Government of Assam Health and Family Welfare Schemes

The Assam Arogya Nidhi (AAN) is an initiative that serves the underprivileged sections of society, especially those families with monthly incomes lower than Rs.10,000 and families who are Below Poverty Line (BPL). AAN provides financial assistance that goes up to Rs.1,50,000.

The financial assistance is provided for the general or specialised treatment of the following conditions:

1. Life-threatening illnesses which include the following:

1. Heart diseases
2. Kidney diseases
3. Urinary diseases
4. Cancer
5. Thalassemia
6. Orthopedic diseases
7. AIDS
8. Bone marrow transplant
9. Mental illness that is chronic with surgical treatment

1. Injuries as a result of manmade or natural disasters (bomb blasts, accidents, etc.)

A selection committee selects the beneficiaries who have been notified by the Government of Assam. Nearly 50% of the funds sanctioned by the State Government is a contribution of the Government of India.

Procedures included under AAN:

These are the procedures that are covered under AAN:

List of Referral Hospitals under Assam Arogya Nidhi

This is a list of some of the referral hospitals, both inside and outside the state, that are empanelled under the AAN:

Chief Minister's Free Diagnostic Services:

The Chief Minister's Free Diagnostic Services scheme ensures that each health institution is equipped with the minimum necessary set of diagnostic equipment and services. Under the scheme, irrespective of the Above Poverty Line (APL) and Below Poverty Line (BPL) status can avail free-of-cost laboratory services, X-ray, and CT scan diagnostics.

Physicians rely on accurate and quick diagnostics services to make the right treatment decisions. That is why access to reliable radiology services is essential to making the right diagnosis, which in turn leads to the right treatment choices. After the cost of medicines, the cost of diagnostics services is the second highest out-of-pocket expenditure for patients. This is why the Chief Minister's Free Diagnostic Services scheme is so important for people in Assam.

Laboratory Services:

Laboratory services at District Hospitals (DH), Community Health Centres (CHC), and Primary Health Centres (PHC) are offered totally free of cost through the Hub-and-Spoke model. There will be 28 district hospitals that will serve as the hub with a district laboratory set up in each one. The laboratories will be equipped with state-of-the-art technology. Samples from the other health institutions are collected and transported to the district hospital hub's laboratory. From here, the samples are analysed and reports are sent as a hard copy and electronically to the health institutions from where the samples were collected. The reports reach the patient the following day. Emergency reports are ready within 3 hours while normal case reports are ready in 24 hours. There are 56 tests that are covered under this scheme. M/S HLL Lifecare Ltd. will be implementing the scheme.

X-ray services:

X-ray machines are made available at District Hospitals (DH), Community Health Centres (CHC), and Primary Health Centres (PHC). These are connected through teleradiology to the hub. Radiographers at the DH/CHC/PHCs capture and transmit the images to the radiologists at the hub. The radiologist analyses the images and writes the report electronically which is then transmitted back as a digital X-ray image along with the radiologist's report. Currently, 130 centres have been selected for teleradiology connections out of which 78 are already operational.

CT Scan Services:

For the first time in the country, CT scan machines which are products of the 'Make in India' initiative are being installed on a large scale in health institutions across the state of Assam. Each CT machine is of the GE make and 16-slice technology. Each of the 28 district hospitals will be equipped with a CT scan centre. The CT scan image reports will be sent through teleradiology by qualified radiologists. Patients referred from government health institutions will receive the CT scan totally free of cost. Reports will be ready in 2 hours for emergency cases and in 6 hours for normal cases.

Community Action for Health:

The National Health Mission (NHM) created the Community Action for Health as a key strategy to place people at the center of the health initiatives in the state to guarantee that their health rights and needs are being fulfilled.

The Community Action for Health gives people the opportunity to ensure that NHM initiatives are being properly implemented in the local areas. This promotes active participation of the community and increases their contribution to the growth and reach of the health services.

