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    Child Anemia Training Module

    Conducted by Government of UP/Jharkhand

    Supported technically by A2Z Micronutrient Project

    ParticipantsSupervisors LHV, Mukhya Sevikas

    ANM, AWW, ASHA, Sahiyas

    Prepared byProfessor Prakash V Kotecha

    Senior Technical Advisor,A2Z, the USAID Micronutrient Project

    AED India

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    How does this training differ from other training courses?

    In this training, there are no teaching sessions!

    What we will be doing would be discussion, experience sharing and skill

    development to be able to effectively communicate and counsel the clients

    (mothers or care givers and their young children) for improving their health

    and adequately seek the medical care as and when required. We will also

    deliberate on how the young children need to be breastfed, fed after the

    age of six months and how to ensure that the food they get is sufficient in

    quantity and quality.

    Other important thing we will do in this module is to ensure that we will be

    able to communicate effectively to frontline workers how will theycommunicate and counsel mothers such that mothers understand, grasp,

    raise questions to them and get satisfied to initiate and/or continue desired

    behavior for the good of the child and for herself.

    How shall we do this?

    We will have counseling material that has been field tested with ANM and

    by ANM with mothers in YOUR community. We are going to take the help of

    these counseling materials and have discussion on these materials

    initially. After we have been satisfied with them, we are going to do role

    play for how to use the counseling material in the field and ensure that

    what we want to communicate has been actually grasped by the

    mothers/caregivers.

    Once we are confident that this is doable and easy, we are going to use

    them in the field to ensure that these easy and simple guide helps to

    discuss and negotiate with mothers to achieve what we want them to

    achieve for the good of their children.

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    Objectives of the Training

    Broad Objective

    The training for three day will provide basic information to front line workers

    about child and maternal anemia in India and UP/Jharkhand and the program in

    place for anemia control in UP/Jharkhand with its importance and the program

    contents. The important focused component of the training is then to build

    the capacity of the front line workers to effectively deliver the service

    components including counseling to the clients and their family members

    that will facilitate the clients to use the services and demand for the available

    services.

    Specific Objectives are as under:

    By the end of the training participants will know

    I. What is anemia and why it is important to treat anemia in women and in

    children. What are the benefits to the child and how her/his growth and cognitive

    function would improve when adequately protected from iron deficiency. What is

    the anemia control program under the government and what is its current

    situation in the country, state and district area where they are working.

    II. What exact activities they need to do for child anemia control program.

    They include:

    1. To identify children 6-23 months and get a list of them by name, age and

    gender and under which AWW and ANM they will be covered

    2. Identify who will deliver IFA syrup with Counseling and demonstration of

    how to give IFA, how long and how to manage side effects

    a. Discuss side effects if any and seek timely help

    b. Make sure that over dose is not given

    c. Store IFA bottle safe in a dark and dry place out of reach for

    children

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    d. One person in the house is responsible for dosing the child every

    time

    3. How the mother should be encouraged to feed the child as required. This

    calls for actual demonstration or explanation after talking to her and

    finding out which of the desired behavior mother is doing and which the

    mother is not currently following and then advising only on those that she

    has not been doing after appreciating that she has been able to do.

    4. Reinforce to visit for biannual rounds for deworming regularly

    5. Encourage pregnant mothers for

    a. IFA tablet collection and consumption timely

    b. Discuss side effects if any and seek timely help

    c. Take one or two extra food during pregnancy

    d. Take nutritious food (one glass milk and more of dal, vegetables,

    egg, meat)

    6. Monitor coverage regularly

    7. Assist in survey for coverage done by supervisors

    Material Required for the Training

    Handouts, Counseling Cards, Posters, Number of flip charts, pen, pencils,

    calculators, Plain papers, Erasers, color cards (VIPP cards)

    Prior Information Required

    AWW, ANM may be requested to bring with them their centers basic information

    that will include population and village/s covered by them, beneficiaries

    registeredand the copy of the last monthly report sent.

