Visitor No.:
School Health Prog.

      School Health Programme:-

 

INDIRA BAL SWATHYA YOJNA (IBSY) - New State Initiative           

A.2.4.1 Situation Analysis (2010-11) :-

In Haryana there are 9301 Government Primary and 2270 Government Middle Schools and 3118 Government Secondary and High Schools and 7810 Government Aided and Private Schools, having total of 4524454 students in schools. The children in school need regular health checkup and their health needs are required to be addressed.

Table-1:  List of Schools:-

Number of Schools in Haryana as on 1-11-2009

Type

Government

 

Non- Government

(Aided)

Non- Government

(Non- Aided)

Total as on 01.11.2009

Pre Primary/ Balwaris

21

-

-

21

Independent Primary

9301

173

3578

13052

Middle Schools

2270

6

1200

3476

High Schools

1600

102

1604

3306

Senior Secondary Schools

1518

104

954

2576

Central Schools

28

-

84

112

Navodaya Vidyalaya

19

-

-

19

Total

14757

385

7420

22562

   Source:- www. schooleducationharyana.gov.in

Table-2: List of number of students in Govt./ Non- Govt. Schools:-

 

Total Including (SC)

 

 

 

Boys

Girls

Total

Non-Govt.

Total

Pre Primary/Balwadi

746

690

1436

0

1436

Nursery

40285

37780

78065

69274

147339

Class I-V

701412

664679

1366091

866880

2232971

Class VI-VIII

313068

325464

638532

490142

1128674

Class IX-X

158408

168691

327099

5944082

6271181

Class XI-XII

154068

126085

280153

132700

412853

Grand Total

1367987

1323389

2691376

1833078

4524454

Source:- www.schooleducationharyana.gov.in

 


A.2.4.2    Indira Bal Swasthya Yojna (IBSY)

The state had launched an integrated Scheme on 26th Jan 2010 for all children between 0-18 years with inter-sectoral convergence of Health, Sarv Shiksha Abhiyan, Women and Child Development and Social Justice & Empowerment. It covered the issues of Nutritional Deficiency, Disability, Disease (including Non communicable diseases). The main components of the Indira Bal Swasthya Yojna include covering school children, Anganwadi Centres and Children out of Anganwadis and School. There are three D s of IBSY namely

 1. Disease

 2. Deficiency

 3. Disability.

Process:-

(1) Covering of Schools: Under IBSY Scheme all the schools (Govt. and Private) were covered in a phased manner.

·      The children in the school were screened through a health card/register by the trained teacher. There are different registers for primary and secondary class students. So far 85500 school health registers have been printed and distributed to all the districts under implementation of Indira Bal Swasthya Yojna.

·      One teacher from each school had been trained as a Health Teacher to conduct health screening. First health screening had been done in all Govt. schools across Haryana. The teachers have been trained to screen a child for nutritional deficiency (Anemia, Night Blindness, Vitamin D Deficiency), chronic cough, fever, bleeding gums or dental caries. This card/ register once filled, give a fair idea of the health needs of the children.  The trained teachers maintain class-wise cards/ registers coordinate school visits by ANMs and Doctors and in distribution of health material. At the time of screening, height and weight, Children with disability and chronic absence due to illness were recorded on the health card/ register.

·      After the screening of the children is done, only the screened children were seen by School Health Officer along with ANM/ MPW (M). There is one school health doctor at every PHC level who covers 40-50 schools in 6 months period. A School Health Officer makes two visits per week (Tue and Fri) in two schools as per micro-planning done by him/her. A Referral slip to the children requiring referral is given and the referral letter  is  addressed to the parents. In the referral slip the specific referral and the facility referred to are being mentioned clearly along with the stamp of Indira Bal Swathya Yojna. The referred students were given a priority attendance at the health centers.

 

(2) Coverage in Anganwadis:-

 

·            In the 2nd Phase: - During this phase the children in the age group of 0-6 years of age who are in Anganwadi Centers were covered. Each child in the Anganwadi was screened by the ANM of the jurisdictional Sub Centre. While doing the checkup she had screened the children for Disease, Disability and Deficiency.

·            Each Anganwadi worker had recorded the weight of each child and other parameters had also been recorded by the Anganwadi Worker in respect of each child in a register. The AWC had also screened the children for the deficiencies as per the card/register and booklet of instruction. The children had been screened for Deficiency in nutrition (Anemia and malnutrition), Disease and Disability.

