RESUMO
Objectives: Recognizing that low iron stores pre-conception continue during pregnancy, the government of Chhattisgarh and Micronutrient Initiative (MI) implemented weekly IFA supplementation (WIFS) program from July 2011 till May 2012 among school-going adolescent girls in classes 9 to 12 (SG) and out-of-school adolescent girls aged 11-18 years (OG). The aim of this program was to demonstrate effective approaches of achieving high rates of coverage and utilization of WIFS among SG and OG. Methods: The project involved multi-department government coordination and was implemented through schools for SG and ‘community based centres for women and children’ - anganwadi centres (AWCs) – for OG. A cascade approach was adopted to train teachers, peer guides and anganwadi workers. Supervised weekly dose of enteric coated IFA was administered to over 95,000 adolescent girls in 424 schools and 6,832 AWCs after counselling for probable side-effects. MI facilitated supportive supervision, program reviews and completion of baseline and endline surveys. Results: 93.8% SG and 73% OG received free IFA tablets. 48.1% of SG and 31.4% of OG completed at least 80 % of the recommended dosage. Post side-effect counselling added to an incremental compliance of 15.4% to a full recommended weekly dose. There was 22.5% increase in the knowledge level among adolescent girls on atleast three causes and prevention of anaemia. Conclusions: Effective multi-department coordination, health and nutrition education and effective counselling on side effects are important success factors for WIFS. Convinced with the impact of WIFS, the program is being scaled up across the state.
RESUMO
Objectives: Estimates from robust cross sectional surveys have brought into question the accuracy of HMIS of VAS in India, including potential errors as HMIS data is rolled up at various levels from health worker- to state-level, limiting the usefulness of these data for program feedback and improvement. In response, we sought to identify errors in monitoring data at different levels, suggest corrective action and establish coverage by a cross sectional survey triangulated with HMIS data. Methods: This exercise was conducted in 16 districts where 48 primary health centers (PHCs) were selected randomly. Data on Vitamin A coverage recorded at districts, PHCs, sub-health centers (SHCs) and health worker/volunteer level were cross-verified with coverage figures recorded at their respective constituent units. Discrepancies between coverage data recorded at health facilities and that aggregated from their constituent units were computed. A 30X7 cluster survey was also undertaken in each of these centers to establish population-based coverage. Results: Overall, there was a 7% discrepancy between figures reported by PHCs and that aggregated from their SHCs. In some PHCs the discrepancy was as large as 40%. The cross-sectional household survey identified 10% higher coverage than that reported by the state government (52% vs 42%). District specific findings were used to identify and facilitate systemic changes in reporting and data compilation. Conclusions: This is a cost-effective method and useful exercise for improving internal data quality and minimizing reporting error. The involvement of government functionaries in the process increased the ownership of study results and facilitated corrective actions.