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    Day I

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    Training Content

    Session I: Welcome and Introduction:

    It is desired that every participant and facilitator put in large bold letter name tag

    and attach it to their dress so that every one can interact with each other by

    name.

    Session II Objectives of the training

    This session will briefly guide the participants what would they be looking for in

    these 3 days interactive sessions of discussion and learning.

    Senior government official present (or as appropriate) welcomes participants and

    mentions briefly the objectives of the training (as mentioned above) highlighting

    the skill development aimed in the training and requests participants to actively

    participate

    Coordinator then requests every participant to introduce themselves: they may

    give their name, place of working, designation and if they have seen a case of

    anemia, one or two symptoms that they noticed. Introduction needs to be short.

    This is the time pretest questionnaire needs to be introduced and shared for 10

    minutes. Participants need not identify them selves. Encourage them to be

    honest in answering as this is not THEIR examination but is a to guide training

    content

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    Session III: What is Anemia 50 minutes

    Objective of session III: Participants will know what is anemia, its dangers

    and why it more common in children and in pregnant women, howwidespread it is and how to control it

    Facilitator: Medical Person Available or Anemia Coordinator (knows thetime limit and also the contents keeping in mind the front line workers levelof understanding, a briefing is required)

    What is Anemia and how widespread is it? (10 minutes)

    (Share with participants hand outs in local language and in big bold letters with

    pictures preferably, main points as below).

    Iron deficiency is the most common form of malnutrition in the world, affecting

    more than 2 billion people globally. Iron deficiency anemia (inadequate amount of

    red blood cells caused by lack of iron) is highly prevalent in less-developed

    countries but also remains a problem in developed countries where other forms

    of malnutrition have already been virtually eliminated. Iron deficiency is not the

    only cause of anemia, but where anemia is prevalent; iron deficiency is usually

    the most common cause. The prevalence of anemia is defined by low

    hemoglobin. (Less than 12 g/dL is anemic for non pregnant and less than 11 g/dL

    for pregnant woman is criteria to diagnose a woman to be anemic, anemia for

    children is defined as hemoglobin value of less than 11 g/dL)

    Recent studies have shown that in India anemia is very common and

    UP/Jharkhand is having of anemia higher than national average. (Please put

    state specific data here). Ethical committee presentations with each state is

    available and detailed data state specific are available in them

    Iron deficiency generally develops slowly and is not clinically apparent until

    anemia is severe even though functional consequences already exist. Where iron

    deficiency anemia is prevalent, effective control programs may yield benefits to

    human health.

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    Consequences of Anemia children (10 minutes)

    1. Child with anemia may be born with low birth weight

    2. When anemia continues or develops early in life, child maynot grow

    adequately and his physical and mental capacity will remain lower as

    compared to healthy children.

    3. Child is more likely to develop infection and does not have good appetite.

    Consequences of Anemia mothers

    4. Increased chance of death during delivery: Overall, about 20 percent of

    maternal and perinatal mortality in developing countries can be attributed

    to anemia. Recent work has shown that most of this impact is in the mild

    and moderate grades of anemia, rather than being limited to severe

    anemia.

    5. Low birth weight babies born: Anemia in pregnant women results in lower

    birth-weight babies who have a higher risk of death.

    Mild and moderate anemia also are detrimental to health and contributes to

    larger proportion of total ill effects due to anemia

    Session IV:Session Objectives

    How to control Anemia? (10 minutes) (USE the TIN Plate that we havedeveloped or appropriate IEC)

    Mothers Level

    1. Register as soon pregnancy is noticed.

    2. Take one tablets of IFA tablet every day at night before going to sleep

    after dinner from fourth month onwards

    3. Need to increase amount of food consumed in pregnancy, one or two

    extra meals during pregnancy besides normal food

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    4. Deworming dose, one course of six tablets (one if albendazole) after four

    months of pregnancy.

    5. Malaria prevention (bednets) and immediate treatment for fever.

    6. Counseling at the place and time that is suitable to mothers

    Child Level (Anemia control and Malnutrition Control)

    1. IFA syrup twice weekly (Wednesday and Saturday or RI days) 1 ml after

    at least one katori full food

    2. Counseling for food: BF to continue + 3 half katorisemisolid food for 6-8

    months, 3 katorisolid food 9-11 months and 4 katorisolid food for 12-23

    months old children. Avoid bottle feeding.

