This presentation was made by Preetu Mishra (UNICEF) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016. For more information about the conference visit our website: www.poshan.ifpri.info

1. The Adolescent Girls' Anaemia Control Programme :
A decade of programming experience to break the
inter-generational cycle of malnutrition in India
The journey from Pilot to Scale

2. Implications of Anaemia
Becomes
anaemic
during
pregnancy
Baby born with low
iron stores and
haemoglobin level.
Increased risk of
childhood stunted.
Uncorrected
anaemia in
infancy and
childhood
Enters
adolescence with
low iron stores &
haemoglobin level
Adolescent enters
reproductive cycle
with low iron stores
& haemoglobin
level
Intergenerational
Impact
Negative
Consequences of
Anaemia
Impaired physical
growth &
cognitive
development
Poor reproductive
outcomes
Reduced work
productivity &
income earning
capacity

3. 20 % of Adolescents (10-19 years) : in world are from
India
48% of Indian adolescents
are GIRLS !!!
1 out of 2
Adolescent girls -
anaemic
• 56% anaemic*
• 20% moderate to severe anaemia
• 16 % begun child bearing
• Dietary iron intake <50% of
Recommended Dietary Allowance
(NNMB 2012)**
*DLHS 2 and NFHS 3Source : World Population Prospects : The 2012 Revision

4. Knowledge centered program cycle :
from Innovation to Universalization
EVIDENCE
Using national and
global research and
findings
INNOVATION
Pilot testing an
innovation with
scale
EVALUATION
Documenting the
effectiveness of an
innovation
REPLICATION
Expanding an
effective
intervention
UNIVERSALIZATION
Scaling up and
mainstreaming Knowledge
generation
and
dissemination
VM Aguayo et. al. 2013
Global research seemed
to indicate Weekly
schedule of Iron and Folic
Acid Supplementation
could be practical, safe
and effective strategy in
reducing anaemia
prevalence

5. UNICEF initiated a Pilot
to control Adolescent Anaemia among girls
Starting: Year 2000
(20 districts in 5 states)
Platform: Govt. schools,
Anganwadi centres
Target
group
School-going adolescent girls
(grade 6th to 12th)
Out of School Adolescent Girls
Channel: Nodal teachers (responsible
for providing interventions
to students), field level
anganwadi workers (for out
of school girls)

6. Programme Elements
Three interventions
 Every week One Iron Folic Acid
tablet (100 mg elemental iron
and 0.5 mg folic acid)
 Biannual deworming
(Albendazole 400 mg)
 Monthly Nutrition Education
Strategy: Fixed day, Fixed site, fixed
responsibility
UNICEF : technical and financial lead
for programme design, capacity
building, IEC, supply gap filling,
monitoring and evaluation,
documentation
Health and
Family
Welfare
Women
and Child
Development
Human
Resource
Department
Convergence of Three
Ministries

7. • UNICEF initiated a
pilot in 20 districts
of 5 states
• Expanded to 52
districts of 13
States* by end of
2005
• Covering 8.8
million adolescent
girls
• Expanded to all
districts of 13
states* by 2011
• Covering 27.6
million adolescent
girls
• Government of
India launched
the
Nation-wide ‘
WIFS’ Programme
in 2012
• Targeting 108
million adolescent
girls and boys
both
2000 – 05
Innovation Phase
2006 – 11
Evaluation -
Consolidation Phase
2012 onwards
Universalization Phase
Phase-wise Progress
* UNICEF supported
Aimed to document cost and
effectiveness
Scaling up by the Government

8. Reduction in prevalence of overall anaemia (HB <120g/l)
in adolescent girls after 1 year of implementation
81
75
88
65
73
78
40
53
80
54
39
54
Andhra
Pradesh
Gujarat Madhya
Pradesh
Maharashtra Uttar
Pradesh
Pooled
Baseline Endline
Over all anaemia : Statistically significant 24 %age point reduction (30.6% decrease)
Moderate to severe anaemia : Average 8.4%age point reduction (43.1 % decrease)

9. For both girls
& boys
Launched in
2012

10. Program Coverage: From Pilot to Universalization (2000 to
2015) : A decade of programming experience
2000-2001 2002-2005 2006-2010 2011 2012-2015
20 districts/5 states
52 districts /13 states
State-wide/13 states
(Govt. funds)
All States and UTs
(Government funds)
Pilot Expansion Universalization
14.5
million
8.8
million
108
million
27.6
million
State-wide/13 states
Girls only Girls and boys both
INR 21 – 62 per adolescent girl per annum
(supplies, training, communication, monitoring and
assessment)

11. INDIA WIFS :
The ten make-
or break
elements
10 1 2
3
4
5
67
8
9
Techno-
managerial
unit at state
level
Partnership with
academic/training
institutes to capacity
building
Preventing
supply stock
outs
Emergency Response
System for managing
adverse effects
Sustained
positive
engagement with
media
Branding
and
celebrities
Basket of
services
On fixed day
Reinventing
strategies for
unreached
Convergence needs
highest authority’s
leadership
Use of evidence
and partner’
coalitions

12. Acknowledgements
Government of India
Victor M. Aguayo
Kajali Paintal
Gayatri Singh
Jee Hyun Rah
Vani Sethi