The Community Action for Health process involves the following steps:

1. The creation and fortification of Village Health, Sanitation, and Nutrition Committees (VHSNCs) at the village level.
2. The creation and fortification of Planning and Monitoring Committees (PMC) at the Primary Health Centre (PHC), block, district, and state levels.
3. Creating awareness in the community about the roles, responsibilities, and entitlements of the service providers and NHM.
4. Monitoring health services through enquiry at the community level.
5. Organising public dialogues (Jan Samwaad) to identify gaps and solutions and advocacy among the stakeholders.
6. Addressing the issues that came up from the enquiry at the community level and public dialogues with follow-up planning and action.

Phases of Community Action for Health Initiative

Pilot phase: This phase was from 2007 to 2009 with nine states being selected and Assam being one of them. Three districts and nine blocks in total had the community monitoring program implemented. These were Chirang, Kamrup, and Dhemaji.

Post-pilot phase: In the post-pilot phase, there were 5 districts that comprised 34 BPHCs, 2,271 villages, and 5,678 VHSNCs were involved. These 5 districts were Jorhat, Dhemaji, Cachar, Chirang, and Kamrup.

Last FY phase: In this phase, the Community Action for Health was successfully implemented across 18 districts that encompassed all the blocks and within each block, 40 VHSNCs were selected. In 18 districts, 105 BPHCs and 4,200 VHSNCs were covered. The districts were categorized into 4 different zones. Zonal NGOs and state nodal NGOs supported this phase of expansion.

Progress under the CAH:

The VHSNC meetings have grown in strength from just a handful to at more than 10 with increasing participation. VHSNC meetings have been regularly scheduled with priority given to maternal and child health. Identity cards have been issued to members which has been an additional motivational factor. IEC activities too have increased. The Untied Fund is being documented, status tracked, and findings shown at the block and district levels. The mothers' groups in tea gardens have been identified and profiled. Labor welfare officers' advocacy has been discussed. The members of VHSNC have been imparted training. The PR/SIRD as well as R&D departments were contacted in order to include the health agendas into the GPDPs.

Comprehensive Abortion Care:

Approximately 8% of maternal deaths is caused by unsafe abortions. This is unfortunate because this is highly preventable. The major reason for this is the lack of qualified providers, lack of hygienic environments, lack of access to abortion services that are safe, and often a combination of all the three. This is the reason that the National Health Mission has focused on providing safe abortion services and access to the same in public sector health facilities.

The aims of the Comprehensive Abortion Care scheme are the following:

1. Provide abortion, post-abortion, and family planning services that are safe, sound, and reliable.
2. Make abortion care services more accessible to women by decentralising them.
3. Make abortion care services acceptable and affordable for women.
4. Provide abortion care services that are tailored to the individual needs and social circumstances of a woman.
5. Address the requirements of young women.
6. Bring about a reduction in the number of abortions or unintended pregnancies.
7. Provide women with services that cater to their reproductive and sexual health needs.
8. Ensure sustainability to health systems.

State Initiative on Comprehensive Abortion Care:

1. Training of Obstetrics & Gynecology (O&G) medical officers as Master Trainers (totally 70).
2. There are 23 training centres to train the service providers.
3. More than 300 service providers trained at the district level.
4. Medical Termination of Pregnancy (MTP) services provided in Primary Health Centres (PHCs).
5. CAC trained providers who provide CAC services at the district level are mentored by Clinical Mentors, with more than 10 Clinical Mentors throughout the state.
6. Assam Medical College & Hospitals, Dibrugarh, has a model CAC Centre.

Free Drugs Service:

The National Health Mission - Free Drug Service was launched by the Government of India in 2013-2014. Under this scheme, needy patients can get essential medicines at no charge in government hospitals and health institutions. This supports the health care that they receive at these institutions without being a financial burden for them.

The National Health Mission Assam has implemented the Free Drugs Service scheme in government health institutions by providing essential surgicals and drugs completely free of cost.

