1) The DFMC (District Fluoride Monitoring Center) was established a year ago in Nalgonda district to monitor fluoride and fluorosis mitigation programs run by 17 line departments. 2) The DFMC collects monthly action taken reports from departments and presents them at review meetings chaired by the Collector. UNICEF provides technical and financial support to strengthen the DFMC. 3) Major programs aimed at mitigation include providing safe drinking water, nutrition support, awareness campaigns, and medical assistance like tricycles for disabled victims. However, accountability and awareness of schemes remains a challenge due to lack of resources and priority given to fluorosis work.

1. Understanding DFMC and status of present
work on Fluorosis in Nalgonda
By Rahul Rathod MSW 4th Semester student,
Department of Social Work
S.P University V.V Nagar
Internship with INREM Foundation, Anand

2. INREM all about
• India Natural Resource Economics and Management
• National NGO
• Head office :- Anand, Gujarat
• Major focuses area is Fluoride and Fluorosis
• Working area Jhabua (Madhya Pradesh)

3. Nalgonda Mandal/Tahsil Map
• The Nalgonda district
• Geographical Area:- 14,322 Sq.K.m
• Population:- 38.88 lakhs
• Scheduled Castes (SC):- 17.73%
• Scheduled Tribe(ST):- 10.55%
• Agriculture:- 81% population depends
• Population density:- 245 Sq. Km
• Total Area:- 14,22,000 ha
• Forest Area:- 5.88%
• Non Agriculture :- 4.3%

4. Cont.…
• Per Capital income Rs. 16526 during 2003/04.
• Annual growth rate of agriculture leading was 30%.
• The annual normal rain fall is 752.60 mm with a very high
frequency of droughts during the past 15 years.
• Ground water is the main source for drinking and irrigation in
the district.
• 5 lakhs plus bore wells.
• The Fluoride in ground water is high as 14.75mg/Lit & WHO
permitted level of 0.5mg/Lit.

5. 1 Bommala Ramaram 2 Turkapally 3 Rajapet
4 Yadagirigutta 5 Alair 6 Gundala
7 Tirumalagiri 8 Thungathurthy 9 Noothankal
10 Atmakur (S) 11 Jajireddigudem 12 Saligowraram
13 Mothkur 14 Atmakur (M) 15 Valigonda
16 Bhongir 17 Bibinagar 18 Pochampally
19 Choutuppal 20 Ramannapeta 21 Chityal
22 Narketpally 23 Kattangur 24 Nakrekal
25 Kethepally 26 Suryapet 27 Chivemla
28 Mothey 29 Nadigudem 30 Munagala
31 Penpahad 32 Vemulapally 33 Thipparthy
34 Nalgonda 35 Munugode 36 Narayanapur
37 Marriguda 38 Chandur 39 Kanagal
40 Nidamanoor 41 Tripuraram 42 Miryalaguda
43 Garidepally 44 Chilkur 45 Kodad
46 Mellachervu 47 Huzurnagar 48 Mattampally
49 Neredcherla 50 Damercherla 51 Anumula
52 Peddavoora 53 P.A.Pally 54 Gurrampode
55 Nampally 56 Chintapally 57 Devarakonda
58 [[Gundlapally ]] || 59 Chandampet
|
Mandals

6. List of the Highly Affected Mandals:
S. NO Name of the Mandal S. No. Name of the Mandal
1 Nalgonda 10 Chitapally
2 Munugonde 11 Choutuppal
3 Gurrampode 12 Narayanpur
4 Thipparthy 13 Aleir
5 Narkatpally 14 Yadagirigutta
6 Marriguda 15 Bibinagar
7 Nampally 16 Thurkapally
8 Chandur 17 Veligonda
9 Deverakonda

7. What are Fluorides ?
• Fluorine as an element was first detected by Scheele in 1771
• First isolated by Moissan in 1886.
• He got Nobel Prize in chemistry in 1906 AD
• Highly reactive element, forms compounds with other elements.
• 13th commonest element in the earth’s crust
• Present in everything we eat, drink & breath.
Fluorosis
Fluorosis is a disease caused by excessive ingestion of fluoride through water
and or food which affects the teeth and bones. The upper limit of optimum
fluoride level in drinking water for India is 0.5 PPM or 0.5Mg/Lit.
Moderate amounts lead to dental effects, and long term lead to potentially
severe skeletal problems.

8. Stages of Fluorosis
• 1) Dental
• 2) Genu Valgum
• 3) Skeletal
• 4) Neurological
• Jhabua photos

9. Cont.…
• Nalgonda is a land where excess fluoride has turned the ground water
into slow poison.
• Crippling people and leaving others in a constant misery.
• People are suffering from dental and skeletal fluorosis.
• Last 80 to 100 years problem is still there.
• Lacks of people are suffering from Fluorosis.
• 17 mandals are severally affected from fluoride.

10. Background
• Andhra Pradesh Legislative Assembly visits in 2012.
• Safe water supply, awareness building campaign, nutritional
interventions, rehabilitation packages etc.
• Observations and Recommendations
• The Nalgonda District
• Fluoride and Fluorosis
• Highly affected mandals in Nalgonda.
• The initiatives.

