I Background and Justification 3-5 II Specific Objectives 6 III …rltrird.cg.gov.in/pdf/Research projects/WHO project completed... · V Timeline of Activities - Gantt Chart 16-18

Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels

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I Background and Justification 3-5

II Specific Objectives 6

III Method and approaches

7-14

IV Epidemiological Profiles and Human Resources

15

V Timeline of Activities - Gantt Chart 16-18

VI Training Curriculum and schedule

19-21

VII District and Block wise Training Report

22-25

VIII Advocacy meetings 26

IX Monitoring of Activities and Follow-up 28

X LESSONS LEARNT AND CONCLUSIONS 29

xi RECOMMENDATIONS FOR THE NEXT

PHASE OF PROJECT

30

TABLE OF CONTENTS


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APW Agreement for Performance of Work

ANCDR Annual New Case Detection Rate

ASHA Accredited Social Health Activist

ANM Auxillary Nurse Midwife

BMO Block Medical Officer

CHC Community Health Centre

CMO Chief Medical Officer

DPMR Disability Prevention and Medical Rehabilitation

DEO Data Entry Operator

HA (M) Health Assistant (Male)

HA (F) Health Assistant (Female)

HSC Health Sub Centre

ILEP International federation of Anti Leprosy Association

MPW Multi Purpose Worker

NRHM National Rural Health Mission

NLEP National Leprosy Eradication Programme

NGO Non Governmental Organization

PR Prevalence Rate

PHC Primary Health Centre

PAL Patient Affected with Leprosy

RD Regional Director

RLTRI Regional Leprosy Training and Research Institute

SHRC State Health Resource Center

SPO (L) State Programme Officer (Leprosy)

ABBREVATIONS USED


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Despite program activities like intensive monitoring through the District Leprosy

Officers, prevalence has continued to remain high (more than 2) in Raipur and Bilaspur

districts of Chhattisgarh and cases are also detected relatively late as evidenced by the

high level of deformities among cases when first detected. Based on the available

evidence, innovative strategies to enhance awareness of vulnerable people and

strengthen delivery of comprehensive services to leprosy affected people needs to be

developed. Organizations/ Forum of people affected by leprosy can be involved,

consulted and made responsible for this. The guidelines developed during the Manila

conference of people affected by leprosy on the 9th & 10th June 2010

encourages/introduces the participation of persons affected by leprosy in leprosy

services. There are many things that the person affected by leprosy can do in the area of

IEC and enhanced risk communication.

The capacity of the existing system of health care needs to be strengthened through

ongoing and regular trainings in leprosy for peripheral health workers and ASHAs.

Supervisory personnel of organizations & People affected by leprosy would also be

sensitized and trained on supportive supervision and monitoring of programme

implementation at the sub-district level.

Program management functionaries at the state and district level require a level of

experience and expertise in the disease control activities. WHO intends to support the

training program of a select group of program personnel in selected states to develop a

sustainable long term training model to improve technical competence of program staff

in the high endemic areas and retain technical competence of program staff in the low

endemic areas. With depleting expertise, a pool of trainers is needed at different levels

that need regular update.

BACKGROUND AND JUSTIFICATION


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The priority areas like disability prevention and medical rehabilitation (DPMR),

community approaches to disability care and rehabilitation needs emphasis in the

training. Partnership with ILEP and other governmental and non-governmental

agencies need to be established.

In order to represent the central Government in the states and to monitor the progress

of the centrally funded health programs, the Central Ministry of Health and Family

Welfare (MoHFW) has placed officers in all the regions of the country. These officers are

known as Regional Directors. They are mainly concerned with coordinating with the

state Governments and ensuring the progress of the National Rural Health Mission.

These officers could be oriented in leprosy and in the activities of the NLEP. They could

then be the local focal points for the project in the concerned districts of the states

where the project activities was undertaken.

Health workers exclusively for the leprosy programme delivered services when the

programme was vertical. However with the integration of leprosy services into general

health care, leprosy work was delegated to the existing peripheral health workers.

Volunteers known as Accredited Social Health Activists (ASHA) known as MITANIN in

CHHATTISGARH assist the peripheral health workers in delivering health care to the

community in the National Rural Health Mission (NRHM). Though initiatives have been

undertaken to involve ASHAs in the delivery of leprosy services, technical & supportive

supervisory support provided to them to carry out basic leprosy services like

identification and referral of leprosy cases has been sub-optimal. Capacity building,

monitoring and supervision is necessary till they become fully equipped to taken on this

responsibility.

