NATIONAL DEWORMING DAY NDD 10 February 2018 Program

NATIONAL DEWORMING DAY - NDD (10 February 2018) Program Overview Presentation: To be used at Video Conferencing at State-level, where district officials discuss program preparedness Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Prevalence of Worm Infection Children aged 1 to 19 years (preschool and school-age children) are at-risk of parasitic intestinal worm infections, known as Soil Transmitted Helminths (STH). Worms can cause anemia and nutritional impairment, thereby impairing cognitive and physical development. Round worm Whip worm Ministry of Health and Family Welfare | National Deworming Day (February 2018) Hook worm

National Deworming Day (NDD) National Deworming Day: Mass deworming of children on a fixed day approach across all States and Union Territories Objective: Deworm all children (boys and girls) aged 1 -19 years (enrolled and nonenrolled) at schools and anganwadis for improved child health, nutritional status, access to education, and quality of life. Stakeholders: Department of Health and Family Welfare; Department of Education ; Department of Women and Child Development (DWCD-ICDS); Ministry of Urban Development, Ministry of Rural Development; Ministry of Tribal Affairs; Ministry of Drinking Water and Sanitation; Ministry of Panchayati Raj; Ministry of Human Resource Development; Evidence Action-Deworm the World Initiative; development partners Ministry of Health and Family Welfare | National Deworming Day (February 2018)

State Factsheet (states to fill in the details -numbers/names here) Indicators for NDD (February 2018) Details Number of government, government-aided schools Number of private schools* Number of AWCs Number of children enrolled in government schools Number of children enrolled in private schools Number of children registered at AWCs Number of out-of-school children Number of unregistered children at AWCs Total number of children to be dewormed Number of Albendazole tablets required Total availability in the state as on _______ date Districts with shortfall of drugs Names of districts to be filled in Districts with excess of drugs Names of districts to be filled in Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Fixed Day Approach National Deworming Day – 10 February 2018 to deworm all enrolled and outof-school children in schools and anganwadis Mop up Day – 15 February 2018 to deworm children who could not be dewormed Albendazole on National Deworming Day. Albendazole tablet 400 mg. should be administered to all children aged 1 to 19 • Children aged 1 -5 years; out-of-school children aged 6 -19 to be dewormed at anganwadis • Children aged 6 -19 years enrolled in schools to be dewormed in schools Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Albendazole Administration – Age-specific Dosage Deworming Drug- Albendazole 400 mg (available free-of-cost) Albendazole should be administered to all children aged 1 to 19 in age-specific doses The older children should chew the tablet. Ensure safe drinking water is available. Albendazole drug that are not chewed or crushed may have significantly lower effectiveness Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Quality of the Procurement Process There is a large variation observed in State’s capacity to buy adequate quantities of Albendazole of the right quality for NDD. State procurement could be improved by: • Better compliance with quality systems during procurement and supply of medicines as recommended by Go. I and applied by state procurement agencies • Ensuring compliance with agreed specifications and quality criteria of manufacturers. • Procuring from a list of preferred suppliers that have undergone an expert review by WHO and can be considered as offering better quality Albendazole drugs. Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Supply Chain Management for NDD Procurement of Albendazole 400 mg Tablets • State Health Department Supply of Albendazole tablets to District Health Departments as per requirement • State Health Department Supply of Albendazole tablets to Block Health Department as per requirement • District Health Department Supply of tablets to all schools and anganwadis with buffer stock • Block Health Department in coordination with Education and ICDS DRUGS AT ALL LEVELS SHALL BE STORED IN A COOL AND DRY PLACE AND AWAY FROM SUN LIGHT Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Training Cascade State-level between 5 -8 December 2017 District-level by 29 December 2017 Block/ Project/ Sector-level/ by 30 Jan 2018 • Training of Master Trainers (SIHFW, Nodal Officers) • Meeting with Regional Deputy Director, NHM Consultants on Nutrition, Child Health, Data and monitoring, State Immunization Officer, SPM, Officials from Education, ICDs, Rural Development, Water and Sanitation, Tribal Welfare Department and other partner agencies • Orientation of District Officials (Health, Education, ICDS) CS/CMHOs, RPM, DPM, NHM consultants, DIO, DPO and other partner agencies • Training of Block/project officials : BPO/MOs/BCM/ BHM/ MO- CHC/PHC/ BEO/BRP, CDPO and others partner agencies • • Block-level: Training of teachers/headmasters and ANMs, AYUSH team Project-level: CDPOs to train Lady Supervisors (LS) at their monthly meetings Sector-level: LS to train AWWs during sector level meetings Block/Cluster-level: ASHAs orientation during monthly review meeting Ministry of Health and Family Welfare | National Deworming Day (February 2018)

NDD Reporting Cascade 1 Level School Functionary Responsible Submitted to Format Principal Respective ANM under whose area the school falls in School Reporting Format Anganwadi Reporting Format Submission date 2 Anganwadi AWW Respective ANM under whose area the AWC falls in 3 Anganwadi ASHA Respective ANM under whom ASHA is working ASHA –Standard Reporting Format 4 Sub-center level ANM MO – BHPC To collect all School and Anganwadi Reporting Formats & ASHA Reporting Formats 5 Block-Level MO-BPHC District M & E Officer Block-level Common Reporting Formats & Monitoring formats; including NDD app reporting 14 March 2018 6 District-Level District M & E State Nodal Officer District-level Common Reporting Formats & Monitoring formats including NDD app reporting 21 March 2018 State Nodal Officer 7 Child Health, Mo. HFW State-level Common Reporting Formats & Monitoring formats including NDD app reporting Ministry of Health and Family Welfare | National Deworming Day (February 2018) 20 February 2018 27 February 2018 30 March 2018