    3. Mother to wash hands with soap and water before feeding the child and

    after defecation and also make child wash hands with soap and water

    before feeding and after defecation.

    4. Deworming dose at 12-18-24 months (if mebendazole 1 tab three days, if

    albendazole, one tablet)

    5. Protection from malaria in form of advising to get fever investigated and

    ensure that mosquito breeding does not take place by keeping

    surrounding clean and avoid water collection and mosquito breeding. Use

    bednets to prevent mosquito bites

    6. Counseling at the place and time that is suitable to mothers for their

    children

    Session V: Introducing MAAYA Strategy

    Current Scenario of Anemia/Malnutrition Control in Your Area (30 minutes)

    This should be converted in to group work after a quick question of concern that

    what actions are required to control anemia and to control malnutrition. Put one

    by one their replies on a flip chart such that the actions required by health care

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    providers are written down on lower

    side and by community on upper side.

    Put them in to four areas from

    pregnancy, 0-6 months, 6-12 months

    and above one year of age. What

    would emerge from their discussion is

    final strategy proposed as mentioned

    here. This will help us in then

    proposing the MAAYA Strategy as their own suggested strategy rather than our

    imposing idea on them.

    Session VI

    Group work for identifying problems and suggested ways to resolve them

    Objective: This is the time where participants will share their experience and

    concerns. They may have been able to do some of the work well while at other

    fronts face problems. They either know why the problem and how to solve them

    but may not have resources or capacity to solve them. Or they know but are not

    in position to solve them. In this group work participants will list and suggest

    action points and possible problems and their suggested actions to resolve them.

    Assignments:

    TOR: The participants will be divided in four groups; one for pregnancy group

    and for 0-6 months; 6-12 months and 12-23 months and each of these four

    groups work with following format and enlist all the activities required as

    perceived by them and what problems may be faced and how to resolve them.

    They will also come up with who can be considered responsible to bring about

    desired changes or can be made accountable

    They should have a chair person and a reporter and should be provided with flip

    charts, pen, pencil and material as requested. The chairperson will ensure active

    participation from every member and will ensure healthy group dynamics

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    Services forreducingmalnutrition andanemia

    Problems andIssues in providingthese services

    Possible solutionsor suggestions tosolve/resolveissues

    Who would beresponsible forthis solution?(Accountable)

    Session VIIPresentation of Group work and discussions facilitation by staff fromGovernment (ICDS or Health)

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    Day II

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    Session 2.1

    Recap of the day 1

    This can be done either by requesting one participant who is confident and wants

    to do it. Better option is to covert this in to a fun game where by rotation each

    participant is asked a question from the previous day. It is necessary in this part

    to skip to the next person if some participant is not able to answer and s/he

    should not be made uncomfortable for not knowing. However a follow up if

    required ensuring all the benefit of the learning exercise is clear to him/her.

    Session 2.2

    Group work

    Terms of Reference for Group Work

    The group would work to identify in their area, how many young children in the

    age group of 6-23 will be there and how many pregnant women will be there.

    They will, then work on how they would identify them and how would they

    register all the beneficiaries.

    They know the exact population they are covering.

    STEP:

    Objectives: participants will know how identify ALL PW in their area; how to

    deliver a package of anemia interventions to them through AWC and special

    arrangements for left-outs; and how to counsel mothers

    Part I: How to identify all pregnant mothers?

    Step I a: Identify Gap: Mothers

    This part of the training is a self learning exercise. Participants are asked to refer

    to their records and register the population served and number of pregnant

    mothers registered for the service. We then request them to apply birthrate

    (when not available; the thumb rule of 3% of birthrate and about 10% of

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    pregnancy wastage so 3.3% will be pregnancy rate). This is the number of total

    pregnant women in one year who would deliver. At any given point of time

    referring to only second and third trimester, about half of total women likely to be

    pregnant in one year will be in second and third trimester and they need to be

    registered with them at any given point of time.