These initiatives are also expected to contribute to reduction in deformity and create

awareness about leprosy and its consequences.


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Regional Leprosy Training and Research Institute (RLTRI), Raipur was established in

1979 with about 80 staff. A 75 beded hospital, OPD and field operation area of 144

villages of Raipur district covering 200,000 (2 Lakhs) populations for monitoring,

technical supervision & research activities on leprosy services were placed under

RLTRI. At present out of 80 posts 19 were vacant and field operation areas were

handed over to state govt. But, leprosy cases are treated at OPD with free MDT services.

The in–patient service regularly admit and treats leprosy patients and a number of

reconstructive surgeries are carried out regularly at institute and camps at district level

within state and neighbouring state for various type of leprosy deformities in the

institute’s hospital. The institute also works as a referral centre for problematic,

complicated and intractable cases. It also works as a nodal training and research centre

particularly programme related research activities in the region for the cause of leprosy

elimination.

This institute also imparts National Level training to State Leprosy Officers

(SLO)/District Leprosy Officers (DLO)/Block Medical Officers (BMO) of state like

Maharashtra, Gujarat, Rajasthan, Haryana, Punjab, Uttar Pradesh, Madhya Pradesh,

Bihar, West Bengal, Assam, Arunachal Pradesh, Andaman and Nicobar Island and

Chhattisgarh

This institute is also working as Regional Directorate of Health & Family Welfare

(ROHFW). It technically supervises and monitors all health programmes from month of

August 2005.


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The immediate objectives of the proposed activity, show the

relevance of these objectives to the programme area(s)/ Work

Plan, and identify the expected outcomes/outputs.

1. Capacity building of health workers in leprosy to suspect,

diagnose, treat, record and report patients as per their

level of expertise.

2. Monitoring and supervisory training for supervisory staff

of general health care at all levels.

3. Programme advocacy at different levels including people

affected by leprosy as potential partner.

4. Review the programme for impact and feedback into the

system.

Orientation training of Self help Group Akaltara, Janjgir champa

The main aim is to build the capacity of different levels of

SPECIFIC OBJECTIVES METHODS AND APPROACHES USED


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health care staff in the high-endemic districts of Chhattisgarh in order to stream line

leprosy case detection, and thereby reduce leprosy burden at sub-national levels. This

can significantly affect the monitoring and supervision of the leprosy programme which

will be strengthened by empowering the supervisory staff. A part from this, advocacy

for the programme will be initiated at all levels by training people affected by leprosy

with potential involvement at all levels.

BRIEF TIMEFRAME OF ACTIVITIES:

1. Identification of training needs of health care staff in leprosy at SC, PHC, CHC and

district level.

2. Preparation of curriculum, training materials and leprosy kits for different levels of

staff (including refresher course).

3. Develop an action plan of participants, resource persons with date and venue.

4. Monitor the training activities for uniformity and quality.

5. Bi-monthly programme review to assess impact at different levels.

TECHNICAL STAFF SUPPORT:

Two districts were supported by one medical officer (MO) who was engaged in all

training related activities. Monthly reports of the activities and the developments in the

project were submitted to the DLO / RLTRI / SLO and WHO. The main job of the MO was

to get the needed support from the DLO / BMO to carry out his routine activities.

Moreover, there were two field workers (one for each district) who assist the medical

officer in data collection, organising trainings, follow-up etc.


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Chhattisgarh Map Showing the leprosy endemicity as per districts (PR <1 and >1 per 10,000 population)

EPIDEMIOLOGICAL PROFILE AND HUMAN RESOURCE IN PROJECT AREAS

The Chhattisgarh state is

endemic for leprosy and

still lags behind the WHO

target of elimination as a

public health problem. This

state with less than 22 % of

country’s population holds

about 6% of new leprosy

case load. Out of 18

districts, 11 are having PR

above 1 per 10,000

populations (Minimum

0.46- maximum 8.44 as on

July 2011)


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a) Epidemiological Aspects (NLEP) of Raigarh District

