supply of drugs to the NRC. If any

case outside drug need to be procured, proper certification for each purchase to be

obtained.

List of commonly used medicines and supplements

RBSK Team has great role in identification & referral of children with SAM and their admission in

NRC from the community. They may do mapping of the block based on malnutrition. Same

information may be used be DCM & BCM to prevent and control malnutrition in respective area of

action through community mobilization.

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i. Antibiotics: (Ampicillin/Amoxicillin/Benzyl penicillin) ii. Co trimoxazole

iii. Gentamycin iv. Metronidazole v. Tobramycin eye drops

vi. ORS vii. Electrolyte and minerals

viii. Potassium chloride ix. Magnesium chloride/sulphate x. Iron syrup

xi. Multivitamin xii. Folic acid

xiii. Vitamin A syrup xiv. Zinc Sulphate or dispersible Zinc tablets xv. Glucose (or sucrose)

xvi. IV fluids (Ringer’s lactate solution with 5% glucose; 0.45% (half normal) saline with 5% glucose; 0.9% saline (for soaking eye pads)

All consumables required for medical and therapeutic treatment of admitted SAM child if not available in supply from state or district may be purchased from operational cost.

e.g.: cannulas, IV sets, paediatric nasogastric tubes etc. But this is in exception and

proper justification to be provided for this kind of purses.

Additional Investigation of SAM children which are not available in the health facility /District Hospital may be arranged from local laboratories using operational cost after

due record of tender process. (Mandatory investigations to be performed for all

admitted SAM children)

JSSK fund can also be utilized for expenditure on Drugs and Diagnostics for Infants up to 1 year of age.

3. Wage compensation for mother /caregiver @ Rs-100/- per mother/caregiver per day is approved for duration of the stay of SAM Child at NRC.

4. Operational Cost and Contingency fund are for round the clock functioning of Nutrition Rehabilitation Centre as per standard protocol.

5. Operational Cost is also approved for maintenance of all equipments, measuring and cooking appliances, making available of linen, laundry, supplies of cleaning agents and tools, kitchen

garden etc. Air Conditioner for maintaining ward temperature may be procured from the

Hospital Fund or Operational Cost of NRC with approval from state H.Q.

6. Provision of safe drinking water, power backup, internet connectivity, photograph print etc. may be provided from Operational Cost or RKS.

7. NRCs which are situated in HI where facility of hospital diet is available will serve free diet to mother/caregiver from the hospital diet.

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8. NRCs which are situated in HI where facility of hospital diet is not available will also serve free diet to mother/caregiver and NRC will get it reimbursed @ approved cost of hospital

diet in the district from the hospital diet fund.

9. Each NRC should have a TV (with USB point) and this to be used for counseling mothers (14 days counseling kit is provided to each Nodal Officers who has attended training on 27th

December, 2019 in a pendrive). Cartoon programmes, Rhymes etc. to be show to children

admitted in NRCs.

Recurrent Expenditure Budget Estimate for 10 bedded NRC with 100% Bed Occupancy

Sl no Item Annual cost

1 Kitchen Supply 1,80,000

2 Pharmacy Supplies and Consumable 1,80,000

3 Other Cost 3,60,000

4 Wage Compensation 42,000

5 Maintenance of equipments, Linen,

Cleaning supplies, Contingency

18,000

Total 7,80,000

Expenditure of the NRC is to be proportionate to bed occupancy. (Each NRC will

receive operational Cost based on bed occupancy &GoI approval. Additional fund may be

allotted to NRCs with good perfomnce)

NRC Protocol:

Following protocols should be maintained without any deviation in all NRCs

Hand washing

1. Working hand washing facilities to be in/ near the ward. 2. Constant hand washing by staff is mandatory each time before handling of food, after

handling of patients.

3. Hands washing demonstration with soap to be done for mothers and caregivers. 4. Hands washing by mothers before feeding children to be monitored.

Bedding and laundry

1. Change of bedding to be every day or when soiled/wet. 2. Storing of diapers to be done for proper disposal 3. Soiled towels and rags to be washed immediately. 4. Place for mothers to do laundry to be arranged. 5. Facility for washing and drying cloths to be arranged.

General maintenance

1. Regular swapping of floors to be done. Floor surfaces should be easily cleanable and should minimize the growth of microorganisms.

2. Proper disposal of trash.

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3. Protection of ward from insects and rodents. Windows should be covered with mosquito and fly covers.

4. NRC to be open 24X7.

Walls: As with floors, the ease of cleaning and durability of wall surfaces must be considered.

Water supply: Unit should have 24 hour uninterrupted running water supply.

Power supply: Unit should have a 24 hour uninterrupted stabilized power supply.

Lighting: Should be well lit.

Ventilation: Should be adequately ventilated, especially for the kitchen area.

Patient area to house the beds; in NRC adult beds are kept so that the mother can be with the

child.

Play and counseling area with toys; audiovisual equipment like TV , DVD player and IEC

material.

Kitchen and food storage area attached to ward, or partitioned in the ward, with enough space

for cooking, feeding and demonstration.

Attached toilet and bathroom facility for mothers and children along with two separate

hand washing areas.

Drainage- Proper drainage facility should be there for disposal of waste.

Food storage

1. Ingredients and food to be covered and stored at the proper temperature. 2. Discard of leftovers. 3. Discard old food items

Dishwashing

1. Washing of dishes to be done immediately after each meal. 2. Dish washing agents to be used for washing of dishes.

Feeding

1. Correct feeds to be served in correct amounts and at prescribed times, even during nights and weekends.

2. Children to be feed in the presence of mothers and nurses (never left alone to feed). 3. Children to be fed milk with a cup (never a bottle). 4. Food intake (and any vomiting/diarrhoea) to be monitored and recorded correctly after

each feed.

Warming

1. The room temperature to be maintained between 25° - 30° C (to the extent possible). 2. Blankets to be provided and children kept covered at night.

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Ward environment

1. Surroundings of the ward should be welcoming and cheerful. 2. Mothers to be provided with space for sitting and sleeping. 3. Mothers should be taught/encouraged to be involved in care.

Benchmark Performance of NRC

Indicators Acceptable Not Acceptable

Recovery Rate >75% =8g

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process by ASHA. After discharge the ASHA will link the child with ICDS special nutrition

programme for malnourished children. After 4th follow up the Dietician/ In charge will certify

the case for approval of ASHA incentive.

Follow upplan should be made at 2weeks in first month and then monthly thereafter until

the child reach -1SD weight for height.

Indicators

Input Indicator

% of functional beds

% of HR in place

% of fund received

Process indicators

% of staff trained % of fund utilization

Output Indicators

% discharged with 15% weight gain Average length of stay % children with 4 follow ups (against due list )

Outcome Indicators

Bed Occupancy Rate

Recovery Rate

Referral Rate Non-respondent rate Defaulter/LAMA Rate Case fatality Rate

Impact Indicators

Infant Mortality Rate Under 5 Mortality Rate Severe Wasting Rate

Guidelines for utilisation of ASHA Incentive for SAM Case Referral and 4 Follow-up

(Details mentioned in ASHA incentive section)

1. Incentives for ASHA for referral and completion of four follow up after discharged of a child treated for SAM at NRC.

2. For ASHA incentive payment each NRC will coordinate with BCM of respective block from which the patient is admitted to motivate the respective ASHA to ensure 4 follow up of the child

at facility or community level using the NRC follow up format (Enclosed with others formats).

This format should be given to the patient along with discharged certificate.

3. ASHA will get 150/- per child after completion of fourth follow up. This to be validated by the 4th follow up completed certificate.

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4. Payments for ASHA incentives for NRC follow-up must be done through the DBT mode. *108 & 102 and Institutional National Ambulance Services may be used for Referral of SAM

children for admission and followup.