NDD Kit: To be distributed to all teachers and AWWs at the block/sector trainings/ meetings 1. Albendazole Tablets– 400 mg in required quantity 2. Handouts (with perforated reporting form and FAQ) per school and AWC 3. IEC: - Banner/Flex: per school and AWC - Posters – per school and AWC 4. Adverse Event Reporting Form NDD kit= Tablets+ Training handout + IEC+ Reporting Form Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Financial Guideline for NDD States to insert financial guidelines based on the final NDD operational guidelines Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Technical Content for District & Block-Level Orientation • Training presentations will be shared and circulated by State department by ---- • Posters, banners and handouts for all schools and AWCs will be made available to district officials (CMHOs) by ------. / • In case of district level printing, prototypes of posters, banners, handouts for all schools and AWCs will be made available to district officials (CMHOs) by ------ for districts to print • ASHA handouts will be made available to all districts by ____ Banner/Hoarding Training Presentation Training Handout Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Adverse Event Management • Events such as nausea, mild abdominal pain, vomiting, diarrhoea, and fatigue may occur amongst a few children, especially those who have high worm infection. Please do not panic. Follow the adverse event management protocol • Any adverse events are temporary and generally can be managed at the school/anganwadi • Self-limiting symptoms do not require hospitalization • In case of an adverse event, make the child lie down in an open, shaded area and give the child water to drink • Choking is not to be considered a serious adverse event and is a medication error Albendazole is an easily chewable tablet. Still, if the child chokes on a part of the tablet, make the child bend over on your lap and pat the child on the back till the tablet comes out Call____ for any medical assistance • • Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Adverse Event Management (AEM) – Do’s and Don’ts Do’s Don’ts Always ask children to chew. Ensure clean drinking water is available. Never administer the tablet to children who are sick or are on any other medication Drug administration to children must be under Do not instruct children to swallow the tablet supervision of teachers/headmasters at schools, and anganwadi worker at anganwadis Use a spoon to administer the Albendazole tablet to the child themselves Do not allow the child to take the tablet home Do not forcefully administer the tablet to any child Nodal person for Adverse Event Management (AEM) at state-level _________ States should disseminate AEM protocol to all district officials. Teachers and anganwadi workers’ trainings and materials will cover all important aspect of AEM. (states to adapt) Manage the Adverse Events as per protocol- call Toll Free Number of Pharmacovigilance Programme of India (PVPI) 1800 180 3024 for assistance in reporting of Adverse Drug Reactions (ADR) and its management. Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Adverse Event Management (AEM) – Reporting • Additionally, physicians must fill PVPI suspected ADR reporting form for all the ADRs (for proper analysis of ADRs) • Anganwadi and ANM workers to fill the Consumer PVPI forms, provided in local languages also such as Hindi, Assamese, Oriya, Bengali, Kannada, Tamil, Telegu, Malayalam and Marathi for any kind of ADR • List of adverse drug reaction Monitoring Centres (AMCs) for all the states is provided for support to fill in the above mentioned forms (Hyperlink) PVPI Suspected Adverse drug reaction reporting form Medicine side effect reporting form Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Roles and Responsibilities of Health Department • Interdepartmental convergence • Ensuring availability of sufficient Albendazole tablets • Provision of Master Trainers to further train functionaries from Education/ICDS. • Develop and provide financial guidelines /budgets • Disseminate Adverse Event Management Guidelines • Develop IEC strategy and provide budgetary allocations • Printing of training material, IEC material and reporting forms • Inauguration of NDD at state and district-level to increase awareness • Ensure community mobilization through ASHAs to support deworming of out-of-school children • Monitoring and timely reporting of coverage data Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Expectations from ICDS • Support and coordinate with Health Department in effective roll-out of NDD • Train/orient anganwadi workers to administer drugs in coordination with Health Department and brief them on possible adverse events and their management • Ensue community mobilisation, especially of out-ofschool children • Deworm all registered and unregistered children between the age of 1 -5 and all out-of-school children in 6 -19 years of age • On mop-up day, administration on mop-up day to children who could not be dewormed on NDD due to absenteeism/ sickness • Monitoring and supportive supervision • Timely reporting Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Expectations from Education Department • Support and coordinate with Health Department in effective roll-out of NDD • Train teachers to administer drugs in coordination with Health Department and brief them on possible adverse events and their management • Community mobilization through School Management Committees, Health and Sanitation days, school assembly etc. • Deworm all enrolled children at schools • On mop-up day, administration on mop-up day to children who could not be dewormed on NDD due to absenteeism/ sickness • Monitoring and supportive supervision • Timely reporting Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Roles and Responsibilities – Development Partners (States to adapt this slide) • Development partners working at different levels should actively contribute in NDD coordination committees at State, District and Block levels • Development partners at different levels to actively contribute in NDD development partners under RMCH+A are encouraged to actively converge with State and District Health Missions to support them in effective implementation of NDD strategy by engaging the state, district, and block- level coordinators of state RMNCH+A unit (SRU) Ministry of Health and Family Welfare | National Deworming Day (February 2018)

Division-Level Drug Status (to be adapted by states) Requirement and availability of Albendazole tablet District Total Estimated Albendazole Required for NDD Available Stock of Albendazole tab (400 mg) Ministry of Health and Family Welfare | National Deworming Day (February 2018) Gap

Checklist • A checklist of all important elements for districts to take note for successful NDD implementation, is being included in the mini operational checklists. • States to share printed/ soft copy of checklist to all district officials by______ (States to adapt) Ministry of Health and Family Welfare | National Deworming Day (February 2018)

THANK YOU Ministry of Health and Family Welfare | National Deworming Day (February 2018)