11. Objective of the Study
• Status of Fluoride Programs in Nalgonda
• 1) DFMC as an institution
• 2)To get an overview of all Fluorosis related programs
• 3)The role of different Departments and programs
• 4)How the fluoride programs get implemented in the villages.

12. SlNo Date Name of the Department Objetives Point Person
1 28.02.2015 Reached Nalgonda and visited DFMC DFMC, Nalgonda
2 01.03.2015 Sunday Holiday
3 02.03.2015 DFMC To understand the staff, Structure, composition, Hierarchy of DFMC, DFMC, Nalgonda
4 03.03.2015 DFMC Roles and responcibilities of the persons at different levels. DFMC, Nalgonda
5
04.03.2015 DFMC
To get the listing of the activities monitoried by DFMC,
to know the role and responcibilities associate organizations with regards
to DFMC
RWS&S, IEC, Veera Reddy
6 05.03.2015
Health, ICDS, Water testing
lab, DWMA
To get the listing of the activities monitored by DFMC, to know the role
and responsibilities associate organizations with regards to DFMC
To get familiar with the Departments. To know the activities of the
departments. Their roles and responsibilities, to get familiar with the on
going programs, to obtain the documents of the programs, to learn about
the association of other departments for implementing the Program.
G.Shankar Babu / DFMC
7 06.03.2015 Holiday Holi
8
07.03.2015 Field Visits
To observe how the programs are implemented at grass root level. What
are the interactions, ( M.Yadavalli Village)
if any between field workers for the execution at field level.
G.Shankar Babu/ DFMC
9 08.03.2015 Field Visit To observe the role played by Stake holders.( Yellareddy Gudem Village) G.Shankar Babu / DFMC
10
09.03.2015 Training Program
To understand Acquire Management and Fluoride Mitigation through
Participatory Approach
DFMC / UNICEF, CGWB
11
10.03.2015 Training Program
To understand Acquire Management and Fluoride Mitigation through
Participatory Approach
DFMC / UNICEF, CGWB
12 11.03.2015 Interaction with DFMO DFMC /Nalgonda
13
12.03.2015 NIN, HYD
NIN, HYD Dr.Arjun
Khandare
14
13.03.2015 NIN, HYD
NIN, HYD Dr. Arjun
Khandare
14 14.03.2015 Traveling to Anand Traveling Back

13. DFMC (District Fluoride Monitoring Center)
• DFMC’s role is to monitoring and evaluation of the Fluoride and Fluorosis related
programs, activities initiated by the 17 line departments.
• To prepare ATR( Action taken report) and present that report in the every months
review meeting. The meeting was held in the supervision of Collector where all
departments point persons( specific responsibilities for fluoride & fluorosis) were
attended.
District
Administration
Establishment
of DFMC
Functioning &
Monitoring the
programs

14. DFMC
• District Fluoride Monitoring Center.
• DFMC center has established before one year.
• Current DFMO is working as head engineer in RWS&S (Rural Water Supply and
Sanitation).
• ATR Report (Action Taken Report)
• UNICEF Consultant, Project Coordinator and Assistant Project Coordinator is
working as full time in DFMC.

15. Hierarchy of DFMC, Roles & Responsibilities at different levels
Collector Chairman
Satyanarayan Reddy
(IAS)
Attend the monthly
meetings, guidelines
&orders
DFMO Head of DFMC
N.V.V Satyanarayan
Guidelines and
Support
Unicef consultant Shrinivas Chikuri Technical &
Financial support
Project Coordinator G.Sankar Babu Bridge between DFMC
and Line Department,
coordination and
monitoring.
Assistant project
coordinator cum
Computer operator
Prasad sir - maintain the data, store
the data in computer on
the regular basis.

16. List of Line Department
• 1) District Administration
• 2) Civil Supplies
• 3) Rajiv Vidya Mission
• 4) DRDA
• 5) Health
• 6) RWS&S (Rural water Supply and Sanitation)
• 7) Arogya Sri
• 8) DWMA
• 9) Social welfare
• 10) Tribal welfare
• 12) Women & Child welfare
• 13) Education
• 14) Horticulture
• 15) Animal husbandry
• 16) Forest
• 17) Minor Irrigation
• 18) District fluoride Monitoring Center (DFMC)

17. Departments Specific work on Fluorosis & Fluoride
• Rajiv Vidya Mission :- Supply tricycles to the Fluorosis Victims (250
tricycles already allotted)
• Health:- Special Fluorosis ward at district Head Quarters Hospital
Nalgonda.
• National Program for Prevention and control of Fluorosis
(NPPCF) Implementation.
• School children urine and blood sample survey is going on.
• Social Welfare
• Tribal Welfare Replacement of Aluminum utensils and
• BC Welfare Provision of supplementary nutrition food

18. Cont..
• RWS&S (Rural Water Supply and Sanitation):-
• Supply of safe drinking water to Schools
• Providing Krishna Water to leftover Habitations.
• Design and Distributing Of IEC (Information Education Communication)
material.
Civil Supplies
• Conversion of ration cards as AAY(Antyodaya Anna Yojana)to the victims
of Fluorosis.
• 852 AAY cards sanctioned by the commissioner civil supplies.
• Rice 35 Kgs per card allotted to the card holder.

