fli6«o Ifo/f]u sfo{qmdnepalntp.gov.np/wp-content/uploads/2018/06/TB_SR...2018/08/06 · PBC :...

$Page 1: fli6«o Ifo/f]u sfo{qmdnepalntp.gov.np/wp-content/uploads/2018/06/TB_SR...2018/08/06 · PBC : Pulmonary Bacteriogically Confirmed PCD : Pulmonary Clinically Diagnosed PPM : Public$
/fli6«o Ifo/f]u sfo{qmd

Sub Recipient (SR) cyf{t ;fem]bf/ ;+:yf

sfo{qm|d ;+rfng lgb]{lzsf

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g]kfn ;/sf/

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List of Abbreviation

ANC : Antenatal Care

CMAM : Community Based Management of Acute Malnutrition

DR : Drug Resistant

DM : Diabetes Mallitus

EP : Extra Pulmonary

FAST : Finding, Actively, Separating, and Treating

IDP : Internally Displaced Population

IMCI : Integrated Management of Childhood Illness

IPT : Isoniazide Preventaive Therapy

IMAM : Integrated Management of Acute Malnutrition

IEC : Information, Education Communication

LFA : Local Fund Agent

MCH : Maternal and Child Health

MAM : Moderate Acute Malnutrition

MTB : Mycobacterium Tuberculosis

MOU : Memorandum of Understanding

NRH : Nutrition Rehabilitation Home

NTP : National Tuberculosis Program

OTC : Outpatient Therapeautic Centre

OPD : Outpatient Department

PR : Principal Recipient

PBC : Pulmonary Bacteriogically Confirmed

PCD : Pulmonary Clinically Diagnosed

PPM : Public Private Mix

SAM : Severe Acute Malnutrition

SOP : Standard Operating Procedure

SR : Sub Recipient

RRMTB : Rifampicin Resistant Mycobacterium Tuberculosis

ljifo - ;'lr

sfo{qmd ;+rfngsf nflu Sub Recipient (SR), k|b]z/If]q, lhNnf :jf:Yo÷hg :jf:Yo sfof{no, :yfgLo lgsfo Pj+ cGo

;/f]sf/jfnf lgsfox?n] kfngf ul/lbg' kg]{]{ j'bfx? M .......................................................................................... 1

lhNnfx?sf] Hard to Reach Area df dfO{s|f];sf]lk ;]jf gePsf :jf:Yo ;+:yfaf6 dfO{s|f];sf]lk ;]G6/df Sputum

transportation ;]jf :yfkgf u/L Ifo/f]u lgbfg ........................................................................................... 3

;a} PBC / !% jif{ eGbf d'lgsf aRrf la/fdLx?sf] 3/kl/jf/sf ;b:ox?nfO{ clgjfo{ Ifo/f]usf] l:s[lgª (Contact

Tracing) ug]{ ...................................................................................................................................... 6

;Defljt Drug Resistant (DR) Ifo/f]u lj/fdLsf] lhg PS;k6{df vsf/ kl/If0f ................................................. 9

Drug Resistant (DR) Ifo/f]u lj/fdLsf] 3/kl/jf/sf ;b:ox?sf] ;Dks{ kl/If0f (Contact Tracing) .................. 10

:jf:Yo ;+:yfdf afnaflnsfdf Ifo/f]u klxrfgsf nflu l:qmlg+u sfo{qmd .............................................................. 12

c:ktfndf s'kf]lift tyf s8f :jf;–k|:jf; ;+s|d0f ePsf afnaflnsfx?df Ifo/f]u klxrfgsf nflu l:qmlg+u sfo{qmd ....... 14

Isoniazid Preventive Therapy (IPT) sfo{qmdsf] ;'?jft tyf lg/Gt/tf.................................................... 16

c:ktfnx?df Ifo/f]u ;+s|d0f /f]syfd tyf lgbfgsf] nflu FAST /0flglt cjnDag ............................................... 17

Ifo/f]usf la/fdLx?df Diabetes Mellitus (DM) sf] l:s[lgª / DM ePsf x?df Ifo/f]usf] l:s[lgª ug]{ cled'lvs/0f

tyf /]km/n ......................................................................................................................................... 19

df};dL sfdbf/ k|jf;Lx?df (Seasonal Labor Migrants) Ifo/f]usf] l:s[lgª ................................................... 21

hf]lvdo'Qm ;d'x (Refugee camps, slum areas, Internally Displaced People (IDP) & others) df Ifo/f]usf]

l:s[lgª .............................................................................................................................................. 22

:jf:YosdL{x?nfO{ ANC / IMCI df cfPsf ue{jtL dlxnfx?sf] Ifo/f]u l:s[lgª af/] cled'lvs/0f...........................25

Ifo/f]u lgbfg, pkrf/ tyf s]; gf]l6lkms]zgdf lghL :jf:Yo ;+:yfnfO{ d'n k|jfxLs/0fdf Nofpg] (Pay for Perfornace to

Private Doctors) ............................................................................................................................ 26

dfOqmf]:sf]kL s]Gb|x?df k'j{fwf/ ljsf;sf] nflu ;xof]u sfo{qmd .......................................................................... 27

ljBfnox?df ljBfyL{x?sf] nfuL Ifo/f]usf] cled'lvs/0f ................................................................................. 28

lghL :jf:Yo ;]jf k|bfosx?;Fu /fli6«o Ifo/f]u sfo{qmd ;DaGwL hfgsf/Ld"ns cGt/lqmof sfo{qmd ............................. 28

sf/fuf/df sfd ug]{ :jf:YosdL{x?sf] nflu Ifo/f]u ;DalGw b'O{ lbg] tflnd ........................................................... 29

sf/fuf/df sfo{/t gfOs] tyf efO{ gfOs] x?nfO{ Ifo/f]u ;DaGwL Ps lbg] cled'lvs/0f ............................................ 30

:yflgo lgsfosf ;Dks{ Joltm tyf k|ltlgwLx?nfO{ Ifo/f]u sfo{s|d ;DjGwL tflnd -cled'lvs/0f_ .............................. 30

sf/fuf/df Ifo/f]uLsf] nflu /0fgLlt tyf tflndsf] kf7\oqmd lgdf{0f ;DaGwL uf]li7 ................................................... 31

:jo+;]jsx?nfO{ d'Vo /0fgLlts sfo{of]hgf ;DalGw Ps lbg] tflnd ..................................................................... 32

Active Case Finding sf nflu If]q, lhNnf, SDPs x?df sfo{qmd ;+rfng sf nflu cg'udg / ;'kl/j]If0f ............ 33

Nepal Chemist and Drug Association (NCDA) ;+u Ifo/f]u sfo{s|d ;DjlGw uf]i7L . ............................... 35

cg';'rLx? .......................................................................................................................................... 36

cg';'rL !: Sputum transportation sfo{df ;+nUg :jf:Yo ;+:yfx?sf] ljj/0f matrix ....................................... 36

cg';'rL @: TB screening questionnaire ............................................................................................ 37

cg';'rL #: sfo{qmd ;xhstf{sf] lhDd]jf/Lx? -s'kf]lift afnaflnsf_ ................................................................... 38

cg';'rL $: sfo{qmd ;xhstf{sf] lhDd]jf/Lx? -FAST strategy_ .................................................................... 39

cg';'rL %: dfOqmf]:sf]lk s]Gb|sf] nflu Assessment checklist ..................................................................... 40

cg';'rL ^: Fast Stratergy Framework .............................................................................................. 41

cg';'rL &: /]sl8{ª tyf l/kf]l6{ª kmf/fd ...................................................................................................... 42


1

sfo{qmd ;+rfngsf nflu Sub Recipient (SR), k|b]z/If]q, lhNnf :jf:Yo÷hg :jf:Yo

sfof{no, :yfgLo lgsfo Pj+ cGo ;/f]sf/jfnf lgsfox?n] kfngf ul/lbg' kg]{]{ j'bfx? M

g]kfn ;/sf/, /fli6«o Ifo/f]u sfo{qmdsf] k+Gr jlif{o /0flglt -@)!^ b]lv @)@!_ ;Dddf tf]lsPsf nIo

k|flKtsf nflu g]kfn ;/sf/, Unf]an km08 / ;]e b lrN8«]g O{G6/g]zgn ljr lqklIfo ;Demf}tfsf] cfwf/df

SR (Sub Recepient) cyf{t ;fem]bf/ ;+:yf dfkm{t ljleGg lhNnf tyf :yfgLo lgsfodf ljleGg

sfo{qmd÷ls|ofsnfkx? sfof{Gjog ug{ nfluPsf] 5 . lo sfo{qmd÷ls|ofsnfkx? ;kmntfk'j{s sfof{Gjog

u/L tf]lsPsf nIo k|fKt ug{ k|b]z/If]q, ;fljssf lhNnf :jf:Yo÷hg:jf:Yo sfof{no tyf :yfgLo lgsfo

nufot ;Dk'0f{ ;/f]sf/jfnf plQs} lhDd]jf/ ePsfn] o;sf] sfof{Gjog Pj+ cg'udg k|s[ofdf ;a} lgsfon]

cf–cfkm\g]f e"ldsf Pj+ lhDd]jf/L jxg u/L sfo{qmd ;+rfng ug{'÷u/fpg' x'g cg'/f]w 5.

SR n] sfo{qmd ;DaGwL vr{ ug{ u/fpbf :jLs[t ah]6 leq /lx, g]kfn ;/sf/sf] b}lgs e|d0f vr{

lgodfjnL @)^$ -;+zf]wg @)&@_, Pj+ cy{ dGqfnosf] sfo{ ;Grfng lgb]{lzsf @)&# cg';f/ sfo{qmd;Fu

;DjlGwt b}=e| eQf Pj+ cGo eQf pknJw u/fpg' kg]{ 5 .

SR dfkm{t lhNnfdf ;+rfng ePsf sfo{qmdsf] cg'udg tyf d'Nof+sgsf nflu /fli6«o Ifo/f]u s]Gb| cGo

sfo{qmd;Fu ;DjlGwt ;/f]sf/jfnf ;/sf/L lgsfo, ;]e b lrN8«]g, Unf]jn km08 / Local Fund Agent

(LFA) af6 tf]lsPsf JolQmn] sfo{qmdsf] k|efjsfl/tfsf ;DjGwdf cg'udg tyf d'Nof+sg ug{ ;Sg]5g\ .

SR n] k|b]z ;/sf/, ;fljssf If]lqo :jf:Yo lgb]{zgfno / lhNnf :jf:Yo÷hg :jf:Yo sfof{no ;Fusf]

;dGjodf, / :yflgo lgsfosf] + ;xsfo{df sfo{qmd ;+rfngsf] of]hgf / sfo{ tflnsf lgdf{0f ul/ sfof{Gjog

ug'{ kg]{5 .

SR n] :jf:Yo ;+:yfdf ;+rfng÷sfof{Gjog ug]{ ;Dk'0f{ ls|ofsnfksf nflu cfjZos hfgsf/L, k|s[of, /]sl8{ª

l/kf]{l6ª nufotsf ljifodf Ps lbg] cled'lvs/0f ;DalGwt :jf:Yo ;+:yfsf sfo{qmd ;+rfngdf lhDd]jf/

sd{rf/Lx?nfO{ ;xeflu u/fO{ ug{' kg]{5 . -gf]6 M ;xefuLtfsf] nflu cl3Nnf] k6ssf] cled'lvs/0fdf ;xefuL

ePsf sd{rf/Lx? afx]s nfO{ ;dfj]z ug'{kb{5 ._

SR n] lhNnf÷:yfgLo tx cGt{ut /x]sf :jf:Yo ;+:yfdf sfo{qmd;Fu ;DjlGwt ljifodf kqfrf/ ubf{

lhNnf:jf:Yo÷hg :jf:Yo sfof{nosf] ;dGjodf :yflgo lgsfo dfkm{t ug{' kg]{5 .

sfo{qmd ;+rfngsf nflu cfjZos ;fdflu| Pj+ /]sl8{ª l/kf]{l6ª ;DjlGw kmd{, km/d]6 lhNnf :jf:Yo÷hg

:jf:Yo sfof{no tyf :yfgLo lgsfosf] ;dGjodf ;DjlGwt :jf:Yo ;+:yfdf SR n] pknJw u/fpg'kg]{5 /

o:tf ;fduL| tyf cfaZos sfuhftx? :yfgLo :jf:Yo ;+:yfdf ;dod} pknAw u/fpg] Joj:yfkgdf

;DalGwt lhNnf :jf:Yo÷hg :jf:Yo sfof{no tyf :yfgLo lgsfon] ;xof]usf] cfjZos Joj:yf ldnfO{

lbg'kg]{5 . ;fy} sfo{qmdsf] Ps slk :jf:Yo ;+:yfdf /fVg'kb{5 .

;DjlGwt :jf:Yo ;+:yf Pj+ dfOs|f];sf]lks ;]G6/n] sfo{qmd;Fu ;DjlGwt /]sl8{ª l/kf]{l6ªsf nflu pknJw

u/fOPsf] kmd{, km/d]6 cg';f/ ug]{ Joj:yf lhNnf :jf:Yo÷hg :jf:Yo sfof{no tyf :yfgLo lgsfon] u/fpg'

kg]{ 5 ;fy} SR nfO{ cfjZos x'g] :jf:Yo ;+:yf Pj+ dfO{s|f];sf]lk ;]G6/sf tYof+s÷k|ltj]bg pknAw u/fO{

;xof]u ug'{ kg]{5 .

lhNnfx?df sfo{qmd sfof{Gjog ubf{ ;dGjo ul/g' kg]{ lgsfo÷JolQm; k|b]z ;fdflhs dGqfno, /fli6«o

Ifo/f]u s]Gb|, If]lqo :jf:Yo lgb]{zgfno, lhNnf :jf:Yo÷hg:jf:Yo sfof{no tyf :yfgLo lgsfo, sfo{qmd

;Fu ;DjlGwt :jf:Yo ;+:yf / k|b]z/If]q:t/df /x]sf ;]e b lrN8]«g cGt{utsf sfo{qmd;Fu

;DjlGwt÷tf]lsPsf clwsf/L÷sd{rf/Lx?;Fu SR n] lgoldt ;dGjo ul/ sfo{qmd sfof{Gjog ug{' kg]{ 5 .

sfo{qmd ;+Grfngsf nflu ljleGg lzif{s cGtu{t sfo{qmddf Joj:yf eP cg';f/ ljlgof]hg ePsf] /sd

tf]lsPsf sd{rf/L cyjf cflwsfl/s JolQmnfO{ SR n] cfjZos sfuhkq k|fKt ul/ pknJw jf e'QmfgL ug{]

u/fpg] Joj:yf ug'{ kg]{5 .


2

Ifo/f]u lgbfg ug{ k|ToIf e'ldsf ePsf sfo{qmdsf] sfof{Gjogsf nflu of] lgb]{lzsf jfx]s ljleGg sfo{qmdx?