In accordance with the National Health Mission's General Ailments, Assam also takes care of the expenses for treatment of life-threatening illnesses such as cancer, thalassemia, and hemophilia. It also takes care of nephrological, neurological, and cardiological disorders.

The drugs that are essential are procured in the generic form. These are then distributed to government hospitals in Assam, to the OPD and IPD patients, free of cost. The State and Central governments support this scheme financially.

The Assam state works in alignment with the Government of India's Sustainable Development Goals which includes access to safe, quality, effective, and affordable vaccines and essential medicines, high-quality essential health-care services, universal healthcare coverage, and financial risk protection.

Towards this end, the Assam Government notified and modified the Essential Drug List (EDL) so that the number of free drugs was increased to 731 from 238. This was done to make the treatment of both non-communicable and communicable diseases accessible to all. This helped families that were both APL and BPL to be able to get access to a wide range of drugs that would have otherwise been a formidable financial burden for them.

The Free Drugs Service scheme is spread out to 27 districts in the state of Assam in all medical colleges, district hospitals, community health centres, and primary health centres. The new EDL has also been notified based on the standard of the National Essential Drug List.

Essential Drug List:

Assam has a state-specific Essential Drug List. Procurement of drugs across the state is based on this list.

Procurement of Drugs:

The Directorate of Health Services and National Health Mission handles the procurement of drugs, which is done in their generic form. The State Government notifies the Essential Drug List for different health institutions based on different categories and tenders are issued for this. The projected annual requirements for each district is communicated to the Procurement Agency. This is done by the District Drug Stores Managers (DDSMs). The DDSMs do this by collating information based on past demand that is reflected in the ledgers. They also base this on the expected consumption that the peripheral health institutions. At the peripheral health institutions, Block Pharmacists are responsible for collection and compilation of this data.

Assam has adopted a system of e-tendering which is scientific and technologically up-to-date. Various commercial and technical parameters are evaluated on the basis of a two-bid system (Price Bid 'BOQ' and Technical Bid). Open tendering is what is generally used for the procurement of drugs. The tender notice is always published on the website of the NIC and NHM. It is also published in local newspapers and one national newspaper.

The Bid Document lists out the terms and conditions on the basis of which the bid is carried out. In the case of the two-bid system, a techno-commercial analysis is done first of the technical and unpriced bids. Only the price bids of those who are techno-commercially qualified is done first. The evaluation of the price bids is done on the basis of many factors such as landed cost, inclusive of taxes and duties, at destination, insurance charges for transit & transportation, packing & forwarding charges, and other incidental charges.

After the techno-commercial evaluation of bids is successfully done, a procurement proposal for award of order is made on the technically acceptable bidder who has bid the lowest. The Mission Director is the approving authority for orders up to Rs.50 lakh. For anything above Rs.50 lakh, approval has to be given by many stakeholders, such as the Chairperson, Governing body of the State Health Society and Co-Chairman, Executive Committee, NHM - Assam, and Minister of Health & Family Welfare Department.

Warehousing & Distribution:

Vendors distribute the ordered drugs directly at the District Drug Stores. This is done in accordance with the distribution plan that has been finalised by the State. At the District Drug Stores, the drugs are all accepted, checked, and stock charged. Vendors get their payments on the basis of this. The drugs are distributed to the peripheral health institutions by the District Drug Stores Managers (DDSMs) with the help of the Block Pharmacists on the basis of the drug requests. The drugs are transported from the warehouses to the different health institutions such as the district hospitals, community health centres, primary health centres, and sub-centres. The DDSMs also take care of the stock inventory and replenishment.

DDSMs are all B.Pharma (pharmacy) graduates with 3 DDSMs at the state headquarters and 27 DDSMs in each of the 27 districts. There are 149 Block Pharmacists who are D.Pharma graduates in each of the 149 blocks.