Particulars

Year

2007-08 2008-09 2009-10 2010-11 2011-12 up to Dec

2012

New cases detected 872 920 921 830 551

Prevalence rate (PR) 4.69 4.86 4.5 3.93 3.61

ANCDR 64 63.7 62.7 55.6 36.9

MB (%) 52.8 63.1 62.5 56.2 52

Female (%) 31.76 36.8 37.7 35.3 38.8

Child (%) 6.3 7.8 5.9 6.8 5.9

Deformity Grade I (%) 4.58 9.5 5.2 7.2 7.9

Deformity Grade. II (%) 2.4 4.8 6 5.9 6.1

No of cases detected by ASHA

NA 2 out of 6 53 out of 90

34 out of NA

NA

The population of the district is 14, 92,013 having 435 villages and 50 health Sub

Centres. The Prevalence rate has dropped from 4.69 per 10,000 populations to 3.93 per

10,000 populations in the year 2010-11. The MB proportion is above 50%. The number

of suspected leprosy cases detected from community by ASHA is still low (<10% of total

suspected). The number of cases reported voluntarily is not available and also not

recorded. The mitanin population ratio is 1: 400 inhabitants.

b)Available Human Resource of District Raigarh

Sr. No. Post Sanction In position Vacant

1 BMO 9 0 9

2 Medical Officer 126 53 73

3 Health Assistant 08 12 0

4 Lab Technician 53 44 9

5 Health Supervisor (M) 36 28 8

6 Health Supervisor (F) 66 44 22

7 Auxillary Nurse Midwifery 370 309 61

8 Multi Purpose Worker 317 213 104

9 Block Program Manager 9 9 0 10 Block Accountant-cum-Data Assistant 9 6 3

11 Data Entry Operator 13 13 0

There is shortage of the MO and grass root (MPW) health workers across the

peripheral health centres.


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c) Epidemiological Aspects (NLEP) of Block – Loing

Sr. No.

Particulars 2007-08 2008-09 2009-10 2010-11

2011-12 up to Dec

2012

1. New cases detected 76 112 130 103 66

2. Prevalence rate (PR) 4.57 7.35 5.77 4.79 4.38

3. ANCDR 61 79.2 90.4 70.5 45.1

4. MB (%) 61.8 74.1 57.6 55.3 51.5

5. Female (%) 34.2 47.3 31.5 28.1 39.3

6. Child (%) 5.2 12.5 6.9 4.8 3

7. Deformity Gr. I (%) 18.4 20.5 4.6 10.6 4.5

8. Deformity Gr. II (%) 5.2 8.9 7.6 6.7 1.5

The population of the block is 1, 46,074. This block is having 147 villages, 37

HSCs and 10 PHCs. The PR ranges from 4.79 to 7.35 and the new cases detected

is more than 100 per year. There are 407 functional ASHAs in the block.

d) Available Human Resource of Block - Loing

Sr. No. Post Sanction In Position Vacant

1. BMO 0 0 0 2. Medical Officer 20 10 10

3. Medical Officer (Ayush)-Contractual 7 7 0

4. Health Assistant 0 2 0

5. Lab Technician 10 3 7

6. Health Supervisor (M) 6 4 2

7. Health Supervisor (F) 6 6 0

8. Auxillary Nurse Midwifery 50 48 2

9. Multi Purpose Worker 37 26 11

10. Block Program Manager 1 1 0

11. Block Accountant-cum-Data Assistant 1 0 1

12. DEO 1 1 0

At the grass root level, 30% of MPW posts were vacant at health sub center.


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e) Epidemiological Aspects (NLEP) of Pussore

Block

Sr. No.

Particulars 2007-08 2008-09 2009-10 2010-11 2011-12

up to Dec. 2012

1. New cases detected 111 104 124 108 68

2. Prevalence rate (PR) 5.39 5.56 5.81 4.97 4.91

3. ANCDR 83.2 77.3 83.1 73.5 46.3

4. MB (%) 39.6 64.4 61.2 42.5 35.2

5. Female (%) 32.4 34.6 41.9 37.9 54

6. Child (%) 5.4 13.4 4 7.4 10.2

7. Deformity Gr.I (%) 7.2 4.8 5.6 2.7 7.3

8. Deformity Gr.II (%) 2.7 2.8 6.4 3.7 4.4

The population of this block is 1, 46,757 and the block is having 148 villages, 28