 

Table 3 Progress in School Health (2009-10) before launch of the IBSY is as under:-

No. of children examined

941554

No of children treated in school 

237971

No of children referred

54058

Anemic children

76393

No of children advised spectacles

4397

 


Table 4 Progress in School Health (up to Dec., 10) after launch of the IBSY is as under:-

 

Achievements under IBSY

So far

Phase – 1

(Govt. Primary Schools)

Phase – 2       (Anganwadi’s )

Phase – 3

(Govt./Private Middle, High, Sr. Secondary Schools)

Total

No. of Schools/ Anganwadis to be covered

9246

18667

5383

33296

Total No. of Schools/ Anganwadis covered

9099

17888

4673

31660

No. of Children to be covered

1410247

1068739

1141605

3620591

Total No. of Children covered

1095153

926226

868238

2889617

Total No. of children with who were found Anemic

616403

244264

171825

1032492

No. Children having Ht/Wt. for age below mean value

44842

37026

43768

125636

No. of children with visual difficulty at night

1859

606

3393

5858

No. of Tuberculosis Cases reported

245

429

238

912

No. of Disability cases Detected

10366

4371

8057

22794

No. of Spectacles Given free of cost to children

13107

7

820

13934

 

A.2.4.3(a)Physical Progress under IBSY so far

·         15 lacs School health cards printed by the Education Department and NRHM and 85500 registers and 6000 manuals printed under NRHM IEC/BCC Flexipool.

·         30000 Teachers Training Module already has been published & distributed.

·         TOT was done for implementation of Indira Bal Swasthay Yojana.

·          120 Trainers trained.

·         7179 teachers already trained under 3rd Phase of IBSY.

·         The teacher training for screening of school children was done at block levels all over the state. CDPOs, BEOs, BEEs & ANM in-charge of sub centers were also trained in the same batch along with teachers.

·         Monitoring of teacher training was done by state level officials to ensure quality training.

·         Printing of pamphlets, banners, posters & booklet of Indira Bal Swasthay Yojana was done under IEC/BCC Activity.

·         Review meeting of Nodal officer of school health was done on monthly basis.

·         Coverage under IBSY for Disease, Deficiency and Disability was done in three Phases.

In the 1st Phase:-  The scheme was implemented in all the Districts in campaign mode with focus on identification of disease, disability & deficiency  in primary schools covering children of 6-12 years of age, collaboration with Sarva Shiksha Abhiyan.

In the 2nd Phase: - During this phase the children in the age group of 0-6 years of age who are in Anganwadi Centers were covered. Each child in the Anganwadi was screened by the ANM of the jurisdictional Sub Centre. While doing the checkup she had screened the children for Disease, Disability and Deficiency.

In the 3rd Phase :- In this phase, all the children in the age group of 12-18 years, who are in both Govt. & Private Middle , High and Senior Secondary Schools are being covered.

The Phase wise progress under IBSY for Deficiency, Diseases and Disability is as             follows:-

·             School Coverage:-

Table 5  No. of Schools/ Anganwadis covered under IBSY is as under :-

Achievements/ Activities Done

Phase – 1

(Govt. Primary Schools)

Phase – 2       (Anganwadi’s )

Phase – 3

(Govt. Middle, High & Senior Secondary Schools)

Total

No. of Schools/ Anganwadis to be covered

9246

18667

5383

33296

No. of Schools/ Anganwadis covered

9099

17888

4673

31660

Percentage

98.41

95.82

86.81

95.08

·          Children Coverage:-

Table 6: No. of Children covered under IBSY is as under:-

Achievements/ Activities Done

Phase – 1

 

Phase – 2

Phase – 3

 

Total

No. of Children to be covered

1410247

1068739

1141605

3620591

No. of Children covered

1095153

926226

868238

2889617

Percentage

77.65

86.66

76.05

79.81

 

·             DEFICIENCY:-

(i)         Anemia: - In IBSY phase-1 Hb(haemoglobin) testing was done of all the children by the LTs. In IBSY phase-2 & 3 Hb testing was done screened children and the anemia was classified as Mild, Moderate & Severe as under:

 

Mild

Hb 10 - 12 gm/dl

Moderate

Hb 7 - 10 gm/dl

Severe

Hb < 7 gm/dl

 

Table 7 No. of Anemic Children detected under IBSY is as under:-

Anemic Children

Phase – 1

(Govt. Primary Schools)

(6-12 Years of Age)

Phase – 2       (Anganwadi’s )

(0-6 Years of Age)

Phase – 3

(Govt./Private Middle, High, Sr. Secondary Schools)