;+rfng ug{ ljsl;t ul/Psf Standard Operating Procedure (SOP) tyf guidelines x? / sfo{qmd;Fu

;DalGwt ;Demf}tfnfO{ dfu{ lgb]{zgsf ?kdf lnO{ sfo{qmd ;+rfng ug'{kb{5 .

o; sfo{s|dsf] k|To]s å]dfl;s k|ult k|ltj]bg tyf sfo{s|dsf r'gf}ltx? csf]{ dlxgfsf] bf];|f] xKtf ;Dddf

;DjlGwt :yflgo txdf k|:t'lts/0f åf/f 5nkmn ug'{kg]{ 5 .

sfo{qmdn] tf]s]sf] tyf sfo{qmddf k|ToIf ;DjGw ePsf JolQm jf nlIft ;d'x eGbf cGo ePdf lgodfg';f/

cfjZos k|lqmof cufl8 a9fO{g] 5 .

o; lgb]{lzsfdf s]xL ;+Gzf]wg ug{'kg]{ cfjZoStf ePsf] v08df SR n] :yflgo tx÷lhNnf :jf:Yo hg

:jf:Yo sfo{fnosf] l;kmfl/;df /fli6«o Ifo/f]u s]Gb| Pj+ PR ;Fu k'j{ l:js[lt lnO{ ;+;f]wg ug{ ;lsg] 5 .


3

sfo{s|d lzif{sM

lhNnfx?sf] Hard to Reach Area df dfO{s|f];sf]lk ;]jf gePsf :jf:Yo ;+:yfaf6 dfO{s|f];sf]lk

;]G6/df Sputum transportation ;]jf :yfkgf u/L Ifo/f]u lgbfg

p2]Zo Ifo/f]u lgbfg x'g af6 5'6]sf lj/fdL kQf nufO{ pkrf/df Nofpg] .

nlIft ;d'x Out Patient Department (OPD) ;]jfdf cfPsf ;Defljt Ifo/f]usf lj/fdLx? –cfdf,

afnaflnsf, ;d]t

sfo{s|d

sfof{Gjogsf

cTofjZos dfkb08

o; sfo{sf nflu :jf:Yo ;+:yfx?nfO{ tn pNn]lvt dfkb08sf cfwf/df 5gf}6 ug'{

kb{5 .

dfOs|f]:sf]lk ;]jf gePsf / ;fljssf] lhNnf ;b/d'sfd af6 !% b]lv @)

ls=ld= 6f9f /x]sf :jf:Yo ;+:yfx? .

:jf:Yo ;+:yf af6 glhssf] dfO{s|f];sf]lk ;]G6/ ;Ddsf] b'/L slDtdf !%

ls=ld= eGbf 6f9f ePsf] jf dfO{s|f];sf]lk ;]G6/df k'Ug lgoldt ;fj{hlgs

oftfoft ;]jf gePsf] / lx8]/ Ps 306f eGbf a9L ;do nfUg] .

cf]=kL=l8= ;]jfdf t'ngfTsd?kdf case load a9L ePsf :jf:Yo ;+:yf -kxfl8

lhNnfsf xsdf :jf:Yo ;+:ydf cf};tdf b}lgs !) hgf / t/fO{sf lhNnfsf xsdf

!% hgf gof lj/fld ;]jf lng cfpg] :jf:Yo ;+:yf . dfkb08 cg';f/ :jf:Yo

;+:yfsf] ;+Vof tf]lsPsf] nIo eGbf tn dfly x'g] ePdf ;f] sf] sf/0f ;lxtsf]

ljj/0f /fli6«o Ifo/f]u s]Gb|df k]z ul/ / PR sf] l:js[lt lnO{ ug'kg]{ 5 .

Sputum transportation sf nflu klxnf ;dfj]; (link) ul/Psf ;lxt cGo :jf:Yo

;+:yfx?sf] ;'lr tof/ ug]{ .

tof/ ul/Psf] :jf:Yo ;+:yfx?sf] ;'lraf6 dfly pNn]lvt dfkb08sf cfwf/df SR

nfO{ lbOPsf] nIo cg';f/sf :jf:Yo ;+:yfx? lhNnf :jf:Yo/hg:jf:Yo sfof{no tyf

:yfgLo lgsfosf ;/f]sf/ JolQmx?;Fu cfjZostf cg';f/ ;dGjo u/L 5gf}6 ug]{ /

lo :jf:Yo ;+:yfx?af6 sputum transportation ;]jfsf] z'?jft tyf lg/Gt/tf ePsf]

x'g' kg]{ .

Sputum transportation ug{ kfos kg]{ dfO{s|f];sf]lk ;]G6/ cGo lhNnfdf kg]{ eP

klg link ePsf] :jf:Yo ;+:yfaf6 sputum transportation ug{ ;lsg] 5 t/

;DalGwt dfO{s|f]:sf]lk ;]G6/ / link ul/Psf] :jf:Yo ;+:yf Pp6} SR sf] sfo{If]qdf

x'g'kg]{ 5 .

cf]=lk=l8=df cfPsf ;Defljt Ifo/f]usf la/fldsf] vsf/ gd'gf 9'jflg ubf{ lgDg

k|lqmof ckgfpg]:

kmfNsf]g 6\o'adf la/fldsf] gfd, cf]=lk=l8= btf{ g+ / vsf/ k7fPsf] ldlt pNn]v ug]{

;+sng ePsf] vsf/nfO{ ltg lno/ KoflsË ul/ dfO{qmf]isf]lks ;]G6/df k7fpg] ।

1. ltg lno/ KoflsË ubf{ vsf/ /fv]sf] kmfNsf]g 6\o'asf] lasf]{ /fd|f];Fu s:g]

2. kmfNsf]g 6\o'asf] lasf]{nfO{ b'O{-ltg /fp08 kf/flkmg l;n 6]kn] a]g]{

3. kmfNsf]g 6\o'anfO{ Knfli6ssf] lhknu Aofudf /fVg]

4. lhknu Aofudf /flvPsf] 6\o'anfO{ vfddf /fd|f];Fu /flv PNd'lgod ˆof]n

6]kn] a]g]{

sfof{Gjog k|s[of 5gf}6 ePsf :jf:Yo ;+:yf / kfos kg]{ dfO{s|f];sf]lk ;]G6/ sf] mapping ug]{ / link

ul/g] :jf:Yo ;+:yf / dfO{s|f];sf]lk ;]G6/sf] ;d'x agfpg] .

5gf}6 ul/Psf :jf:Yo ;+:yfx? tyf dfOs|f]:sf]lk ;]G6/x? ljj/0f cg';'lr ! df ePsf]

detail matrix tof/ u/L ;DalGwt :jf:Yo ;+:yf / dfOs|f]:sf]lk ;]G6/nfO{ hfgsf/L


4

u/fpg] . -gf]6M :jf:Yo ;+:yf / dfO{s|f]:sf]lk ;]G6/x?sf] detail matrix ;DalGwt

:jf:Yo ;+:yf / dfOs|f]:sf]lk ;]G6/x?sf] kmf]sn JolQm;Fusf] ;xsfo{df SR sfo{qmdsf]

s'g} klg cled'lvs/0fdf agfpg ;lsG5 / ;f]xL ;dodf cfjZos logistics x?

pknAw u/fpg' kb{5 ;fy} ;f] sf] pknAwtf dfl;s ?kdf hfgsf/L lnO{ stock out

gePsf] ;'lglZrt ug'{kb{5 _.

:jf:Yo ;+:yfx?n] Sputum transportation ug{sf] nflu tf]lsPsf] lbgsf] hfgsf/L

OPD df ;a} hgfn] b]lvg] u/L display u/]/ /fVg] . :jf:Yo ;+:yf Pj+ dfOs|f];sf]lk

;]G6/nfO{ SR n] s'g} klg sfo{qmdsf] cled'lvs/0fdf OPD df cfPsf ;Defljt

Ifo/f]usf lj/fldsf] vsf/ ;+sng, packaging / Sputum transportation ubf{{

Ifo/f]usf] ;+s|d0faf6 ;'/lIft x'g ckgfpg' kg]{ ljlw h:t} tLg lno/ packaging ,

sputum transportation ug]{ ljlw, transportation tflnsf, sfo{qmd;Fu ;DjlGwt

/]sl8{ª l/kf]{l6ªsf ;fy} pQm lqmofsnfk;+u ;DalGwt ah]6 Joj:yfkg ,e'QmfgL k|s[of,

/ ;+:yfn] dfl;s ?kdf Sputum transportation ug'{kg]{ nIo h:tf ljifo–j:t'sf]

af/]df hfgsf/L lbg] .

:jf:Yo ;+:yfsf] OPD df l:s|lgª ePsf ;Defljt Ifo/f]usf lj/fdLnfO{ vsf/ hfFrsf]

ljsNk lbg]Ù klxnf] ljsNk– lj/fdLn] vsf/ ;DjlGwt :jf:Yo ;+:yfdf lbg O{R5's

ePdf ;f]lx lbg Sputum container lbO{ vsf/ ;+sngsf nflu tf]lsPsf] lbgdf

ljxfgsf] vsf/ Nofpg lj/fldnfO{ hfgsf/L u/fpg] / bf];|f] ljsNk– dfOs|f];sf]lk

;]G6/df la/fdL cfkm} uO{ vsf/ hfFr u/fpg rfx]df vsf/ hfFr Nofj cg'/f]w kmf/d

el/ k7fpg] .

vsf/ ;+sng ug]{ lbgdf lj/fdLsf] ljxfgsf] vsf/ ;+sng ug]{ / lj/fdLsf] csf]{

vsf/sf] gd'gf ;f]lx lbg supervised spot vsf/ gd'gf lng] .

:jf:Yo ;+:yfn] tf]lsPsf] lbgsf] !@ ah] leq vsf/ ;+sng ul/ plx lbg tf]lsPsf]

dfO{s|f];sf]lk ;]G6/df Sputum transportation ug]{ Joj:yf ldnfpg] / pQm

dfO{s|f];sf]lk ;]G6/n] ;Dej eP ;Dd plx lbg vsf/ hfFr ug]{ . :jf:Yo ;+:yfaf6

dfO{s|f];sf]lk ;]G6/df Sputum transportation ug{ ljleGg modality h:t} s'l/o/

sDklg jf ;fj{hlgs oftfoft ;Fu ;Demf}tf jf :yflgo JolQm jf :yfgLo ;]jf k|bfos

;+:yfsf JolStx? hf] lgoldt ?kdf dfO{s|f];sf]lk ;]G6/ ePsf] :yfgdf cft]hft] ul/

/xG5 jf ;Dks{ kl/If0fsf nflu 5gf}6 ePsf JolQmx?sf dfWodaf6 vsf/ 9'jflg

h:tf modality ;DalGwt :jf:Yo ;+:yf ;Fusf] ;dGjodf lgwf{/0f ul/ ;f]lx cg';f/

ug]{ Joj:yf ldnfpg] . -gf]6M obL cfjZos k/]sf] cj:yfdf :jf:Yo ;+:yfsf] sfof{no

;xof]uLnfO{ sfof{nosf] sfdsfhdf c;/ gkg]{ u/L Sputum transportation df k|of]u

ug{ ;lsg]5_ .

obL dfly pNn]lvt lawLaf6 vsf/sf] lgoldt transportation ug{ g;lsPdf :jLs[t ah]6sf] l;df leq /lx cfjZostf cg';f/ cfjZos ;+Vofdf ;fdflhs kl/rfns

lgo'lQm ul/ vsf/ ;+sng u/fO{ dfO{s|f];sf]lk ;]G6/df vsf/ hfFr u/fpg] Joj:yf

ldnfpg] .

;fdflhs kl/rfns (Social Mobilizer) lgo'lQm ul/ Sputum transportation ug'{

kg]{ ePdf Ù lhNnfdf Sputum transportation ug{' kg]{ :jf:Yo ;+:yfsf] mapping ul/

vsf/ ;+sngsf nfuL cluster agfpg] / lo cluster cGt{utsf :jf:Yo ;+:yfaf6

vsf/ ;+sng / transportation ug{ xKtfsf] s'g} lglZrt lbg / ;do tf]Sg] . -Cluster cg';f/ lbg / ;do km/s km/s x'g ;S5 ._

ljleGg cluster cGt{ut{sf :jf:Yo ;+:yfaf6 vsf/ ;+sngsf nflu tf]lsPsf lbgdf


5

:jf:Yo ;+:yfaf6 ;fdflhs kl/rfnsn] vsf/ ;+sng ul/ ;DjlGwt dfO{s|f];sf]lk

;]G6/df hfFrsf] nflu Sputum transportation ug]{ .

vsf/ hfFrdf kf]lhl6e e]l6Psf lj/fldsf] glthf ;DjlGwt :jf:Yo ;+:yfnfO{ ;Dej

ePdf dfOs|f];sf]lk ;]G6/n] kmf]g dfkm{t hfgsf/L u/fpg] / Nofj l/kf]{6 Sputum

transportation k4ltaf6 ;DjlGwt :jf:Yo ;+:yfdf k7fpg] .

Nofj glthf g]u]l6e ePsf t/ Ifo/f]usf] lrGx÷nIf0f ePsf lj/fldsf] vsf/sf] Pp6f

gd'gf yk hfFrsf nflu ;DalGwt :jf:Yo ;+:yfx?n] vsf/ ;+sng ul/ vsf/sf]

9'jflg k|0fflnaf6 dfO{s|f];sf]lks ;]G6/n] lhg–PS;k6{ ;]G6/df vsf/ hfFrsf nflu

k7fO{ glthf ;'lglZrt ug]{ ;fy} cfjZostf cg';f/ ;DalGwt lrlsT;ssf]df Ifo/f]u

lgbfgsf] nflu /]km/ ug]{ / ;f] sf] glthf ljj/0f klg /fVg] .

lgbfg ePsf lj/fdL pkrf/df gcfPdf ;DjlGwt :jf:Yo ;+:yf dfkm{t kmnf]ck u/fO{

pkrf/df cfPsf] ;'lglZrt ug]{ .

k|To]s dlxgf :jf:Yo ;+:yf Pj+ dfO{s|f];sf]lk ;]G6/n] tof/ u/]sf] dfl;s k|ltj]bg /

cfjZos sfuhftx? lhNnf :jf:Yo/hg:jf:Yo sfof{no cyjf :yfgLo lgsfo dfkm{t

k|fKt ug]{ Joj:yf ldnfpg] / ;DjlGwt cfjZos sfuhftx? ?h' ul/ oL sfo{;Fu

;DjlGwt /sd e'QmfgL ug]{ .

k|b]z/If]q, lhNnf :jf:Yo/hg:jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf] ;dGjodf

SR n] lgoldt ?kdf :jf:Yo ;+:yf Pj+ dfO{s|f];sf]lk ;]G6/sf] cg'udg u/L sfo{qmdsf]

lg/Gt/tf / k|efjsfl/tf ;'lglZrt ug]{ / ;f]sf] k|ltj]bg tof/ u/L ;DjlGwt lgsfodf

k]z ug]{ .

k|To]s dlxgfdf Sputum transportation ePsf ;+:yfx? tyf ;DalGwt :jf:Yo

;+:yfx?af6 ePsf] Sputum transportation / ;f] af6 lgbfg ePsf] Ifo/f]u la/fdL

;+Vof dfl;s nIo cg'?k eP gePsf] ljZn]if0f ug]{ . Sputum transportation

gePsf] jf eP/ klg lgbfg ePsf] Ifo/f]u la/fdLsf] ;+Vof dfl;s nIo cg'?k

gb]lvPsf] ;+:yfx?nfO{ focused u/]/ supportive supervision ug]{ / nuftf/ @

dlxgf;Dd Sputum transportation gePsf] ;+:yfx? / dfl;s nIo cg'?k Ifo/f]u

la/fdL lgbfg gePsf]] ;+:yfx?nfO{ sfo{qmddf tt\ kZrft\ ;dfj]z gu/fpg] -gf]6 M ;f]

;+:yfx?df ;fdflhs kl/rfns kl/rfng u/L lhDd]jf/L tf]sL sfo{ ;+rfng ug{

;lsg]5_ .

ck]lIft pknlAw OPD ;]jfdf cfPsf ;Defljt Ifo/f]usf lj/fdLdf Ifo/f]u lgbfg eO{ pkrf/df btf{ x'g]5

/ Ifo/f]usf] s]; gf]l6lkms]zgdf j[l4 x'g]5 .

cfly{s afF8kFmf8

ah]6 nfO{g %,^, &

/ *

-g]kfn ;/sf/sf]

k|rlnt cfly{s P]g

lgodsf] clwgdf /lx

s/ s§L nufotsf sfo{

;d]t ug]{ _

l;=g+= ljj/0f PsfO{ b/ k6s hDdf

1

Sputum transportation -t/fO{_

Sputum transportation -kxf8_

xKtf

#))

*))

!