HSCs and 7 PHCs. The PR ranges from 4.91 to 5.81, and the new cases detected

are more than 100 per year. There are 415 ASHA (mitanins) functional in the

block.

f) Available Human Resource of Block Pussore

Sr No Post Sanction In Position Vacant

1. BMO 1 0 1

2. Medical Officer 21 5 0

3. Medical Officer (Ayush)-Contractual 7 7 0


5. Laboratory Technician 9 9 0

6. Health Supervisor (Male) 7 0 7

7. Health Supervisor (Female) 7 7 0





12. DEO 1 1 0

The regular post of BMO is vacant, and all post of health supervisor (Male) was

vacant both at the PHC and block level. At the grass root level, 40% of MPW posts

were vacant at health sub center.


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g) Epidemiological Aspects (NLEP) of District Janjgir Champa

SN Particulars 2007-

08 2008-

09 2009-

10 2010-

11 2011-

12

1 Annual new case detected 490 797 703 581 496

2 Prevalence Rate(PR) 2.29 4.12 4.65 2.28 1.54

3 Annual new case detection rate(ANCDR)

33.68 53.97 46.85 38.40 32.40

4 MB (%) 47.03 58.97 59.03 56 47.78

5 Female (%) 32.72 31.87 34.71 35.40 37.78

6 Proportion of child 10.43 6.02 6.83 6.80 4.11

7 Deformity Grade. I (%) 4.70 3.51 11.09 4.40 2.32

8 Deformity Grade. II (%) 2.86 4.02 6.4 6.30 4.02

9 No of cases detected through ASHA

13 117 112 125 180

10 No of cases detected through voluntary reporting

244 398 312 281 240

The population of the district is 15, 34,634 having 913 villages and 266 health sub centres and 45 PHCs.

The Prevalence rate has dropped from 4.65 per 10,000 populations to 1.54 per 10,000 populations in the

year 2011-12. The MB proportion is above 50%. The number of suspected leprosy cases detected from

community by ASHA is 36% of the total in the year 2011-12. The number of the cases reported

voluntarily is near about 50% of total detected. There are 3611 ASHA working at the village level in the

district.

h) Available Human Resource of District Janjgir

Champa

Sr. No. Post Sanction In Position Vacant


2. Lab Technician 30 5 25

3. Health Supervisor (M) 54 20 34

4. Health Supervisor (F) 62 41 21



7. Block Program Manager 9 9 0 8. Block Accountant-cum-Data

Assistant 9 7 2

9. Data Entry Operator 13 11 2

The District Nucleus Team (DNT) medical officer post is vacant and almost 50% post of the medical

officers is vacant. At the grass root level, 41% of MPW posts were vacant at health sub centre.


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i) Epidemiological aspects (NLEP) of Pamgarh

Block

SN Particulars 2008-09 2009-10 2010-11 2011-12

up to Dec. 2012

1. New cases detected 46 46 98 72

2. Prevalence rate (PR) 3.1 3 4.35 2.3

3. ANCDR 33 32 60 46

4. MB (%) 55 60 62 60

5. Female (%) 30 32 30 29

6. Child (%) 12 4.2 6 8

7. Deformity Gr.I (%) 0 0 5 2.2

8. Deformity Gr.II (%) 8 4.2 6 5.6

9. No of cases detected through ASHA

- 8 12 21

10. No of cases detected through voluntary reporting

46 38 86 51

The population of the block is 1, 56,530. The PR ranges from 4.35 to 2.3 per 10,000 population in 2011-

12, and the new cases detected is more than 72 in the same time period. There are 415 ASHA (mitanins)

functional in the block.

j) Available Human Resource of Block Pamgarh

Sr No

Post Sanction In Position Vacant

1. Block Medical Officer 1 1 0










11. Data Entry Operator 1 1 0

More than 50% of the posts of medical officer were lying vacant. At the grass root level, 46% of MPW

posts were vacant at health subcenter. There are 400 ASHAs delivering services in the block.


