1. WIFS Supply chain system in Rajasthan (Issues, challenges with solutions proposed)

2. Overview with Spatial Distribution of Anemic Children aged 6-59 months, Rajasthan (NFHS –IV, )
Rajasthan
Surface Area (in sq. km)- 3.42
Population (Census 2011) lakhs
Population Density- 200per sq. km (compared to 382 of India)
Literacy rate (Female literacy being very low- 52.1)
Total no. of health facilities (including CHC, PHC SC, DH,SDH)
Total no. schools (as per DISE 2017)
Total no. of AWC (as per ICDS)
Total no. of OOS Adoles. Girls
Total no. of students (Class 6 to 12)

3. Top & Bottom five Districts of Rajasthan in terms of Anemia prevalence according to NFHS 4, 2015-16
(Ranked)
Children age 6-59 months who are anemic (%)
Pregnant women age years who are anemic (%)
Top -5
Ganganagar (40.2%)
Hanumangarh (20.3%)
Churu (42.2%)
Jhunjhunu (27.7%)
Jaisalmer (42.5%)
Dausa (28.6%)
Dausa (45.2%)
Jaipur (30.0%)
Hanumangarh (46.2%)
Sawai Madhopur (30.8%)
Bottom-5
Baran (76.3%)
Banswara (68.7%)
Jhalawar (76.6%)
Baran (69.5%)
Udaipur (79.1%)
Jhalawar (69.6%)
Bundi (80.0%)
Chittaurgarh (71.6%)
Banswara (84.6%)
Udaipur (73.5%)

4. Problem Statement
To provide health services in a state being largest in terms of surface area, 7th largest in terms of population with huge variance in population density (very scattered population due to difficult geographic terrain)
One of the lowest female literacy rate with huge drop outs and poor nutritional status of girls (27% of females- 15 to 49 yrs have BMI below normal i.e. less than 18.5 kg/m sq.)
High anemia prevalence (60.3%) for children 6 to 60 months and (46.8%) for women in reproductive age group (15 to 49 yrs.)

5. Created demand for Inter-departmental Convergence
MEDICAL DEPARTMENT
ICDS DEPARTMENT
EDUCATION DEPARTMENT

6. Interventions to prevent and control Anemia
Source: Iron deficiency anaemia: assessment, prevention and control. A guide for Programme Managers; WHO WHO/NHD/01.3
Strategies for prevention and control of iron deficiency and Anemia
Food based strategies
Supplementation
Improved Health Services
WIFS
NIPI
Deworming
Dietary
diversification
Food
fortification

7. WIFS Overview
The Ministry of Health and Family Welfare, Government of India has launched the Weekly Iron and Folic Acid Supplementation (WIFS) Programme to reduce the prevalence and severity of nutritional anemia in adolescent population (10-19 years) in FY
In Rajasthan, the programme was launched on July 25th 2013 for the following two target groups in both rural and urban areas:
Adolescent girls and boys enrolled in government/government aided/municipal schools from 6th to 12th classes.
Adolescent Girls who are not in school.

8. Current strategies under the program
Convergence meetings/workshops- have been organized at state, district and block level that sensitizes officials of all the three depts.
For maximum coverage, strengthening Supply Chain Management system - RMSCL (Rajasthan Medical Services Corporation) has been established as a centralized procurement agency for effective, transparent and timely procurement of drugs for the department of Medical, Health and Family welfare of Rajasthan under RTPP Act (The Rajasthan Transparency in Public Procurement Act, 2012 and Rules 2013)
Demand generation
Ensuring supply to ICDS and Education Dept.- Through BCMOs instead of supplying through district level officers of their own departments by utilizing the budget sanctioned in PiP for transportation of tablets till schools and AWC

9. WIFS/NIPI Supply System
Demand
Supply
INSTITUTE
Demand from School and AWWs
BLOCK
Compilation at Block level (Edu. & ICDS)
A Copy to BCMOs with name and demand of institutions
DISTRICT
Compilation at DEOs /DD ICDS offices
DEOs /DD ICDS officer to Dep. CMHO office of health Dept.
STATE
All Dep. CMHOs to State office
RMSC
District wise demand from State Office to RMSC for Procurement (with amount sanctioned in PIP RoP)
RMSC
RMSC Supply WIFS tab/syrup to DDW at Districts through his suppliers (Nestor and Vivek Pharmac. In Raj.)
DISTRICT
Dep. CMHOs receive supply from DDWs; will ensure Supply upto Block level
BLOCK
BCMO will receive Supply from Dist; and Demand from BEOs/ CDPOs
BCMO will ensure supply upto institutions with coordination of BEOs/Nodal/ CDPOs
INSTITUTE
Receive supply; ensure proper storage, consumption, recording and reporting

10. Calculation of demand for IFA under WIFS
By education Dept Total no. of girls and boys (Class 6 to 12) + Total no. of teachers * 52 tablets + 10% buffer stock
By ICDS Dept Total no. of adolescent girls registered under ICDS + Total no. of ASHAs and AWW * 52 tablets + 10% buffer stock

11. WIFS Transportation guidelines (developed by the state)
For the supply of WIFS tablets from district to block level for both the departments, mini trucks are hired twice a year maximum at the rate of Rs. 20 per km(including loading and unloading expenses).
Dep. CMHO’s transport the tablets to the BCMHO’s from district level to block level.
For the supply of tablets from block level to schools and anganwadis, 4 vehicles are hired twice a year (2 for Education and 2 for ICDS Dept.) on the basis of state guidelines

12. WIFS Transportation guidelines (developed by the state)
BCMO’s coordinate with the block officers of ICDS (CDPOs) and Education Dept. (BEOs and Nodal Principals) to ensure the supply of drugs at the school and AW level by pre mapping of schools and anganwadis and estimating the required demand of drugs.
Dep. CMHO’s and BCMOs undertake the group visits to schools and AW’s with the district and block level officers of Education and ICDS Dept. respectively.
Centers in the urban areas are monitored by the nearest urban facility under NUHM.

13. Challenges faced in the current system
Less utilisation of the amount sanctioned for transportation of WIFS tablets by the districts
Lack of and awareness and demand generation from community and beneficiaries
Lack of convergence and coordination among block level officers of all the three departments at block and ground level ( for ensuring supply till schools and anganwadis

14. Challenges continued..
Non reporting of stock out or Lack of demand generation by Education and ICDS
Delay in supply to DDWs by the supplier of RMSC and thus causes stock out
Lack of monitoring from district level to regulate the supply between DDWs and schools & Anganwadis as till now E- Aushadhi (RMSC software) shows stock availability till DDWs only but now we are in the process to strengthen it

15. Suggestions for Solutions proposed
For Education system-
Involving PEEOs (Panchayat Elementary Education Officer)- Ensuring supply directly to MO/IC (PHC/CHC) through DDWs on a monthly basis who will coordinate with PEEOs of the Panchayats falling under their areas for the further supply till schools
For ICDS -
Ensuring supply till AWCs by again involving MO/IC (PHC/CHC) who will provide to ANMs and they will further to ASHAs and AWWs instead of involving CDPOs and LS in the current system of ICDS

16. Expectations on supply chain
To increase the convergence- need to organize joint VC of all the three departments from GoI level on bi-annual basis and directions to conduct VCs at the state level on a quarterly basis for the effective implementation, monitoring and timely resolution of issues.
IEC/BCC- It is requested to provide detailed execution plan for the implementation of IEC and BCC activities under the program.
Fund for prevalence survey- State should be able to conduct its own prevalence survey for the program for which amount should be sanctioned from GoI to the states.

17. Thank You