Fluoride and Fluorosis Mitigation Programme: Blue Print

Location: Village/habitation in an endemic block / district


  • To provide safe drinking water
  • To prevent and control Fluorosis
  • To improve health

Stages to follow for Implementation for a project

(State I)
Arrow Survey
(Stage II)

(Stage III)


STAGE I: Human Resource Development (HRD)

What does it involve?

  • Human resource development/capacity building
  • Objectives - to impart knowledge; to develop skills; to bring about attitudinal changes.

Who should be trained?

  • Doctors/health professionals posted in the location in health delivery outlets
  1. Primary Health Centers (PHCs)
  2. Community Health Centers (CHCs)
  3. District Hospital
  4. Others, if any
  • Public Health Engineers / Personnel of water supply department
  • School teachers
  • Para medical workers
  • NGOs, if any
  • Social workers / any other

Who will impart training?

  • Responsibility of FR and RDF, through the best talents available in the country.
  • Shall induct local talents, if available

Duration of training?

  • Duration depends upon the number of trainees
  • Minimum of 3 days to a maximum of 4-5 days (depends upon the blocks/villages to be covered.



What does it involve?

  • The trained man power will undertake 3 different surveys to obtain baseline information. All requisite material for survey i.e Precoded forms, water collection of bottels, technical handouts, flip-charts to be procured and made available to the trainees on the last day of training.


Type I: School Dental Fluorosis survey & water sample for testing (to be carried out by trained school teachers only)


  • To identify endemic locations
  • To record dental fluorosis prevalence in school children.
    1. Middle and secondary schools to be listed. (not primary schools)
    2. Children above 8 years of age to be surveyed.
    3. School dental fluorosis survey information to be recorded in specially designed proforma.

Type II: House to house survey to record ill-health complaints


  • To assess the magnitude of the health problems.
  • To identify those having early warning signs of fluoride poisoning,
    1. Health survey of every member of the families, living in the identified villages are carried out by the para medicals / NGOs /social workers under the supervision of the health professionals in pre-coded proforma.

Type III: Water quality survey


  • To assess the drinking water contamination with fluoride in all sources in a village
  • To identify safe and fluoride contaminated sources
    1. Every drinking water source, Government or privately owned are tested for water quality focusing only on fluoride
    2. A map is prepared for every village


Review Meeting: The data emerged from Stage II are reviewed by Water Supply Agencies, Funding Agencies, FR & RDF and any other agency involved; and implementation strategy(ies) is/are planned.

Survey Data Analysis:

  • Dental Fluorosis survey data for schools reveal:
    1. Children enrolled = 500; children examined = 400.
    2. Children with dental fluorosis = 175
    3. % Dental fluorosis prevalence = 43%
    4. Children came from 3 villages including the village where the school is located.
    5. All the 3 villages are enddemic as children have Dental Fluorosis
  • House to house survey data reveals
    1. Total households in the village = 12
    2. Total population = 96
    3. Number of people suffering from dental fluorosis = 66
    4. Number of people suffering from skeletal fluorosis = 27
    5. Number of people suffering from non-skeletal fluorosis = 80
    6. Total disease prevalence = 173
  • Water quality analysis data on fluoride reveals
    1. Hand pumps = 3
    2. Open well = 1
    3. Total = 4 sources
  • Fluoride content of drinking water sources
    1. Hand pump a = 6.8 ppm
    2. Hand pump b = 12 ppm
    3. Hand pump c = 4 ppm
    4. Open well = 0.7 p

Review of information /data collected suggests:

  • 43% of school children have dental fluorosis i.e. very high
  • Health survey indicate
    1. 80% of the population suffer from non-skeletal fluorosis
    2. 66% from dental fluorosis
    3. 27% from skeletal fluorosis
  • Water quality testing of 4 sources for fluoride indicate that all hand pumps were contaminated with fluoride.
  • Open well near the school is a safe source.
  • Therefore, 1 safe source; 3 contaminated sources.

Decisions to be arrived at in consultation with the community

  • Can the water available in the open well be used for providing 10 liter / capita for cooking and drinking purposes?
  • Or community prefers domestic filters using activated Alumina? / bucket treatment (Nalgonda)
  • Cost sharing need to be considered
  • Village facility for regeneration of activated alumina of the filter to be set up.
  • An individual, educated, unemployed youth to be trained for regeneration; payment of honorarium to the youth to be decided by the village committee.
  • Operation and maintenance would be the community responsibility and should be managed through village committee.


STAGE III: Practise of Intervention

Interventions to be practised are:

  • Provision of safe water on a sustainable basis
  • Nutritional counselling
  • FR & RDF / any other to provide a one day workshop Nutritional counselling prior to the grass root level functionaries entering the field.
  • Special counselling material needs to be provided.

Monitoring impact assessment

  • First impact assessment to be conducted on 15th day or thereabouts to find relief felt by the community.
  • Second and third impact assessments: 3 months and 6 months later, then the victim would have relieved from almost 90% from the complaints.


APPENDIX 1: Material required for 3 types of Survey (Stage II activities)

Dental Fluorosis survey

  • School dental fluorosis survey: pre-coded format to be printed in sufficient quantity to hand over to school teachers at the end of the training (HRD - Stage I), so that they start survey the very next day.
  • One pre-coded proforma (1 leaf) is enough to record information of 10 children. There shall be (1) Class summary (2) School summary & (3) Block summary.
  • Depending upon the number of children - 8 years and above and the number of schools to be surveyed, forms need to be printed.

House to house survey

  • Pre-coded family survey forms (2 leaves) to be printed and adequate quantity is made available for distribution to para medical workers and others on the last day of HRD - Stage I.
  • One proforma has the provision for recording information of one family only (with 8 members) and summary of health complains will also be recorded.
  • Total population of the block or district divided by 8, the number of forms to be printed.

Water quality survey

  • 100 ml capacity plastic bottles for water sample collection ought to be procured.
  • Johnson adhesive tape to be fixed on it - 3" x 3 " for writing the details of the source with a pencil.
  • Quantity - approximate number to be assumed. The bottles can be reused.
  • The code number on the water bottle label should be the same on the Health Survey forms.

CONTACT FOR ASSISTANCE: Dr. A.K. Susheela - [email protected]