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k) Epidemiological Aspects (NLEP) of Akaltara Block

SN Particulars 2008-09 2009-10 2010-11 2011-12

up to Dec. 2012

1. New cases detected 90 80 98 72

2. Prevalence rate (PR) 4.0 3.02 4.19 2.2

3. ANCDR 50 48 60 45

4. MB (%) 60 50 60 60

5. Female (%) 28 30 35.2 20

6. Child (%) 13 25 6 5.2

7. Deformity Gr. I (%) 6 - 4 1.3

8. Deformity Gr. II (%) 5 5 5 2.6

9. No of cases detected through ASHA NIL 8 12 22

10. No of cases detected through voluntary reporting

90 72 86 50

The population of the block is 1, 60,220. Block constitutes 148 villages, 28 HSCs and 7 PHCs. The PR

ranged from 4.91 to 2.2 per 10,000 population and new cases detected more than 72-98 per year. The

413 ASHA (Mitanin) is functional in the block.

l) Available Human Resource of Block Akaltara

Sr No Post Sanction In Position Vacant

1. Block Medical Officer 1 1 0








9. Block Program Manager 1 1 0 10. Block Accountant-cum-Data Assistant 5 5 0

11. DEO 1 0 1

50% of medical officer posts at primary health centres were lying vacant. At the grass root level, 33% of

MPW posts were vacant at health sub center.


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Sr No Activities

01/10/2011 to

14/10/2011

15/10/2011 to

04/11/2011

05/11/2011 to

17/11/2011

18/11/2011 to

30/11/2011

01/12/2011 to

06/12/201

A) Pre training Activities

1 Staff Recruitment

2 Data collection from district and village

3 Selection of training places and dates

4 Pre training Visit of the staff

5 Preparation and printing of the training module of Supervisory staff and ASHA

B) Training Raigarh and Janjgir Champa district Blocks

7 Raigarh -Pussore block- supervisory staff Training

8 Raigarh -Pussore block- ASHA/PAL Training- 4 batches

9 Raigarh-Loing block- Supervisory Staff Training

10 Raigarh -Loing block- ASHA/PAL Training- 4 batches

11 Jangir- Akaltara block- supervisory staff Training

12 Jangir- Akaltara block- ASHA/PAL Training- 4 batches

13 Jangir- Pamgarh block- supervisory staff Training

14 Jangir- Pamgarh block- ASHA/PAL Training- 4 batches

TIME LINE OF ACTIVITIES - GANTT CHART


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The training manuals were prepared and designed for the ASHA, ANM, MPW and Health

Supervisors. The experts from the RLTRI and the State were involved in the preparation

of the training modules.

A) ASHA Module: The manual includes the causes of leprosy, signs and symptoms to

suspect leprosy; the common disabilities and deformities in leprosy and how they can

be prevented by promoting early diagnosis and treatment. It also includes how to

encourage person affected by leprosy (PAL) to take the medicine regularly and

complete the course of MDT. The pictures were added for the better understanding of

the patches. ASHAs are the main persons to disseminate correct information about

leprosy to person affected with leprosy and their families, and to the community in

which they live and work. They will visit the leprosy affected persons, their family

members and invite community members for a meeting and tell them about disease.

The role of ASHA workers in the NLEP at village level is also elaborated in the manual. It

also mentions the incentives applicable/paid to ASHA under the National Leprosy

Eradication Programme. At the end of session, open time was given for question and

answers and for clarifications, if any.

ASHA (mitanin) NLEP training module

TRAINING MANUAL – DESIGNING


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Supervisory Module: The cardinal signs & symptoms, differential diagnosis of leprosy,

classification of disease, treatment of leprosy (including MDT regime), and recording

and reporting of NLEP were included. Common disability and deformities leprosy -

its prevention and management by encouraging the patient for early reporting and

complete treatment. The emphasis is on IEC activities and counselling of patients

affected with leprosy. The slogans from the school group meeting and the village health

and sanitation committee were also integrated in the curriculum.

DPMR activities and formats at the primary level were also added. The roles and

responsibilities of the health workers in the integrated set-up were included in the

manual. At the end of session, open time was given for question & answer, and

clarifications, if any.

Supervisory NLEP training module with DPMR


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Flash Cards: Flash cards were prepared and distributed to the ASHAs as well as

supervisory workers during the training.