There are five regional warehouses in Assam which are well equipped for the storage as well as handling and movement of the drugs. For storage, there are steel racks with slotted angles and pallets. For handling and movement there are pallet trolleys and mechanised stackers. For the receipt and dispatch of consignments, there are ramps. The stock ledger has a record of all transactions and these are stored in the computerised format in the district warehouses. The state government is in the process of building new warehouses to counter the lack of space in the hired warehouses that are being used currently.

System of Monitoring Drugs:

A MoU was signed with the CDAC to take responsibility for the supply chain management of the drugs in the state, including the peripheral hospitals and district drug stores. A Drug Stock Monitoring System, completely online, was developed by the NHM, Assam. The District Drug Store Managers (DDSMs) take the drug inventory from the peripheral health centres on a weekly basis and uploads it onto the Drug Stock Monitoring System. This can be viewed at both the district and state levels.

The Drug Stock Monitoring System helps to get a bird's eye view of the drugs inventory at the different health institutions in different areas of the state which helps in replenishing stocks at the right time. Replenishment of stock is done from the state level in two ways - diverting stock from a location that has a surplus to a location where there is insufficient stock and through infusion of fresh stock directly from the state level. The status of the availability of essential medicines is available on the public domain. The official website of the NHM Assam has a link to access the information.

Quality Assurance:

There is a strong quality assurance and regulatory framework related to the drug supply that is followed by NHM Assam. Some of the best practices of this framework are as listed below:

1. The bidder should possess a valid manufacturing license or drug license that is issued by the licensing authority or the Drug Control Authority that is related to it.
2. For the products that are offered, the manufacturer should have 3 years of market standing.
3. The manufacturing facility should comply with WHO GMP or COPP standards.
4. The manufacturer should have had an annual average turnover over the last 3 years of Rs.20 crore at the least.
5. An Inspector of Drugs is responsible for sampling of the drugs on a regular basis. The Inspector is engaged by the Drug Control Authority. Samples are sent confidentially for analytical testing at empanelled NABL government laboratories, either in Assam or outside the state.
6. Supplies should be accompanied by an analysis report that is done batch-wise in an NABL-certified laboratory. The batch has to also have a notarised copy of the NABL accreditation submitted alongside. If further testing is deemed necessary, then it will be done at the Government Drugs Testing Laboratory or any other NABL-certified facility.

Free Operations for Children Having Congenital Heart Disease:

The Government of Assam's Health and Family Welfare Department introduced an initiative that would be life-changing for the children having congenital heart disease. Under the scheme, children born to those who are permanent residents of Assam, who suffer from congenital heart disease, and who have been recommended heart surgery, will have all the expenses of their surgery borne by the Government of Assam. These expenses also include airfare for the child and one adult. These expenses will be for travel that is to and from the hospital that is a designated referral hospital. The guardian who is caring for the child will also be provided with accommodation in the hospital or in the vicinity of the hospital for the duration of hospitalisation of the child. These free surgeries will be conducted at Narayana Hrudayalaya in Guwahati, Calcutta, and Bangalore.

Eligibility Criteria:

To be eligible for the scheme, the following criteria have to be met:

1. Children should be between 0 to 14 years.
2. The HOD of Pediatric Surgery, GMCH, has to certify that the patient requires cardiac surgery.
3. The guardian should be a permanent resident of the state of Assam.
4. The guardian's income should not exceed Rs.6 lakh p.a.

Procedure to apply for the scheme:

Application to be selected for the scheme must be submitted to the nodal officer along with the following documents:

1. Application for financial aid
2. Address proof
3. Permanent residential certificate for Assam
4. All the relevant documents pertaining to the illness, including laboratory test expenditure receipts for pathology tests, X-rays, doctor's consultation, etc.
5. Medical certificate that the child requires cardiac surgery from a qualified and competent cardiac surgeon.
6. Guardian's employment details.
7. Referral certificate for the cardiac surgery, including name of the referral centre.
8. Income certificate.
9. Letter from the referral hospital with the tentative surgery date mentioned.
10. Patient must be presented to the State Nodal Officer. He/she can be exempted from physical examination if grounds for exemption are submitted.