Approved district wise budget break up

Sl no Distict

Operational Cost

(Lakhs)

ASHA Incentive

(In Lakhs)

F.M.R. 1.3.1.4 F.M.R 3.1.1.1.5

1 Baksa 0.975 0.0560

2 Barpeta 1.300 0.1000

3 Bongaigaon 1.950 0.1550

4 Cachar 0.975 0.0510

5 Chirang 0.975 0.0520

6 Darrang 3.000 0.2000

7 Dhemeji 0.975 0.0580

8 Dhubri 3.000 0.2020

9 Dibrugarh 1.900 0.1390

10 Golaghat 1.300 0.0790

11 Goalpara 3.000 0.2380

12 Hailakandi 1.300 0.0500

13 Jorhat 3.750 0.2840

14 Karimganj 1.950 0.0940

15 Kamrup R 0.975 0.0250

16 Kamrup M 3.900 0.1910

17 Kokrajhar 2.600 0.1320

18 Karbi Anglong 0.650 0.0350

19 Lakhimpur 1.950 0.1625

20 Morigaon 2.600 0. 1395

21 Nagaon 5.000 0. 1920

22 Nalbari 0.975 0.0370

23 Sivasagar 0.970 0.0990

24 Sonitpur 2.780 0.1590

25 Tinsukia 1.300 0.1730

26 Udalguri 1.300 0.1470

Total district allocation 51.35 3.25

State allocation 0 0

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Formats/ Registers

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Daily Care Chart

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FOLLOW UP VISIT CARD FOR NRC DISCHARGE CHILDREN( FOR ASHA)

Name of the NRC:_________________________________________________________________SAM No:__________________________

Name of the Child:________________________________________________________Sex(M/F):_________________________________

Date of Birth:______________ Date of Discharge:_______________ Discharge Weight(KG):______________

Discharge Height/Length(CM):__________ Discharge W/H(Z-Score):_________________Discharge

MUAC(CM):___________________

Fathers Name:__________________________________________________________________________

Mothers Name:_________________________________________________________________________

Address:___________________________________________________________________________________________________________

___

Visit Scheduled

Date

Visit

Date

Place of Check

Up

Height/

Length(cm)

Weight

(KG)

W/H

Z-

score

(SD)

MUAC

(CM)

Bipedal

Odema

(0/+, ++,

+++)

Signature

of MO/

ANM

Signature

of Patent

1st (At One

Week)

2nd (At Two

Week)

3rd (At 2nd

Month)

4th (At Third

Month)

Instructions for ASHAs:

1. ASHA to ensure the timely follow ups as per schedule. 2. 1st, 2nd& 3rd Follow up checks can be done at nearest Sub-Centre/AWC/PHC/CHC/DH. 3. 4th Follow up check up should be compulsorily done at NRC. 4. ASHA Can use 108 for bringing the child for 4th follow up to NRC. 5. Apart from 4th follow up visit, in case of any emergency or danger sign develop in the child, ASHA may bring the child to NRC with help

of 108.

6. Signature of ANM/MO of SC/PHC/CHC/DH where follow up check up done. Dietician should sign only after completion of 4th follow at NRC.

Signature of ASHA Signature of Dietician

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Mothers Absolute Affection (MAA)



MAA ASHA Incentive 3.1.1.1.2 SCM DCM BCM

World Breast Feeding Week 11.5.1 Consultant Nutrition DME BCM

Breast Feeding Counselling Corner 12.1.4 Consultant Nutrition DME Counsellor/ SN

Delayed initiation of breastfeeding followed by inappropriate feeding practices in the new-born

leads to undernutrition in infants and children. The 1,000 days between conception and child’s

second birthday offer a unique window of opportunity to shape healthier and more prosperous future.

Infant and Young Child Feeding (IYCF) practices are set of well-known, common and scientific

recommendations for appropriate feeding of newborn and children under two years. To improve the

breastfeeding and young child feeding practices in the country, the nationwide programme - ‘MAA’

(Mothers’ Absolute Affection) was launched in August 2016. It involves a comprehensive set of

activities on protection, promotion and support of breastfeeding and child feeding at community as

well as facility levels.

2.1. Components of MAA

Building an enabling environment & demand generation through Mass media and Mid media

Capacity building of community health workers – ASHAs, AWWs & ANMs – on breastfeeding

Community diagoue – by ASHAs through mother’ meetings; & lactation support and interpersonal communication – by skilled ANMs at VHNDs/sub-centres

Capacity building of auxiliary nurse midwives (ANMs)/nurses doctors on lactation support and managment at facilities

Role reinforcement on breastfeeding – at all delivery points

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Monitoring and Awards/Recognition.

2.2. Activities under MAA for 2020-21

Sensitization of health service providers on IYCF. Mothers meeting

Sensitization of health service providers on MAA:

1. Regular platform of monthly meetings are to be used to sensitize all health service providers at least

twice year. Participants of the programme will be all health care providers of the blocks and

districts. State and district level MAA trainers on IYCF at Guwahati should be requested for this.

Topics to be covered

Lecture on IYCF practices based on MAA training modules. Lecture on IMS Act.

2. The District Community Mobilizer (DCM) of the respective district will be responsible for co-coordination and organization of the programme under the supervision of the District

Programme Manager (DPM).

3. Sensitization will be as per the module (One Day MAA Sensitization Module) prescribed under MAA Guidelines

4. DCM of the respective district will be responsible for submission of the completion report to

the CH section within one week of completion of the training in their respective district with

following enclosures-

a) Detailed participants list. B) Photographs

Mothers meeting

1. Total 3 rounds of Mother’s meeting to be held by ASHA during 2020- 21 at any suitable place.

2. Multiple meetings may need to conduct to be covered all pregnant and lactating mothers in each round.

3. DCM/ BCM will be ensure conduction of regular mothers meeting.

4. DCM has to submit the monthly report to the Child Health Section on or before 8th of

each month in the following format.

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5. DPM will be the Nodal officer for the MAA programme at district and BPM will be the

nodal officers at block level All activity and

reports related to the programme should be

done through the Nodal Officer.

District / Block Mother’s Meeting Reporting format

1. Name of the district Nodal Officer on MAA 2. Name & Contact no of Person preparing the report

3. Reporting Month 4. Date of Report Submission

Sl

No District Block

Total No of

Lactating

mothers

Total No of ANC

mothers

Total No of

Lactating

mothers

present in

Mothers

Meeting

Total No

of ANC

mothers

present in

Mothers

Meeting

Total no

of Rounds

completed

Nodal Officer DCM

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ANM - MAA reporting format

Name of the SC Reporting

Month

Name of

the

District

Name of

the block

Number of

Mothers’

meetings held.

Number and % of Pregnant

& lactating

mothers who attended

mother’s meetings.

Number and % of

ASHAs having

IYCF tool kit

Signature of ANM

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ASHA - MAA reporting format

Name of the SC

Name of the village

Reporting

Month

Availibility of ASHA tool kit (Yes/ No)

Number of Mothers’ meetings held in the reported month

Date of

Mothers’

meetings held.