Flash cards for ASHA and health workers


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Table I: Allotment of project area (blocks) to project staff

Sr no Name of district Selected block Name of

Supervisor

Name of

Medical Officer

1 Janjgir Champa Akaltara Shri G.N. Rathore

Dr. A.K. Mishra Pamgarh

2 Raigarh Pussore Shri M.K. Ansari

Loing

Table II: Number of faculties involved in the trainings for supervisory staff

District Block No of Batches

Medical officer

Raigarh Pussore 1 4

Loing 1 4

Janjgir

Champa

Akaltara 1 4

Pamgarh 1 4

Total 4 16

Table III: Number of supervisory staff attended training

District Block No. of Batches

No. of Supervisory staff

Raigarh Pussore 1 60

Loing 1 60

Janjgir

Champa

Akaltara 1 60

Pamgarh 1 60

Total 4 240

DISTRICT AND BLOCK WISE REPORT OF THE TRAINING FOR MITAININS AND GENERAL HEALTH CARE STAFF


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Report of supervisory staff training in Raigarh:

1) Block- Pussore

Dates: 05.11.2011

Venue: Community Hall, Pussore

60 ANMs and 10 Supervisors attended. The training programme was conducted by-

1. Dr. R. N. Sabat, Director, RLTRI, Raipur

2. Dr. V. Deodia, DLO, Raigarh

3. Dr. A. K. Mishra, MO, WHO Project

4. Dr. M. K. Patel, BMO, Pussore block

Training of supervisory staff Supervisory staff training

2) Block- Loing

Dates: 26.11.2011

Venue: CHC, Loing

60 ANM and 10 supervisors attended. The training programme was conducted by-

1. Dr. R. N. Sabat, Director, RLTRI, Raipur

2. Dr. V. Deodia, DLO, Raigarh


4. Dr. G.S Paikra BMO, Loing

Report of supervisory staff training in Janjgir-Champa:

3) Block- Akaltara

Dates: 18.11.2011

Venue: CHC Akaltara


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60 ANM and 10 supervisors attended. The training programme was conducted by

1. Dr S.L Gupta, SHRC, Raipur

2. Dr M.K Soni, RLTRI, Raipur


4. Dr C.P Singh, BMO Akaltara

4) Block- Pamgarh

Dates: 1 12.2011

Venue: Community Hall, Pamgarh

60 ANM and 10 supervisors attended. The training programme was conducted by

1. Dr Ravi Rao, RLTRI,Raipur

2. Dr M.K .Soni, RLTRI,Raipur

3. Dr. S.L Gupta,SHRC

4. Dr K K .Dahire, BMO,Pamgarh

Training of supervisory staff Supervisory staff training

A total of 240 supervisory staffs were trained in leprosy in four batches in the identified

four blocks of two high endemic districts in Chhattisgarh. Both theoretical as well as

practical aspects including DPMR activities in brief were covered during the one day

training. The block medical officers (BMO), RLTRI and SHRC faculty and people affected

by leprosy were involved during training. There is significant improvement in the

knowledge and skills before and after training in the selected general health care staff

and ASHA (Mitanin) workers. The Training Kits were distributed among all the

supervisory staff during training session.


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Table IV showing number of ASHA (Mitanin) trained in Raigarh and Janjgir

Champa districts

District Block No of Batches No of ASHA and PAL

Raigarh Pussore 4 198

Loing 4 202

Janjgir

Champa

Akaltara 4 195

Pamgarh 4 205

Grand Total 16 800

District: Raigarh

1) Block- Pussore

Dates: 08.11.2011 and 09.11.2011

Venue: Community Hall, Pussor

2) Block- Loing

Dates: 29.11.11 and 30.11.2011

Venue: CHC, Loing

ASHA (mitanin) training SLO addressing ASHA (mitanin)

District: Janjgir Champa

3) Block- Akaltara

Dates: 16.11.2011 and 17.11.2011

Venue: Satnam Bhavan, Akaltara


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4) Block- Pamgarh

Dates: 02.12.2011 and 03.12.2011

Venue: Community Hall, Pamgarh

ASHA (mitanin) training ASHA (mitanin) training

A total of 800 ASHA (Mitanins) workers were trained in leprosy in 16 batches in the

select four blocks of Raigarh and Janjgir-Champa districts. Both theory as well as

practical was covered during the training session. The medical officers, BMO and

supervisors of RLTRI, Raipur / State govt. / SHRC, Raipur were involved in the trainings.