    Area covers 1000 population: Expected birth is 30. Expected pregnancy 33

    Expected number of pregnant women in second and third trimester in any one

    month will be 33/2 equivalent to 16-17 pregnant women who should be

    registered. Any number shorter than this is a gap suggesting they have not been

    able to reach.

    Total population served= 1000 XTotal pregnancy expected= 33 XTotal pregnancy in any month in second and third trimester= 17 X(approximately)Total registered pregnant women=YGap =17 X Y (if 17X>Y)

    Concept needs to be simplified for the understanding.

    Step I b: Identify Gap: Children

    Number of children will be 4.5% of total population.Population = 1000 XChildren will be 45 XIf they have registered children as Y45X-Y = GAP if 45X >Y

    Step II: How to reach out to those women and children who are not

    registered?

    Having identified the missing women and children, find out why are they not

    registering? Specific community, specific area, caste/religion groups? How best

    to reach out to them and motivate and convenience them to come forward?

    Alternatively how to reach out to them for minimum package of services? What

    will be the role of ASHA/Sahiya? Who else can help to reach out and provide

    services and counseling? Transfer these names to ANM for possible depot

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    holder in out reach area that can provide IFA, deworming medicine to these left

    out groups.

    Step III: How to counsel the mothers for them and for their children?

    Counseling does not mean sharing information. It means to be able to

    understand the need of the client and provide and assist her with what she really

    needs. Helping her in taking decision for action. Basic steps of counseling

    include

    Greet: Mothers should be greeted and felt welcomed and made comfortable.

    Ask: Make sure you ask relevant questions in simple, short sentences that mother

    understands and feels comfortable in answering

    Listen: It is very important to listen carefully what she has to say, and her

    concerns. It is necessary when advice is given; it is given based on her needs and

    is not generic. To do this it is important to listen to what mother has to say.

    Praise: To make her follow what advice is given, it is important she has trust in

    you and in the system. This is best obtained by genuine praise for points which is

    praise worthy. The fact that she is in the counseling session is bear minimum

    positive point for praise. If she comes for counseling or for ANC regularly, you

    can appreciate that or her diet or her weight gain

    Advise: Package for anemia control to mothers needs to be advised but keepingwhat she is following already. What she follows need to be appreciated and what

    she needs to be following now onwards need to be explainedwith reasons

    Check understanding: This is important step for effective communication. We

    have advised mothers for steps and counseled but has she understood correctly?

    This needs to be checked by asking appropriate questions. E.g. How many iron

    tablets you will take? What part of the day will you take table iron tablets?

    Questions should not be asked in leading format where answer can emerge as

    yes or no as we will not be able to ensure the understanding when she says

    yes, whether she has really understood what is being conveyed.

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    Session 2.3: Interventions 20 minutes

    Objective of Session2.3: Participants will be able to understand and act onwhat are the components of intervention for reducing child anemia andmalnutrition.

    Facilitator: This is interactive and participatory sessions and monotony and

    lecturing should be avoided here. Hand outs can be shared and then discussion

    held.

    Ask participants to say what they are doing at present for pregnant mothers for

    1. IFA,2. Deworming,

    3. Extra food for pregnant mothers, (ICDS and otherwise)4. Malaria

    Ensure participations and encourage talking by everyone turn by turn without

    repetition of activities. Encourage them to say everything that they do at the

    clinic, during field visit and at RI sessions. Find out what messages are being

    given along with above services and note down. Do not at this stage criticize.

    Also then ask what are they doing to young children for reducing anemia andmalnutrition?

    IFA syrupDeworming medicineFood advicePrevention of malariaICDS services

    SERVICE PACKAGE FOR ANEMIA CONTROL for Mothers:1. Advice for one or two extra meal during pregnancy: Woman will in

    normal case increase weight of about 8-12 kg during pregnancy; this goes

    towards weight increase due to growing foetus; increased size of uterus,

    placenta and increased amount of blood volume plus preparation for breast

    feeding. Not all weight is for growing foetus; but it is important to gain minimum of

    8 kg weight during pregnancy and for that extra food is required.