Between the years 2009 and 2017, more than 4,000 children were treated under the scheme. Approximately Rs.6,000 lakh was the budget provision for the scheme during this period of time. This scheme has undoubtedly brought succour and relief for thousands of these children and their families.

Janani Shishu Suraksha Karyakram (JSSK):

The Janani Shishu Suraksha Karyakram (JSSK) is a scheme launched by the Government of India in 2011 that provides free Cesarean sections to women who have their deliveries in public health institutions. The scheme covers the following:

1. Free drugs
2. Free diagnostics
3. Free Cesarean section delivery and treatment
4. Free blood transfusion
5. Free diet
6. Free transportation from home to institution and back home
7. Free transportation between facilities if there is a referral and back home

All sick newborns who come into the care of public health institutions for any treatments up to 1 year of birth are also entitled to the same free facilities and services.

Janani Suraksha Yojana (JSY):

The Janani Suraksha Yojana (JSY) is an initiative under the National Rural Health Mission (NRHM) to ensure safe motherhood among the poor. Its objective is the reduction of neonatal and maternal mortality through the promotion of institutional delivery among the pregnant poor women. Along with delivery and post-delivery care, cash assistance is also provided to the women. The determinant for the success of the scheme is the increase in institutional deliveries among the poor families in the state. The scheme also provides cash assistance to women who have their deliveries in accredited private hospitals and government health institutions. For mothers in the Below Poverty Line (BPL) category, Rs.500 is given if it is a home delivery.

Kayakalpa:

The Kayakalpa scheme was created to promote infection control, hygiene, and cleanliness practices in public health care facilities. It also recognises health institutions that have shown standards of exemplary adherence to these protocols. It aims to promote a culture of peer review and ongoing assessment that is related to these protocols of infection control, hygiene, and cleanliness. It also seeks to share sustainable practices that will lead to positive health outcomes in public health facilities.

Operation Smile:

Operation Smile provides free surgery for any child having cleft lip and palate. This was a joint initiative by Operation Smile, NHM, and the Government of Assam's Department of Health & Family Welfare. There was a special drive for cleft palate and cleft lip patients in the year 2009. A Comprehensive Cleft and Child Care Centre was established in the Mohendra Mohan Choudhury Hospital in Guwahati. This provides surgical care to people with cleft deformities on a year-round basis. The centre is equipped to conduct 6 such surgeries simultaneously with world-class technology at its disposal. Since its inception in 2009 till 2014, approximately 11,000 children with cleft lip or cleft palate have been treated successfully under Operation Smile.

PPP with Charitable Hospital:

The urban poor population is served by a large number of charitable hospitals in the state. The NHM, Assam, has entered into a Memorandum of Understanding (MoU) with trust hospitals or private hospitals to improve maternal and child health in each district. Special focus will be given to BPL families, outreach areas, and municipal wards.

The list of services that charitable hospitals are required to provide are as given below:

1. Maternal and child health services in the selected wards or slums of each district
2. Routine antenatal care for women
3. Vaccination of children
4. Basic laboratory tests for expectant mothers such as urine, stool, and blood
5. Delivery in the hospital at special rates that are prescribed by the District Health Society and Hospital Management Authority
6. Family planning services, including permanent sterilisation for females as well as IUCD insertion, condom
7. Medical Termination of Pregnancy (MTP) at the hospital premises for safe abortions
8. Outpatient Department (OPD) services
9. Awareness about family planning methods that lead to stabilisation of population

Allotment of funds:

The Hospital Management Committee is provided with Rs.15 lakh p.a. to provide the above-mentioned services.