(12-18 Years of Age)

Total

Total Children examined

1095153

931324

828638

2855115

Mild

321744 (29.37%)

141583 (15.20%)

99207 (11.97%)

562489

Moderate

283651 (25.90%)

97780 (10.49%)

69941 (8.44%)

451372

Severe

11008 (1.00%)

4901 (0.52%)

2677 (0.32%)

18586

Total

616403

244264

171825

1032492

Percentage

56.28

26.22

20.73

36.16

·                  In the 1st Phase of IBSY:-  Total of 2,74,51,063 Iron & Folic Acid tablets and De- worming Doses were given to 570163 anemic children(56.2%). All severly anaemic children were referred to district child health clinincs where their PBF was made and investigated. Those requiring BT were given BT at district hospitals.

·               Under 2nd phase of IBSY:-    244264 anemic(26.2%) children were given iron and folic acid syrup and tablets.

·               Under 3rd phase of IBSY:-   174905 children(20.5%) have been diagnosed to be anemic out of total 850804 children examined so far and  iron and folic acid tablets are also being given to them.

·               De worming campaign was carried out in all school children.


(ii)           Data regarding Ht/Wt. for age as per ICMR charts:

Criteria:-

     Malnutrition was measured as per standard ICMR Ht/Wt. for age charts. Children falling below the mean value had been classified as Malnourished. As per the scheme these were to be investigated for the cause and parents of these children were to be given Nutritional education.

Table 8 No. of Children having Ht/Wt. for age below mean value under IBSY is as under:-

Activity

Phase – 1 (Govt. Primary Schools)

(6-12 years of age)

Phase – 2   (Anganwadi’s)

(0-6 years of age)

Phase – 3

(Govt./Private Middle, High, Sr. Secondary Schools) (12-18 years of age)

Total

Total Children examined

1095153

931324

828638

2855115

Children having Ht/Wt. for age below mean value

44842

37026

43768

125636

(iii)       Vitamin A Deficiency:-

Table 9 No. of Children reported as visual difficulty at night:-

Activity

Phase – 1

(Govt. Primary Schools)

(6-12 years of age)

Phase – 2       (Anganwadi’s )

(0-6 years of age)

Phase – 3

(Govt./Private Middle, High, Sr. Secondary Schools)

(12-18 years of age)

Total

Total Children examined

1095153

931324

828638

2855115

No. of children with visual difficulty at night

1859

606

3393

5858

Under IBSY so far - 2404 children with visual difficulty at night were given Vitamin A doses as per schedule. The history of decreased/reduced vision at night was used for presumptive diagnosis of vitamin –A deficiency and these children were given Vitamin –A doses .

 

 

 

 

·                     DISEASES:-

(i)         Childhood Tuberculosis:-

Table 10 No. of Tuberculosis Cases Detected under IBSY is as  under :-

Activity

Phase – 1

(6-12 Years of Age)

Phase – 2

(0-6 Years of Age)

Phase – 3

(12-18 Years of Age)

Total

Total Children examined

1095153

931324

828638

2855115

No. of Tuberculosis Cases reported

245

429

238

912

Children with swellings at axillary and cervical areas, with wasting and anemia, chronic cough, blood in sputum and having a history of contact were identified at AWC and school levels and were referred for sputum and x-ray examination to health centres. Closer monitoring of all cases was done through the district TB programme.

(ii)        Diarrhoea:-

Under IBSY Phase 2, children attending the Anganwadi’s (0-6 Years of age) were covered and total of 12799 diarrhoeal cases identified.

The Zinc and ORS is already provided in the kits and Training of ANM, School teachers, AWW and ASHA had been already done to identify signs of Dehydration.

(iii)     Respiratory Infection:-

       Under IBSY 18821 ARI cases have been identified and treated so far.

      Cotrimoxazole is already provided in the drug kit for ANM and ANMs are already using the same           for treating mild ARI cases and for moderate and severe  ARI cases ANM refer these cases to     PHC/CHC/GH.

 

(iv)  Non- Communicable Diseases:-

Under IBSY so far, total of 418 cases have been referred to tertiary level care out of which there are 35 heart diseases cases, 269 disability cases and one case of each malignancy and cleft palate.

All children from 0-18 with signs and symptoms of non-communicable diseases (heart disease, Diabetes, cleft lip and palate) were identified and referred by ANMs/ School Health Officer/ Medical officers on VHND on the basis of school health cards and assessment registers

Special monthly free clinics were held at District Hospitals on second Saturday of every month to diagnose various non-communicable diseases (Heart diseases, Childhood malignancies, Nephrotic Syndrome, Juvenile Diabetes,  Bleeding Disorders, Haemoglobiniopathies (Thalassemia), Cleft Lip and Palate).