!

#))

*))

2 Slide hfFr -k|lt lj/fdL_ k|lt slide !!=&^ @ @#=%@

!= dfly pNn]lvt vr{sf] b/ cf};tdf /flvPsf] x'bf SR n] :yfg / b'/L cg';f/ -ls|ofsnfksf] nIo / ah]6

kl/jt{g gx'g] ul/_ vr{sf] b/ kl/jt{g ug{ ;Sg] 5 .

@= dfOs|f];sf]lk ;]G6/nfO{ dfly tf]lsPsf] /sd x/]s dlxgfsf] cGtdf Sputum transportationdfkm{t

cfPsf slide / ;f] hfFr u/]sf] ?h' u/L e'Qmflg ug{' kg]{ 5 .

@= :jf:Yo ;+:yfaf6 Sputum transportation ug{ SR n] ;DjlGwt lzif{sdf l:js[t ePsf] ah]6sf]

l;df leq /lx lhNnfsf] cj:yf cg';f/ 5'6} Sputum transportation sf] modality agfO{ /f=If=s]=

dfkm{t Principal Recipient (PR) sf] l:js[lt lnO{ vr{ ug'{ kg]{ 5 .


6

sfo{s|d lzif{sM

;a} PBC / !% jif{ eGbf d'lgsf aRrf la/fdLx?sf] 3/kl/jf/sf ;b:ox?nfO{ clgjfo{ Ifo/f]usf] l:s[lgª

(Contact Tracing) ug]{

p2]Zo Ifo/f]usf lj/fdLx?sf] 3/kl/jf/sf ;b:ox?df Ifo/f]u lgbfg ul/ pkrf/df Nofpg] .

nlIft ;d'x pkrf/t PBC / s'g} klg k|sf/sf]] (PBC, PCD, EP) Ifo/f]u ePsf afnaflnsfsf]

3/kl/jf/sf] ;b:ox?

b'O{ jif{sf] cjlwdf Ifo/f]u lgbfg ePsf PBC / s'g} klg k|sf/sf]] (PBC, PCD, EP)

Ifo/f]u ePsf afnaflnsfsf]] 3/kl/jf/sf ;b:ox?

sfo{qmd

sfof{Gjogsf

cTofjZos dfkb08

Ifo/f]usf] contact tracing ug]{ JolQm (contact tracer) :jf:Yo ;+:yfn] 5gf}6 ug'{kb{5 .

:jf:Yo ;+:yfn] contact tracer 5gf}6 ubf{ lgDg s'/f Wofg lbg'kb{5 .

Contact tracer 5gf}6 ubf{ n]v k9 ug{ ;Sg] lgDg JolQm dWoaf6 k|fyfldstfdf

/flv 5gf}]6 ug{' kg]{5:

!. dlxnf :jf:Yo :jo+ ;]ljsf (FCHVs),

@. cfdf ;d'xsf] ;b:o (Mother’s Group),

#= sG6\ofS6 6«];/

#. ;fd'bflos 86\; ;]jf k|bfos jf

$. Ifo/f]u lgsf] ePsf] la/fdL

olb lo JolQmx? gePdf Ifo/f]u sfo{s|d jf/] cled'lvs/0f lnPsf jf Ifo/f]u

sfo{qmd a'em]sf ;d'bfosf JolQm h:t} lzIfs, ;fdflhs kl/rfns, :yfgLo ;]jf

k|bfos ;+:yfsf ;b:o tyf :jf:Yo ;DjlGw tflnd, cWoog u/]sf JolQm klg

5gf}6 ug{ ;lsg]5 .

pkrf/t PBC / s'g} klg k|sf/sf]] (PBC, PCD, EP) Ifo/f]u ePsf afnaflnsfsf]

3/kl/jf/sf ;b:ox?nfO{ pkrf/ cjlw ;lxt Ps jif{sf] cjlwdf slDtdf rf/

dlxgfsf] cGt/fndf contact tracer dfkm{t b'O{ k6s l:s|lgª ul/ Ifo/f]u lgbfg ug]{ .

b'O{ jif{sf] cjlwdf Ifo/f]u lgbfg ePsf PBC / s'g} klg k|sf/sf]] (PBC, PCD, EP)

Ifo/f]u ePsf afnaflnsfsf]] 3/kl/jf/sf ;b:ox?nfO{ contact tracer dfkm{t Ps

k6s l:s|lgª ul/ Ifo/f]u lgbfg ug]{ .

dfO{s|f];sflks ;]G6/n] ;+sngePsf] vsf/sf] gd'gf dWo]af6 Ppbf /fd|f] gd'gf ;'/lIft

/fVg] . olb :k'6d dfO{s|f];sf]lksf] glthf g]u]l6e ePdf pQm vsf/sf] gd'gf lhg

PS;k6{ ;]G6/df hfFrsf nflu vsf/ 9'jflg k|0fflnaf6 k7fpg]

Ifo/f]u lj/fdLsf] 3/kl/jf/sf ;b:o eGgfn] p:sf] cfkm\gf] kl/jf/sf ;fy} pQm 3/df

j;f]jf; ug]{ kl/jf/ eGbf aflx/sf ;b:o ;d]t eGg] j'emg' k5{ / lt ;a}nfO{

Ifo/f]usf] l:s|lgª ug'{ kb{5 . ;fy} lj/fdLsf] 3/ eGgfn] p xfn a;f]jf; ul//x]sf]

ef8fsf] 3/ jf cGo JolQm h:t} ;fly jf gft]bf/sf] 3/ klg eGg] j'em\g' kb{5 .

Ifo/f]usf lj/fdLsf] 3/kl/jf/sf ;b:odf kfFr jif{ d'lgsf jRrf 5g\ / p;df

Ifo/f]usf] lrGx nIf0f gePdf IPT (Isoniazid Preventive Therapy);'? ug'{ kg]{

ePsfn] IPT sf nfuL :jf:Yo ;+:yfdf lnP/ hfg' kg]{ 5 .

Ifo/f]usf] ;Dks{ kl/If0f ubf{ Ifo/f]usf] lrGx tyf nIf0f e]l6Psf 3/kl/jf/sf

;b:ox?nfO{ Ifo/f]u lgbfgsf] nflu glhssf] :jf:Yo ;+:yfdf k7fpg' kb{5 .

Ifo/f]usf] l:s|lgª ubf{ Ifo/f]usf] lj/fdL k|lt ;d'bfosf JolQm, 3/ wlg Pj+ kl/jf/sf

;b:o af6 x'g ;Sg] e]befjdf ;Dj]bglzn e} contact tracer n] sfo{ ug{' k'j{


7

Ifo/f]usf] pkrf/ lnPsf JolQm af6 cGo JolQmdf ;+qmd0f x'g] ;Defjgf Psbd} Go'g

x'g] s'/fsf] hfgsf/L pQm 3/kl/jf/ Pj+ ;d'bfosf dflg;nfO{ o; ;DjlGw k/fdz{

(counseling) ug'{ kg]{5 .

Contact tracing ubf{ cg';'lr @ df pknJw u/fO{Psf] Ifo/f]usf] screening

questionnaire sf] k|of]u ug'{kb{5 ;fy} ;DalGwt JolQmsf] df}lvs dGh'/L klg

lng'kb{5 .

sfof{Gjog k|s[of SR af6 lgo'Qm sfo{qmd kmf]sn JolQmn] lhNnf :jf:Yo/hg:jf:Yo sfof{no tyf

:yfgLo lgsfosf ;/f]sf/ JolStx?;Fu ;dGjo u/L Ifo/f]usf ljdf/L pkrf/{t :jf:Yo

;+:yfx?nfO{ k|fylds/0f u/L 5gf}6 ug]{ .

k|fylds/0f ubf{ pkrf/df btf{ ePsf PBC Ifo/f]u / s'g} klg k|sf/sf]] (PBC, PCD,

EP) Ifo/f]u ePsf afnaflnsfx?sf] ;+Vof w]/} ePsf] :jf:Yo ;+:yfnfO{ k|fyldstfdf

/fVg] .

SR n] lhNnf :jf:Yo/hg:jf:Yo sfof{no tyf :yfgLo lgsfosf] ;dGjodf 5gf}6df

k/]sf :jf:Yo ;+:yfsf :jf:YosdL{nfO{ sfo{qmd ;DaGwL cled'lvs/0f u/L cfjZos

logistics pknAw u/fpg] ;fy} dfl;s ?kdf logistics sf] hfgsf/L lnO{ stock out

x'g glbg] .

lhNnf :jf:Yo/hg:jf:Yo sfof{no tyf :yfgLo lgsfosf] ;dGjodf 5gf}6df k/]sf

:jf:Yo ;+:yfx?nfO{ contact tracer 5gf}6 ug{ hfgsf/L tyf kqfrf/ ug]{ .

:jf:Yo ;+:yfn] 5gf}6 u/]sf contact tracer nfO{ o; sfo{qmd ;DalGw cled'lvs/0f

u/fpg] .

:jf:Yo ;+:yfdf xfn pkrf/t / b'O{ jif{sf] cjlwdf btf{ e} Ifo/f]usf] pkrf/ lnPsf

;a} PBC / s'g} klg k|sf/sf]] (PBC, PCD, EP) Ifo/f]u ePsf afnaflnsfx?sf]

7]ufgf ;lxtsf] ljj/0f agfO{ :jf:Yo ;+:yfn] contact tracer nfO{ pknJw u/fpg] .

;fy} :jo+;]jsn] ;Dks{ kl/If0f ;DjlGw sfo{ / o;sf] clen]vsf] ?h' Pj+ lj/fldsf]

3/kl/jf/sf] ;Dks{ kl/If0f sfo{s|ddf tf]lsP adf]lhd eP gePsf] Plsg ug]{ .

pknAw ljj/0fsf] cfwf/df ;DalGwt contact tracer n] Ifo/f]u lj/fdLsf] 3/kl/jf/sf

;b:osf] pNn]lvt dfkb08 cg';f/ / cg';'lr @ df ePsf] screening questionnaire

k|of]u u/L l:s[lgª ug]{ .

l:s[lgªubf{ Ifo/f]usf] nIf0f ePsf] kfO{Pdf vsf/ kl/If0fsf] nflu :jf:Yo ;+:yfdf

lj/fdL NofO{ kl/If0f u/fpg] . lj/fdLn] :jf:Yo ;+:yfdf hfg gdfg]df contact tracer

n] lj/fdLsf] vsf/ ;+sng ul/ ;Dej ePdf dfO{s|f];sf]lk ;]G6/df hfFr u/fpg] /

;Dej gePdf glhssf] :jf:Yo ;+:yfdf vsf/ ;+sngsf] lbg / ;do cg';f/

a'emfpg] .

vsf/ ;+sng ul/ dfO{s|f];sf]lk gePsf] :jf:Yo ;+:yfdf vsf/ n}hfg' kg]{ cj:yf

ePdf, ;Defljt Ifo/f]usf] lj/fdLsf] vsf/ ;+sngsf nflu Pp6f a6\6f l:s[lgª ug]{

lbgdf 5f]8g] / :jf:Yo ;+:yfdf vsf/ ;+sng x'g] lbgdf lj/fdLsf] ljxfgsf] vsf/ /

To; lbgsf] Spot vsf/ ;+sng ul/ :jf:Yo ;+:yfdf n}hfg] .

:jf:Yo ;+:yfn] contact tracing af6 ;+sng ePsf] vsf/sf] j6\6fdf contact tracing

hgfO{ glhssf] dfO{s|f];sf]lk ;]G6/df sputum transportation sf] dfWodaf6 k7fpg] .

Contact tracer dfkm{t Ifo/f]u l:s[lgª u/L vsf/ kl/If0fsf nflu /]km/ ul/Psf

JolQmdf Ifo/f]u lgbfg ePdf 6L=jL= /lhi6/sf] k|]if0f/lgbfg dxndf ;Dks{ kl/If0f

dfkm{t cfPsf] elg pNn]v ug]{, To:t} Nofj /lhi6/df k7fpg] æ:jf:Yo ;+:yfsf] gfdæ


8

eGg] dxndf k7fpg] :jf:Yo ;+:yfsf] gfd pNn]v ug]{ .

vsf/ k/LIf0f ubf{ Ifo/f]usf] ls6f0f' gb]lvPdf ;DjlGwt :jf:Yo ;+:yfn] clinical

Ifo/f]u lgbfgsf] nflu la/fdLnfO{ lrlsT;ssf] df /]km/ ug]{ . ;fy} dfO{s|f];sf]lks

;]G6/n] vsf/sf] Pp6f gd'gf vsf/ 9'jflg k|0ffln dfkm{t lhg PS;k6{ ;]G6/df hfFrsf]

nflu k7fpg] / ;f]sf] glthf ;DjlGwt :jf:Yo ;+:yfdf lbg] .

Contact tracing af6 kQf nfu]sf] t/ pkrf/df cfpg gdfg]sf] la/fdLnfO{ pkrf/df

Nofpg :jf:Yo ;+:yfn] contact tracer kl/rfng u/L pkrf/df Nofpg] Joj:yf

ldnfpg] .