Name of the

participants

Physiological state of the

beneficiary (Pregnant /

Lactating)

Number and % of

ASHAs having IYCF

tool kit

Signature of ASHA

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ASHA Incentive on Mothers Meet

1. ASHA will get Rs 300/ (@Rs 100 per round) as incentive for total 3 rounds of meeting.

2. An eligibility criterion for ASHA incentive @ Rs 100 per round, is to cover 100% pregnant and

lactating mothers in one round. ( Detail refer ASHA Incentive page)

District wise budget break up

Sl No Name of the District ASHA Incentive

(F.M.R. 3.1.1.1. 2)

1 Baksa 2.14

2 Barpeta 3.62

3 Bongaigaon 1.69

4 Cachar 4.11

5 Chirang 1.67

6 Darrang 2.20

7 Dhemaji 1.68

8 Dhubri 4.49

9 Dibrugarh 2.92

10 Dima Hasao 0.53

11 Goalpara 2.40

12 Golaghat 2.38

13 Hailakandi 1.61

14 Jorhat 2.85

15 Kamrup Metro 1.52

16 Kamrup Rural 3.92

17 Karbi Anglong 2.54

18 Karimganj 2.78

19 Kokrajhar 3.10

20 Lakhimpur 2.94

21 Morigaon 2.13

22 Nagaon 5.50

23 Nalbari 1.74

24 Sivasagar 2.83

25 Sonitpur 4.38

26 Tinsukia 3.34

27 Udalguri 2.40

Total district allocation 73.23

State allocation 0

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Quiz Completion

ANMs of all Sub Centre will conduct quiz for all ASHA and ASHA Supervisors of their

jurisdiction on IYCF practices. A set of questions will be developed by the DMEs with the help of

MAA ToTs based on ASHA Module. All ANMs will be sensitized on IYCF during their monthly

meeting prior to conduction of the competition. The best ASHA & ASHA Supervisor will be selected

for next level of competition. In next step, Block level quiz will be conducted and each Sub Centre

will participate in the competition. The group for block level quiz competition will be constituted with

participant ANM, ASHA (best in SC) & ASHA Supervisor (Best in SC). BCM will organize the

programme in coordination with DME. Similarly, at district level, best performed group of the block

will compete for state level participation. For block and district level quiz competition MAA ToTs &

Nutrition Counselor of the district will be responsible for question settings and related issues based on

ASHA module, MAA training module and IYCF guidelines. Expenditure of the activity is to be

booked under F.M.R. 11.5.1 @ Rs 7000/ per block and Rs 5000/- district

Level Participants Group

Sub Center All ASHA & ASHA Supervisors Individual participant

Block ANM, Best ASHA & ASHA Supervisor at Sub Centre level ANM+ ASHA + ASHA (SC wise)

District Best group from each block ANM+ ASHA + ASHA (SC wise)

State District winner groups ANM+ ASHA + ASHA (SC wise)

Celebration at Delivery points (Establishment of Breast Feeding Counseling corners):

Each delivery point shall set-up breast feeding counselling corners near to the maternity ward

for providing counselling on IYCF by using IEC material. The counsellor/ GNM will counsel each

new parents and care taker on IYCF. Establishment cost @ Rs-700/ Per DP is approved under

F.M.R 12.1.4.

Key messages

1. Early initiation of breast feeding within 1 hour of birth. 2. Exclusive breast feeding up to 6 months. 3. Introduction of complementary feeding from 181 days of birth. 4. Continued breast feeding up to 2years or beyond.

IEC materials (expenditure approved under F.M.R 12.1.4):

Celebration of

Breast feeding

Week

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1. Poster (10 Posters for each DPs @ Rs 8/- per posters) 2. Leaflets (50 Leaflets per DP for parents of New Born/care taker/PW/LW @Rs-3.5/ per leaflet )

District wise budget break up for World Breast Feeding Week

Sl no District Quiz Competition

Breast Feeding

Counselling Corner

F.M. R 11.5.1 F.M.R. 12.1.4

1 Baksa 0.47 0.32470

2 Barpeta 0.54 0.54435


4 Cachar 0.61 0.42975

5 Chirang 0.19 0.24830

6 Darrang 0.33 0.34380

7 Dhemaji 0.40 0.35335

8 Dhubri 0.54 0.76400

9 Dibrugarh 0.47 0.21965

10 Dima Hasao 0.26 0.15280

11 Goalpara 0.40 0.59210

12 Golaghat 0.40 0.31515

13 Hailakandi 0.33 0.31515

14 Jorhat 0.54 0.27695

15 Kamrup Metro 0.4 0.11460

16 Kamrup Rural 0.89 0.49660


18 Karimganj 0.40 0.52525

19 Kokrajhar 0.33 0.62075

20 Lakhimpur 0.47 0.46795

21 Morigaon 0.26 0.42975

22 Nagaon 0.82 0.77355

23 Nalbari 0.33 0.24830

24 Sivasagar 0.61 0.20055

25 Sonitpur 0.54 0.44885

26 Tinsukia 0.33 0.37245

27 Udalguri 0.26 0.23800

Total district allocation 12.06 10.8393

State allocation - 1.72080

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23






T3 Camp 2.3.1.1.1 Nutrition Consultant DCM & DCo BCM & BCo

T3 Camp 11.5.1 SME DCM & DCo BCM & BCo

Printing 12.2.3 SPM DCM BCM

Training 9.5.2.23 Nutrition Consultant DCM & DCo BCM & BCo

Anaemia is a major public health issue of India and 50% of total anaemia is caused by iron

deficiency. Anemia is the second highest cause of maternal mortality in Asia. Mortality due to anemia

contributes to 22% (n=115,000) of the total maternal deaths every year, 90,000 deaths in both sexes and

all age groups were due to iron deficiency anemia alone and India contributes to about 80% of the

maternal death due to anaemia in South Asia.

The Ministry of Health and Family Welfare (MoH&FW) has launched Anemia Mukt Bharat

Programme with special focus on the health and nutrition needs of children, adolescents, women of

reproductive age group and pregnant mothers and lactating mothers. Its main objectives are IFA

distribution and compliance, anaemia detection, referral and treatment for achieving the goal of better

hemoglobin status among the people of India.

This will be achieved through six interventions, implementation of which will be facilitated by

six robust institutional mechanisms. To facilitate seamless implementation of the interventions, a

training tool kit has been developed which will be used to orient and train different stakeholders at

various levels for effective implementation of Anemia Mukt Bharat (AMB) strategy.

Six Beneficiaries:

• Children 6-59 months • Children 5-9 years • Children 10-19 years • Pregnant Women • Lactating Women • Women of Reproductive age

Anaemia Mukt Bharat (AMB)

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Six interventions:

Six Institutional Mechanisms

1Intra-ministerial

coordination2

National Anemia Mukt

Bharat Unit

3

National Centre

of Excellence and

Advanced Research on

Anemia Control

4Convergence with

other ministries

5Strengthening supply

chain and logistics 6

Anemia Mukt Bharat

dashboard and digital

Portal - one-stop shop

for anemia

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25


Prophylactic dose and regime for Iron Folic Acid supplementation

Age Group Dose and regime

Children 6–59 months of

age

Biweekly, 1 ml Iron and Folic Acid syrup Each ml of Iron and Folic

Acid syrup containing 20 mg elemental Iron + 100 mcg of Folic Acid

Bottle (50ml) with ‘auto-dispenser’.

Children 5–9 years of

age

Weekly, 1 Iron and Folic Acid tablet Each tablet containing 45 mg

elemental Iron + 400 mcg Folic Acid, sugar-coated, pink colour

Children 10–19 years of

age


elemental iron + 500 mcg Folic Acid, sugar-coated, blue colour

Women of reproductive

age (non-pregnant, non-

lactating) 20–49 years


elemental Iron + 500 mcg Folic Acid, sugar-coated, red colour

Pregnant women and

lactating mothers (of 0–6

months child)

Daily, 1 Iron and Folic Acid tablet starting from the fourth month of

pregnancy (that is from the second trimester), continued throughout

pregnancy (minimum 180 days during pregnancy) and to be continued

for 180 days, post-partum Each tablet containing 60 mg elemental Iron +

500 mcg Folic Acid, sugar-coated, red colour

Note 1: Prophylaxis with iron should be withheld in case of acute illness (fever, diarrhoea, pneumonia,

etc.), and in a known case of thalassemia major/history of repeated blood transfusion. In case of SAM

children, IFA supplementation should be continued as per SAM management protocol.