·                     Disability:-

Under IBSY total of 78 disability camps had been done so far in which 3119 disabled children were examined and 1887 disability certificates issued and Aids and Appliances were given to 159 cases through Red Cross.

Table 9 No. of Disability Cases Detected under IBSY is as under :-

Type  of disability

Phase- 1(Govt. Primary Schools)

(6-12 Years of Age)

Phase – 2       (Anganwadi’s )

(0-6 Years of Age)

Phase – 3

(Govt./Private Middle, High, Sr. Secondary Schools)

(12-18 Years of Age)

Total

Hearing & Speech

3748

1194

1651

6593

Orthopedic

3040

1401

1902

6343

Visual

1488

741

4079

6308

Mental

2090

1035

425

3550

Total

10366

4371

8057

22794

 

Disability camps were organized at Block CHCs on every quarter on 4th Saturday where the orthopedic and Eye surgeons, audiometrist (on hire with audiometer) and ENT surgeon and Paediatrician and Psychologist (on hire) and Dy. Civil Surgeon had visited and had issued Disability certificates to all disability children (orthopedic, visual, hearing speech and Mental retardation/ Cerebral Palsy) who were referred under the IBSY and these children were also assessed for aids and appliances and corrective surgeries and tie up with Red Cross.

 

 

 

Free Spectacles distributed to children:-

Screening for refractive errors was done for each child under IBSY. For this purpose opticians were hired who along with the Medical Officer visited the school on the day of the visit. The screened children were provided the spectacles under the Blindness Control Programme and funds were provided by the Sarv Shiksha Abhiyan. Testing of eyes was done by Optical Assistant and for the purpose of screening E-charts were distributed to all the districts.

Table 10 No. of Spectacles Distributed free of cost under IBSY is as under:-

Activity

Phase – 1

(6-12 Years of Age)

Phase – 2

(0-6 Years of Age)

Phase – 3

(12-18 Years of Age)

Total

Spectacles Suggested

22509

758

24787

48054

Spectacles Given

13107

7

820

13934

·                      Other Health Problems.:-Under third phase of IBSY 229 children with Hernia &Hydrocele, 886 children with Epilepsy,106 children with Heart Diseases,39 children with Juvenile Diabetes,84 children with Thyroid Disorder and 4747 children with Gynecological problems have been detected and reported so far.

·                   Computerization of Data:- During the implementation of IBSY, a large volume of data is  being collected and needs to be entered in to the excel format comprising of  42 data elements developed by NHSRC for Developing an effective name based tracking system. Under IBSY phase 1, total of 1095153 children data entries already made on excel         format. The total cost Rs. 526244/- was met out of School Health budget component of NRHM (Comp. No. 2.4.3.3).

A.2.4.3(b)       Financial Progress in School Health (IBSY) so far(2010-11):-

 

No. of Visits by School Health Officers

Budget Sanctioned For Mobility Support of School Health Officers

Expenditure  on Mobility Support of School Health Officers

%

Budget Sanction For  Carrying out Camps and Hiring the Audiometerist & Psycologist at Camps at CHC / DH Level

Expenditure  on Camps and Hiring the Audiometerist & Psycologist at Camps at CHC / DH Level

Total Budget Sanctioned

Total Expenditure

%

11225

3244800

1281512

39.49

1084000

55300

4402400

1336871

15.1

 

·                 Training of Teachers:- A one day training of two teachers (one male & one Female) as Health Teacher from each school was done under IBSY at block level. The training was arranged by department of Secondary Education with SSA at their premises at the district level and doctors from the Health Department had trained these teachers. The budget for trainings was met out of SSA funds.

·                 Iron & Folic Acid Tablets:- Under IBSY Phase-I , 27451063 Iron & folic Acid tablets & de-worming doses were given to 570163 anemic children & in IBSY phase II & III Iron & Folic Acid doses were given to 244264 & 174905 Anemic children. These Iron & Folic acid tablets were provided by WCD Department & the NRHM.

·                 Printing of Manuals & Registers/Cards:- As large no. of children were to be covered under IBSY, a large no. of data was collected and filled on the formats in the form of cards in the Phase-I and on the registers in the Phase-II & III. 15 lac cards were printed & distributed to all the districts for recording of the vital Components of health screening. The budget was provided by SSA and for the Phase – II & III 85500 registers & 6000 manuals were printed for carrying out screening in the Anganwadi’s & School Children. The budget was provided under the head IEC/BCC, NRHM Flexipool.