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    2. IFA Supplementation: One IFA tablet daily to be taken from 4th month of

    pregnancy. It is preferable to take this tablet after food and preferably (not

    necessarily) at night. This advice is to avoid likely side effects. Following

    components need to be stressed:

    1. How many IFA tablets to take? One a day after 4 months or pregnancy:

    minimum 100 tablets.

    2. When to be taken? It should be taken after food to avoid side effects and

    to avoid those sensation it is better taken at night; so the woman goes to

    sleep after that and would not have side effects perceived

    3. Why it should be taken? We need to explain the mother that it is goodfor her health and for her childs physical and mental health. Child is likely

    to be clever and would have better capacity to fight against diseases if

    mother takes ALL IFA tablets during pregnancy.

    4. Side Effects: Possible side effects like nausea and black color stool should

    be explained to the mother with assurance that these are not serious side

    effects and nausea would decline on continuation of taking tablets. Black

    color stool will continue but is harmless. Any persistent side effect for long

    time, doctor should be consulted.

    5. The tablets should be kept away from the children to avoid accidental

    consumption of tablets by the children

    6. Advice to use IFA regularly also needs to be shared with the family

    members who could then support the regular IFA consumption.

    Particularly with husband and mother in law.

    3. Deworming medicine one dose after 3 month of pregnancy:

    Mothers need to be advised for one course of deworming medicine after three

    months or pregnancy is over any time. The one full course of deworming

    medicine dose consisting of 6 tablets of mebandazole (one tablet to be taken

    twice a day for three days) needs to be provided.

    4. Protection form Malaria

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    Mothers if develop fever, it is possible that fever is due to malaria. So she should

    get herself examined for blood smear and if she has malaria, treatment should be

    taken for the same. Even ASHA/Sahiya kits have medicines. To avoid getting

    malaria, she should sleep under mosquito net preferably insecticide impregnated

    mosquito nets.

    5. Food from ICDS

    If the woman is eligible to get ICDS THR, she should regularly get it and

    consume it herself without sharing it with any other members.

    SERVICE PACKAGE FOR MALNUTRITION CONTROL FOR CHILDREN

    Children at this age of 6 months onwards are most vulnerable to malnutrition and

    so package of services to prevent malnutrition is required.

    1. Continue Breast Feeding

    Mothers must continue breast feeding the child as

    many times as possible as the child wants. Mothers

    should not discontinue breast feeding during sickness.

    2. Complementary Feeding:

    Child needs energy much more than as a proportion to

    its weight as compared to adults. So besides breast

    milk, after six months of age child will need extra food

    and that should be fed to the child with active efforts by

    the mother/family members. To make it rich in energy

    adding ghee/oil is very useful. This is because child has small stomach and

    cannot eat more. So what ever child eats need to be rich in energy.

    For this reason child should get food appropriate to its requirement

    Up to 6 Months ofAge

    Breastfeed as often as thechild wants, day and night,at least 8 times in 24 hours.

    Do not give any other foodsor fluids not even water

    Remember: Continue breastfeeding ifthe

    child is sick

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    6 Months up to 8 Months(BF+3 half katori full semisolid food)

    Breastfeed as often as the child wants. Give at least one katori serving* at a time :

    - Mashed roti/ rice /bread/biscuit mixed insweetened undiluted milk OR

    - Mashed roti/rice/bread mixed in thick dal withadded ghee/oil or khichri with added oil/ghee.Add cooked vegetables also in the servingsOR

    - Sevian/dalia/halwa/kheer prepared in milk orany cereal porridge cooked in milk OR

    - Mashed boiled/fried potatoes______________________________________*3 times per day if breastfed; 4 times if not breast fed

    Remember:

    Wash your own and childs hands with soapand water every time before feeding

    Keep the child in your lap and feed with yourown hands/spoon

    9 Months up to 11 Months(BF+3 full katori full semisolid food)

    Breastfeed as often as the child wants. Give at least one katori serving* at a time :

    - Mashed roti/ rice /bread/biscuit mixed insweetened undiluted milk OR

    - Mashed roti/rice/bread mixed in thick dalwith

    added ghee/oil or khichri with addedoil/ghee.