Note 2: All women in the reproductive age group in the pre-conception period and up to the first

trimester of the pregnancy are advised to have 400 mcg of Folic Acid tablets, daily, to reduce the

incidence of neural tube defects in the foetus.

Note 3: Promotion and monitoring of delayed clamping of the umbilical cord for at least 3 minutes (or

until cord pulsations cease) for newborns across all health facilities will be carried out for improving

the infant’s iron reserves up to 6 months after birth. Simultaneously, all birth attendants should make an

effort to ensure early initiation of breastfeeding within 1 hour of birth

Deworming (Except pregnant and lactating mothers others to be covered during NDD)

Dose and regime for deworming

Age Group Dose and regime

Children 12–59 months of age Biannual dose of 400 mg albendazole (½ tablet to children

12–24 months and 1 tablet to children 24–59 months)

Children 5–9 years of age Biannual dose of 400 mg albendazole (1 tablet)

Children 10–19 years of age Biannual dose of 400 mg albendazole (1 tablet)

Women of reproductive age (non-

pregnant, non-lactating) 20–49 years

Biannual dose of 400 mg albendazole (1 tablet)

Pregnant women One dose of 400 mg albendazole (1 tablet), after the first

trimester, preferably during the second trimester

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26


Therapeutic Management of Anemia

Traget Group A Children 6–59 months

Who will screen and

place of screening

ANM: VHND/sub-centre/session site RSBK team: AWC/school Medical

Officer: health facility

Periodicity

RBSK/ANM: as per scheduled microplan

MO: opportunistic

If Haemoglobin is 7–10.9 g/dl (mild and moderate anemia)

First level of

treatment (at all

levels of care)

mg of iron/kg/day for 2 months

For children 6–12 months (6–10.9 kg): 1 ml IFA syrup, once a day

For children 1–3 years (11–14.9 kg): 1.5 ml IFA syrup, once a day

For children 3–5 years (15–19.9 kg): 2 ml IFA syrup, once a day

Line listing for all anemic children to be maintained by the ANM/ASHA/

AWW

Follow-up

Every month by ANM at VHND

Hb estimation after 2 months for completing 2 months of treatment to document Hb>= 11g/dl

Monitoring by ASHA for compliance of IFA syrup every 14 days for a period of 2 months

If haemoglobin levels have improved to normal level, discontinue the treatment, but continue with the prophylactic IFA dose

If Haemoglobin is

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27


Periodicity

Once a year

Opportunistic screening, e.g., routine Hb assessment of sick children presented to health facility

If Haemoglobin is 8–11.4 g/dl (mild and moderate anemia)

First level of

treatment (at all

levels of care)

3 mg of iron/kg/day for 2 months

Line listing of all anemic cases to be maintained in the school register for Iron

Folic Acid supplementation and given to the ANM/LHV/Multiple Purpose

Health Worker for designated area

Follow-up

Class teacher/ Nodal teacher at school to orient parents during Parent Teacher Meeting (PTM) for compliance of treatment

Parents to ensure follow-up of child after 30 days and 60 days at nearest SC/health facility

Follow-up by ANM/LHV/MPW of designated area, as feasible.

Hb estimation after completing 2 months of treatment to document Hb>=11.5 g/dl

If haemoglobin levels have improved to normal level,discontinue the treatment, but continue with the prophylactic IFA dose

If no improvement

after first level of

treatment

In case the child has not responded to the treatment of anemia with daily dose

of iron for 2 months, refer the child to the FRU/DH medical

officer/paediatrician/physician for further investigation

If Haemoglobin is

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28


Periodicity

Annually

Mild and Moderate Anemia (Hb cut-off as per Table 1)

First level of treatment

(at all levels of care)

Two IFA tablets (each with 60 mg elemental iron and 500 mcg folic acid),

once daily, for 3 months, orally after meals

Follow-up

Line listing of all anemic cases to be maintained in the school register

for Iron Folic Acid supplementation and given to the

ANM/LHV/MPHW of designated area

Follow-up by ANM/LHV/MPHW of designated area, as feasible for

the state

Parents to ensure follow-up of adolescent after 45 days to 90 days at

the nearest sub-centre/ health facility>

If haemoglobin levels have improved to normal level, discontinue the

treatment, but continue with the prophylactic IFA dose

If no improvement


treatment

If no improvement after three months of treatment (i.e., still in mild/moderate

category), ANM/MO of nearest facility to refer adolescent to First Referral

Unit (FRU)/District Hospital (DH)

If Haemoglobin is

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29


If Haemoglobin is 10–10.9 g/dl (mild anemia)

First level of

treatment (at all

levels of care)

Two tablets of Iron and Folic Acid tablet (60 mg elemental Iron and 500 mcg

Folic Acid) daily, orally given by the health provider during the ANC contact

Parental iron (IV Iron Sucrose or Ferric Carboxy Maltose (FCM) may be

considered as the first line of management in pregnant women who are detected

to be anemic late in pregnancy or in whom compliance is likely to be low (high

chance of lost to follow-up)

Follow-up

Every 2 months for compliance of treatment by health provider during the

contact

If haemoglobin levels have come up to normal level, discontinue the treatment

and continue with the prophylactic IFA dose

If no improvement


treatment

If no improvement in haemoglobin (

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30


treatment provider

The case to be referred to FRU/DH for further investigations for cause of anemia

and may be managed with IV Iron Sucrose/FCM

If Haemoglobin is 5.0–6.9 g/dl (severe anemia)

First level of

treatment

Management of severe anemia in pregnant women will be done by the medical

officer at PHC/CHC/FRU/DH

The treatment will be done using IV Iron Sucrose/Ferric Carboxy Maltose (FCM)

by the medical officer

*Immediate hospitalization recommended in the third trimester of pregnancy at a

health facility where round-the-clock specialist care is available

Follow-up after

first level of

treatment

After the first level of treatment, monthly or as prescribed by the medical officer

Treatment protocol

if no improvement

As prescribed by the medical officer

Note

For severely anemic pregnant women with haemoglobin less than 5 g/dl,

immediate hospitalization irrespective of period of gestation where round-the-

clock specialist care is available. This is to be done till normal level of

haemoglobin is achieved.

Management protocol for severe anemia mentioned is contraindicated for patients with thalassemia

major and sickle cell disease. Treatment of anemia through folic acid is recommended in thalassemia

major cases.

Service delivery platform for IFA supplementation:

• Children 6–59 months

• » Children 6–59 months will be reached with biweekly IFA syrup by ASHA through home

visits and mothers will be equipped with skills to provide biweekly IFA dose in households.

State can choose to distribute the 50 ml IFA syrup bottle (with auto-dispenser) to mothers

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31


through respective ASHA on VHND or utilized platforms like dedicated rounds such as

Vitamin A round, etc. ASHA will receive the required number of IFA syrup bottle from the

PHC/sub-centre. ASHA will provide IFA syrup (1 ml) biweekly for the first week during the

home visit under her supervision.

» Additionally, ASHA will demonstrate skills to mothers/ caregivers to provide IFA syrup through the

auto dispenser bottle and counsel mothers on the benfits of IFA syrup for their child, improving iron

and folate content of the diets and the importance of sanitation and hygienic practices in order to

prevent anaemia and worm infestation in the child.

• » From the second week onwards up to the month end (the remaining 6 doses for the month),

ASHA will undertake a fortnightly home visits and encourage the mothers to administer IFA

syrup to their child themselves in her presence. This would help in confidence building of the

mothers in providing IFA syrup to her child. ASHA will record compliance in the IFA

compliance card attached with the MCP card and teach mothers to mark the compliance after

administering every dose.

