This is a presentation made by Srinivas Chekuri, Regional Coordinator of the "Nalgonda Collaborative" - an initiative of the Fluoride Knowledge and Action Network www.fluorideindia.org

1. Fluorosis Management in a District
Review and Monitoring System from Nalgonda DFMC
Srinivas Chekuri
Regional Lead
FKAN

2. Overview the Problem:
National Level:
High levels of Fluoride were reported in 230 districts of 20 States.
>14000 habitations are affected with fluorosis. Population at risk being
11.7 Million.
Telangana & A.P.
• District: Nalgonda
• Affected villages: 1108 (17 Mandals)
• Affected Population: > 300000
• Scope for scale up: 12 districts are affected by fluoride in A.P &
Telangana;
Therefore, Review & Monitoring System quite essential

3. Structure of the Presentation
I. Current System of Review and Monitoring
• National Program for Prevention and Control Fluorosis
(NPPCF)
• District Fluoride Monitoring Center (DFMC)
II. Bottlenecks at various levels
III. Proposed Review and Monitoring System

4. Directorate General of Health Services
• Advisor Nutrition/In Charge Nutrition & IDD
• National Nodal Officer ( NNO)
• State Nodal Officer (SNO)
• District Nodal Officer
• District Consultant
1. NPPCF Structure

5. NPPCF – R& M System
• Monthly Report : of activities and expenditure sent by District
Nodal Officer to State Nodal Officer by10th of each month
• Quarterly Report: sent by the District Nodal Officer to the
State Nodal Officer and to be forwarded to Central Fluorosis
Cell by 15th of the subsequent month at the completion of the
quarter
• Six Monthly Report: along with the cumulative progress
should be sent to the Centre by 15th of October and 15th April
every year by the State Nodal Officer. Utilization Certificate
and statement expenditure to be forwarded to the Center
every six months.

6. 2. DFMC Structure
Chairman
(Dist Collector)
Monitoring
Officer
Partnerships
Other Stakeholders
17 Key Line Depts
HoDs & Point Persons

7. 1. District Administration
2. Rural Water Supply and Sanitation (RWS)
3. Civil Supplies
4. Rajiv Vidya Mission
5. District Rural Development Agency (DRDA)
6. Health
7. Arogya Sri
8. District Water Management Agency (DWMA)
9. Social Welfare Department
10. Tribal Welfare Department
11. BC Welfare Department
12. Women and Child Welfare Department
13. Education
14. Horticulture
15. Animal Husbandry
16. Forest
17. Minor Irrigation
DFMC Key Line Department :

8. DFMC-Review Meetings
REVIEW MEETINGS:
• Regular bi-monthly review meetings held
with 17 key line departments
• Review done against performance indicators
embedded in Action Taken Report (ATR)
• District Collector as Chairman, DFMC
presides over review meetings
• All Heads of Depts (HoD) attend meeting
along with Point Persons
• So far 4 such review meetings organised and
status updated in ATR
• ATR submitted to District Collector &
circulated to all constituent departments
• Monthly review meeting held with Point
Persons

9. Major Bottlenecks…
Community Level:
• Water Distribution Issues: irregular and inadequate
supply, Pipe line leakages, no caps fixed on air
walls, new taps not replaced timely in place of old
taps, improper chlorination, water testing reports
not sent to GP, Color coding of water sources not
done, Krishna water and ground flow in one pipe
only (mixing of water)
• No awareness on safe drinking water – Krishna
water using for cooking and RO water for drinking
• Nutrition - improper distribution/lack of supply -
milk, egg, fruits, full meal (children & pregnant
women) – a month’s supplies are dumped at a
time – leading to rotting.
• Health system: no referrals for re-surrective
surgeries
•
• No review done at GP
Pipe Leakage at Munugodu village
opposite Govt High School

10. Major Bottlenecks…
• Capacity building of front-line workers - ASHA,
AWW, VHSC,VWSC Teachers, SMCs, GP
ward members
• Awareness & SBCC - Drinking the same water
in the fields/work sites
• No surveillance and listing of RO plants
• Schools, Aangan Wadi Centers,
Model schools, Kasturiba
schools, Residential hostels –
Lack of access to safe drinking
water – spread of water borne
disease like diarrhea
• No coordination between Krishna water
lineman & village waterman
• Field Testing Kits (FTKs) – not put to proper
use
• Some of the Testing Labs – do not have Ion
Meters and reagents
Primary School, Sivannagudem,
Marrigudem

11. Major Bottlenecks…
Mandal/block Level:
• Fluorosis mitigation is not an agenda item in Mandal level meetings
even in severely affected mandals
• Mandal level planning, review, monitoring is absent
• No accountability at the mandal level
• Data gaps and implementation gaps not attended at mandal level
• Public representatives willing to involve in planning at the mandal
level, but there is no space for them
• DFMC involved only at district level coordination

12. Major Bottlenecks…
District Level:
• Absence of Intra-departmental and inter-departmental review
• Every dept says there is no budget for F activities
• 10 bedded Fluorosis ward in Head Quarters Hospital –non functioning
• Disabled Certificates in SADAREM Camps are not issued on time &
proper assessment of disability not done, inordinate delays
• Convergence is brought by DFMC & it has to go a long way in term of
resource sharing
• Involvement of Zilla Panchayat is not there
• NGO/CSOs engagement

13. Suggested Model…
• Setting relevant performance indicators for R & M
• Constant feedback from various level-
GP/Com/PHC/CHC/Mandal/District /State/National /media
• Credibility of information
• Sustainability process
• Incentives
• Role for other key stakeholders
• Documentation of media information

14. Suggested Model…
District
Level
State
Level
National
Level
Commun
ity Level
PHC/CH
C
Mandal
/Block
Level

15. Suggested Model:
Community Level:
• Monitoring & Surveillance by NGO/CSOs
• PRI Functionaries, village water man
• VWSC/VHSC/SHGs/Youth,SMCs
• ASHA, AWWs
• School Teachers,
PHC/CHC Level:
• Medical functionaries – Doctors
• AHSA, AWWs
• VHSC/VWSC/SHGs
• Referrals

16. Suggested Model…
Mandal/Block Level:
• Mandal Development Officer
• Public Representatives: MPP, MPTCs, GP Sarpanches
• Line Departments
• NGOs/CSOs/SHGs
District Level:
• District Collector
• Heads of line departments, point persons
• District Consultant –NPPCF, District Nodal Officer-NPPCF
• NGOs/CSOs,
• Other stakeholders – technical & support agencies

17. Suggested Model…
State Level:
• NPPCF – State Nodal Officer, District Nodal Officer, District
Consultants
• Key stakeholders & line departments
• District Collectors
• ZP-CEOs and Chairpersons
• MDOs& MPP
• NGO/CSO representatives
• Public Representatives –MLAs,MP, ZP Chairpersons
• Involvement of technical, resource agencies
National Level:
• Inter-state coordination
• Involvement of technical, resource agencies
• NGOs

18. Tools for Effective R& M
Exclusive
Web Portal
Helpline
Center
Fluorosis
Resource
Cell
Rehabilitation
Centers at
endemic
areas
MIS & ME
Systems
Newsletter

19. THANKS