The phase wise expenditure done under IEC/BCC budget head is as under:-

Phase-I

15 lac Cards

Rs. 1050000/-

Budget provided by SSA

Phase –II

35500 Registers

6000 Manuals

Rs. 343900/-

Rs. 128100/-

Budget met off from the IEC/BCC, NRHM Flexi pool.

Phase-III

50000 Registers

Rs. 900000/-

 

A.2.4 .4 Strategies/ Plan for 2011-12

School provides the platform for learning and self development of the child. Different aspects of life taught through different subjects in school. A child grows with the learning taught in schools and implements these learning throughout his/her life. Also children functions as messengers. They discuss the things taught in school among their family members and friends. Taking these things in account it is imperative that health coverage and health education should be included as a special programme in schools.

Although health related issues has been taught in schools in life sciences. But it does not have practical applicability. Therefore provisions has been made in NRHM to introduce the specific School Health programme to impart the understanding of health among children, promote health through the children and health screening of the children and providing preventive and curative services.

The Indira Bal Swasthya Yojna is a package of comprehensive Health coverage/ Services for children of age 0 -18 years in Haryana State. The various programmes by different departments are in existence to provide nutrition and healthy life style in the children but due to lack of coordination between the different departments targets were not achieved at par. The main focus of IBSY is to combat all round health problems of the children by convergence of allied health departments (WCD, SSA, Education Department).

The results so far under IBSY indicate that Anemia dominate the charts as per as health of child is concerned.

 

Modes of Operation:  

1.      Sensitization and capacity building of service provider on the school health issue.

2.      Strategic intervention of promoting and strengthing of health care services to children at block and sub centre level.

3.      Promotion of health education and communication to the Primary and Secondary target children  for reducing psycho- social and health isssues.

4.      Convergence with other department and programmes.

 

The strategies planned/ proposed for the next year are as under:-

Coverage of School:-

(i)                 It is proposed to cover all schools twice a year and the schedule of coverage for whole year will be made in advance in joint consultation with education department.

(ii)               The 1st coverage will be done in the month of May, July, August as it in an ideal time (Non Festive, Non Exam period, maximum attendance) to capture the health screening of all primary, Secondary & Sr. Secondary Schools simultaneously and 2nd coverage will be done in January to March and in the remaining period/ months/  follow-up of the screened children will be done.

 

 

Screening:-

(iii)             The screening of the school children will be block wise instead of school level wise (Primary, Middle, High, Sr. Secondary)/ Phase wise & the doctors will be visiting all the school levels (Primary, Middle, High, Sr. Secondary)  in the block respectively.

(iv)              The coverage under next Phase of IBSY,  Health screening of the primary school children will be done on Register formats instead of Cards and the registers will be printed under NRHM and the district wise  data of fresh enrollment (class 1st students) will be provided by SSA.

 

Training:-

(v)                The district levels trainers from the Health Department will be training the freshly recruited JBT teachers from the Education Department on the issues regarding screening and follow up guidelines for health coverage of the primary school children and the number and district wise data of JBT teachers available for training will be provided by SSA.

 

Disability Camps:-

(vi)                   To institutionalized the holding of disability camps for which a schedule for the full year can be made in advance jointly in consultation with the health department and SSA so that disability camps can be done smoothly and effectively in convergence with SSA.

(vii)            The budget for spectacles required under IBSY will be met/ provided from the funds of SSA and incase of non availability of budget ,funds to be met from District Blindness Control Society(DBCS)

(viii)          As the burden of Anemia is quite large in primary school level children, a fresh strategy for giving iron & folic acid doses to these children needs to be chalked out in consultation with Elementary Education Department.

 

A.2.4.5            Budget requirement and interventions based on the above strategy for year 2011-12.