SR n] lhNnf :jf:Yo/hg:jf:Yo sfof{no tyf :yfgLo lgsfo dfkm{t dfl;s ?kdf

cfjZos k|ltj]bg / sfuhftx? a'lem norms cg';f/sf] e'QmfgL ;DjlGwt

dfO{s|f];sf]lk ;]G6/ dfkm{t jf :yfgLo lgsfo dfkm{t :jf:Yo ;++:yfnfO{ jf ;DalGwt

JolQmnfO{ lbg] .

;DjlGwt :jf:Yo ;+:yfn] contact tracer af6 e/]sf] l:s|lgª kmf/d / contact tracer

n] k|of]u ug]{ contact tracing /lhi6/df l:s[lgª ul/Psf la/fdLsf] 3/ kl/jf/sf

;b:ox?sf] lj:t[t ljj/0f nufot ;lx 5fksf] slk lnO{ contact tracer nfO{

oftfoft vr{ lbg] .

:jf:Yo ;+:yfdf contact tracing sf] nfuL lhDd]jf/ JolQmn] lj/fdL kmnf]cksf] nfuL

u/]sf] communication vr{ SR n] ekf{O{ u/fO{ pknAw u/fpg] .

of] sfo{sf] /]s{l8ª contact tracer n] pknAw u/fPsf] contact tracing /lhi6«/df

:jf:Yo ;+:yfn] hfgsf/L cWofjlws u/L lgh la/fdLsf] vsf/ glthf klg pNn]v ug]{

;fy} kf]h]l6e cfPsf] xsdf pkrf/sf] ;'lgZrt ug]{ .

ck]lIft pknlAw lj/fdLsf] ;Dks{df ePsf 3/ kl/jf/sf ;b:odf Ifo/f]u lgbfg eO{ pkrf/ x'g]5 /

Ifo/f]usf] s]; gf]l6lkms];gdf j[l4 x'g]5 .

cfly{s afF8kFmf8

ah]6 nfO{g $

,(,!) ,!!, !@ / !#

-g]kfn ;/sf/sf]

k|rlnt cfly{s P]g

lgodsf] clwgdf /lx


;d]t ug]{ _

l;=g+= ljj/0f PsfO{ b/ k6s

hDdf

! Contact tracer nfO{ oftfoft vr{ k6s $)) @ *))

@

lgbfg eO{ pkrf/df gcfPsf] lj/fdLnfO{

pkrf/df Nofpg contact tracer nfO{

oftfoft/kmnf]ck vr{

k6s $)) ! $))

#

:jf:Yo ;+:yfdf contact tracing sf] nfuL

lhDd]jf/ JolQmn] lj/fdL kmnf]cksf] nfuL

u/]sf] communication vr {

lj/fldsf]

k|lt

3/kl/jf/

#)) ! #))

$

vsf/ k/LIf0f ubf{ Ifo/f]usf] ls6f0f'

gb]lvPdf t/ Ifo/f]usf] lrGx, nIf0f

oyfjt /x]sf] ;+efljt la/fdLsf] k'gM vsf/

;+sng u/L lhg PS;k6{df hfFrsf] nfuL

vsf/ nfg] JolQm nfO{

k|lt la/fdL !)) ! !))

%

dfO{s|f];sf]lks ;]G6/sf Nofj sd{rf/LnfO{

k|lt lj/fdL vsf/ kl/If0f jfkt z'Ns k|lt slide !!=&^ @ @#=%@

^

5kfO{ vr{ kmd{ kmd]{6 - Eof6 afx]s _

k|lt lhNnf !#@&

$ !

!#@&

$

:jf:Yosld{nfO{ o; sfo{s|d jfkt pknJw u/fO{Psf] communication /sd To; :jf:Yo ;+:yfdf SR

dfkm{t ul/g] cGo sfo{s|dsf nflu ul/g] communicationsf] vr{ ;d]t ePsf] ;DjlGwt :jf:Yosld{nfO{


9

hfgsf/L u/fpg] .

vsf/ kl/If0fsf] e'Qmflgdf cfjZos s/ sl§ ug]{ . o; ls|ofsnfkdf vsf/ hfFrsf nflu Nofj sd{rf/LnfO{

lbO{g] /sd :jf:Yo ;+:yfaft vsf/ 9'jflg ls|ofsnfk cGt{ut ljlgof]hg ePsf] /sdaf6 e'Qmflg ug]{ .

sfo{qmd lzif{s M

;Defljt Drug Resistant (DR) Ifo/f]u lj/fdLsf] lhg PS;k6{df vsf/ kl/If0f

p2]Zo DR Ifo/f]u lj/fdL kQf nufO{ pkrf/df Nofpg] .

nlIft ;d'x Ifo/f]usf] ;a} PBC / PCD la/fdLx? Ù ljz]ift k'g pkrf/df btf{ eO{ pkrf/

lnO{/x]sf, pkrf/sf] @÷#, % dlxgf / pkrf/sf] cGtdf vsf/ kf]h]]l6e ePsf /

Ifo/f]usf] pkrf/ lnPsf t/ ;Gtf]ifhgs ;'wf/ gePsf ;j} Ifo/f]usf lj/fdLx? .

/fli6«o Ifo/f]u sfo{s|dn] lgdf{0f u/]sf]] lhg–PS:k6{ cNuf]l/bd -cg';'lr @_ leq kg]{

cGo ;a} Ifo/f]usf ;Defljt lj/fdLx?

sfo{qmd

sfof{Gjogsf

cTofjZos dfkb08

:jf:Yo ;+:yf Pj+ dfOs|f];sf]lk ;]G6/nfO{ SR sfo{qmd cGt{ut lbOg] s'g} klg

cled'lvs/0fdf ;+efljt DR Ifo/f]usf la/fdLx?, vsf/ ;+sng k|s[of,

packaging / transportation ubf{{ Ifo/f]usf] ;+s|d0faf6 ;'/lIft x'g ckgfpg'

kg]{ ljlw h:t} transportation sf nflu tLg lno/ packaging, k|of]u x'g]

sputum container nfO{ cfjlws ;+qmd0f /lxt (disinfection) ug]{ tl/sf,

transportation ug]{ ljlw, transportation tflnsf Pj+ sfo{qmd;Fu ;DjlGwt

/]sl8{ª tyf l/kf]{l6ªsf ;fy} pQm lqmofsnfk;+u ;DalGwt ah]6 Joj:yfkg /

e'QmfgL k|lqmof h:tf ljifo–j:t' af/] SR n] ;DalGwt :jf:Yo ;+:yfnfO{

hfgsf/L u/fpg' kg]{5 .

vsf/ 9'jflgug]{ ug]{ JolQm tyf ;+:yfsf] 5gf}6 dfly “:jf:Yo ;+:yfaf6

Ifo/f]usf ;Defljt lj/fldsf] vsf/ 9'jflg sfo{s|d” cGt{ut tf]lsP cg';f/

ug]{ . sfo{qmd k'j{ g} lhNNff :jf:Yo/ hg:jf:Yo sfof{no tyf :yfgLo lgsfo,

lhg PS:k6{ ;]G6/ / ;DjlGwt :jf:Yo ;+:yfsf] larsf] ;dGjodf vsf/

;+sng÷transportation / hfFr x'g] lbgx? lglZrt ug]{ / ;f]lx cg';f/

Joj:yf ldnfpg'kb{5 .

:jf:Yo ;+:yfaf6 Ifo/f]u lgbfgsf nflu Sputum collection /

transportation ug]{ lbgdf jf cfjZostf cg';f/ cGo lbgdf klg ;+efljt

DR Ifo/f]u lj/fdLsf] vsf/sf] gd'gf ;+sng ul/ lhg PS;k6{ ;]G6/df

k7fpg'kb{5 . To:t} dfO{s|f];sf]lks ;]G6/df cf]=lk=l8= af6 vsf/ kl/If0fsf

nflu k7fOPsf lj/fldsf] df Ifo/f]u lgbfg ePsf, vsf/sf] kmnf]ck hfFrdf

kf]lhl6e ePsf ljdf/Lsf] vsf/sf] gd'gf vsf/ 9'jflg k|0ffln dfkm{t

dfO{s|f];sf]lks ;]G6/n] cfkm\gf] :jf:Yo ;+:yfdf tf]lsPsf] lglZrt af/df lhg

PS;k6{ ;]G6/df vsf/sf] gd'gf k7fpg] \ .

lhg PS;k6{ kl/If0faf6 RR-MTB lgbfg ePdf lhNnf :jf:Yo/hg:jf:Yo

sfof{no tyf :yfgLo lgsfonfO{ t'?Gt hfgsf/L u/fO{ kQf nfu]sf DR

Ifo/f]u lj/fdLsf] pkrf/sf] ;'lglZrttf ug'kb{5 .

sfof{Gjog k|s[of

:jf:Yo ;+:yf Pj+ dfOs|f];sf]lk ;]G6/nfO{ SR sfo{s|d cGt{ut lbOg] s'g} klg

cled'lvs/0fdf pNn]lvt dfkb08 cg'?k hfgsf/L u/fpg] ;fy} cfjZos logistics

pknAw u/fO{ dfl;s ?kdf hfgsf/L lnO{ stock out x'g glbg] .

;DalGwt :jf:Yo ;+:yfn] pkrf/t ;+efljt DR Ifo/f]usf la/fdLx?sf] lbOPsf]


10

/lhi6/df ljj/0f tof/ ug]{ / tf]lsPsf] lbgdf lgh lj/fdLx?sf] Pp6f vsf/sf]

;+sng u/L lhg PS;k6{ ;]G6/df kl/If0fsf nfuL k7fpg]] .

lhg PS;k6{ ;]G6/df ;+sng ePsf] vsf/ gd'gf ;f]xL lbgdf hfFr ug{ g;s]sf] xsdf

;f] gd'gfsf] plrt e08f/0f u/L csf]{ lbgdf hfFr ug]{ .

vsf/ hfFrsf nflu k7fpg] :jf:Yo ;+:yfn] lj/fdLsf] vsf/ hfFrsf] glthf lhg‐PS;k6{ ;]G6/sf sd{rf/L];Fu ;Dks{ ul/ ;'lglZrt ug{] / kl5 vsf/ 9'jflg k|0ffln

dfkm{t Nofjsf] glthf k|fKt ul/ /lhi6«/df cWofjlws ug]{ . lhg PS;k6{ hfFraf6

Rifampicin resistant lgbfg ePdf Ifo/f]usf] /lhi6/df moved to second line

treatment elg hgfpg] / t'?Gt DR Ifo/f]u pkrf/sf nflu ;DjlGwt DR Ifo/f]u

pkrf/ s]Gb|df k7fO{ lj/fdLn] pkrf/ lnPsf] ;'lglZrt ug]{ .

lhg‐PS;k6{ ;]G6/df vsf/ hfFr u/] jfkt sd{rf/LnfO{ lbOg] k|f]T;fxg vr{ g]kfn

;/sf/sf] ;|f]t cGt{ut k|b]z ;/sf/ /If]lqo :jf:Yo lgb]{zgfno dfkm{t pknJw x'g]

ePsfn] ;f]lx cg';f/sf] hfgsf/L lhg PS;k6{ ;]G6/nfO{ u/fpg] .

SR n] ;DalGwt :jf:Yo ;+:yfaf6 lhNnf :jf:Yo/hg:jf:Yo sfof{no jf :yfgLo

lgsfo / lhg PS;k6{ ;]G6/ dfkm{t cfjZos sfuhftx? ;+sng ug]{ / ;f] sf] ?h'

u/L e'StfgL ug]{ .

ck]lIft pknlAw ;+efljt DR Ifo/f]u la/fdLx?df DR Ifo/f]u kQf nflu pkrf/df cfpg] .

cfly{s afF8kFmf8

ah]6 nfO{g !$

-g]kfn ;/sf/sf]

k|rlnt cfly{s P]g

lgodsf] clwgdf /lx


;d]t ug]{ _


1 :jf:Yo ;+:yf af6 lhg PS;k6{ ;]G6/df vsf/ 9'jflg

k|lt

lj/fdL !)) ! !))

vsf/ 9'jflgsf nflu k|lt gd'gf ? !)) cf};tdf /flvPsf] x'bf SR n] o; sfo{sf nflu lbOPsf] s'n ah]6

/ nIosf] l;df leq /lx ;DjlGwt ;/f]sf/jfnfsf] ;dGjodf 7fpF / b'l/sf cfwf/df k|lt gd'gf 9'jflg b/

lgwf{/0f ug]{ / ;f]sf] PR af6 k'j{ l:js[lt lnO{ sfo{ ;+rfng ug]{ .

sfo{qmd lzif{s M

Drug Resistant (DR) Ifo/f]u lj/fdLsf] 3/kl/jf/sf ;b:ox?sf] ;Dks{ kl/If0f (Contact Tracing)

p2]Zo DR Ifo/f]u lj/fdLsf] 3/kl/jf/sf ;b:ox?sf] ;Dks{ kl/If0f ug]{ / kQf nfu]sf]

la/fdLnfO{ pkrf/df Nofpg] .

nlIft ;d'x DR Ifo/f]u pkrf/ s]Gb| tyf pkrf/ pk s]Gb|df gofF tyf pkrf/t DR Ifo/f]usf

la/fdLx?

vsf/ 9'jflg af6 RR-MTB lgbfg ePsf lj/fldsf] 3/kl/jf/sf ;b:ox?

b'O{ jif{sf] cjlwdf Ifo/f]u lgbfg eO{ pkrf/df btf{ ePsf DR Ifo/f]u la/fdLx?

sfo{qmd

sfof{Gjogsf

cTofjZos dfkb08

;Dks{ kl/If0f ug]{ JolQmsf] 5gf}6 PBC lj/fldsf] ;Dks{ kl/If0fdf dfly pNn]v eP

jdf]lhd ug]{ .

klxnf] ;Dks{ kl/If0f ubf{ 3/3'/L e]63f6df :jf:Yo sld{ / :jo+;]js u} ug]{, bf];|f]

;Dks{ kl/If0fdf :jf:Yosld{n] dfq ug]{ .

:k'6d s'l/o/af6 RR-MTB lgbfg ePsf lj/fldsf] 3/kl/jf/sf ;b:ox?nfO{ ;f]

lj/fld pkrf/{t :jf:Yo ;+:yfsf] :jf:Yosld{x?n] 3/b}nf]df u} ;Dks{ kl/If0f ug]{ .

DR center tyf Sub Center df pkrf/{t l8=cf/= lj/fldsf xsdf olb lj/fldsf]

3/kl/jf/ jf p a;f]af; ug]{ :yfg l8=cf/= pkrf/ s]Gb| tyf pk s]Gb|sf] glhs ePdf

pQm s]Gb|sf :jf:Yosld{ u} kl/jf/sf ;b:osf] contact tracing ug]{ . olb lj/fldsf]


11

3/ tyf a;f]jf; :yfg 6f9f tyf cGo lhNnfdf eP p:sf] 3/ glhssf] :jf:Yo

;+:ysf sd{rf/L u} ug]{ Joj:Yff ldnfpg] .