    Add cooked vegetables also in theservings

    OR- Sevian/dalia/halwa/kheer prepared in milk

    orany cereal porridge cooked in milk OR

    - Mashed boiled/fried potatoes

    ______________________________________*3 times per day if breastfed; 5 times if not

    breast fed

    Remember:

    Wash your own and childs handswith soap and water every time

    Feeding should be done to the child by

    mother with active efforts to ensure

    that the child consumes all the food

    offered. It is going to take some extra

    efforts by the mother to make sure that

    child completes all food that is offered

    to him. Mother must make sure that

    child gets food that s/he likes. Before

    feeding the child, mother must wash

    hands with soap and water.

    Quantity and foods are depicted in the

    boxes:

    6-8 months child must have three

    katori of semisolid food at least during

    the day; 9-11 months should have

    energy rich food at least 3 katori full

    during the day. Child above one year of

    age should consume food by

    himself/herself observed and promoted

    by the mother/parent to ensure that

    child finishes all the food given. At least

    four full katori of energy rich food is

    what child needs to consume.

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    12 Months up to 2 Years(BF+4 full katori full solid food)

    Breastfeed as often as the child wants.

    Offer food from the family pot

    Give at least 11/2 katori serving* at a time of :- Mashed roti/rice/bread mixed in thick dal with addedghee/oil or khichri with added oil/ghee. Add cookedvegetables also in the servings OR- Mashed roti/ rice /bread/biscuit mixed in

    sweetened undiluted milk OR- Sevian/dalia/halwa/kheer prepared in milk or any

    cerealporridge cooked in milk OR

    - Mashed boiled/fried potatoes____________________________________* 4-5 times per day.

    Remember:

    Wash your childs hands with soap and waterevery time before feeding

    Sit by the side of child and help him to finish theserving

    3. Iron Syrup

    Child should get one ml of IFA syrup (to be taken from bottle using dropper that

    will take one ml of syrup when filled up to the top). Child should be fed first and

    on full stomach only child should get one ml of IFA syrup on two days of the

    week (Wednesday and

    Saturday preferably or as

    suitable to mother/family).

    One member of the family

    should be responsible for

    IFA syrup administration.

    Over dose should be

    avoided. IFA syrup should

    be stored at a cool and dry

    place and away from the

    rich of the children.

    4. Deworming Medicine

    Dose of deworming medicine to be given to all children after their fist birthday.

    One course would mean 3 tablets (one tablet daily for 3 days) of mebendazole.

    5. Protection from Fever/Malaria

    Child should be protected from malaria by advising them to sleep under mosquito

    net and get them selves investigated when they have fever. Surrounding to keep

    clean to avoid mosquito breeding

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    Monitoring and support to weak performing area

    Objective: Participants will know how to carry out supporting actions for

    delivering services to pregnant women. From the reports available, they

    will be able to assess their own performance. Over 70% coverage will be

    assessed as good, 50-70% will be assessed as average and below 50%

    coverage may be considered poor. This will be based on the ANC coverage

    (any ANC). For child counseling for anemia and for nutrition counseling on

    feeding same norms can be applied and revised based on the performance

    of all workers as required.

    Supply: Participants ANM (form 6) and AWW (MPR) is aware of their format.

    These formats give their covered areas actual population size. Using that

    population and applying the area specific birth rate, it is possible to calculate

    expected number of women who should have been registered. Applying

    principles as in earlier sessions, they will be able to derive their performance

    level. This level then can be discussed with Medical Officers and Facilitators and

    possible reasons for their good, average and poor performance may be

    discussed. From the learning of peers and guidance of the resource person,

    strategy to improve for poor and average performance may be planned out.

    Similar exercise can be done for IFA supply position and also for IFA distribution.