A. Programme operations:

(a)        Printing of School Health Registers:-    It is proposed to cover left out/ freshly enrolled primary school children and children out of school/Anganwadis in the subsequent phases of IBSY, the requirement of the registers is proposed as follows:-

Printing of Skill based Education formats & School Health registers

50000 Registers to be printed  @ Rs 20/ register

Rs = 1000000/-

 

 

(b)        Training of School Teachers :- As it is proposed to train 2 teachers per school of the total  22562 schools in the Haryana.   For one day training at block level the proposed budget is as follows:-

Sensitization training of school teachers

22562 schools x 2 teachers per school one day training at block level

To be provided by SSA

 

 

 (c)          Mobility Support for School Health Officers:- It is proposed to give Rs. 100/ School Health Officer as an mobility support for making 8 visits per month. The budget required will be:-

Mobility support for School health officer

427 School Health Officers in PHCs x 8 visits per month x Rs100 per visit as mobility support x 12 months

Rs.4099200/-

 

 

(d)       The budget for Iron & Folic Acid tablets/doses :- Considering 50 % of the total children to be anemic. The total load of iron and folic acid tablets for the next year will be as under:-

 

 

Iron and folic acid tablets to be given

50% of the children supposed to be anemic i.e. 1438640*100 tabs each/child *cost of 1 tablet @Rs .21/tablet

Rs = 30211440/-

Is being supplied by the WCD Department

 

The School Health Officer also gives Albendazole Tablets to suspected worm infested children and IFA tablets to children found to be anaemic.

De-Worming tablets (Albendazole)

4524454 children to be dewormed x 1 campaign per year x 2 tablets per campaign x Rs1.19/- per tablet

 

Rs.10768200/-

To be budgeted under Part B

 

 

(e)    Budget for General Assistant with Computer Knowledge: - As large amount of data is being called for from the field, a Computer Assistant is required for assisting the programme officer at the State level.

General Assistant with computer knowledge

Rs 9000/- salary for 10 months

Rs.90000/-

 

 

(f)       Computerization Data:-  During the implementation of IBSY, a large volume of data is  being collected and needs to be entered in to the excel format for developing and effective name based tracking system. Under IBSY total of 4524454 children data entries to be made on the excel format. It is proposed to make these entries @ Rs. 2/ entry.

Computerization of data

4524454 children data  entries to be made @ Rs 2/child entry

Rs. 9048908/-

 

A.   Specific Interventions :

B.1        DEFICIENCY

      B.1.1     Strategy for Management of Anaemia:-

Objectives :  To reduce childhood Anemia in children of  0-18 years.         

Activities:

·   Screening of children by means of colour comparison of Palms, nails and tongue by AWW and trained school teacher in schools. 

·      Hb(haemoglobin) testing of all the anaemic children during VHNDs/ School Heath Day and identification of children with anemia and follow up of the previously anemic children.

·      Categorizations of children into mild, moderate and severe. (Below 7 gms/dl-severe) ,investigation of all severly anaemic children.

·      Reporting of the number and name wise list of severe cases at District level and compilation at state level.

·         Provision of IFA and Ayurvedic medicines and complete investigation for cause of anaemia and provision of Blood Transfusion for Anemic below 5gms/dl wherever indicated. IFA and folic acid tablets will be provided in Kit A and B to subcenters and through WCD to AWC.

·         Including IFA tablets, Ayurvedic medicines and Deworming tablets in drug kits of Asha, AWW and Schools.

·       6 monthly De-worming in schools and AWCs.

·          Providing education and counseling material on dietary changes to improve anaemia.

·         ASHA would make visits to the home of severly anemic children and ensure that they are given 100 tablets and their name registered in the primary health centre(PHC).Once the child completes the 100 iron tablets course the ASHA will submit her report to ANM along with registration details of the anemic child to claim her incentive of Rs 25/ child. During three phases of IBSY 18586 children with severe anaemia have been detected through blood tests Hb <7gms%.

 B.1.2  Strategy for Management of Children having Ht/Wt. for age below mean value :-

As per NFHS 3 data 35.9% of children in Haryana are stunted, 16.7% are wasted and 41.9% are under weight.

 To address these problems following activities are proposed.

·         Identification of severely malnourished/ undernourished children and treatment and rehabilitation.

·         Treatment of underlying diseases if any.

·         Periodic De-worming of children. 

·         Provision of Fe and Folic acid tablets.

·         Zinc supplementation for all diarrhea cases.

·         Provision of 9 doses of Vitamin A as per GoI guidelines.

·         Provision of nutritional supplementation through Anganwadis.

·         Nutrition Education of adolescent girls, pregnant and lactating mothers.

·         Early initiation of breast-feeding for all institutional delivery cases.

·         Promotion of exclusive breast feeding for 6 months and continuation of breast feeding up to 2 years,

·         Introduction of timely complementary feeding.

·         Growth and development monitoring.

