#1AMS Assessment of the Quality of Biannual Vitamin A Supplementation (VAS) through External Monitoring in Uttar Pradesh, Chhattisgarh and Madhya Pradesh, India Research | Consulting | Training : NUTRITION INTERNATIONAL Nourish Life#2Contents Technical Approach and Methodolo gy Vitamin A Supplemen tation IFA Syrup Distribution Awareness among Frontline Adherence to COVID- 19 Protocols Growth Monitoring workers and Caregivers Way Forward#3Technical Approach and Methodology#4Background and Context Benefits of Vitamin A Vitamin A Deficiency Immune function, vision, reproduction and cellular communication Risk of respiratory diseases, diarrhoea, measles and vision problems. It is estimated that Vitamin A deficiency is affecting 190 million children under five years of age. (WHO, 2009)#5Background and Context Biannual Rounds of VAS Vitamin A supplementa tions (VAS) Prevention of Malnutrition Counselling of IYCF practices Routine immunization and IFA 1st dose of VAS to target children 9 to 12 months along with measles vaccine in VHND 2nd to 9th dose of Vitamin A to children 2-5 years Growth monitoring of all the children under 5 years to identification Referral of severely malnourished children Promotion of early exclusive and prolonged breastfeeding and complementary feeding Promotion of daily consumption of Iodized Salt Measles and MMR Vaccinations Supplementat IFA Syrup Distribution and Counselling regarding correct ion dosage#6Objectives of the Assignment Assess implementation of VAS biannual rounds in UP, MP and CG as per the standard operating procedure including precautionary measures taken for COVID-19 Understand the level of convergence between health and ICDS functionaries Assess availability of requisite supplies and reporting formats Understand key barriers and enablers for VAS campaign#7Sample Coverage Particulars U.P. M.P. C.G. Total No. of NHM Total 18 7 5 30 Divisions No. of Districts (@ 1 per NHM 18 7 LO 5 30 div.) No. of Blocks / 2 CHCS (@2 per 36 14 10 60 dist.) No. of PHCs (@ 2 72 28 20 120 Sample per block) No. of SCs (@ 2 144 56 40 240 per PHC) No. of AWCs (@ 144 56 40 240 1 per SC) No. of VAS Sessions (@ 1 144 56 40 240 ° per AWC) 1. Uttar Pradesh 18 Districts 144 Sessions 2. Madhya Pradesh 7 Districts 56 Sessions о 3. Chhattisgarh 5 Districts 40 Sessions#8बाल स्वास्थ्य पोषण माह द्वितीय चरण - दिसम्बर 2019 (नियमित टीकाकरण दिवस पर) 9 माह से 5 वर्ष के सभी बच्चों को है। टे क तितका संदर्भ एवं ताल में करवाएं। की विटामिन ए की खुराक छः माह के अन्तराल पर अवश्य पिलवाये। अपने भोजन में आयोडीन युक्त नमक करें। अपने बच्चे के अच्छे स्वास्थ्य के लिये बच्चे को विटामिन 'ए' अवश्य पिलायें NUTRITION अपर मुख्यकारी unicef मुख्य चिकित्सा अधिकारी मेरठ every child जिला स्वास्थ्य समिति, मेरठ DHS-MEERUT/E-TENDER/2019-20 दस्तक अभियान 14-15 15/2/2 से 21/2/202 "शिशु संरक्षण माह जनवरी 2021 वि. A खुराक 2242021 पिलाना है, • मूत्रालय IEC Material Regarding VAS Round Displayed at the Session Sites#9Findings related to Vitamin A Syrup Supplementation 3037 children aged 9-12 months Average of 13 children per session Children covered during 240 VAS sessions Average of 48 children per session 11619 children aged 1-5 years#10State State wise coverage of Vitamin A Syrup Supplementation Children aged 9-12 months Chhattisgarh Madhya Pradesh 366 (9.15 per session) 653 (11.6 per session) Children aged 1-5 1942 (48.5 per session) years 2052 (36.6 per session) Uttar Pradesh 2018 (14 per session) 7625 (53 per session)#11Availability of Requisite Support for VAS Distribution of Sessions by Observation pertaining to Conduct of Review Tour by the Health Functionaries before the session (%) State-wise Percentage of Sessions where Health Functionaries did review tour before conducting the session 25% 75% ■Review Tour Conducted Review Tour not Conducted 85.0% 66.1% 75.7% Chhattisgarh Madhya Pradesh Uttar Pradesh N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#12Availability of Requisite Support for VAS Monitoring & Supervision of Session Sites 65.4% Visits by 57.5% Health Officials Visits by ICDS Officials Visits by Health Officials Visits by ICDS Officials N = 240 session sites Uttar Pradesh Chhattisgarh Madhya Pradesh 144 Sessions 40 Sessions 56 Sessions 70.1% 85% 39.3% 60.4% 70% 41.1%#13Availability of Requisite Support for VAS 99.6% 44444 Session sites where ANMS/ MPWs were present. 