There is significant improvement in the knowledge and skills before and after training

in the selected ASHA (Mitanins) workers. The training kits were distributed among the

all mitanins during training sessions.


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Raigarh: The advocacy meeting took place in district Raigarh on 16/11/2011 as part of

the WHO Project. The purpose of the meeting was to sensitize the district level leaders

on the needs in the field of leprosy and to take recommendations from the local leprosy

experts for the betterment of leprosy programme in the selected district with political

goodwill. The meeting was held at telemedicine room of Kirodimal Government district

hospital, Raigarh under the chairmanship of Director of Regional Leprosy Training and

Research Institute, Raipur.

The Chief Medical & Health Officer (CMHO) of Raigarh was the chief guest of the

meeting. It was attended by Civil Surgeon, District Leprosy Officer, District Health

Officer, Block Medical Officers of Loing & Pussore block, Assistant Director of Education

Department, Doctors from Railway & Police department, members of the Red cross

society, Gayatri parivar, Mitanin Supervisors, local media, State Forum of people

affected by leprosy (PAL). The project medical officer welcomes all the invitees and

narrated the purpose of the meeting. He also presented the epidemiological situation of

the Raigarh district. The DLO spoke on present and future plans to be taken in the

district to reduce leprosy burden in the district.

Advocacy meeting at Raigarh Health officers, Political leader and Media persons etc at advocacy meeting at Raigarh

ADVOCACY MEETINGS


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Dr. Ramanath Sabat, Director, RLTRI emphasized on concerted efforts by all

individuals present irrespective of organisations in the elimination and eradication of

leprosy.

He requested everybody to spread the key leprosy messages that they have

heard so that the disease can be detected early and completely cured. All members

present in the meeting agreed to be involved in the programme for creating awareness

in their area of work and give priority to the programme. They have also decided to

support the special activities like RCS camp, special campaign, door to door survey etc.

at all possible levels.

There was an open time to discuss various issues affecting the leprosy

programme. Involvement of the local media to create awareness through printed media

was also discussed and its sustainability was ensured. Many recommendations made by

different people were noted down. The same will be submitted to the local district

authorities for further consideration. Advocacy for the programme will be initiated at all

levels by empowering people affected by leprosy (PAL) with potential involvement at all

levels. Significant advocacy tasks still remain at the district level. The continued

involvement of district/block and village level administrators, and implementer’s

remains crucial which will have considerable impact on the achievement of program

goals.


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Janjgir Champa District: The Advocacy Meeting took place at Akaltara, Janjgir district

on the 3rd December, 2012 as a part of the WHO Project. The purpose of the meeting

was to sensitize the district level leaders on the needs in the field of leprosy and to take

recommendations from the local leprosy experts for the betterment of leprosy

programme in the selected district with political goodwill. The meeting was held at

meeting hall of Shreeji Hotel under the chairmanship of the Director of Regional

Leprosy Training and Research Institute, Raipur.

Dr. Bhatpahare, State Leprosy Officer (SLO) of Chhattisgarh was the chief guest of the

meeting. The Chief Medical and Health Officer (CMHO) of Janjgir district was the key

speaker. It was attended by DLO, leprosy consultant from state health resource centre

(SHRC), Raipur, BMOs of Akaltara & Pamgarh blocks, Child Development Project Officer

(CDPO) members from the local Municipality, Gayatri parivar, Mitanin supervisors, local

media, leaders from the forum of persons affected by leprosy (PAL). The Consultant

from SHRC, Raipur welcomed all the invitees and narrated the purpose of the meeting.

He also presented the epidemiological situation of the Janjgir district. The DLO spoke on

present and future plans to be taken in the district to reduce the leprosy burden in the

district.

Dr. Ramanath Sabat, Director, RLTRI emphasized on concerted efforts by all

individuals present irrespective of organisations in the elimination and eradication of

leprosy. He requested everybody to spread the key leprosy messages that they have

heard so that the disease can be detected early and completely cured. Dr. Bhatpahare,

State Leprosy Officer described the epidemiological situation of Chhattisgarh state and

the steps he has taken towards it. The CMO is committed to implement the programme

successfully by taking necessary help/involving persons from all organizations.


Page 27

All members present in the meeting agreed to be involved in the programme for creating awareness in their jurisdiction and give priority to the programme.

