1. Zinc Supplementation Roll Out Plan

2. Roll-Out of Zinc Supplementation with New ORS in the Districts Ongoing in Purulia Being initiated in Malda, Murshidabad, Uttar & Dakshin Dinajpur and Purba Medinipur with UNICEF supply of Zinc tablets to start with Will roll-out in all districts as soon as Kit A with Zinc tablets supplied to all districts by state government-in early 2009

3. Availability of zinc and new-formula ORS The Govt of West Bengal has incorporated the new formula ORS in its drug list. It is expected that the new-WHO formula ORS will henceforth be procured by the govt. and supplied to the districts as routine supply and in Kit A (when available). However, the old WHO formula ORS will continue to be used, as long as available. Zinc has been added in Kit A as per GOI guidelines and is being procured by the state as a Kit A item. However for the 6 districts, UNICEF is supplying the first 6-months (approx) supply of zinc sulphate tablets.

4. REQUIREMENT OF ZINC & ORS per sub centre Under 5 population = 13% Therefore in 1 sub centre area U5 children will be = 13/100 * 5000 = 650 Average 2 diarhhoea cases per year so 1300 episodes per year 20% cases of diarhhoea come to the sub centre for treatment per year So 260 episodes of diarhhoea come to the SC/yr An average child needs 2 packets of ORS and 1 tab of Zinc Sulphate (20 mg) per day x 14 days per episode Therefore ORS required per sub centre per year: 260 x 2 = 520 packets Zinc tablets required per sub centre per year: 260 x 14= 3640 (20 mg) tablets

5. Distribution of Zinc tablets The zinc tablets for 5 districts available in Central Family Welfare Store, Bagbazar (UNICEF supply). Amount: Malda-874,000, Purba Medinipur- 1,204,000, Murshidabad-1,420,000, Uttar Dinajpur 580,000, Dakshin Dinajpur 422,000 Total 4,500,000 + Purulia (already in use) The districts need to pick it up and distribute the tablets to BMOHs. The BMOHs will distribute the same to the ANMs for the sub centres after the training of the ANMs and the Supervisors. For All districts zinc will be supplied by State Govt to subcentres as a kit A item (to be in place by Jan-Feb ‘08?)

6. Training/Orientation on new diarrhoea guidelines Clubbed with Routine Immunization Training Training of BMOHs, MOs, B/PHNs and other district officials along with RI-TOT BMOHs/MOs will train the ANMs and Health Supervisors in their respective blocks along with RI training The training of the ANMs and the Supervisors will roughly include the same topics as covered in BMOHs training but with more emphasis on practical demonstration Before the training of the ANMs demonstration items like new formula ORS, zinc tablets, jug, water, spoon, measuring bottle etc. have to be kept handy

7. DISTRIBUTION OF ZINC MODULES FOR TRAINING For the 5 districts: Zinc Bengali booklets: At the training of the BMOHs, BPHNs and MOs one booklet each will be given out to all the participants. (plus a CD on the new diarrhoea management guidelines) Additionally requisite numbers for the ANMs & H. Supervisors will be handed over to the BMOHs/PHNs for distribution during the ANM training.(see next slide) Modules for ICDS personnel- CDPOs, ICDS Supervisors and AWWs have been supplied to the 5 districts (Consignee- CMOH -marked for ICDS). These will have to be distributed via the CDPOs as per the following (see next slide) For other districts- At the training of the BMOHs, BPHNs and MOs of PHCs one booklet each will be given out to all the participants. (plus a CD on the new diarrhoea management guidelines) For ANMs, AWWs, CDPOs etc- decision will be taken after discussion with state and supplied to the districts

8. ZINC TRAINING MODULES for 5 districts For ICDS DistrictsCDPOsSupervisorsAWWsTotalRounded off Uttar Dinajpur976300030763100 Dakshin Dinajpur868241124792500 Purba Medinipur25150500051505200 Murshidabad26180651266926750 Malda16126427444004450 22000 For Health officials (for training) BMOHs PHC MOsANMs Health SupervisorsMunicipality*DistTotalRounded off Uttar Dinajpur922344984820541600 Dakshin Dinajpur819247652420383400 Purba Medinipur2554706223602010881100 Murshidabad2670832254842012861300 Malda16355111462420752800 Total84200264078624010040504200

9. IEC Materials Posters & Leaflets have already reached the districts for health & ICDS-in 5 districts. For other districts- decision will be taken after discussion with the state.

10. Reporting Report on Use of Zinc (with new ORS)- A line needs to be added (by hand) in Monthly Return form by sub centres in the section on diarrhoea: ‘ No of children given zinc tablets’. This needs to be collated at block and district level and sent with the district monthly report. Also keep a report on how many workers trained /oriented

11. Issues that need to be decided Modalities of AWWs distributing Zinc Tablets with ORS- All zinc tabs and ORS to be given to ANMs at present-AWWs will take tablets from ANM and at end of month give report to ANM. What about ASHAs?-no decision taken yet Training of ICDS staff: CDPOs preferably included with BMOHs,B/PHNs and MOs. CDPOs will in turn train/orient supervisors and AWWs. AWWs also be oriented by ANM during convergence meetings. Letter already sent to all districts by CFW to 5 districts. Letter needs to be to be issued by DPO-ICDS to CDPOs & CMOH to all BMOHs & MO-PHC, before the sensitization meeting