94.2% Uttar Pradesh Chhattisgarh Madhya Pradesh 144 Sessions 40 Sessions 56 Sessions Presence of ANMs/MPWS 100% 100% 98.2% + Session sites where ASHA/ link workers were present. 82.9% Presence of ASHA 94.4% 97.5% 91.1% or link workers Presence of AWWS 82.6% 85% 80.4% Session sites where AWWs were present. N = 240 session sites#14Availability of Due List and Calculation of Beneficiaries as per Due List Distribution of Session Sites by Availability of Due List (%) State-wise Percentage of Sessions where Due Lists were available 5% 95% ■Due List Available ■Due List Unavailable 97.5% 100.0% 92.4% Chhattisgarh Madhya Pradesh Uttar Pradesh N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#15Availability of Due List and Calculation of Beneficiaries as per Due List 100% 100% 98.5% 39 56 131 Distribution of Session Sites by Status pertaining to calculation of beneficiaries being done as per due list Chhattisgarh Madhya Pradesh Uttar Pradesh (n= 39 session sites where due list was available) (n= 56 session sites where due list was available) (n= 133 session sites where due list was available)#16Sub-Centre Level Schedule: Availability & Adherence Distribution of Session Sites by Availability of Sub-center level schedule (%) 5% 95% ■Sub centre level schedule available Sub centre level schedule unavailable State-wise Percentage of Sessions where sub center level schedules were available 97.5% 100.0% 92.4% Chhattisgarh Madhya Pradesh Uttar Pradesh N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#17Sub-Centre Level Schedule: Availability & Adherence Distribution of Session Sites by Status of Listing of Beneficiaries in the schedule according to gender 100% 39 Chhattisgarh Madhya Pradesh 100% 56 85% 113 Uttar Pradesh (n= 39 session sites where schedule was available) (n= 56 session sites where schedule was available) (n=133 session sites where schedule was available)#18Sub-Centre Level Schedule: Availability & Adherence 96% 97.5% Proportion of Session Sites organized as per schedule 100.0% Chhattisgarh 100.0% 100.0% Madhya Pradesh ■Proportion of Sessions organized as per dates mentioned in the schedule ■ Proportion of Sessions organized as per places mentioned in the schedule 93.8% 98.5% Uttar Pradesh 99% N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#19Availability of VAS Tools Distribution of Session sites by Observation pertaining to ANMs Updating the MCP cards during the Session (%) State-wise Percentage of Sessions where ANMs were updating MCP Cards 2.5% 97.5% 99.3% 96.4% 92.5% Chhattisgarh Madhya Pradesh Uttar Pradesh ■MCP Card being updated ■MCP Card not being updated N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#20Availability of VAS Tools State wise numbers of sessions where essential documents/materials were available at session site 97.5% 80.0% 63% Chhattisgarh 91.1% 76.8% 70.0% 55.4% 53.5% Madhya Pradesh 97.9% 92.4% Uttar Pradesh O Vitamin A Register No.7 ■Reporting format/tally sheet Vitamin A IEC Material 96% 80% N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#21*. विटामिन ए - सम्पूरण SA शिशु व छोटे बच्चों को दें उचित आहार और बनाएं सेहत का भण्डार मैं विटामिन ए हूँ हाँ. मैं विद्यामिन ए हूँ शरीर का महता हूँ पहुँचकर जारियों से बचाए हूँ वो बल पर जाता है जोधी और अपन से दूर ले जाए वो कमाल बन जाता हूँ भारत के शिशु avidor eft call or 3 & हर उम्र के लोगों में स्वास्थ्य समस्य ● ten at top ww red dnes है। ● और समय से पहले • आयो की कविवर सत्य है। • क मी है। was an h आयोडीन नमक का रख-रखाव जय आयोडीन नमक खरीदें सके-के •की ये • नीर खुली हुई काली खरीदे है। • के लिए सकार खरीदें इसे खाने से जाते है जिसे जाती है। MOORED SA • 12 खाने में जाती है 5नवरों के और नुसार बीमारियों से पच्यों में ड. मैं विटामिन ए हूँ सेहो तर को मार भगाता हूँ जा रहे नक मैं शरीर के काम बहुत आता हूँ उपयुक्त आहार