Advocacy meeting at Janjgir Champa Health officers, Political leader and Media persons etc at advocacy meeting at Janjgir Champa

They have also decided to support the special activities like RCS camp, special

campaign, door to door survey etc at all possible levels.

There was an open time to discuss various issues affecting the leprosy programme.

Involvement of the local media to create awareness through printed media was also

discussed and its sustainability was ensured. Many recommendations were made by

different people were noted down. The same will be submitted to the local district

authorities for further consideration.

Advocacy for the programme will be initiated at all levels by training people affected by

leprosy(PAL) with potential involvement at all levels. Significant advocacy tasks still

remain at the district level. The continued involvement of district/block and village

level administrators and implementers remains crucial which will have considerable

impact on the achievement of the program goals.


Page 28

PROPOSED ACTIVITIES AFTER TRAINING

(a) The methods of evaluation intended to be used to assess its effectiveness.

(b) The methods of evaluation intended to be used in order to assess the long-term

impact of the activity.

(c) The follow-up actions that are intended to be taken and their time-frame.

(d) The time-frame for the preparation and submission of the Report.

Follow up activities

Periodic field visit by the assigned medical officer of the district to monitor leprosy

work among various categories of health care staff

Regular feedback from staff in sector meetings

FGD/individual interview of trained staff / patients / community members

Discussion with the GHC staff of peripheral health facilities

District data showing number of new leprosy cases with deformities reported

through voluntary reporting and through trained ASHAs

Assess knowledge, attitude and practice (KAP) in leprosy among community

members

MONITORING, EVALUATION AND FOLLOW UP


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1. Since the duration of this project was four months, there was limited time to

study the impact of the training given to the general health care staff and

ASHAs (mitanin). It is also too early to observe any significant change in the

general health care staff and field workers in suspecting and referring

patients early. It is suggested to review the impact of the programme in the

next phase after a period of 1 year.

2. It was learnt that the size of the batch (60 participants) was too large to

manage, and to give effective attention to individual trainees. It is suggested

that the group size should be about 25 to 30 participants in one batch.

3. In a block there are about 400 to 500 ASHAs (mitanin). It is suggested that all

ASHA (either functional or non-functional) in the block should be trained.

Screening of ASHA to reduce the number to be trained was found to be

difficult.

4. The Village Health & Sanitation Committee (VHSC) members and Panchayati

Raj Institutions (PRI) members can also be involved in the training for

sensitisation and programme advocacy at the village level.

5. Had logistics difficulties transportation transporting ASHA training kits from

RLTRI to the training venue of selected district and blocks as there was no

provision for transportation in the project budget.

6. Involvement of key stakeholders like State Health Resource Centre (SHRC),

State programme authorities, district level officials and block level officers in

the trainings would have had better impact in terms of ownership, follow up,

sharing of resources and would have avoided duplication of resources and

activities.

7. Strategies and activities to promote programme advocacy need to be in place

in order to maintain high visibility of NLEP Programme amongst the policy

makers and other stakeholders, opinion of leaders and the community at

large to support the efforts for improving case detection and treatment

completion, combating stigma and discrimination and empowering people

affected by leprosy.

LESSONS LEARNT AND CONCLUSIONS


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1. Periodic field visits to follow up, monitor and supervise leprosy work among

various categories of health care staff

2. Regular feedback from staff in sector meetings in the selected block to assess

the impact of the training.

3. Efforts to integrate ‘intensified case detection activities’ at different levels of

NLEP, particularly in high endemic /high focus districts.

4. Conduct Focus Group Discussion (FGD)/individual interview of trained staff /

patients / community members to assess the impact of the NLEP activities in

the selected area of the districts

5. Assess knowledge, attitude and practice (KAP) in leprosy among community

members.

6. Analyse data related to the new leprosy cases through voluntary reporting

and the new cases with deformities.

7. Analyse performance of ASHA in referring the suspect leprosy case at an

early stage to the nearest health facility.

8. Efforts to be taken for implementation of suggestions and recommendations

received during the advocacy meeting.

RECOMMENDATIONS FOR THE NEXT PHASE OF PROJECT

Documents

I Background and Justification 3-5 II Specific Objectives 6 III …rltrird.cg.gov.in/pdf/Research projects/WHO project completed... · V Timeline of Activities - Gantt Chart 16-18