• »After a month, it is expected that mothers would acquire the required skills and confidence in

providing IFA syrup to their child twice a week and marking the same on the compliance card.

• » In addition, screening for anaemia in children under-5 years will be done biannually and

follow-up with the children diagnosed with anaemia in scheduled visits by Rashtriya Bal

Swasthya Karyakram (RBSK) team as per protocol.

• School children 5–9 years will be provided weekly IFA (Pink) tablet in schools using spot feeding

approach of IFA after the mid-day meal through teachers in Government aided schools and after lunch

break in private schools. Out-of-school children between 5–9 years will be provided IFA tablets

through ASHA during home visits. States may consider rolling out this protocol in private schools, as

per their discretion.

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32


• School-going adolescents 10–19 years will be provided weekly IFA (Blue) tablets by school

teachers. In addition, these adolescents will also be screened for anemia annually and provided point-

of-care treatment after referral from RSBK teams.

• Out-of-school adolescent girls 10–19 years will be provided IFA (Blue) tablets through monthly

Adolescent Health Day component of Rashtriya Kishore Swasthya Karyakram (RKSK) programme at

Anganwadi centres or through AWC.

• Women of reproductive age (WRA) who are not pregnant or non-lactating will be provided weekly

IFA (Red) tablets. Each state is encouraged to integrate provision of IFA tablets, Folic Acid tablets and

deworming (albendazole) for WRA interventions through immunization day/VHND platform where

feasible. States should ensure preparation of line listing of newlyweds and married women of 20–24

years age by ANM/ASHA using the Eligible Couple Register (ECR). ASHA will mobilize the target

beneficiaries to attend the VHNDs, where they will be counselled by ANM on the importance of IFA

supplementation and deworming to prevent anaemia. Beneficiaries will be encouraged to undergo

haemoglobin testing at the nearest health facility and, if diagnosed to be anemic, treatment will be

provided as per protocol with advice on supplementation, once the Hb is normal. If Hb is found to be

normal, weekly IFA supplementation will be provided and if the woman is planning for pregnancy, she

is to be counselled to stop IFA supplementation and initiate Folic Acid supplementation. If she is

already pregnant and in the first trimester of pregnancy, she will be counselled to continue Folic Acid

supplementation till 12 weeks of pregnancy and begin IFA supplementation after 12 weeks as per

standard ANC protocol. The Folic Acid tablets will be provided at the VHND/SCs by ANM.

• Pregnant women will be provided services under the strategy through antenatal care contacts (ANC

clinics/VHND/ PMSMA), receipt of IFA and Folic Acid tablets, screening and point-of-care treatment

of anaemia, and screening and prevention of malaria.

• Lactating women will be provided IFA tablets via the VHND platform when they bring their

children for immunization.

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33


All target groups will be reached through age-appropriate Behaviour Change Communication

(BCC) activities using monthly group counselling platforms, service delivery contacts and home visits

for targeted groups by ASHA.

Reporting:

All AMB reporting are to be done through the HMIS. The no of children dewormed during

NDD is also to be reported through HMIS along with NDD portal.

To streamline line the ABM reporting through HMIS, a SC level reporting register (similar as

RCH register) has been developed. District should supply at least 4 registers per sub centre mandatorily

and immediately to ensure proper reporting. The format of the register will be sent to districts for

printing through email. Printing budget break up under FMR 12.2.3 is enclosed in next page.

Supply of IFA tablets & surup

The department of Health& Family Welfare will make the IFA tablet & syrup available up to

the Sub Centre level. ASHA, Nodal teachers and AWW will submit their requirement and collect

medicine from sub center or nearest HI. Furthermore ANM/MPW will be responsible for estimation of

requirement of IFA, stock enquiry and availability of IFA for different age group. Nodal officers are

requested to orient ANMs & MPWs on calculation IFA requirement for different age group referring

the information below. Each SC should have 3 months stock at any point, but at the same time wastage

should be at minimum.

Age Group Annual Requirement

06-59 months 2 bottle of 50 ml IFA syrup / child/ year

5-10 years 52 pink tablet/ child/ year

10-19years 52 blue tablet/ adolescent/ year

Women of Reproductive Age 52 red tablet/ women/ year

Pregnant & Lactation 180 red tablet/ preganatwomen/ year &180 red tablet/ lactating women/ year

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Monitoring:

District and block Nodal Officers of AMB are requested for random monitoring visits any of

the places motioned below. Items to check

ASHA line list of pregnant women, lactating women, Women of reproductive age, Out

of school girls & under 5 children for IFA supplementation and tally one or two cases

with home visit.

Random school and AWC visit and supply and record keeping in WIFS registers

Tally ASHA record with ANM record at Sub Center

Other heath officials may follow the following.

Through home visit:

DCM & BCM should do random home visit to know about implementation of IFA

supplementation among under 5 children.

At school/ AWC:

The nodal teacher and class teachers at school and AWW at AWC will be responsible for administration

of IFAtablet and correct reporting and recording. Regular random visit by District Coordinator is must.

From Sub Center (SC) Level:

The MPW (M) and ANM will visit schools and AWC under their jurisdiction and monitor the school/

AWC reporting register on WIFS fortnightly.

At Block Level:

All BMO, BPM, BCM, HE, BEE, LHV, BPA ABPM will visit one school and one AWC per

week regularly to monitor WIFS programme. Each person will visit separate institutions every time.

At District Level:

SDM&HO ( School Health)/ i/c SDM&HO ( School Health), DPM, DME, DCM, RBSK

Coordinator, Urban Health Coordinator will visit one schools and one AWC per month regularly to

monitor WIFS programme.

(* District has to provide mobility support for AMB monitoring)

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District wise Budget break up

(Printing of AMB & Nutrition Sub Center Register)

Sl no District

Approval

(In Lakhs)

FMR 12.2.3

1 Baksa 0.94

2 Barpeta 1.58

3 Bongaigaon 0.65

4 Cachar 1.62

5 Chirang 0.52

6 Darrang 0.95

7 Dhemaji 0.59

8 Dhubri 1.43

9 Dibrugarh 1.40

10 Dima Hasao 0.46

11 Goalpara 0.93

12 Golaghat 0.86

13 Hailakandi 0.64

14 Jorhat 0.87

15 Kamrup Metro 0.31

16 Kamrup Rural 1.67


18 Karimganj 1.38

19 Kokrajhar 0.97

20 Lakhimpur 0.94

21 Morigaon 0.73

22 NAGAON 2.11

23 Nalbari 0.73

24 Sivasagar 1.32

25 Sonitpur 1.70

26 Tinsukia 1.00

27 Udalguri 0.90

District total 28.15

State 0

ASHA Incentive:

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District wise budget break up

sl no District

Incentive of

ASHA for

WRA (in

Lakhs)

ASHA

Incentive

children (6-

59 months) (

In lakhs)