शिशु और छोटे बच्चों के स्वस्थ जीवन की नींव है। की कमी से है हाँ. मैं ही बच्चो के शरीर का सुरक्षा आइये, जानें कि इस नींव को कैसे और मजबूत बनाया जा सकता है। बहुत आसान हाँ, मैं बिटागन ए हूँ। उत्तर हुन मैं शरीर के बहुत काम आता हूँ। wd be what नारीको देश में 15 पीपीएम का क अपरा है। एक और 1000 है। unic unicef और परिवार बधाई हो! आप बन गए हैं स्वास्थ्य सुपरस्टार! आपने अपने बच्चे को दिलवाई है विटामिन ए की सभी 9 खुराक NUTRITION INTERNATIONAL आयोडीन नमक का कमाल - बच्चा बढ़े बुद्धि और सेहत के साथ विटामिन, SOLUT ए की पहली खुराक 9 महीने पर खसरे के टीके के साथ -good NUTRITION दस्तक अभियान Vitamin A IEC Material at Session Sites ww LODMPCUBES) PCLIES POL लालिमा योजना 000000 और Footer wh गर्म 65 5। वर्ष 211311CES 212 46 गुल 21110-169 199 2011-129 A-ILY <7 <x OSHOPCLUES OSHOPCLUES SHOPCLI BE फूल#22Availability & Adequacy of Vitamin A Syrup Bottles State wise Percentage of Session Sites where adequate Vitamin A syrup bottles were available State wise Percentage of Session Sites where non- expired Vitamin A syrup bottles were available 100 100 Chhattisgarh Chhattisgarh 100 98.2 Madhya Pradesh Madhya Pradesh 99.3 95.8 Uttar Pradesh Uttar Pradesh N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#23Administration of Vitamin A Syrup to Children Session sites where dose measuring spoon was being used (only for UP and MP) || || || 99% 88% 98.7% Sessions sites where separate/disposable spoon was being used Session sites where tally sheet was being used to keep track of beneficiaries N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#24Administration of Vitamin A Syrup to Children State wise numbers of sessions where mandated procedures were being followed during administration of VAS to children 100.0% 87.5% Chhattisgarh 98.0% 96.4% 89.3% Madhya Pradesh 98.6% 100.0% 88.2% Uttar Pradesh Sessions sites where separate/disposable spoon was being used Session sites where tally sheet was being used to keep track of beneficiaries Session sites where dose measuring spoon was being used (only for UP and MP) N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#25Administration of Vitamin A to children at Session Sites#26Administration of Vitamin A Syrup to Children All children were being provided the correct dosage as per their age at all 240 session sites. Proportion of Session sites where Confirmation of last date of receipt of Vitamin A syrup for Children was being done by health workers 4% 10% 86% ■ Yes, asked for all children ■ Yes, asked for only some children ■ Not asked for any children N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#27Findings related to IFA Syrup Distribution 6894 children aged 6-59 months Beneficiaries covered during 240 VAS sessions 85% Mothers received IFA syrup bottles#28State Children aged 6-59 months Mothers who received IFA Syrups State wise coverage of IFA Syrup Distribution Chhattisgarh 2044 (51 per session) 100% Madhya Pradesh Uttar Pradesh 1302 (23 3548 (25 per session) 74% per session) 85%#29IFA Syrup Bottles: Availability and Adequacy State wise Percentage of Session Sites where IFA syrup bottles were available State wise Percentage of Session Sites where adequate number of IFA syrup bottles were available 95 97.4 Chhattisgarh Chhattisgarh 77 79.1 Madhya Pradesh Madhya Pradesh 87 97.6 Uttar Pradesh Uttar Pradesh N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP) N = 206 session sites (125 sessions in UP, 38 sessions in CG, 43 sessions in MP)#30IFA Syrup Bottles: Distribution 76.3% Sites where iron syrup bottles were being distributed to children aged 6 months to 5 years. Distribution of Bottles Uttar Pradesh 144 Sessions 79.2% Chhattisgarh Madhya Pradesh 40 Sessions 56 Sessions 95% 55.4%#31IFA Syrup Bottles: Counseling of Mothers and Administration of Syrup State wise distribution of Sessions by Awareness and Practices of Mothers regarding IFA administration 98.8% 41.8% Chhattisgarh 100.0% 91.6% Madhya Pradesh 100.0% 92.6% Uttar Pradesh 99.8% Mothers counselled regarding correct dosage ■Mothers giving correct dosage to children 82.5% N = 407 mothers who received IFA syrup bottles (80 in CG, 83 in MP and 244 in UP)#32assuntos Coson Journ WELCO ग्रामीण पोषण दाल वितरण दिवस IFA Syrup Distribution and Counselling provided to Mothers at Session Sites#33Findings related to Growth Monitoring Number of sites where children were weighed for growth monitoring. 