·         Incentive to ASHA for identification/bringing malnourished child of Grade III and Grade IV to Health Institution and counseling of their family @Rs25/- per case. The incentive would be given to her on identification and getting the child registered with AWC or RCH outreach session. There is persistent need for identification of such malnourished children whether they go to school or not. Provision of incentive will help in identification and treatment of such children.

·         Referral transport will be provided free of cost to all Grade III and Grade IV children below 5 years of age.

 

B.1.3   Strategy for Management of Vitamin A deficiency:-

Objective: To reduce incidence of night blindness (Vitamin –A deficiency) and             Xeropthalmia

Under IBSY the data of children with Vitamin –A deficiency so far is as follows:-

            Total No. children with Vitamin –A deficiency so far are:- 5858 out of which :-

·         1859 children with Vitamin –A deficiency are among 6 – 12 Years of age.

·         606 children with Vitamin –A deficiency cases are among 0 – 6 years of age.

·         3393 children with Vitamin –A deficiency cases are among 12 – 18 Years of age.

The above data shows a huge incidence of Vitamin A deficiency among the children Haryana. Further strengthening will be done at the field level to contract Night Blindness cases. For the above purpose it is proposed to conduct a proper training of the workers at the field level quarterly and administration of the Vitamin –A doses   under supervision of trained workers.

Activities:

Training of ANMs, School Teachers, AWWs and ASHAs to identify night blindness and Xeropthalmia (Dry cornea, Bitot Spots, Keratomalacia). The questions already had been incorporated in the health card/ registers being developed jointly in consultation with Education department and WCD.

·                     More rigorous Screening and Identification of night blindness and Xeropthalmia.

·                     Colored Referral Card screening and priority attendance at OPD. 

·                     Maintenance of uninterrupted supply of Vitamin-A at AWC and Sub centers. The supply of Vitamin- A bottles will be budgeted in procurement.

·                     Reporting of cases with night blindness as identified in school health programme, at AWCs and in OPDs.

B.2      DISABILITY

B.2.1    Strategy for Management of Children with Disability:-

Objective: Early identification, certification and rehabilitation of Children with Disability (CWD).

Activities:

·                     Training of ANMs, School Teachers, AWWs and ASHAs to identify CWD with respect to all disabilities (Ortho, Visual, Hearing-speech and Mental).

·                     Referral to Disability Camps on fixed day approach – once a week on referral card at District level.

·                     SSA has proposed to conduct disability camps in convergence with NRHM for the year 2010-11and had a budgetary provision of Rs 30000 per block for organizing these medical assessment camps. They have intimated that the expenditure of hiring private doctors/specialists, hiring of equipments if required, providing transportation facilities to the CWSN and refreshments to the CSWN & their attendants / teachers / medical staff shall be met from Education Component of SSA.

·                     If need arises for hiring of specialists then the same can be incurred from proposed IBSY budget of Rs.876000/-.

·                     Provision for hiring private audiometrist with audiometer and psychologist for helping in certification of hearing/ speech disabled child.

 

 

Audiometrist

Hiring of audiometrist @Rs.500/- per   camp x 2 camps per year x 93 CHCs

93000

 

 

Total=

876000

Hiring of audiometrist @Rs500/- per camp x 12 camps per year x 21 district hospitals

126000

 

Psychologist

Hiring of Psychologist @Rs1500/- per camp x 2 camps per year x 93 CHCs

279000

 

Hiring of Psychologist @Rs1500/- per camp x 12 camps per year x 21 district hospitals

378000

 

·                     In monthly Disability camps at District level for

o     Identification of person with all types of disability at PHC through                  camp approach.

o    Assessment of Percentage of Disability by specialists.

o    Certification of Type and extent of Disability.

o    Assessment of Need – Surgical correction or/and Aids and Appliances.

·                     Coordination with District Red Cross and Social empowerment and Justice Representatives to facilitate corrective surgeries and Aids and Appliances.

·                     Free Surgery would include corrective orthopedic surgeries, contracture release, cataract surgeries etc. Cost To be covered under free surgical package (self sustaining).

·                     Hiring of one state level disability coordinator to coordinate the disability work in the state (for orthopedic and   for visual and mental retardation)

State coordinator

Hiring of 1 State level disability coordinator x Rs30000/- for 10 months

Rs.300000/-

 

 

B.3      DISEASE:

B.3.1   Strategy for Management of Communicable Disease :

Programme aims at identifying diseases at early stage and guiding the child for treatment or referral. Ongoing programme covers many diseases, however the most prevalent diseases which causes morbidity burden for the child have been focused under this programme.