DR Ifo/f]u lj/fdL xfn a;f]jf; ul//x]sf] 3/sf ;Dk'0f{ ;b:osf] Ifo/f]u l:s|lgª ul/

Ifo/f]usf] lrGx tyf nIf0f ePsf] lj/fldnfO{ hfFrsf nflu ] vsf/ ;+sng ul/ lhg

PS;k6{ ;]G6/df vsf/ 9'jflg k|0ffln dfkm{t k7fpg] jf lhg PS;k6{ ;]G6/ glhs eP

cfkm} nlu a'emfpg] .. olb vsf/ 9'jflg k|0ffln pknJw gePdf jf lhg PS;k6{ ;]G6/

6f9f eP lhg PS;k6{ ;]G6/df lj/fld /]km/ ul/ lgbfg eP gePsf] ;'lglZrt ug]{ .

pkrf/t DR Ifo/f]u la/fdLsf] 3/kl/jf/sf ;b:ox?nfO{ contact tracing pkrf/

cjlw leqdf slDtdf 5 dlxgfsf] cGt/fndf b'O{ k6s l:s[lgª ug'{kb{5 eg] pkrf/

k'/f u/]sf] b'O{ jif{ cjlw ;Ddsf lj/fldsf] 3/kl/jf/ssf ;b:ox?nfO{ Ps k6s dfq

l:s[lgª ug]{ .

DR Ifo/f]u lj/fdLsf] 3/ kl/jf/sf ;b:o eGgfn] p:sf] cfkm\gf] kl/jf/sf ;fy} pQm

3/df j;f]jf; ug]{ kl/jf/ eGbf aflx/sf ;b:o ;d]t eGg] j'emg' k5{ / lt ;a}sf]

Ifo/f]usf] l:s|lgª ug'{ kg]{ 5 . ;fy} lj/fdLsf] 3/ eGgfn] p xfn a;f]jf; ul//x]sf]

ef8fsf] 3/ jf cGo JolQm h:t} ;fly jf gft]bf/sf] 3/ klg eGg] j'em\g' kb{5 .

DR Ifo/f]u lj/fdLsf] 3/kl/jf/sf ;b:ox?sf] l:s|lgª ubf{ lj/fdL k|lt ;d'bfosf

JolQm, 3/ wlg Pj+ kl/jf/sf ;b:o af6 x'g ;Sg] e]befjdf ;Dj]bglzn e} pkrf/

lnPsf JolQm af6 cGo JolQmdf Ifo/f]u ;+s|d0f x'g] ;Defjgf Go'g x'g] s'/fsf]

hfgsf/L pQm 3/kl/jf/ Pj+ ;d'bfosf dflg; nfO{ k/fdz{ (counselling) ug'{ kg]{5 .

Contact tracing ubf{ cg';'lr @ df ePsf] Ifo/f]usf] screening questionnaire sf]

cfwf/df ug'{kb{5 ;fy} ;DalGwt JolQmsf] df}lvs dGh'/L klg lng'kb{5 .

sfof{Gjog k|s[of

SR af6 lgo'Qm sfo{qmd kmf]sn JolQmn] k|b]z/If]q, lhNnf :jf:Yo/hg:jf:Yo sfo{no

tyf :yfgLo lgsfosf ;/f]sf/ JolStx?;Fu;dGjo u/L sfo{qmd sfof{Gjog sf] tof/L

ug{] .

DR Ifo/f]u pkrf/ s]Gb| tyf pkrf/ pk s]Gb|df gofF, pkrf/t / b'O{ jif{sf] cjlwdf

btf{ eO{ DR Ifo/f]usf] pkrf/ lnPsf ;a} la/fdL Pj+ vsf/ 9'jflg dfkm{t RR-MTB

lgbfg ePsf Ifo/f]usf pkrf/{t lj/fldsf] 7]ufgf ;lxtsf] ljj/0f tof/ u/L contact

tracing register df cWofjlws ug{] .

pknAw ljj/0fsf] cfwf/df ;DalGwt kmf]sn JolQmn] la/fdLsf] 3/ ePsf] j8fsf]

d=:jf=:jo+=;]ljsfsf] ;xof]udf DR Ifo/f]u lj/fldsf] 3/kl/jf/sf ;b:osf] cg';'lr @

pNn]lvt screening questionnaire sf] k|of]u u/L l:qmlgª ug]{ .

l:qmlgª ubf{ Ifo/f]usf] nIf0f ePsf] kfO{Pdf vsf/ ;+sng u/L kl/If0fsf] nflu lhg–

PS:k6{ ;]G6/|df Sputum transportation sf] dfWodaf6} k7fpg] jf tyf lhg PS;k6{

;]G6/ glhs eP :jf:Yo sld{n] cfkm} lnO{ hfg] jf lj/fdL cfkm} hfg rfx]df vsf/

cg'/f]w kmf/fd el/ k7fpg] .

;DjlGwt :jf:Yo ;+:yfn] vsf/ hfFrsf] glthf vsf/ lnO{ hfg] jf lhg‐PS;k6{

;]G6/ |sf sd{rf/LnfO{ ;f]lw ;'lglZrt ug]{ . olb RR-MTB lgbfg ePdf t'?Gt DR

Ifo/f]u pkrf/ s]Gb|df k7fO{ pkrf/ lnPsf] ;'lglZrt ug]{ ;fy} MTB with

Rifampicin Sensitive kQf nfu]df ;DalGwt 86\; ;]G6/df pkrf/sf] ;'lglZrttf

ug]{ .

SR n] lhg PS;k6{ ;]G6/ jf DR pkrf/ s]Gb| jf pks]Gb|df uO{ sfo{qmd;Fu ;DjlGwt

cfjZos sfuhft ?h' ul/ /sd e'Qmflg ug]{ ;fy} z+sf:kb DR Ifo/f]usf] vsf/


12

hfFrsf] nflu Sputum transportation ;Fu link u/L k7fpg] / ;f] sf] /sd vr{

Sputum transportation vr{ cg';f/ e'StfgL ug]{ .

lhg‐PS;k6{ ;]G6/df vsf/ hfFr u/] jfkt sd{rf/LnfO{ lbOg] k|f]T;fxg vr{ g]kfn

;/sf/sf] ;|f]t cGt{ut k|b]z/If]lqo :jf:Yo lgb]{zgfno dfkm{t pknJw x'g] ePsfn]

;f]lx cg';f/ pknJw x'g] s'/fsf] hfgsf/L lhg PS;k6{ ;]G6/nfO{ u/fpg'kb{5 .

ck]lIft pknlAw DR Ifo/f]u la/fdLsf] ;Dks{df ePsf 3/kl/jf/sf ;b:ox?df Ifo/f]u lgbfg eO{

pkrf/df cfpg] .

cfly{s afF8kFmf8

ah]6 nfO{g !%

-g]kfn ;/sf/sf]

k|rlnt cfly{s P]g

lgodsf] clwgdf /lx


;d]t ug]{ _


!

DR Ifo/f]u pkrf/ s]Gb| jf pkrf/ pk s]Gb|sf kmf]sn

JolQmnfO{ DR Ifo/f]u lj/fdLsf] 3/ e]6 ul/ Ifo/f]usf]

l:s|lgª ug{ oftfoft vr{ - clwstd_

k|lt

lj/fld %)) @ !)))

@

;DalGwt j8fsf] d=:jf=:jo+=;]ljsfnfO{ DR Ifo/f]u

lj/fdLsf] 3/ e]6 ug{ oftfoft vr{ .

k|lt

lj/fdL $)) ! $))

gf]6M DR Ifo/f]u pkrf/ s]Gb| jf pkrf/ pk s]Gb|sf kmf]sn JolQm / la/fdLsf] 3/ /x]sf] j8fsf]

d=:jf=:jo+=;]ljsfn] contact tracing ug{ g;s]sf] jf grfx]sf] v08df cGo lj/fldsf] 3/kl/jf/ klxrfg

ug]{ cGo :jf:YosdL{ tyf JolQm kl/rfng u/L l:s[lgª ug]{ .

sfo{qmd lzif{sM

:jf:Yo ;+:yfdf afnaflnsfdf Ifo/f]u klxrfgsf nflu l:qmlg+u sfo{qmd

p2]Zo s'kf]lift tyf s8f :jf;–k|:jf; ;+s|d0f ePsf afnaflnsfdf Ifo/f]usf] lgbfg ul/

pkfrf/df Nofpg]

nlIft ;d'x :jf:Yo ;+:yfdf cfPsf s'kf]lift Pj+ s8f :jf; k|:jf; ;+s|d0f ePsf afnaflnsf .

sfo{qmd

sfof{Gjogsf

cTofjZos dfkb08

o; sfo{sf nflu :jf:Yo ;+:yfx?nfO{ lhNnf :jf:Yo÷hg:jf:Yo sfof{no tyf :yfgLo

lgsfo ;Fusf] ;dGjodf tn pNn]v ePsf] dfkb08sf cfwf/df k|fylds/0f ug'{ kb{5 .

1. of] sfo{s|d t'ngfTds?kdf sd :jf:Yo ;'ljwf ePsf :jf:Yo ;+:yfdf ug{'kg]{

ePsfn] ;fljssf lhNnf ;b/d'sfdaf6 6f9f -slDtdf !% ls=ld=_ ePsf /

t'ngfTds?kdf al9 :jf:Yo ;]jf lng cfpg] :jf:Yo ;+:yfx?

2. s'kf]lift tyf s8f :jf;k|:jf; ;+s|d0f ePsf afnaflnsf al9 ePsf :yfgsf

:jf:Yo ;+:yfx? -;b/d'sfdaf6 !% ls=ld= eGbf sd ePklg_

3. ;]jfsf] kx'Fraf6 6f9f ePsf, l;dfGts[t, clt ljkGg tyf lk5l8Psf

hg;d'bfo a;f]af; u/]sf :yfgsf :jf:Yo ;+:yfx?

4. kf]if0fsf] sfo{s|d -IMAM/CMAM_ ;+rfng ePsf] lhNnfdf Outpatient

Therapeutic Center (OTC) ;]G6/x? ePsf] :jf:Yo ;+:yfx? .

of] sfo{qmd ;DalGwt :jf:Yo ;+:yfn] dfly pNn]lvt afnaflnsf :jf:Yo ;+:yfdf ;]jf

lng cfPsf a]nfdf ug'{kb{5 . tf]lsPsf :jf:Yo ;+:yfdf ;]jf lng cfPsf tyf OTC

;]G6/df btf{ ePsf Severe Acute Malnutrition (SAM) aRrfx?nfO{ clgjfo{

Ifo/f]u lgbfgsf] nflu ;DalGwt /]km/n c:ktfndf k7fpg'kb{5 / Moderate Acute

Malnutrition (MAM) tyf s8f :jf; k|:jf; ;+s|d0f ePsf aRrfx?nfO{ cg';'lr @

cg';f/sf] screening questionnaire k|of]u u/L :s[lgª ubf{ Ifo/f]usf] lrGx, nIf0f

b]lvPdf Ifo/f]u lgbfgsf] nflu ;DalGwt /]km/n c:ktfndf k7fpg'kb{5 .

Ifo/f]u lgbfgsf nflu /]km/ eO{ hfg] s'kf]lift afnaflnsf / p ;Fu ;fydf hfg]

cleefasn] k|fKt ug]{ oftfoft tyf a;f]af; /sd Ifo/f]u lgbfg /]km/n ;]G6/ -


13

c:ktfn_ af6} pknAw u/fpg'kb{5 .

/]km/ ePsf afnaflnsfsf] Ifo/f]u lgbfg lhg–PS:k6{ jf PS;/] jf Uofl:6«s nfefh

lgsfnL lhg–PS:k6{ af6 ul/g' kg]{ 5 .

x/]s b'O{ dlxgfdf afnaflnsfdf Ifo/f]u lgbfgsf nflu ul/Psf] sfo{s|dsf] ;ldIff ug]{

.

sfof{Gjog k|s[of

SR n] dfly pNn]lvt dfkb08sf cfwf/df of] sfo{s|d ;+rfng ug]{ :jf:Yo

;+:yfx?nfO{ lhNnf :jf:Yo÷hg:jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf] ;dGjo

df k|fylds/0f ug]{ .

SR sfo{qmd ;Fu ;DjlGwt s'g} klg cled'lvs/0fdf s'kf]lift afnaflnsfdf Ifo/f]u

sf] l:s[lg+u ;DalGw laifoa:t', Ifo/f]u lgbfgsf nflu /]km/ ul/ k7fpg' kg]{ c:ktfn,

ToxfF la/fdLn] kfpg] ;'lawf / sfo{qmd ;Fu ;DjlGwt /]sl8{ª Pj+ l/kf]{l6ª h:tf

ljifox?sf ;fy} :jf:Yo ;+:yfn] l:s[lgª ug]{ cg'dflgt dfl;s nIosf af/]df hfgsf/L

lbO cfjZos logistics x? pknAw u/fpg] .

:jf:Yo ;+:yfx?n] /]km/ ul/ k7fpg] c:ktfnsf] Plsg ul/ pQm c:ktfnsf]

lrlsT;snfO{ afn Ifo/f]u ;DalGw Ifdtf clelj[l¢ tflnd ug]{/u/fpg] jf tflnd k|fKt

lrlsT;ssf] k'0f{ ljj/0f -;Dks{ JolSt, ;Dks{ g+=, /]km/ ug]{ lbg cflb_ hfgsf/L

;DalGwt :jf:Yo ;+:yfnfO{ pknAw u/fpg] . ;fy} /]km/n c:ktfndf lgo'Qm ePsf

:jf:Yo :jo+;]jsx?sf] gfd / ;Dks{ gDj/ :jf:Yo ;+:yfnfO{ pknJw u/fpg] . :jf:Yo

:jo+;]jssf] ;xlhs/0fdf /]km/n ePsf aRrfdf Ifo/f]usf] lgbfg u/fpg] .

:jf:Yo ;+:yfdf cfPsf SAM aRrfnfO{ Ifo/f]u lgbfgsf nflu l;w} /]km/n c:ktfndf

k7fpg] / MAM cGtu{t juL{s[t ePsf aRrfx? dWo] weight for height –wasting

or weight for age –under weight aRrfx? Pj+ s8f :jf;k|:jf; ePsf aRrfx?df

Ifo/f]usf] lrGx tyf nIf0fsf cfwf/df l:qmlg+u ul/ ;Defljt Ifo/f]usf aRrfx?nfO{

/]km/n c:ktfndf lgbfgsf nflu k7fpg] .

/]km/n c:ktfndf k7fO{Psf aRrfx?n] vsf/ lgsfNg g;s]df tflnd k|fKt

lrlsT;sn] Uofl:6«s nfefh lgsfnL lhg PS:k6{af6 Ifo/f]usf] lgbfg ug]{, Uofl:6«s

nfefh lgsfNg ;Dea gePdf PS;–/], df]G6’ 6]:6 / clinical lg0f{osf cfwf/df

lgbfg ug]{ . ;Defljt EP Ifo/f]usf xsdf cfjZostf cg’;f/ FNAC ul/ lgbfg

ug]{ .