80.4% Yes (193) 16.2% 3.3% No (8) Weighing scale not available (39) N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#34Findings related to Growth Monitoring Yes Uttar Pradesh 144 Sessions 80.6% Chhattisgarh Madhya Pradesh 40 Sessions 56 Sessions 87.5% 75% Weighing scale 17.4% 7.5% 19.6% not available No 2.1% 5% 5.4% N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#35प्रधानमंत्री भातृ वंदना योजना प्रथम वाली गर्भवती महिलाएं एवं महिलाको मजदूरी हानि के आशिक के लाभ की राशि उसके में सीधे जमा क बैंक के बकरण कराउसे 1) के जानलेवा जीमयों से बचा आय Growth Monitoring at Session Sites BRO#36Findings related to Awareness among FLWs and Mothers 239 ANMS 226 ASHAS 199 AWWS Sample Coverage 480 Mothers#37Awareness among FLWs regarding VAS services and Correct Dosage of Vitamin A Proportion of health workers aware about the services offered under Biannual VAS round (%) State wise distribution of health functionaries aware about all the services provided under biannual VAS round in their respective states 43 34 35 S. ANM AWW ASHA No State Total Present % Total Present % Total Present % 1. Chhattisgarh 40 62.5% 34 50.0% 39 46.2% 2. Madhya Pradesh 55 43.6% 46 30.4% 51 37.3% ANM AWW ASHA 3. Uttar Pradesh 144 36.8% 119 30.3% 136 30.1% Total 239 42.7% 199 33.7% 226 34.5% N = 239 ANMS, 199 AWWs, 226 ASHAS#38Awareness among FLWs regarding VAS services and Correct Dosage of Vitamin A Proportion of health workers aware about number of doses of Vitamin A for children aged less than 5 years (9 doses) (%) 73.2 69.8 State wise distribution of health functionaries aware about number of doses to be given to children aged less than 5 years S. No State ANM AWW ASHA 73 Total Present % Total Present % Total Present % 1. Chhattisgarh 40 97.5% 34 94.1% 39 97.4% ANM AWW ASHA 2. Madhya Pradesh 55 78.2% 46 73.9% 51 76.5% 3. Uttar Pradesh 144 64.6% 119 61.3% 136 64.7% Total 239 73.2% 199 69.8% 226 73.0% N = 239 ANMS, 199 AWWs, 226 ASHAS#39Awareness among FLWs and Mothers about at least 3 benefits of Vitamin A 51% ANMS 43% AWWs 44% ASHA workers 36% Beneficiary Mothers N = 239 ANMs, 199 AWWs, 226 ASHAS, 480 Mothers#40Awareness among FLWs and Mothers about at least 3 benefits of Vitamin A State wise distribution of Sessions by Awareness of FLWs and Mothers about at least 3 benefits of Vit A 72.5% 61.8% 56.4% 52.5% Chhattisgarh 72.7% 66.7% 63.0% Madhya Pradesh 48.2% 36.1% 32.4% 29.4% 26.7% ANM AWW ASHA workers ■Mothers N = 239 ANMs, 199 AWWs, 226 ASHAS, 480 Mothers Uttar Pradesh#41Findings related to Adherence to COVID- 19 Protocol 68.8% Sites where beneficiaries were given different time slot. 61.3% Sites where service providers were using mask & gloves. ༣༩ 85.4 % Sites where physical distancing was followed. 82.1% Sites where service provider was using hand sanitizer. 89.2% Sites where unique spoons were used for each beneficiary. N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#42Findings related to Adherence to COVID- Use of Mask and Gloves 144 Sessions 58.3% Uttar Pradesh Chhattisgarh Madhya Pradesh 40 Sessions 56 Sessions 82.5% 53.6% Physical 79.8% 97.5% Distancing 91.1% Use of 87.5% 95% 89.3% Unique Spoon 19 Protocol Use of Hand Sanitizer 79.1% 100% 76.8% Different Time-slot 59.7% 85% 80.4% N = 240 session sites (144 sessions in UP, 40 sessions in CG, 56 sessions in MP)#43LACK OF PHYSICAL DISTANCING AND MASKS/GLOVES AT SESSION SITES AT UTTAR PRADESH HAND WASHING AND SANITIZATION AT SESSION SITES AT CHHATTISGARH AND MADHYA PRADESH Use of Sanitizers and Lack of Physical Distancing at Session Sites#44Way Forward Effective Planning of Sessions and Ensuring Availability of Requisite Supplies Improved Monitoring and Supervision Training of Health Functionaries Community Mobilization and Awareness#45Thank you!