FMR 3.1.1.1.8 FMR

3.1.1.1.9 1 Baksa 1.71 3.99

2 Barpeta 2.898 6.76


4 Cachar 3.2868 7.67

5 Chirang 1.2910 3.12

6 Darrang 1.7604 4.11

7 Dhemaji 1.3428 3.13

8 Dhubri 3.5928 8.38

9 Dibrugarh 2.3382 5.46

10 Dima Hasao 0.4284 1.05

11 Goalpara 1.9206 4.56

12 Golaghat 1.9026 4.44

13 Hailakandi 1.287 3.00

14 Jorhat 2.277 5.31

15 Kamrup M 1.2168 2.84

16 Kamrup R 3.1392 7.32


18 Karimganj 2.223 5.19

19 Kokrajhar 2.4786 5.79

20 Lakhimpur 2.3544 5.49

21 Marigaon 1.7064 3.98

22 Nagaon 4.3974 10.26

23 Nalbari 1.395 3.24

24 Sibsagar 2.2608 5.19

25 Sonitpur 3.3861 7.89

26 Tinsukia 2.5254 5.90

27 Udalguri 1.9155 4.47

District total 58.42 136.31

State 0 0

FMR Activity Revised Guideline

3.1.1.1.8 NIPI incentive for mobilizing WRA and ensuring compliance and report

ASHA will get a total of Rs150/*- per month per ASHA for covering at least 70 percent of the beneficiaries for IFA

supplementation in two age groups: children 6-59 months and

WRA. 3.1.1.1.9 NIPI incentive for mobilizing Children

and ensuring compliance and report

The fund for ASHA

incentive is approved under the

FMR 3.1.1.1.8 & 3.1.1.1.9. (*Rs 50/- will come from FMR

3.1.1.1.8 & Rs 100/- will come

from FMR 3.1.1.1.9)

The details on revised

ASHA incentive guideline is

mentioned below-

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Training on AMB Guidelines:

1. Training on AMB to be provided to ASHA/ ANM/ MPW/ASHA Supervisor/Teacher/AWW in

2020-21.Maximum Rs 110/- is approved as training cost per participant (under FMR 9.5.2.23. This

includes 1 lunch and 2 tea with biscuit and other arrangements.

2. Training handout for ASHA/ASHA Supervisor /ANM/ MPW is approved @ Rs-10/ (maximum)

per piece under FMR 11.5.1. Training handouts for AWW/School Teachers @ Rs-2/(maximum)

per hand out under FMR 11.5.1.

3. The training of ASHAs, ASHA Supervisor/ MPW and ANMs to be organized together at sectoral

level/block level based on availability of venue/space.

4. The training of School teachers and AWWs to be organized at micro level such as sectoral / ICDS

Project/ CRCC level utilizing local govt. school buildings/ conference halls/ colleges etc to avoid

venue charge. Training for Teachers and AWW to be planned separately.

5. As it is a flagship programme of POSHAN the education and social welfare department may be

directed by the Deputy Commissioner of the district to ensure mobilization respective departmental

trainees for the training and refreshment and trainers may be arranged by the health department.

6. Batches size of training should not cross 50 participants/ batch.

7. The orientation training to be conducted with proper arrangements of lights and sound system and

the venue should be large enough with proper seating arrangements to accommodate the

participants comfortably.

8. Prototype of handouts will be shared from SHQ.

9. The training to be conducted in presence of District Nodal Officers /Block Nodal Officers /DCMs/

District Coordinators who attended orientation on AMB in Feb 2020 at Guwahati.

10. To complete the training in a short period a team AMB trainers (MO/MO RBSK/ Nursing Tutor/

SN engaged in administrative work) may be developed at district level for sectoral and block level

trainings using budget from the same FMR. AMB training Modules supplied from state to be

handed over to these trainers.

11. The training programme and reporting to be overseen by DPM of respective district and the DCM

& the District Coordinator-RBSK/RKSK/WIFS of NHM will be responsible for successful

completion and proper record keeping and reporting of the orientation training programme.

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12. Block wise line list of participant with phone has to be submitted to State Head Quarter

without fail on monthly in excel format for record keeping.

District wise budget break for AMB training

Sl no District

Approved fund

(In Lakhs)

(FMR 9.5.2.23)

1 Baksa 6.655

2 Barpeta 9.8813

3 Bongaigaon 4.0073

4 Cachar 10.3851

5 Chirang 3.6729

6 Darrang 5.1359

7 Dhemaji 5.7442

8 Dhubri 10.5743

9 Dibrugarh 6.8937

10 Dima Hasao 2.3155

11 Goalpara 7.2622

12 Golaghat 6.5428

13 Hailakandi 6.1952

14 Jorhat 7.0499

15 Kamrup M 3.3913

16 Kamrup R 10.5996


18 Karimganj 6.7496

19 Kokrajhar 7.15

20 Lakhimpur 8.613

21 Marigaon 5.0193

22 Nagaon 14.2362

23 Nalbari 4.3571

24 Sibsagar 7.0455

25 Sonitpur 8.7219

26 Tinsukia 6.2073

27 Udalguri 5.3075

District Total 187.44

State 0.57

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T3 Camps (Anaemia Test Talk Treat camp)

RBSK team will do anaemia test using digital haemoglobin meter in schedule visits in schools

and AWCs. Anaemic children will be counselled, and treated at community or facility as required.

Similarly, Hb level of each woman of reproductive age is to checked in VHND at least biannually. Hb

level of identified anaemic children/ adolescent/women are to be checked as per protocol. Sub Centre

wise 2 anemia screening camps (annually) are to be organized during POSHAN MAAH & POSHAN

PAKWADA (1 camp per event) @ Rs 1000/- per SC per camp under the FMR of 2.3.1.1.1.

Details on T3 Camp:

• AMB district nodal officer will chair a meeting on T3 during POSHAN MAAH & POSHAN

PAKWADA one month prior to the event with the help from DCM & DCo.

• AMB block nodal officer - calls for meeting (20 days before camp)

• Participants: NHM BPMU Staff, Education, Panchayati Raj, Medical and Nutrition colleges &

development partners

• Discuss - date, venue, time, work allocation, social mobilization, logistics, checklist

• Issue Joint Letter for implementing T3 camps - respective PMUs (Health & Education)

• District & block level – directives to frontline workers to plan & organize activities

• Plan for biomedical waste disposal

Venue of the camp should be a large clean area with sufficient seating area, electicity,

ventilation etc such as school/ college etc, and should have arrangement for drinking water. Local

volunteers such as local lady, young and smart students etc. may be identified and asked for

assistance for activities other than medical task.

Consumables: To be used items available in NHM, EDL.

Record keeping:

• Brief data collection for reporting - the age, gender, Hb value and treatment option

• Mobile applications/ Registers can be used

• Take pictures of the T3 camps

• Enter the consolidated data on the POSHAN Abhiyaan –Jan Andolan Website

• Portal for T3 camp to be established on AMB website

• Give the filled prescription slip to the participants (teacher at schools) – for follow-up

Reporting: HMIS reporting and data uploading in POSHAN Portal

IEC- BCC:

• IPC/ counselling campaign by ASHA, AWW and ANMs at community

• Nukkad Natak by local people/ direct media tools like posters and banners and community

media tools like puppet shows

• One banner per sub center per camp (POSHAN MAAH /POSHAN PAKWADA) is approved

@ Rs 180/- under FMR 11.5.1.