19. Hierarchy of the ICDS department
• Project Director
•
• Assistant Project Director
•
• CDPO(Child dev. Project Officer) 4/5 Mandals
•
• 1 Supervisors (25-30 centers)
•
•
• Aaganwadi Workers/Helpers (4,202 Centers)
•

20. Interaction with director of ICDS department
• N.Mophi mam
• Arogya laxmi program 1st Jan 2015 – Eggs, daily milk, food mile will be supply to
the 59 mandals.
• Rice civil supply, Red gram dal, Milk A.P Dairy and Eggs NEK farmers
• Bal Amrutha – Provide Nutrition food, snacks (kurkure). The anganwadi worker
should went to the every household and gave that to the mothers.
• Awareness program on Health education, nutrition education with the help of
other departments.

21. Health Department
• Structure
• DHMO
•
• Unit Officer
•
• Consultant
•
• L.T (Lab technician)
•
• Sub Centers
•
• ANM
•

22. Cont..
• Mr. Manmohan is a newly appointed point person.
• Awareness camps at field level.( vegetables and food)
• Primary school’s Students urine Samples were collected.
• 90% samples results were positive.
• Department major focus on the awareness campaigning at 17
affected mandals.
• Fluorosis ward is situated at area hospital.
• Urine and Blood Testing.
• PHCs staff is not aware about Fluorosis ward.

23. District water testing lab.
• Vira Reddy is the head of the department.
• 9 testing lab. District lab is situated in Nalgonda only.
• Field assistant went to the different villages. then he/she asked the
permission for collect the water sample. Then they sent the water
samples to the nearer lab. where chemist and micro biologist did the
tests.
• one water person appointed who marked the water source green and
red. Green indicates water is safe and fluoride free while red mark
suggestes that fluoride content in the water.
• . The role of district level laboratory staff is to maintain the data. state
level lab situated in Hyderabad. The divisional labs were sent their
data to the district level and district level lab sent available data to the
state level then to the national level. Then they posted the data on
government website.

24. Visit at District Water Testing Lab

25. Other partners (back End Support to Mitigation Agenda)
DFMC
(District fluoride
Monitoring
Center)

26. Role of the partner Organization
• UNICEF :-
• Strengthening of DFMC.
• Developing communication Material
• Developing partnerships
• Developing District fluoride mitigation Plan
National institute of nutrition(NIN):-
• Conducting impact assessment study
• Capacity building of lab technicians on water quality testing
• Development of training manual for Frontline workers and
• Capacity Building
MG university:-
• Conducting of action research on the performance of line departments.

27. Opportunities
learning under the supervision of Srinivas Chikuri sir (UNICEF
Consultant)

28. Attended the lecture of Dr. Arjun Khandare sir Scientist of NIN.
Topic: Fluorosis Nutrition Management

29. Visit at Mahatma Gandhi University &
National Institute of Nutrition(NIN)

30. What needs to be for DFMC…
• DFMC did not utilize the fund provided by UNICEF.DFMC should utilize the
available funds in proper manner.
• Government should work properly so dedicated people who joined DFMC who
wants to prevent the disease, wants to bring change in the life of fluorosis Victims
they should be encouraged.
• Next month meeting will be held with Head of the 17 line department.
• Plan to organize meeting with NGO/CSO.
• As a supportive organization M.G University students already got training for
monitoring.
• Students will going to conducting action research on the performance of line
departments.
• They organized a seminar on “ The Role of Higher Education Institutions in
Fluorosis Mitigation” and involved students from Dept. of Social Work and Dept.
of Geology in the survey for NIN.

31. Cont..
• Staff who appointed at DFMC and the point persons at different departments feel
Fluorosis and Fluoride as “ Extra Work”.
• Continues and proper monitoring helps to improve the condition.
• The regular payments, salary should paid to the people(staff) so they can work
more effectively.
• DFMC has changed all the point persons from last month because DFMC was not
satisfied with their work.
• Accountability of each point person should be specifically told.
• Meeting with new point persons will arrange shortly.

32. Suggestions
• Role and specific responsibilities
• Accountability
• Fund
• Training and workshops
• Regular monitoring and Evaluations
• Support from other organization
• Awareness campaigning about government scheme for Fluoride
Victims.

33. Monitoring, Evaluation & follow up
strategies
• Surprise inspection
• Regular monthly meetings
• Regular supervisions
• Training for point person, ANM, Etc.

34. Challenges
• working with Government
• Broad Area
• Ensuring accountability of key persons
• Lack of Awareness about Schemes
• Low Nutrition Level

35. Fluorosis Victim
When all
people will
get Safe
Water…???
Water
Nutrition
Surgery
Awareness

36. The good monitoring & Evaluation of every programs is playing vital role
in the Project.
Thank you