:jf:Yo ;+:yfdf sfo{qmd ;ldIff ug{{ nfUg] ah]6 ;DalGwt :jf:Yo ;+:yfsf] kmf]sn

JolQmnfO{ k]:sL :j¿k pknAw u/fpg] / dfl;s ?kdf cfjZos sfuhftx? ;+sng

u/L km/5\of}6 ug]{ .

SR af6 :yfgLo lgsfosf] ;dGjodf lgoldt ?kdf ;DalGwt :jf:Yo ;+:yfdf

cg’udg ul/ sfo{qmd sfof{Gjog p2]Zo cg’?k ePsf] ;’lglZrt ug]{ .

ck]lIft pknlAw ;Defljt afnaflnsfdf Ifo/f]u lgbfg eO{ pkrf/df Nofpg] .

cfly{s afF8kFmf8

ah]6 nfO{g !& ,!*

/ !(

-g]kfn ;/sf/sf]

k|rlnt cfly{s P]g

lgodsf] clwgdf /lx


! å}dfl;s sfo{s|d ;ldIff a}7ssf] nflu

Ps di7 vr{ . k|lt a}7s !))) ^ ^)))

@

aRrfdf Ifo/f]usf] lgbfg ug{ cleefjs

;lxt ;Defljt Ifo/f]usf] aRrfnfO{

/]km/n c:ktfndf kUg lbOg] Ps di6

/sd oftfoft, vfgf tyf af; vr{_-

k|lt afns

@))) ! @)))


14


;d]t ug]{ _

#

afnaflnsdf Ifo/f]usf] lgbfg ug{

cfjZos kl/If0f vr{

PS;–/]÷df]G6 6]:6

k|lt lj/fdL

#))

!

#))

Uof;l6«s nfefh

k|lt lj/fdL

!%)) ! !%))

$= EP Ifo/f]u lgbfgsf nflu FNAC –

cfjZos afnaflnsfnfO{ dfq_

k|lt lj/fld @))) !

gf]6 l;=g+ ! sf] vr{ afx]s cGo lzif{ssf] vr{ /]km/n c:ktfn af6 pknJw u/fpg] . Ifo/f]usf] lgbfgsf nflu

pknJw ah]6sf] l;df leq /lx tf]lsPsf lgwfgfTds kl/If0fx? af:tlas vr{sf cfwf/df ug]{ cyf{t

lgbfgfTds kl/If0fsf nflu lbOPsf lzif{sx?df jf:tljs nfUg] vr{sf cfwf/df lgbfgfTds ;]jfsf nflu

lbOPsf] s'n ah]6 af6 af8kmf8 ul/ cfjZostf cg';f/ vr{ ug]{ .

sfo{qmd lzif{sM

c:ktfndf s'kf]lift tyf s8f :jf;–k|:jf; ;+s|d0f ePsf afnaflnsfx?df Ifo/f]u klxrfgsf nflu

l:qmlg+u sfo{qmd

p2]Zo s'kf]lift tyf s8f :jf;–k|:jf; ;+s|d0f ePsf afnaflnsfdf Ifo/f]u lgbfg ul/ pkrf/df

Nofpg]

nlIft ;d'x c:ktfndf cfPsf s'kf]lift Pj+ s8f :jf; k|:jf; ;+s|d0f ePsf afnaflnsf .

Nutrition Rehabilitation Home -kf]if0f k'g{:yfkg s]Gb|÷u[xdf_ egf{ ePsf

afnaflnsf . sfo{qmd

sfof{Gjogsf

cTofjZos dfkb08

sfo{qmddf lbOPsf] nIo cg'?k lhNnfdf ePsf ;/sf/L tyf u}x| ;/sf/L 7'nf

c:ktfn 5gf}6 ug'{kb{5 / 5gf}6 eO;s]sf] c:ktfnsf] k'0f{ ljj/0f tof/ ug'{kb{5 .

5gf}6 ubf{ c:ktfnsf] OPD tyf Indoor df la/fldsf] s]; nf]8 klg ljZn]if0f

ug'{kb{5 .

sfo{qmd ;xhstf{ -;Dej eP;Dd c:ktfns} s'g} :jf:YosdL{ dWo]af6_ 5gf}6 ug{

;lsg]5 jf 5gf}6 eO;s]sf] xsdf pgLx?nfO{ g} lg/Gt/tf lbO{ sfo{qmd ;+rfng ug{

;lsg]5 . ;fy} o; sfo{sf nflu / FAST /0fgLlt cGtu{t kg]{ sfo{sf] sfo{s|d

;xhstf{ Ps} x'g] 5g\ . -gf]6M sfo{s|d ;xhstf{sf] ;+Vof c:ktfnsf] s]; nf]8sf]

cfwf/df lgwf{/0f ug{ ;lsg]5 tyf lghsf] kfl/>lds cfjZos k/]sf] v08df lghsf]

work load / ah]6 l;df leq /xL SR n] PR sf] k"j{ cg'dlt lnO{ vr{ ug{ ;S5_.

sfo{qmd ;xhstf{sf] e'ldsf -cg';'lr $_ lhNnfsf cGo :jf:Yo ;+:yfaf6 /]km/ eO{

cfPsf ;Defljt Ifo/f]usf lj/fldsf] /f]u lgbfgdf ;xlhs/0f ug]{ klg x'G5 .

c:ktfnsf] OPD, O{d/h]G;L, afn lSnlgs÷jf8{, kf]if0f k'g{:yfkg s]Gb|÷u[x tyf cGo

jf8{df cfPsf aRrfx? ljz]if u/L s'kf]lift, s8f :jf;–k|:jf; ;+s|d0f ePsf

afnaflnsfdf Ifo/f]usf] l:s|lgª tyf lgbfg sfo{df ;xhLs/0f ug]{ d'Vo bfloTj

;xhstf{sf] x'g]5 .

sfo{qmd ;xhstf{n] o; sfo{sf] /]sl8{ª tyf l/kf]{l6ª ;DalGwt /lhi6/df u/L SR

nfO{ dfl;s k|ltj]bg ug{' kb{5 . PR n] pknA3 u/fPsf] 9fFrfdf SR n] dfl;s

k|ltj]bg a'emfpg kg]{5.

o; sfo{qmdsf] cg'udg SR n] lhNnf :jf:Yo /hg :jf:Yo sfof{no tyf :yfgLo

lgsfo;Fusf] ;dGjodf dfl;s ?kdf ug'{kb{5 .

sfo{qmd ;+rfng ePsf] c:ktfndf lgoldt?kdf k|To]s lbg sfo{qmd ;+rfng

ug{'kg]{5 .

sfof{Gjog k|s[of

lhNnf :jf:Yo÷hg:jf:Yo sfof{no tyf :yfgLo lgsfosf] ;dGjodf c:ktfnx?

5gf}6 ug]{ / 5gf}6 ePsf jf klxn] g} 5gf}6 ePsf c:ktfnsf] s]; nf]8 ljZn]if0f


15

u/L cfjZos k'0f{ ljj/0f tof/ ug]{ .

lhNnf :jf:Yo÷hg:jf:Yo sfof{no tyf :yfgLo lgsfosf] ;dGjodf c:ktfnsf

lrlsT;s tyf cGo :jf:Yosld{nfO{ sfo{qmdsf] cf}lrTo, ljwL, /]sl8{ª tyf

l/kf]{l6ª, ck]lIft ;xof]u cflb h:tf ljifodf hfgsf/L u/fpg] .

c:ktfnsf] ;dGjodf sfo{qmd ;xhstf{sf] 5gf}6 ug]{ jf 5gf}6 ul/Psf] ;xhstf{x?

;Fu sfo{qmd ;+rfngsf] nflu ;dGjo ug]{ .

x/]s lbg c:ktfndf pkrf/sf nflu cfPsf, ljz]ift s'kf]if0f Pj+ s8f :jf;–k|:jf;

;+s|d0f ePsf afnaflnsfdf Ifo/f]usf] l:s|lgª ul/ ;Defljt Ifo/f]u e]l6Pdf yk

lgbfg sfo{ ug]{ .

Ifo/f]usf] l:s|lgªdf ;Defljt Ifo/f]usf aRrfsf lgbfgsf nflu tf]lsPsf

lrlsT;ssf]df k|]if0f u/fO{ lgbfg u/fpg] . Ifo/f]usf] lgbfgsf nflu lrlsT;sn]

cfjZostf 7fg] cg';f/ :k'6d dfO{s|f];sf]lk, df]G6', lhg PSPk6{, PS;—/], PkmPgPl;

cflbsf dfWodaf6 Ifo/f]ussf] lgbfg u/fpg] . aRrfn] vsf/ lgsfNg g;Sg] ePdf

Uof;l6«s nfefh lgsfln lhg PS;k6{df kl/If0f u/fO{ Ifo/f]us lgbfg ;'lglZrt ug]{

. olb cGo c:ktfndf /]km/ ul/ lgbfg ug{' kg]{ ePdf Uof;l6«s nfefh 4f/f lhg

PS;k6{ af6 kl/If0f ug]{ Joj:yf ldnfOPsf] c:ktfndf /]km/ ul/ lgbfg ug]{ .

:jf:Yo ;+:yf cyjf c? lhNnf c:ktfnaf6 /]km/ eO{ cfPsf s'kf]lift Ifo/f]usf

;+efljt afnaflnsfx?df Ifo/f]u lgbfg sfo{ ug]{ .

SR n] s'kf]lift afnaflnsfdf Ifo/f]u lgbfg cGt{ut cGo :jf:Yo ;+:yfaf6 k|]if0f e}

cfPsf la/fdLnfO{ lbOg] oftfoft vr{ sfo{qmd ;xhstf{nfO{ k]ZsL :j?k pknAw

u/fpg] / dfl;s ?kdf cfjZos sfuhftx? ;+sng u/L k]ZsL /sd km/5\of}6 ug]{ .

sfo{qmd ah]6df tf]s] jdf]lhd o; sfo{qmd cGt{ut lgbfg sfo{df ;+nUg

lrlsT;snfO{ k|f]T;fxg eQf -z'Ns_ pknJw u/fpg] .

lhNnf :jf:Yo/hg:jf:Yo sfof{no tyf :yfgLo lgsfon] dfl;s ?kdf nIo cg'?k

lgoldt sfo{qmd ;+rfng eP/gePsf] PsLg u/L cfjZos ;dGjo tyf ;xof]u ug]{ .

ck]lIft pknlAw ;Defljt afnaflnsfdf Ifo/f]usf] lgbfg eO{ pkrf/df cfpg] .

cfly{s afF8kFmf8

ah]6 nfO{g

@),@@,@# / @$

-g]kfn ;/sf/sf]

k|rlnt cfly{s P]g

lgodsf] clwgdf /lx


;d]t ug]{ _


@

afnaflnsdf Ifo/f]usf] lgbfg ug{

cfjZos kl/If0f vr{

PS;–

/]÷df]G6'

6]:6 k|lt

lj/fdL

#))

!

#))

Uof;l6«s

nfefh k|lt

lj/fdL

!%)) ! !%))

EP Ifo/f]u lgbfgsf nflu FNAC –

cfjZos afnaflnsfnfO{ dfq_

k|lt lj/fld @))) ! @)))

# c:ktfndf afnaflnsfdf Ifo/f]u

l:s|lgª Pj+ lgbfg u/] jfkt z'Ns

k|lt lj/fld !%) ! !%)

$ c:ktfndf sfo{s|d ;xhstf{nfO{

lbOg] eQf

k|lt dlxgf $))) ! $)))

gf]6 Ifo/f]usf] lgbfgsf nflu pknJw ah]6sf] l;df leq /lx tf]lsPsf lgwfgfTds kl/If0fx? af:tlas

vr{sf cfwf/df ug]{ cyf{t lgbfgfTds kl/If0fsf nflu lbOPsf lzif{sx?df jf:tljs nfUg] vr{sf cfwf/df

lgbfgfTds ;]jfsf nflu lbOPsf] s'n ah]6df af8kmf8 ul/ cfjZostf cg';f/ vr{ ug]{ .

. ah]6 nfO{g @!


16

sfo{qmd lzif{s M

Isoniazid Preventive Therapy (IPT) sfo{qmdsf] ;'?jft tyf lg/Gt/tf

p2]Zo kfFr jif{ eGbf d'lgsf afnaflnsfx?nfO{ ;s[o Ifo/f]u (Active TB) x'gaf6 arfpg] .

nlIft ;d'bfo PBC Ifo/f]usf lj/fdLsf] ;Dks{df /x]sf kfFr jif{ eGbf d'lgsf afnaflnsfx?

sfo{qmd sfof{Gjogsf

dfkb08

SR n] ;DjlGwt k|b]z/If]lqo :jf:Yo lgb]{zgfno / lhNnf hg:jf:Yo÷:jf:Yo

sfof{no tyf :yfgLo lgsfo;Fusf] ;dGjodf sfd ug'{kb{5 .

of] sfo{s|d contact tracing sfo{qmd ;Fu ;DjlGwt ePsfn] Ifo/f]u lj/fldsf

3/kl/jf/sf ;b:odf Ifo/f]usf] l:s|lgª ubf{ IPT sf nflu kfFr jif{ d'lgsf aRrf

;a}nfO{ ;d]6\g' kb{5 . of] sfo{qmd contact tracing ul/g] ;Dk'0f{ :jf:Yo ;+:yfdf

nfu' ug'{kb{5 .

of] sfo{qmdsf] ;kmntf afnaflnsfsf] cleefjsnfO{ IPT ;DjlGw ul/g] k'j{

k/fdz{df lge{/ x'g] ePsfn] :jf:Yosld{n] cleefjsnfO{ k'0f{ / ;xeflud'ns

k/fdz{ ug'{kb{5 .

Ifo/f]usf] s'g} klg nIf0f tyf lrGx gePsf t/ Ifo/f]usf lj/fdLsf] ;Dks{df

ePsf aRrfx? IPT sf nflu of]Uo x'g] 5g\ .

Contact tracing af6 Ifo/f]u ;s[o Ifo/f]u eP gePsf] ;'lglZrttf nflu

:jf:Yo ;+:ydf /]km/ ul/Psf afnaflnsfdf ;s[o Ifo/f]u gePsf] elg

lrlsT;sf jf IPT ;DjlGw cled'lvs/0f lnPsf :jf:Yosld{n] lglZrt u/]l5

cleefjsnfO{ k/fdz{ kZrft IPT ;'? ug'{kb{5 .

IPT sf] cjlw ^ dlxgfsf] x'g] 5 / of] cjlwdf :jf:YosdL{sf] k|ToIf lgu/flgdf

ug{ cfjZos 5}g . t/ :jf:Yo ;+:yfn] x/]s dlxgf cf}ifwL lng cfP gcfPsf] /

aRrfn] 3/df lgoldt cf}ifwL vfP/gvfPsf] ;'lgZrt ug'{kg]{ 5 .

cf}ifwL ;]jg ug]{ aRrfnfO{ x/]s dlxgf Ps dlxgfsf nflu :jf:Yo ;+:yfn] cf}ifwL

pknAw u/fpg]5 .

of] sfo{qmdsf] ;Dk'0f{ ;+rfng tyf cg'udg ;DjlGw lhDd]jf/L lhNnf

:jf:Yo÷hg:jf:Yo sfof{no tyf :yfgLo lgsfosf] ;dGjodf SR sf] x'g] 5 .