• Announcements through public platforms/ religious institution

• School assemblies to mobilize children

• Social media tools - Facebook and Twitter by the Health Department, Education Department

and other partners and stakeholders

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District wise budget break for AMB T3 Camp

Sl no District

Organizing Cost @ Rs

1000/ camp (In Lakh)

1banner @180 per Sub

centre per camp ( In

Lakhs)

FMR 2.3.1.1.1 FMR 11.5.1

1 Baksa 3.14 0.5652

2 Barpeta 5.28 0.9504


4 Cachar 5.40 0.972

5 Chirang 1.74 0.3132

6 Darrang 3.18 0.5724

7 Dhemaji 1.96 0.3528

8 Dhubri 4.76 0.8568

9 Dibrugarh 4.68 0.8424

10 Dima Hasao 1.52 0.2736

11 Goalpara 3.10 0.5580

12 Golaghat 2.88 0.5184

13 Hailakandi 2.14 0.3852

14 Jorhat 2.90 0.5220

15 Kamrup Metro 1.02 0.1836

16 Kamrup Rural 5.58 1.0044


18 Karimganj 4.6 0.8280

19 Kokrajhar 3.24 0.5832

20 Lakhimpur 3.14 0.5652

21 Morigaon 2.44 0.4392

22 Nagaon 7.04 1.2672

23 Nalbari 2.44 0.4392

24 Sivasagar 4.4 0.7920

25 Sonitpur 5.68 1.0224

26 Tinsukia 3.32 0.5976

27 Udalguri 3.00 0.5400

District Total 93.82 16.8700

State 0 -

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Reporting formats

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Monthly School reporting format

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ASHA Report on IFA Supplementation of Women in Reproductive Age (20-49 years)

Name of the ASHA-

Total (nonpregnant & non lactating women of

20-49 years) Month

SN Name of

Women(WRA)

Husband

Name Age

No. of

IFA

Tablets

Received

No. of

IFA

Tablets

in hand

No. of

IFA (Red)

Tablets

consumed

Anaemic

yes/no

If

yes,

Hb

level

Reffered

yes/no

Treat

(yes/no)

Albendazole

Administration

yes/no

1

2

3

4

5

6

7

8

No of women taken 45 tablets in the month

No of anaemic women

No of severly anaemic women (Hb

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Orientation 9.5.2.2 Consultant Nutrition DCM BCM

ASHA Incentive 3.1.1.1.7 SCM/ Consultant Nutrition DCM BCM

Printing 12.2.7 SPM/ Consultant Nutrition DME _

IEC 11.5.1 SME/ Consultant Nutrition DME _

The Ministry of Health and Family Welfare regularly implements the Intensified Diarrhea

Control Fortnight (IDCF) in order to intensify efforts to reduce child deaths due to diarrhoea. It

aims to create mass awareness about the most effective and low-cost diarrhoea treatmen of a

combination of Oral Rehydration Salt (ORS) solution and Zinc tablets. Almost all the deaths due

to diarrhoea can be averted by preventing and treating dehydration by use of ORS (Oral

Rehydration Solution), administration of Zinc tablets along with adequate nutritional intake by

the child. Diarrhoea can be prevented with safe drinking water, sanitation, breastfeeding

/appropriate nutrition and hand-washing.

ASHA worker would undertake distribution of ORS packets to households with under-

five children in her village. ORS-Zinc Corners will be set-up at health care facilities and non-

health facilities such as Schools and Anganwadi centres. Frontline workers will hold

demonstration of ORS preparation, along with counselling on feeding during diarrhea and

hygiene and sanitation.

Intensified Diarrhoea Control fortnight (IDCF)

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Objectives of IDCF:

To ensure high coverage of ORS and Zinc use rate in children with diarrhoea Inculcation of appropriate behaviour in care givers for diarrhoea prevention and

management

Special focus on high priority area and vulnerable community Improvement of awareness on use of ORS and Zinc for child hood diarrhoea Strategies: Improved availability and use of ORS and Zinc at the community Facility level strengthening to manage cases of dehydration Enhanced advocacy and communication on prevention and control of diarrhoea through

IEC campaign

Target Beneficiaries:

All U5 children of each household U5 children suffering from diarrhoea Secondary Household members like mothers/ Caregivers School Teachers/School going children PRI members Health and ICDS functionaries Private caregivers

Pre campaign Planning

Activation of steering committees at state & district level and conduction of the meeting.

Assessment of availability of ORS and Zinc at all levels of the district Stock assessment and indent for ORS and Zinc to the state. District drug distribution plan of ORS and Zinc. Planning of orientation at district and block.

IEC plan based on guidelinesfor Launching and community awareness activity

Plan of printing of IEC materials and other requisite formats

Priority Area:

Areas with vacant sub-centres: No auxiliary nurse midwife (ANM) posted for more than three months

Villages/areas with ANMs on long leave or other similar reasons. High risk areas (HRAs) with populations living in areas such as:

Urban slums with migration

Underserved and hard to reach populations (forested and tribal populations, hilly areas etc.).

Other migrant settlements (fisherman villages, riverine areas with shifting populations) Nomadic sites/Brick kilns Construction sites Orphanage/ Street children

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Areas known for or with diarrhoeal outbreaks, in last two years. Areas known for poor sanitation and water supply. Small villages, hamlets Tea garden population

Community based activities

Activity Responsibility

Distribution of ORS and demonstration at the household level

ASHA / Link Worker

IPC activities on sanitation and hygiene along with management of Diarrhoea

ANM

Hand washing demonstration in schools Education department, Health and Family Welfare department & SBM

Service delivery at Urban slum/ Underserved area/ Vulnerable pocket

Mobile Health team / Boat clinics/ MAS

Distribution of ORS and demonstration at the household level

Distribution of one ORS sachets to each under five children. Delivering key messages related to diarrhoea and use of ORS and on the danger signs

of diarrhoea.

Group demonstration on by involving 4-8 households on Steps of preparation of ORS. Importance of hygiene and sanitation.

Identification and referral of diarrhoeal cases to ANM/ health facilities Report all diarrhoeal deaths during the fortnight Reporting of the activities at the end of the campaign

IPC activities on sanitation and hygiene along with management of Diarrhoea

Conduct IDCF meeting in her Sub centre village and VHNDs (as per her existing micro-plan)to disseminate information on prevention & control of diarrhoea, esp. involving care

givers of under-five children.

Imparting Key messages like importance of ORS and Zinc/ Continuing feeding during diarrhoea /Importance of hand washing in control of diarrhoea

To carry out participatory learning technique on Hygiene and Sanitation.

Hand washing demonstration in schools

Needs to be carried out in all primary and middle schools. Each school should have poster pasted at the hand washing area on steps for effective

hand washing.

After the morning assembly / prayers, message on importance of hand washing should be delivered to all the students.

Before mid-day-meal, all children should be taught to wash hands following the steps in the poster with water and soap.

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Prabhat pheri or rally by school children on topic of hand-washing to be carried out.

Service delivery at Urban slum/ Underserved area/ Vulnerable pocket

Urban slum/ Underserved area/ Vulnerable pocket to be covered under NUHM, NULM, Mobile Health team / Boat clinics/ MAS.

Facility based activities:

Setting up of ORS and Zinc Corner at all health facilities Promote standard case management of diarrhoeal cases Cleaning of the water tank/ Aqua Guards of the public health facility and over all

hygiene and sanitations activity to be undertaken

Setting up of ORS and Zinc Corner at all health facilities

To be established in OPD/ Paediatric word of the Hospital or in a easily noticeable area of the hospital

To be established in all Health Institutions i.e.

Medical Colleges

District Hospital

Block CHC / PHC

Sub Centre

Anganwadi centres

Private medical practitioners

Pasting and display of facility appropriate treatment protocols in the corner to be ensured.

Prescription of ORS along with Zinc tablet to be done. The area of ORS - Zinc Corner should be near a toilet or a washing facility, where

mothers can clean the child and wash their hands before feeding them.

Mothers can sit comfortably while administering ORS to their child. The room should be pleasant and well-ventilated. The corner should be functional for 24X7 in the hospital Ensuring sufficient availability of ORS and Zinc in the ORS and Zinc corner Counselling to be done to the mother by using IEC material related to ORS and Zinc One litre ORS solution to be made and to be kept in the Corner every day Area should be thoroughly and immidiately cleaned if there would be diarrhea or

vomiting by the child

Promote standard case management of diarrhoeal cases (IDCF Tool kit is enclosed)

Training of staffs and Medical Officers on various protocol of Diarrhoea management Plan A : No dehydration Plan B: Some dehydration Plan C : Severe Dehydration

Display of Protocols in the health institutions Plan A and B in OPD Plan C in wards

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Cleaning of the water tank/ Aqua Guards of the public health facility and over all hygiene

and sanitations activity to be undertaken (with SBM and PHE department.)