 

 

 

B.3.1 (a) Childhood Tuberculosis:

Children with swellings at axillary and cervical areas, with wasting and anemia, chronic cough, blood in sputum and having a history of contact were identified at AWC and school levels and were referred for sputum and x-ray examination to health centres. Closer monitoring of all cases was done through the district TB programme.The ASHA being DOT provider in her area would be given the list of all children diagnosed as T.B. cases and for which DOTS treatment to be started along with the other medicines. She will receive her ASHA incentive as mandated in the ASHA program for treating the children on priorty basis under supervision of District School Health Officer.

 

B.3.1 (b) Strategy for Management of Diarrhoea:

In case outbreaks are identified during the campaign, then camps for promotion of Zinc and ORS for treatment of diarrhea can also be organized in such places.

Acute Diarrheal Diseases (ADD) can lead to death among children. Aim of the      programme is to reduce incidence and severity of ADD. In this programme

·         Training of health workers on classification of Diarrheas into a) Diarrheas without Dehydration b) Diarrheas with Dehydration and referring cases of dehydration to health centres from AWCs, Sub centres and schools.

·         Promote exclusive Breast Feeding for 6 months in Infants and Young Children.

·         Hygiene Education and Promoting hygiene practices in AWCs and Schools. Convergence with Total Sanitation Campaign. Community awareness through ICC/BCC.

B.3.1 (c) Strategy for Management of Acute Respiratory Illness(ARI):-

Objective of the programme is to Reduce Deaths due to Acute Respiratory Infection among children. Reduce incidence and severity of ARI.

   Aim of the programme:-

·          Training of ANM and ASHA to identify signs of ARI like increase respiratory rate, and in drawing of chest, wheeze and drowsiness.

·          Identification and referral of sick children.

·          Ensuring availability of Paediatric antibiotics at PHC/CHC/SDH/DH level.

·          Community Awareness through ICC/BCC.

 B.3.2  Strategy for Management of Non Communicable Diseases :-

Identification :

       There are large number of non-communicable diseases among children in rural population which go undiagnosed because of lack of awareness and facility Special focus would be there to identify Heart Disease, Cancer, Diabetes, Cleft Lip and Palate. Names of all children along with phone numbers of their parents and name and phone number of their school will be intimated to the District School Health Officer who inturn will forward these to the HQ officer. The HQ officer will follow-up these cases and also intimate to the School Health Department for follow-up. The nature of follow-up would be as follows:

·      All the cases of Hernia & Hydrocele will be tied up for surgeries at the district hospital level and the funds will be met of from the surgical package program.

·      All the children with Gynaecological problems will be referred to special child health clinics/ARSH clinics where these cases will be thoroughly investigated and will be managed by the female gynaecologist(specialist) only and health education will also be imparted to them

·      Further investigation and management of cases like Epilepsy, Thyroid Disorders, juvenile diabetes, Heart Disease

  • The DSHO will ensure with the help of field level officers that these children are brought to the District Hospital and examined by specialist to confirm the diagnosis and conduct lab investigations of such children.
  • In case referral to tertiary level care centres like AIIMS, PGIMER, PGIMS is needed  same is would be  done and followed up by the DSHO The DSHO would designate one of the MO, school health for coordinating all cases needing secondary and tertiary care services.
  • After conformation of the  diagnosis these patients will be put on proper treatment and the  follow-up of these patients will be ensured by the school health officers who in turn send the detailed report to the headquarters about the interventions done.
  • For The poor children requiring surgeries or tertiary level care, funds will be provided from the Arogya kosh and other funds for non-BPL children.
  • Provision of Rs200000/- for cost of medicines and surgery for SC/BPL/10% non BPL children undergoing surgery for heart disease and malignancies at empanelled tertiary centers.

Provision of surgery

Rs.200000/- per child belonging to SC/ non-BPL poor category for heart surgeries x 10 children per year

Rs.2000000/-

 

A.2.4.6  CHILDREN FUND :

A fund was to be started for meeting out cost of specialized surgeries and treatment for cancers incurred in Govt hospitals like AIIMS, PGI etc was to be met out of the fund. This fund would be started with an initial donation of Rs 50 lacs  invested in Scheduled Bank. The fund was to be widely advertised and donations from private individuals and corporate would be invited. The day to day administration of the  Fund was to be under the DGHS.   The fund was to be registered as a fund under the Indian Trust Act and income Tax exemption under S.80G for donations from private parties. Rules of the fund were to be drawn up separately. The funds would be completed during FY 2010-11. This fund would be operationalised in the remaining months of 2010-11.