:jf:Yo ;+:yfdf IPT sf] ljt/0f / pkef]u, stock sf] nfut /fVg] lhDd]jf/L SR

n] ;DjlGwt :jf:Yo ;+:yfsf] ;xof]udf ug]{ 5 .

sfof{Gjog k|s[of

SR n] lhNnf hg:jf:Yo tyf :jf:Yo sfof{no tyf :yfgLo lgsfo;Fu ;dGjo

ul/ IPT ;]jf lbg] :jf:Yo ;+:yfx?sf] ljj/0f tof/ kfg]{ .

Contact tracing nfu' ul/g] :jf:Yo ;+:yfsf :jf:Yosld{x?nfO{ lbO{g] Ps lbg]

cled'lvs/0f sfo{s|ddf of] ;DjlGw ljifo–a:t' ;dfof]hg u/L cfjZos hfgsf/L

lbg] .

Contact tracing ubf{ s'g} kl/jf/df kfFr aif{ d'lgsf aRrfx? e]l6Pdf IPT sf

nflu contact tracer n] ;DjlGwt :jf:Yo ;+:yfdf k7fpg] .

pQm :jf:Yo ;+:yfsf :jf:Yosld{n] ;f] aRrfdf Ifo/f]usf] lrGx / nIf0fx? eP

gePsf] Plsg ug]{, olb Ifo/f]usf] nIf0f gb]lvPdf pQm aRrfnfO{ IPT z'? ug{

;+:yfdf l;kmfl/; ug]{ .

IPT ;'? ug{' k'j{ jRrfsf] cfdf jfj' tyf cleefjsnfO{ IPT af6 jRrfnfO{ x'g]

kmfO{bf Pj+ o;sf] k|lts'n c;/, Ifo/f]usf lrGx tyf nIf0fsf jf/]df clgjfo{


17

?kdf hfgsf/L u/fpg] .

jRrfx?df IPT lnbf lnb} Ifo/f]usf] lrGx tyf nIf0f jf cGo :jf:Yo ;d:of b]vf

k/]df t'?Gt :jf:Yo ;+:yfdf lnP/ cfpg' k5{ eGg] jf/]df hfgsf/L u/fpg] .

:jf:Yo ;+:yfn] olb IPT lnPsf] aRrfdf Ifo/f]usf] lrGx ,nIf0f tyf cGo :jf:Yo

;d:of ePsf] 5 eg] pQm s'/fsf] lgbfg u/L plrt pkrf/ Joj:yfkg ug]{ . olb

:jf:Yo ;+:yfn] aRrfsf] :jf:Yodf ;d:of jf Ifo/f]u lgbfg ug{ g;Sg] ePdf

dflyNnf] lgsfo jf lgbfg ;'ljwf ePsf] :jf:Yo ;+:yfdf t'?Gt /]km/ ul/ k7fpg] .

l;kmfl/; adf]lhdsf] IPT ;]jf ;'? ug]{ / cf}iflw lbbf Ps dlxgfsf] nflu lbg] .

pQm aRrf cleefjs ;lxt 5 dlxgf ;Dd x/]s dlxgf :jf:Yo ;+:yfdf cfP/

IPT sf] cf}iflw lng] .

pQm aRrfn] cf}iflw vfP gvfPsf] lgoldt cg'udg tyf kmnf]ck ;DjlGwt :jf:Yo

;+:yfn] ug]{ . lj/fdLsf] 3/}df uO x/]s b'O dlxgfsf] km/sdf pkrf/ cjwLe/df

sDtLdf # k6s r]slni6sf] k|of]u u/L kmnf] ck ug]{. -gf]6M kmnf]ck r]slni6 SR

n] agfO{ :jf:Yo ;+:yfnfO{ lbg'kb{5 _.

;DalGwt :jf:Yo ;+:yfn] IPT df btf{ ePsf aRrfx?sf] cfjZos /]s{l8ª tyf

l/kf]{l6ª SR sfo{s|dsf] OPD register sf] clGtd k]hdf ePsf] IPT sf] hfgsf/L

/fVg] dxndf cWofjlws ug]{ . obL gePsf] v08df SR n] /]s{8sf] 9fFrf agfO{

:jf:Yo ;+:yfnfO{ pknAw u/fpg] .

SR n] aRrfx?nfO{ lbOg] oftfoft vr{ ;DalGwt :jf:Yo ;+:yfsf] kmf]sn

JolQmnfO{ k]ZsL lbO{ aRrfx?n] oftfoft vr{ kfP gkfPsf] ;'lglZrt ug]{ / dfl;s

?kdf cfjZos sfuhftx? ;+sng u/L km/\5of}6 ug]{ .

;fy} :jf:Yo ;+:yfaf6 aRrfn] cf}ifwL vfP gvfPsf] ;'lgZrt ug{ aRrfsf] 3/df

uO{ ul/g] cg'udg tyf kmnf]ck cjnf]sgsf] l/kf]{6 / cGo cfjZosLo sfuhftx?

;+sng u/L cg'udg /sd e'QmfgL ug]{ .

ck]lIft pknlAw Ifo/f]usf lj/fdLsf] ;Dks{df ePsf afnaflnsfdf Ifo/f]usf]] ;+s|d0f x'g af6 arfO{

Ifo/f]u ;+s|d0fsf] z[ªvnf cGt ug{ d2t k'Ug] .

cfly{s afF8kFmf8

\ ah]6 nfO{g @%

-g]kfn ;/sf/sf] k|rlnt

cfly{s P]g lgodsf] clwgdf

/lx s/ s§L nufotsf sfo{

;d]t ug]{ _


! aRrfnfO{ IPT ;+sngsf nflu oftfoft vr{ k|lt

dlxgf $)) ^ @$))

@ :jf:YosdL{nfO{ IPT kmnf]ck vr{ - ^ dlxgf

cjlw ;Dd_

k6s ^)) # !*))

sfo{qmd lzif{s M

c:ktfnx?df Ifo/f]u ;+s|d0f /f]syfd tyf lgbfgsf] nflu FAST /0flglt cjnDag

p2]Zo c:ktfndf Ifo/f]usf] ;+qmd0f /f]syfd ug{ ;xof]u k'/\ofpg] .

;+efljt Ifo/f]usf la/fdLsf] Ifo/f]u lgbfg u/L pkrf/df Nofpg]

nlIft ;d'bfo c:ktfnsf] OPD tyf In patient department (Indoor) df cfPsf ;+efljt

Ifo/f]usf la/fdLx?


18

sfo{qmd sfof{Gjogsf

dfkb08

SR n] aRrfdf Ifo/f]u lgbfg sfo{s|d cGt{ut 5gf}6 ePsf c:ktfnx?df of]

sfo{s|d ;+rfng ug'{kb{5 .

k|To]s 5gf}6 ePsf c:ktfndf FAST /0fgLlt sfof{Gjogsf] nflu Ps hgf

sfo{qmd ;xhstf{sf] 5gf}6 ug'{kb{5 .

o; /0flglt cGt{ut Ifo/f]usf] l:s[lgª lrGx tyf nIf0fsf cfwf/df / PS;/]sf

dfWod af6 u/fpg] .

Ifo/f]u sfo{s|daf6 PS; /] dlzg pknJw ePsf c:ktfn] Ifo/f]usf] l:s[lgª

lgz'Ns u/fpg] / cGo xsdf c:ktfnsf] lg0f{o cg';f/ lj/fldnfO{ z'Ns jf

lgz'Ns u/fpg ldNg] .

sfo{qmd ;xhstf{ cfjZostf cg';f/ ;f]xL c:ktfn jf c:ktfn aflx/sf] :jf:Yo

sfo{qmddf cg'ej ePsf] x'g' kb{5 . -gf]6M sfo{qmd ;xhstf{sf] kfl/>lds lghsf]

work load / ah]6 l;df leq /xL SR n] /f=If=s]= dfkm{t PR sf] k'j{ cg'dlt lnO{

vr{ ug{ ;Sg]5g\_ .

sfo{qmd ;xhstf{n] c:ktfndf cfPsf x/]s k|sf/sf la/fdLx?nfO{ la/fdL btf{

x'g] 7fpF b]lv g} vf]sL nfu] gnfu]sf] l:s[lgª u/L cfjZos Joj:yfkg o;

sfo{qmdsf] SOP df /flvPsf] Algorithm cg';f/ ug'{kb{5 .

o; sfo{sf] /]sl8{ª l/kf]{l6ª sfo{s|d ;xhstf{n] SR nfO{ dfl;s?kdf pknAw

u/fpg' kb{5 .

of] sfo{s|d c:ktfn ;+rfng ePsf] x/]s lbg ug'{ kg]{5 .

sfof{Gjog k|s[of

SR n] k|b]z/If]q, lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf]

cfjZos ;dGjodf tf]lsPsf] dfkb08 cg';f/ tf]lsPsf] ;+Vofdf c:ktfnx? 5gf}6

u/L FAST /0flglt cjnDjg ug]{ . -gf]6M obL c:ktfnx? 5gf}6 eO{;s]sf] 5 eg]

;f] c:ktfnx?nfO{ s]; nf]8 sf ;fy} MCH clinic ;+rfngsf] cj:yf ljZn]if0f

u/L lg/Gt/tf lbg ;lsG5 cyjf cGo c:ktfnx? 5gf}6 klg ug{ ;lsG5_ .

c:ktfnsf] ;dGjodf cfjZostf cg'?k sfo{qmd ;xhstf{sf] 5gf}6 Pj+ lgo'lSt

ug]{ .

lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf] ;dGjodf pSt

c:ktfnx?sf] Joj:yfkg kIf tyf cGo ;/f]sf/jfnfx? ;Fu Ps lbgsf]

cled'lvs/0f u/L FAST /0flglt af/] hfgsf/L u/fpg] .

PR ;Fusf] ;dGjodf 5gf}6 ePsf sfo{qmd ;xhstf{nfO{ FAST /0flglt af/] b'O{

lbg] cled'lvs/0f ug{] . cled'lvs/0fdf sfo{qmdsf] cfjZostf, ;xhstf{sf]

e'ldsf tyf lhDd]jf/L -cg';'rL $_, FAST /0flgltsf] cf}lrTo / p2]Zo, /]s{l8ª,

l/kf]{l6ª tyf SR sfo{qmd cGt{ut{sf cGo lqmofsnfkx?sf] af/]df hfgsf/L

u/fpg] .

SR sf] kmf]sn JolQm / sfo{qmd ;xhstf{n] c:ktfnsf] Joj:yfkg;Fu ;dGjo

u/L sfo{qmdnfO{ cfjZos kg]{ :yfg -Separation) sf] Joj:yf ug]{ .

sfo{qmd ;xhstf{n] c:ktfn ;+rfng ePsf] x/]s lbgdf la/fdL btf{ kmfF6;Fu

;dGjo u/L cfPsf k|To]s la/fdLnfO{ vf]sL nfu] gnfu]sf] l:s[lgª ug]{ u/fpg] .

l:s[lgª ubf{ vf]sL nfu]sf] la/fdLsf] OPD card df FAST sf] stamp nufO{

c:ktfndf Joj:yf ul/Psf] 5'§} -Separation) :yfgdf k7fpg] . pSt :yfgdf

;Dk"0f{ la/fdLx?nfO{ cg';'rL @ df /flvPsf] screening questionnaire cg';f/

Ifo/f]usf] l:s[lgª ug]{ ;fy} o; c:ktfndf PS;/] ;]jf pknJw ePdf pQm


19

lj/fldsf] PS;—/] af6 klg Ifo/f]usf] l:s[lgª u/fpg] .

vf]sL nfUbf ;+qmd0f /f]syfdsf nflu d'v 5f]Kg] tyf cGo pkfo ckgfpg'kg]{

ljifosf af/]df hfgsf/L u/fpg] .

Ifo/f]usf] l:s[lgª af6 Ifo/f]usf ;Defljt lj/fld b]lvPdf pQ lj/fldnfO{

Ifo/f]usf] lgbfgsf nflu tn pNn]lvt k|s[of ckgfO{ /f]u lgbfg sf] ;'lglZrt ug]{

.

lhg PS;k6{ ;]G6/ ePsf] c:ktfndf Ifo/f]usf] z+sf:kb JolQmx?sf] vsf/sf]

gd'gf (Spot sample) ;+sng ug]{ / vsf/ hfFr cg'/f]w kmf/fd e/L lhg

PS;k6{df hfFrsf] nflu k7fpg] .

lhg PS;k6{ ;]G6/ gePsf] c:ktfnsf] xsdf vsf/sf] b'O{ j6f -Ps j6f sputum

microscopy / csf]{ lhg PS;k6{ hfFrsf] nflu_ gd'gf (Spot sample) ;+sng

ug]{ / vsf/ hfFr cg'/f]w kmf/fd e/L sputum microscopy / lhg PS;k6{

hfFrsf] nflu k7fpg] ;fy} laxfgsf] vsf/ gd'gf (Morning sample) ;+sngsf]

nflu sputum container lbO{ la/fdLnfO{ csf]{ lbg cfpgsf] nflu ;Nnfx lbg] .

dflysf] k|s[of k'/f eO{;s]kl5 ;f] la/fdLx?nfO{ ;DalGwt lrlsT;ssf] df ;]jf

lngsf] nflu ;se/ nfO{gdf ga;fO{ ;]jf lng] Joj:yf ldnfpg] .

lhg PS;k6{ ;]G6/ cyjf sputum microscopy sf] nflu k7fPsf] vsf/ gd'gf

;f]xL lbgdf hfFr ug]{ / obL hfFr ug{ g;lsPsf] v08df plrt e08f/0f u/L csf]{

lbgdf hfFr u/L l/kf]{6 lbg] .

lhg PS;k6{ hfFraf6 k|fKt l/kf]{6df pNn]lvt l/hN6sf] cfwf/df /fli6«o Ifo/f]u

sfo{qmdsf] treatment guideline cg';f/ pkrf/sf] ;'lglZrt ug]{ . -gf]6M

;xhstf{n] la/fdLnfO{ vsf/ hfFrsf] l/kf]{6 lng] lbg tyf ;dosf] hfgsf/L

u/fpg'kb{5 tyf cfjZostf cg';f/ l/kf]{6 lnP glnPsf] kmnf]ck ug'{ kb{5 ._

sfo{qmd ;xhstf{n] sfo{qmd ;Fu ;DalGwt /]s{l8ª tyf l/kf]{l6ªsf] Joj:yfkg ug]{

;fy} cfjZos /]s{8 tyf l/kf]{6sf] 9fFrf /f=If=s]= af6 pknAw u/fO{g]5 .