Guidelines for release of the fund

The following are the guidelines for releasing of the fund:

1. The fund will be used for monthly outreach or urban camps, manpower, medicines, and maintenance of the hospital.
2. The fund is released in two different instalments.
3. The first instalment is released according to the Action Plan where specific activities are listed.
4. The second and all subsequent instalments are released after the submission of the verification report of the outstanding advances and on submission of 75% UC.
5. The monthly report of services is to be submitted to each district's Joint Director of Health Services.
6. Documents that are related to hospital records are provided by the concerned hospital on an as-needed basis.

PPP with Tea Garden Hospitals:

The community of tea garden workers in Assam has always been a marginalised community that has been socially excluded for decades. They have a high mortality rate and high incidence of diseases as well. This is due to the paucity of healthcare facilities for them. The National Health Mission (Assam) has entered into a Memorandum of Understanding (MoU) with tea garden hospitals. This is under the Public Private Partnership (PPP). The purpose of this is to address the gap between the health needs of tea garden workers and the availability of healthcare services for them. This scheme, launched in 2007, makes healthcare services available to all tea garden workers. While it started off with only 50 tea garden hospitals on its launch, today it has grown to include more than 150 hospitals across the state.

The scheme is focused on the following areas:

1. Child and maternal healthcare
2. Emergency services
3. Referral services
4. Management of non-communicable and communicable diseases
5. Development of the existing infrastructure in the tea garden hospitals

The scheme also finances the salary and incentives of doctors and paramedics who are working in the tea garden hospitals. Financial assistance is also provided for the renovation of hospital infrastructure, purchasing equipment, and improving the quality of delivery of services. Medicines were given free of cost and an ambulance was also provided to each hospital to be used for referral purposes.

Each tea garden hospital sends a monthly report in a prescribed format to the NHM, Assam.

Financial Assistance:

Under the PPP, as central assistance, Rs.7.5 lakh was assigned to each tea garden hospital. This is released in two instalments. The first instalment will be paid after the MoU is signed and the second instalment is paid after submission of the SoE and UC of the first instalment.

RMNCH+A:

The National Health Mission (NHM) and the Millennium Development Goals (MDG) 4 and 5 have set specific national health goals. These goals can only be achieved when there are significant improvements in maternal and child health. SDG Goal 3 also focuses on the reduction of maternal, child, and newborn mortality rates.

The National Rural Health Mission (NHRM) was launched in 2005 and since then has received increasing financial aid for healthcare infrastructure, Reproductive and Child Health (RCH), workforce, and expansion of the capacity for programme management. To increase the impact of the RCH programme, it is important to recognise the interconnectedness of maternal, reproductive, and child health. For example, an adolescent girl's health will have a direct impact on later pregnancy while a pregnant woman's health will have an impact on the newborn and later, the child. So interventions have to be made available at different stages of these life cycles and they have to be linked together.

It is on the basis of this that the RMNCH+A scheme was initiated. It implements the 'Continuum of Care' strategy that includes maternal, reproductive, newborn, child, and adolescent health. The 'plus' in the scheme denotes many different things such as:

1. Adolescence is a distinctive life stage.
2. Connecting child and maternal health to reproductive health and its components like Pre-conception (PC), Prenatal Diagnostic Techniques (PNDT), gender, HIV, family planning, etc.
3. Connecting facility-based and community care, and referrals to create a pathway that is continuous between various levels of the healthcare system.
4. Connecting the overall impact and outcomes.

Programmes under RMNCH+A:

1. Reproductive Health: Family planning, comprehensive abortion care or safe abortions
2. Maternal health
3. Newborn health
4. Child health: RBSK
5. Adolescent health: RKSK, adolescent-friendly healthcare clinics, and WIFS

Sanjeevani - Village Health Outreach Programme:

The Sanjeevani - Village Health Outreach Programme results in health services being converged at the village level for greater efficacy and reach. This is a fixed date, monthly outreach programme. There are 80 Mobile Health Units (MHU) throughout the state of Assam that facilitate the outreach. The MHU is manned by several personnel, such as the pharmacist, lab technician, pilot, ANM, and Registration & Measurement officer. The aim of the programme is screening, early identification, free medicines, follow-up, and referral for effective management of chronic diseases. The beneficiaries are first screened in the VHOP and then referred to the PHCs for further confirmation, prescriptions, and beginning the treatment. The services are delivered to 2 villages and a 3,000-strong population on an average daily basis. In a monthly cycle of 24 days, this is 48 villages. The combined strength of the 80 MHUs covers a population of 60 lakh in 4,000 villages on a monthly basis.