    IFA supply: Target is to have at least minimum two months quota with the sub

    health center and this has been possible to calculate based on the total

    requirements. A formula for total requirement is based on pregnancy rate at

    3.3%. So total number of IFA required for sub health center will be 3.3*total

    population. Two month quota for sub health center will be 3.3/6 *total population

    served. When IFA stock fall below this number, they MUST request for additional

    supply and also follow up for their requirement in next block level meetings and

    request MOIC who in turn should procure it from district authorities if he does not

    have supply available with him. Similarly at MO PHC level at least one month

    supply should be available as buffer supply when any sub health center requests.

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    Self Assessment Form: (Enclosed)

    To further strengthen the capacity building, based on what the participants are

    expected to do after they return to their service units, a self assessment form isdevised. It is important that participants understand the purpose of this form and

    how to use this form. By rotation each of the participants can read question by

    question this form, discuss whether questions raised here are relevant and would

    help them to monitor them selves or not, taking their feed back in the process,

    final self monitoring format can be evolved. This self monitoring format they

    would then carry with them. Medical Officer in charge be then motivated to

    supply these forms to each participants in the subsequent block meeting and

    discuss the completed forms that participants will be encouraged to bring in the

    block level meeting. In the block level meeting, this works as monitoring the

    activities and also for identifying areas that call for special efforts to improve and

    other problem solving approaches.

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    Day 3

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    Practice for Counseling:

    This is important step for capacity building. Every participant will get an

    opportunity to do a supervised counseling to the mother for child anemia

    reduction and malnutrition control. Supervisor would observe the counseling

    without any interruption and encourage the participant to complete counseling

    based on the learning. After the counseling is over, supervisor would give feed

    back to the participants from counseling skills point of view as well as contents

    point of view. These would include principles of counseling observed as

    discussed above and the package of services discussed as above. In doing so,

    supervisor would also follow counseling skills steps and encourage the

    participants first of the correct actions and then constructively put forward the

    observations that needed to improve. (Check list enclosed)

    This is the important step for capacity building and should not be rushed.

    Adequate provision for timings and providing opportunity for the counseling be

    important and integral part of the training.

    Tools and Job Aids:

    Counseling Material: For counseling simple tools in form of flip chart and poster

    or tin plate are made available or will be made available soon. Till the final tools

    are made available, please use that we have developed till date. For this

    program 8-9 slides maximum should be used 4 for maternal anemia and 5 for

    child anemia and IYCF. These may be further reduced as we finally develop.

    It is necessary to have these tools with health workers. The training involves

    educating and orienting participants how to use these tools. At what stage of

    counseling these charts and poster need to be referred to and how best to use

    them. Pictures are area specific and culture specific and messages are short and

    simple in the language that community understands and in the local language to

    facilitate the community members to grasp the message easily and with interest.

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    Self Assessment Form: It is proposed that a simple self assessment form

    based on the job description of AWW/ANM be shared with participants. This form

    is primarily to remind all health care providers as the check list for what task they

    are to accomplish to achieve effective intervention for anemia control and

    nutrition during pregnancy. If motivated to use properly and the training will cover

    this part, this tool will work effectively to discuss areas and level of performance

    by health care provider at the cluster/sector meetings and block level meeting.

    Collected and compiled properly, this format will also work as monitoring

    activities for the job functions of health workers.

    Microplans

    Objective: participants will develop micro plans to reach ALL women

    through RI/NHD and other special outreach activities for non-AWC listed

    women: (format for this I would shortly email )

    Now that what is the intervention required for effectively control child anemia and

    malnutrition is shared and participants are empowered with the contents for

    anemia control package and methodology of how to approach and counsel the

    clients, this session will be devoted to make micro plans and details of action and

    time line to be able to effectively implement in future.

    Medical Officers and CDPO should be resource persons and should be present

    when the work plans are shared by the participants in plenary sessions and

    assure the participants support as required.

    Post training questionnaire can be shared here if planned and available

    Training session ends by MOIC / Health / ICDS senior staff thanking

    participants for work plans and assuring the support for the task.