Multi Sectoral Involvement

Name of the

Department

Roles and Responsibility

Department of Health and

Family Welfare

• Over all coordination, planning, monitoring and reporting of the programme

Department of WCD

• Involvement in community distribution of ORS • Monitoring and supervision of the programme • Establishment of ORS and Zinc corner in AWC • Launching of the programme at the district level

Department of Drinking water and

sanitation

• Involvement of launching of the programme at the district level • Facilitation of provision of safe drinking water at the schools and AWC

Department of Education

• Involvement of launching of the programme at the district level • Facilitation of school level WASH activity • Arrangement for hand washing demonstration in schools • Arrangement of various competitions among school children

Department of PRI • Facilitation of District Launching of programme • Facilitation of setting up of ORS and Zinc corner at the AWC • Dissemination of messages of IDCF at the community

IAP/ IMA • Facilitation of state and district launching programme • Organising sensitisation meeting of private paediatricians, chemists regarding use of ORS and Zinc

• Creating awareness about rational use of antibiotics during diarrhea

• Facilitation of setting up of ORS and Zinc corner at the private facilities

Development Partners UNICEF

• Technical support for planning and organising workshops • Facilitation of state and district (HPD) launching • Monitoring and supervision of IDCF activity with a special focus in HPDs

Reporting Each ASHA shall provide the filled monitoring formats at the end of the IDCF to the

ANM (Within first two days of post Fortnight)

ANM will submit the compiled report to the Block within the next two days of receiving from ASHA.

The Block DEO will collate the reports and submit it to the district M and E in another 2 days.

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The district M&E will submit the compiled duly signed copy to the State level in another 3 days after receiving from the Block.

State IDCF reports would be sent to National level. (Formats Enclosed)

Set up of ORS – ZINC CORNER

ORS - Zinc Corners are usually meant for childhood diarrhoea with some dehydration to be

administered ORS under supervision for 4 hours. Also no-dehydration cases that come directly

to facilities could be treated at the ORS – Zinc corners. When there are no diarrhoea cases using

the ORS – Zinc corner, the area can be used for treating other problems

Location:

ORS – Zinc corners should be permanently at health facilities like like Medical Colleges,

District Hospitals, Block health facilities, primary health centres, sub-centres, private paediatrics

facilities etc. Earmark a suitable area in the health facility for the corner. A small corner in the

OPD or ward or any other suitable area in the health facility is generally enough for this purpose.

The space required would depend on the case load. While earmarking such an area it should be

ensured that:

In case of hospital, the area is close to the workplace of the Doctor so that assessment of the child can be carried out frequently.

The area is near a toilet or a washing facility, where mothers can clean the child and wash their hands before feeding them.

Mothers can sit comfortably while administering ORS to their child. Pleasant and well-ventilated.

Timings:

The ORS – Zinc corners should be functional during OPD timings and 24 hours in

paediatrics ward. A health worker who is trained in preparation of ORS solution and Zinc

solution, should be posted to manage the corner. The corner should be prominently labeled as

“ORS – Zinc Corner for treatment of diarrhoea”

Materials required for management of ORS – Zinc corner

One table and two chairs / one bench with a back where the mother can sit comfortably while holding the child should constitute the corner

Shelves to hold supplies Sufficient ORS packets and Zinc tablets with potable drinking water in a clean container,

five glasses (200 ml), bowl / cup, soap, waste-backet, one litre vessel, clean spoons and

leaflets should be on the table.

Counselling at the ORS – Zinc corners:

The doctor / staff should counsel the mother in person using MCP card and administration of Zinc for 14 days.

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ORS – Zinc corner is a good place to display informative materials. Banner and poster on ORS – Zinc, hand washing and continued feeding should be displayed at the corner.

Activities: At least one litter of ORS solution should be prepared daily after washing hands with

soap and water. The solution should be kept at the ORS – Zinc corner. It should be

readily available to the mother when required. Replenish the solution whenever required.

More than 24 hours prepared solution should be discarded and not be used. After the

mother has washed her hands thoroughly with soap and water, provide the ORS solution

in bowl / cup or glass with spoon to enable her to administer the solution.

In case of a diarrheal episode during ORS administration, the child and mother and the area should be thoroughly cleaned. After washing hands again with soap and water the

mother should administer ORS.

If the child vomits, the child and mother and the area should be thoroughly cleaned. After washing hands again with soap and water the mother should administer ORS more

slowly.

In case of no-dehydration diarrhoea,

Administer ORS solution at the corner for some time till the child is comfortable.

Explain the mother on how to prepare the ORS solution, if possible demonstrate.

Demonstrate on how to prepare age appropriate Zinc tablet solution in a spoon.

Administer the first dose of Zinc tablet solution.

Explain when to administer ORS and Zinc.

Provide at least one ORS packet and 13 tablets of Zinc to take home.

Advice on age appropriate feeding during diarrhoea

Advice when to return In case of some-dehydration diarrhoea, Administer ORS solution at the corner for 4 hours Re-asses the child for status of dehydration. In case of no dehydration, follow the above steps for no-dehydration diarrhoea. In case of severe-dehydration, the child needs to be admitted for Plan C treatment.

Content for VHSNC meeting to be conducted during IDCF:

ANM should carry out IDCF meeting with VHSNC members in her subcentre village and those

villages where her VHND workplan falls in the IDCF weeks. ASHA will mobilize all families

with under-five children as well as VHSNC members for the session.

1. ANM should start the session with key message of the IDCF campaign highlighting

importance of ORS and Zinc, hand-washing and importance of Sanitation & hygiene in control

of childhood diarrhoea.

a. After highlighting importance of hygiene and sanitation, ANM and or ASHA would demonstrate hand-washing with soap and water.

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b. ANM will demonstrate preparation of ORS and Zinc, importance of safe water, hand-washing.

c. ANM will communicate on danger signs of diarrhoea.

d. ASHA would distribute ORS to each family with under-five child who are present during the session.

e. If there are cases of diarrhoea then ANM or ASHA will assess the child and provide ORS

– Zinc. If child is severely dehydrated then referral will be ensured.

2. PLA technique to be used for advocacy around sanitation & hygiene: PLA (Participatory

Learning Approach) techniques should be carried out such as mapping of open defecation areas

in and surrounding the village and plan for stopping open defecation should be chalked out, with

active participation of VHSNC members and representatives from Department of Drinking

Water and Sanitation.

a. The ASHA / ANM will ask the participants to narrate the ailments caused due to water contamination. This could be Diarrhea, Typhoid, Intestinal worms, Abdominal pains,

Vomiting etc.

b. The ASHA / ANM will ask participants to say what contaminates the water and food to cause these diseases. A relationship between human faeces, water and the diseases will

be established. Focus on how faecal matter slowly recedes into the soil. She will explain

how contaminated human faeces get into water and food from open defecation through

flies.

c. The ASHA / ANM will ask one of the participant’s who had suffered from Diarrhea, about the suffering and cost involved for treatment.

d. A calculation of quantity of faeces will be done. For this The ASHA / ANM will ask the

participants the average percentage of households that do not have a toilet.

Average percentage of households that do not have toilet X Total population of the village = No. of people defecating in the open.

No. of people defecating in the open. X 0.3 kg (average faeces excreted per person per day) = Daily quantity of faeces excreted in open (in kg).

Daily quantity of faeces excreted X 30 days = Monthly quantity of faeces excreted in open (in kg).

Monthly quantity of faeces excreted per day X 12 months = Annual quantity of faeces excreted in open (in kg).

e. The importance of use of toilet for defecation will be emphasised.

f. A rough map of the village will be drawn on the ground using a stick or stone.

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g. Geographical areas within the village and it’s vicini

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