Weekly Iron Folic Acid Tablets Free Distribution - Uttarakhand

What is the Weekly Iron Folic Acid Tablets Free Distribution programme?

Weekly Iron Folic Acid Supplementation, usually shortened to WIFS, and described in Uttarakhand's scheme lists as free distribution of weekly iron folic acid tablets; is a public health intervention that gives adolescents one free iron and folic acid tablet every week to prevent and reduce anaemia. It is not a cash scheme and there is nothing to apply for; the tablet reaches the child where the child already is, in the classroom.

According to the National Health Mission, Uttarakhand, WIFS is one of the core interventions delivered under the Rashtriya Kishore Swasthya Karyakram (RKSK), the adolescent health programme that Uttarakhand launched on 23 September 2014. NHM Uttarakhand lists three headline interventions under RKSK: Adolescent Friendly Health Services, the Menstrual Hygiene Scheme, and Weekly Iron Folic Acid Supplementation.

Anaemia matters in Uttarakhand for a practical reason. An anaemic adolescent tires quickly, concentrates poorly and falls ill more often, and an anaemic girl who later becomes pregnant carries that deficit into the pregnancy. Iron and folic acid taken weekly rather than daily is enough to correct mild and moderate iron-deficiency anaemia in this age group while being far easier to sustain in a school setting.

Design of the programme

• One iron and folic acid tablet per week, taken on a fixed day, supervised in school.
• Deworming with albendazole twice a year, because intestinal worms are a major cause of continuing iron loss.
• Nutrition and health education for adolescents on iron-rich foods and on the causes of anaemia.
• Screening and referral of severely anaemic adolescents to a health facility for treatment.

Who is covered, and who is not

Covered:

• Adolescents aged 10 to 19, both boys and girls, enrolled in government, government-aided and municipal schools; in practice classes 6 to 12.
• Out-of-school adolescent girls in the same age band, reached through anganwadi centres rather than schools.
• Adolescents in all districts of Uttarakhand. NHM Uttarakhand runs a dedicated RKSK team of one State RKSK Consultant, six District RKSK Coordinators and 74 dedicated adolescent health counsellors, with peer educators: Saathiya, trained across 51 blocks in six focus districts out of 95 blocks in 13 districts.

Not covered / not eligible:

• Adults over 19. Pregnant and lactating women receive iron and folic acid under the separate maternal health programme, not under WIFS.
• Children below 10. Younger children are covered under the separate age-appropriate iron supplementation and nutrition interventions, not by the weekly adolescent tablet.
• An adolescent with severe anaemia diagnosed on testing should not be left on weekly supplementation alone, that case is referred for treatment at a health facility, and the weekly tablet is not a substitute for it.

There is no income test, no caste category test and no ration-card test. WIFS is a universal programme for the covered age group, which is why no eligibility document is demanded from a student or a parent.

What documents are required?

How to apply for and get the free weekly iron and folic acid tablets

1. If the child is in school, do nothing. The school is the delivery point. The class teacher distributes the tablet on the school's fixed WIFS day each week, and the child takes it in front of the teacher, after a meal.
2. If the school has not started distribution, ask the head teacher to raise it with the block education officer and the block medical officer, since tablet supply flows from the district health office to the school.
3. If the girl is out of school, go to the nearest anganwadi centre and ask the anganwadi worker to enrol her for the weekly tablet, this is the designated route for out-of-school adolescent girls.
4. Take the biannual deworming tablet when the school or anganwadi announces the deworming round, normally alongside the national deworming day activity.
5. For a health question or a suspected severe case, call the 24x7 adolescent helpline on 104, or take the adolescent to the nearest Adolescent Friendly Health Clinic.

Where the tablets are given in Uttarakhand

Uttarakhand delivers WIFS through three linked networks:

• Schools. Government, government-aided and municipal schools are the main delivery point for enrolled adolescents, with the class teacher supervising intake on the fixed weekly day.
• Anganwadi centres. These reach out-of-school adolescent girls, the group with the highest anaemia burden and the hardest to reach through schools.
• Adolescent Friendly Health Clinics (AFHCs). NHM Uttarakhand reports 64 AFHCs in the state to 56 in RKSK districts and 8 in non-RKSK districts: distributed across 3 medical colleges, 12 district hospitals, 3 sub-district hospitals and 46 community health centres. These are the referral point for an adolescent who needs more than a weekly tablet.

Around 10,000 service providers and change partners have been trained in Uttarakhand under RKSK, including medical officers, ANMs, ASHAs and counsellors, and about 8,800 peer educators (Saathiya) have been identified and trained.

How to take the tablet correctly

• Take it after a meal, not on an empty stomach, which sharply reduces nausea.
• Take it on the same day every week, the fixed day is what makes the habit stick and lets the teacher supervise it.
• Do not take tea or coffee immediately before or after the tablet; the tannins reduce iron absorption. Vitamin C, a citrus fruit, amla, guava: improves it.
• Keep tablets away from small children. Iron tablets are a common cause of accidental poisoning in young children.
• Expect dark stools. Blackish stool is a normal effect of oral iron and is not a sign of bleeding.

Common reasons a child misses the tablet, and what to do

• Absent on the fixed weekly day. The tablet is given only on the WIFS day, so a child absent that day misses the dose. Ask the teacher whether a catch-up dose can be given.
• Supply gap at the school. Tablets flow from the district drug store to the block and then to the school. Persistent gaps should be raised with the block medical officer through the head teacher.
• Stopped because of nausea. This is the most common reason adolescents drop out of the course, and the fix is almost always to take it after food rather than to stop.
• Out of school and not enrolled at an anganwadi. Adolescent girls who have dropped out are the group most likely to be missed entirely; the anganwadi worker of the ward is the person to approach.
• Assumed to be a paid service. No one is authorised to charge for these tablets. They are supplied free under the National Health Mission.

Help and grievance redressal

• Adolescent health helpline (24x7): 104
• National Health Mission, Uttarakhand: nhm.uk.gov.in
• Local escalation: the head teacher and block education officer for a school supply gap, the anganwadi supervisor for the out-of-school route, and the block or district medical officer for the health side
• Referral care: the nearest Adolescent Friendly Health Clinic, at a community health centre, sub-district hospital, district hospital or medical college

Weekly Iron Folic Acid Supplementation is entirely free. If any school, shop or private clinic asks for money for these tablets, report it to the block medical officer or on the 104 helpline.