Abstract of Dissertation

Keyword : National Deworming Day; Programme Implementation; Anganwadi-based Deworming Program

Background : There is a key gap between existing programs and the coverage needed for STH treatment in India, much of which can be filled by a high-quality school and Anganwadi-based deworming program designed to reach preschool and school-age children at scale. The school and Anganwadi-based deworming program approach, under the aegis of National Deworming Day (NDD), provides an easy and cost-effective way to reach all children aged 1-19 years, through existing infrastructure. Contributing to the same Government of India’s (GoI) National Deworming Day (NDD) initiative, the state of Bihar implemented round eight of the mass school and Anganwadi based deworming program in February 2018. NDD was conducted across 36 districts on February 19, 2018, followed by mop-up day on March 7, 2018.

Recommendations :The study was done to understand and describe the implementation of the eighth round of NDD in Bihar, conducted on February 19, 2018, with a Mop-up Day on March 7, 2018. Based on national level STH mapping and WHO guidelines, Bihar is required to conduct NDD twice a year. Desk review was done to understand program implementation in the NDD preparatory phase including the advocacy efforts and convergence of key stakeholders. During NDD and Mop-up day, visits were made to schools and Anganwadi to understand the implementation at sampled schools and Anganwadi. In consultation with Evidence Action team, recommendations were drafted and shared with the state government for corrective actions to state/district and block officials. The report is discussed under the headings of policy and advocacy, program planning and management, drug procurement, logistics and storage, training and distribution cascade, community awareness and mobilization and monitoring and evaluation. A program of such a large scale requires stakeholder convergence and collaborative efforts at each administrative and implementation level, which is imperative for effective implementation. Interdepartmental collaboration is the key to smooth program implementation. The analysis of Evidence Action monitoring visits showed that there were sufficient drugs in 89-92% schools and Anganwadi. The provisions of deworming- drug (90-92%) and reporting form (100%) were high but the availability of ORS packets was low (11-23%) in schools and Anganwadi. 98% of teachers and 95% of Anganwadi workers attended block level training and almost 100% of teachers & Anganwadi workers were aware of adverse events. Bihar NDD program is the largest school-based deworming program in the world and thus become a learning platform for other states where NDD is implemented, as well as other school health programs which reach out to all children aged 1-19 years.