Sneha Sparsha:

Sneha Sparsha is a healthcare scheme for children below the age of 12. It means 'Touch of Love' and is an initiative of the Government of Assam's Department of Health and Family Welfare. The scheme was inaugurated in 2013 with a starting fund of Rs.5 crore for the year 2013-2014. This scheme aims to support the expenditure of very expensive medical and surgical treatments such as kidney transplant, liver transplant, thalassemia that requires bone marrow transplant, and cochlear implant.

Eligibility Criteria

Priority is given to families who are Below Poverty Line (BPL) as well as those with incomes less than Rs.2.50 lakh p.a. To be eligible, the guardians or beneficiaries must submit an income proof that is issued by a reliable authority such as the Block Development Officer, Circle Officer, Sub-Divisional Circle Officer, Deputy Commissioner, or any other authority that is Government-notified.

Permitted Procedures and Amount Admissible:

The amounts listed below are indicative only. The actual admissible amount is fixed through a process that is transparent.

Susrusha - Financial Assistance For Kidney Transplantation:

For people who underwent kidney transplantation after 1 April 2010, the Susrusha scheme provides Rs.1 lakh as financial aid. To be eligible for the scheme, the beneficiary has to be a resident of Assam with an individual or family income that does not exceed Rs.3 lakh. From the inception of the scheme in 2009 to the year 2017, more than 300 people have benefited from the scheme with more than Rs.300 lakh utilized in total.

Village Health and Nutrition Day:

The Village Health and Nutrition Day is a scheme that is conducted on Wednesdays in specific villages. It is a joint effort of ASHA, AWW, and ANM. The VHND aims to promote health-positive behaviors and practices within the community, covering both preventative and curative aspects of health. Before the start of the VHND, the Accredited Social Health Activist (ASHA) of the villages prepares the list of eligible couples, children, and pregnant women who will benefit from the service. She will also mobilise the beneficiaries and ensure their participation in the scheme.

Weekly Iron Folic Acid Supplementation (WIFS):

The Weekly Iron Folic Acid Supplementation (WIFS) is a scheme for boys and girls of adolescent age (10-19 years) as well as girls who are out of school (10-19 years) in both rural and urban areas. This scheme is implemented with the help of Anganwadi Centres (AWCs), municipal schools, aided schools, and government schools. The folic acid supplementation is distributed on a fixed day - Monday. Teachers and Anganwadi Workers (AWW) supervise the distribution of the folic acid supplements.

The objectives of the scheme are:

1. Ensure administration of Iron Folic Acid (IFA) tablet once a week.
2. Ensure administration of Albendazole for deworming twice a year.
3. Educate adolescent boys and girls on healthy dietary practices that will increase the intake of iron.
4. Educate on hygienic practices that will prevent the infestation of worms, including the importance of using footwear.

The scheme's strategy is as follows:

1. Screening of the target demographic to detect moderate or severe anemia on time.
2. Referral of appropriate cases to the relevant healthcare facilities.
3. Weekly administration of WIFS (this is an iron folic acid tablet that contains 500 ug folic acid and 100 mg elemental iron) on a fixed day, which is Monday, for 52 weeks of the year.
4. Administration of deworming tablet Albendazole 400 mg.
5. Dissemination of nutrition information, counseling on dietary intake to improve iron intake, and steps to prevent infestation of intestinal worms.