SR n] dfl;s ?kdf cfjZos l/kf]{6 ;xhstf{ dfkm{t ;+sng ug]{ ;fy} ;f]

sfo{qmd lgoldt ?kdf k|efjsf/L ?kdf ;+rfng eP gePsf] SR n] lhNnf

:jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfosf] ;dGjodf ;'lglZrt ug]{ .

gf]6M Indoor df egf{ ePsf la/fdLx?sf] klg dfly pNn]lvt k|s[of cg'?k FAST

/0flglt cg';f/ l:s[lgª ug]{ .

ck]lIft pknlAw c:ktfnx?df Ifo/f]usf] ;+qmd0f /f]syfd x'g]5 / ;+efljt Ifo/f]u la/fdLsf] lgbfg tyf

pkrf/ eO{ s]z gf]l6lkms];gdf j[l¢ x'g]5 .

cfly{s afF8kFmf8

ah]6 nfO{g @@




;d]t ug]{ _


! c:ktfndf sfo{s|d ;xhstf{nfO{ -k|lt

dlxgf_ k|lt dlxgf $))) ! $)))

gf]6 pk/f]St s[ofsnfk s]Gb|af6 l:as[t FAST /0flglt k|fKt ePkl5 ug]{ .

sfo{qmd lzif{s M

Ifo/f]usf la/fdLx?df Diabetes Mellitus (DM) sf] l:s[lgª / DM ePsf x?df Ifo/f]usf] l:s[lgª ug]{

cled'lvs/0f tyf /]km/n


20

p2]Zo Ifo/f]u la/fdLx?df DM tyf DM ePsf la/fdLx?df Ifo/f]usf] l:s[lgª u/L TB-

DM ;x ;+s|d0f kQf nufO{ pkrf/ Joj:yfkg ug]{ .

nlIft ;d'bfo DR TB pkrf/ s]Gb|sf DR TB kmf]sn JolQm

lhNnf c:ktfn, c~rn c:ktfn, pk If]lqo c:ktfn, If]lqo c:ktfn / s]lGb|o

c:ktfnx?sf] ;DalGwt lrlsT;sx?

sfo{qmd sfof{Gjogsf

dfkb08

of] sfo{qmd ;+rfng ug{sf] nflu k|b]z/If]lqo :jf:Yo lgb]{zgfno ;Fu ;dGjo u/L

nlIft c:ktfnx? tyf DR TB pkrf/ s]Gb|sf] ;'rL ljj/0f tof/ ug'{kb{5 .

cled'lvs/0fsf] nflu s]Gb| jf k|b]z/If]q ;Fu ;dGjo u/L ;xhstf{sf] Joj:yfkg

ug'{kb{5 . -gf]6M ;xhstf{ DM tyf Ifo/f]usf] af/]df cg'ej ePsf] cyjf TB-DM

;x ;+s|d0f af/] hfgsf/ x'g'kb{5_.

cled'lvs/0fdf TB-DM ;x-;+s|d0fsf] cj:yf, l:s[lgªsf] cf}lrTosf ;fy}

cfjZos pkrf/ Joj:yfkg nufotsf ;fy} cGo ljifoj:t'x? ;dfj]z u/L ;+rfng

ug{ ;lsG5 .

cled'lvs/0f kZrft ck]lIft l:s[lgª eP gePsf] hfgsf/L kmnf]ck /fVg'kb{5 .

sfof{Gjog k|s[of

of] sfo{qmd ;+rfng ug{sf] nflu k|b]z/If]lqo :jf:Yo lgb]{zgfno ;Fu ;dGjo u/L

nlIft c:ktfnx? tyf DR TB pkrf/ s]Gb|sf] ;'rL ljj/0f tof/ u/L

cled'lvs/0fsf] ldtL tf]Sg] .

tof/ ul/Psf] ;'lr cg';f/ c:ktfnx? tyf DR TB pkrf/ s]Gb|nfO{ k|b]z/If]lqo

:jf:Yo lgb]{zgfno dfkm{t ;xefuLtfsf] nflu kqfrf/ ug]{ .

cled'lvs/0fsf] nflu s]Gb| jf k|b]z/If]q ;Fu ;dGjo u/L ;xhstf{sf] Joj:yfkg

ug]{ ;fy} cled'lvs/0fdf ;dfj]z ul/g] ljifoj:t'x?sf] l6kf]6 u/L ;xhstf{nfO{

cfjZos tof/Lsf] nflu ;'lrt ug]{ .

cled'lvs/0fdf rflxg] cfjZos ;fdfu|L nufot cGo sfdx?sf] k"j{ tof/L tyf

af8FkmfF8 ug]{ . ;fy} :yfg, vfhf, :6];g/L, handsout, cflbsf] pknAwtf ;'lgZrLt

ug]{ .

cled'lvs/0f sfo{qmd sfo{ tflnsf cg';f/ ;+rfng ug]{ .

cled'lvs/0fdf DR TB pkrf/ s]Gb|af6 /]km/ ePsf DM sf la/fdLnfO{ ;DalGwt

c:ktfn/lrlsT;sn] /]km/n slip sf] cfwf/df pkrf/ Joj:yfkg ug]{ / ;f]

pkrf/sf] nflu consultation fee sf] /sd SR sf kmf]sn JolQmn] cfjZos

sfuhftsf] cfwf/df e'StfgL ug]{ Jof]xf]/f hfgsf/L u/fpg] .

cled'lvs/0fdf ;xefuL ePsf c:ktfnx?n] ;]jf lng cfPsf DM sf

la/fdLx?df Ifo/f]usf] hfFr / Ifo/f]usf la/fdLnfO{ DM hfFr ug{ ;Nnfx lbg] .

DR TB pkrf/ s]Gb|sf DR TB kmf]sn JolQmn] pkrf/t DR TB la/fdLx?sf]

lgoldt DM sf] hfFr u/L DM ePsf] kQf nfu]df ;DalGwt lrlsT;ssf]df plrt

pkrf/ Joj:yfkgsf] nflu /]km/ ug]{ tyf /]km/ u/]sf] /]s{8 /fVg] .

o; sfo{df /]km/n vr{ SR n] ;DalGwt DR TB kmf]sn JolQmnfO{ k]ZsL pknAw

u/fpg] tyf cfjZos sfuhftx? ;+sng u/L km/5\of}6 ug]{ ;fy} ;DalGwt

la/fdLn] /]km/n vr{ kfP gkfPsf] ;'lgZrt ug]{ .

ck]lIft pknlAw TB-DM ;x-;+qmd0fsf] plrt pkrf/ Joj:yfkg x'g]5 .


21

cfly{s afF8kFmf8

ah]6 nfO{g !@$ / !@%




;d]t ug]{ _


! DR TB pkrf/ s]Gb| df pkrf/t DM sf

la/fdLnfO{ /]km/n -oftfoft_ vr{ k|lt la/fdL %)) ! %))

@ Consultation Fee k|lt la/fdL %)) ! %))

gf]6M sfo{s|d ;DjlGw cled'lvs/0f tf]lsPsf c:ktfnsf ;DjlGwt lrlsT;s tyf l8=cf/= ;]G6/x?df sfo{/t

lrlstT;s jf :jf:Yosld{x?nfO{ o; ls|ofsnksf nflu 5'6\ofPsf] ah]6 cg';f/ ug]{ . lj/fldsf nflu lbO{g]

oftfoft tyf lrlsT;snfO{ lbO{g] kl/If0f z'Ns l8=cf/= ;]G6/sf dfWodaf6 Tolx pkrf/{/t lj/fldsf nflu dfq

ePsf]n] ;f]lx cg';f/ ug]{ . cGo c:ktfndf pkrf/{t tyf lgbfg ePsf Ifo/f]usf lj/flddf dw'd]xsf] lgbfg tyf

pkrf/sf nflu cfly{s ;xof]u xfn o; sfo{s|ddf g/x]sfn] lj/fld / lrlsT;ssf] ;dGjodf ug]{ elg hfgsf/L

u/fpg] .

sfo{qmd lzif{s M

df};dL sfdbf/ k|jf;Lx?df (Seasonal Labor Migrants) Ifo/f]usf] l:s[lgª

p2]Zo Ifo/f]usf] ;Defljt seasonal labor migrants df Ifo/f]u lgbfg ul/ pkrf/df

Nofpg] .

nlIft ;d'bfo Jf}b]lzs /f]huf/ af6 kmls{g] sfdbf/x? (Seasonal labor migrants)

sfo{qmd sfof{Gjogsf

dfkb08

of] sfo{ k|b]z g+= & sf] b'O{ j6f w]/} sfdbf/ kmls{g] gfsf 5gf}6 u/L ;f]xL gfsfx?df

sfo{ ;+rfng ug{' kb{5 .

of] sfo{ ;DalGwt lhNnfsf] sfdbf/ kmls{g] gfsfdf x'g] cf}nf] sfo{qmd;Fu ;dGjo

u/L ug]{ .

of] sfo{ ;+rfng ug{sf] nflu gfsf ePsf] :yfgsf] ;DjlGwt :yflgo lgsfo, lhNnf

k|x/L sfo{fno, 6«flkm|s sfo{fno tyf cGo ;/f]sf/jfnfx?nfO{ sfo{qmdsf] p2]Zo tyf

cf}lrTo jf/] hfgsf/L u/fO{ cfjZos ;xof]u lng] .

lhNnf :jf:Yo/hg:jf:Yo sfo{fno tyf :yflgo lgsfo;Fu ;dGjo ul/ k|To]s gfsfdf

Ifo/f]usf] l:s[lgª ug{ b'O{ hgf outreach workers 5gf}6 ul/ kl/rfng ug]{ .

cfjZostf cg';f/ gfsfdf l:s[lgª x'g] lbg eGbf cGo lbgdf outreach worker

nfO{ lhNnfdf x'g] cGo Ifo/f]usf lgbfgfTds sfo{df ;xlhs/0f sfo{df nufpg] .

Ifo/f]usf] :s[lgªdf e]l6Psf ;Defljt Ifo/f]usf lj/fld af6 Pp6f vsf/sf] gd'gf

lnO{ outreach worker af6 glhsf] lhg PS;k6{ ;]G6/df vsf/ 9'jflg u/fO{

kl/If0f u/fpg] .

Outreach worker 5gf}6 ubf{ lgh ;Fu outreach sfo{, Ifo/f]usf] ;fy} cGo :jf:Yo

sfo{qmdsf] cg'ej ePsf] Joltm 5gf}6 ug]{ .

SR sf kmf]sn Joltm tyf outreach worker n] sfo{qmd ;+rfng x'g] gfsfsf]

pko'tm 7fpFdf Pp6f screening desk :yfkgf ug]{ .

ptm screening desk df Ifo/f]usf] hfgsf/L d'ns ;+b]zx? ;lxtsf] jf]8{ /fVg] tyf

Ifo/f]usf] cGo IEC materials klg /fVg' kb{5 .

;DalGwt outreach worker n] dfl;s ?kdf cfjZos sfuhftx? SR sf kmf]sn

JoltmnfO{ pknAw u/fpg' kb{5 .

sfof{Gjog k|s[of

SR n] 5gf}6 u/]sf outreach worker nfO{ sfo{qmd ;DaGwL cfjZos cled'lvs/0f

(Onsite coaching) u/fO{ cfjZos logistics k|bfg ug]{ .

b'j} outreach worker n] lgoldt ?kdf gfsfdf j;L ef/taf6 g]kfn k|j]z ug]{

Joltmx?sf] cjnf]sg ug{] .


22

ptm Joltm ef/taf6 sfd u/]/ kms]{sf] z+sf nfu]df lgh Joltm sxfF uO{ clejfbg

ug]{, cfkm\gf] kl/ro lbg] / lgh Joltm ef/tdf sfdbf/sf] ?kdf j;]/ kms]{sf] s'/f

Plsg ug]{ .

obL ;f] JolQm ef/tdf sfdbf/sf] ?kdf j;]/ kms]{sf] eP, lghnfO{ ;DalGwt

sfo{qmdsf af/]df hfgsf/L u/fpg] / Ifo/f]usf] l:s[lgªsf] nflu cg'dlt lnO{

screening questionnaire sf] k|of]u ul/ Ifo/f]usf] lrGx nIf0fx?af/] ;f]Wg] .

olb Ifo/f]usf] lrGx tyf nIf0f gb]lvPdf Ifo/f]u af/] :jf:Yo lzIff lbO{ wGojfb

;lxt labf ug{] .

olb lgh Joltm ef/taf6} Ifo/f]u lgbfg eP/ kms]{sf] eP g]kfndf sxf btf{ eO{

cf}ifwL ;]jg ug]{ eGg] s'/fsf] hfgsf/L lbg]] .

olb Ifo/f]usf] ;Defljt lj/fdL ePdf, lghnfO{ vsf/ hfFrsf] dxTjjf/] hfgsf/L

u/fpb} vsf/sf] spot sample ;+sng ug]{ / ptm sample kl/If0fsf] nflu glhssf]

Gene-xpert s]Gb|df df hfFrsf] Joj:yf ldnfpg] . olb vsf/ kl/If0faf6 Ifo/f]u

lgbfg ePdf outreach worker n] hfFrsf] glthf SR sf] kmf]sn JoltmnfO{ hfgsf/L

u/fpg] . kmf]sn Joltmn] ;DjGwLg lj/fdLnfO{ kmf]g dfkm{t lghsf] l/kf]6{sf] jf/]df

j'emfO{ glhssf] :jf:Yo ;+:yfdf pkrf/sf]nflu hfg cg'/f]w ug]{] . csf]{ ljsNk h:t},

olb ;f] la/fdL ;DalGwt lhNnf s} xf] eg] SR kmf]sn Joltmn] la/fdLsf] 7]ufgf ePsf]

:jf:Yo ;+:yfsf] :jf:YosdL{ dfkm{t jf d=:jf=:jo+=;]ljsf kl/rfng u/L pkrf/df

Nofpg] Joj:yf ldnfpg] . obL ;f] la/fdL cGo lhNnfsf] ePdf ;f] lhNnfsf] SR sf]

kmf]sn Joltm jf lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo dfkm{t

;DalGwt :jf:Yo ;+:yfsf] :jf:YosdL{nfO{ l/kf]{6sf] hfgsf/L lbg] / lghnfO{ pkrf/df

NofPsf] ;'lglZrt ug]{ .

Outreach worker n] /]s{8 cg';'lr & /flvPsf] /lhi6/sf] 9fFrf agfO{ cfjZos

hfgsf/L cWofjlws /fVg] .

ck]lIft pknlAw Ifo/f]usf ;Defljt Seasonal labor migrants x?df Ifo/f]u lgbfg eO{ s]z

gf]l6lkms]zgdf j[4L x'g]5 .

cfly{s afF8kFmf8

ah]6 nfO{g !&)




;d]t ug]{ _


! Outreach worker kl/rfng vr{

lj/fld;Fu ul/g] sDo'lgs];g ;d]t k|lt dlxgf ())) ( *!)))

gf]6 M o; sfo{sf] nflu outreach worker nfO{ lbg] /sd k|lt s];sf] cfwf/df ah]6 pNn]v eP klg

cfjZostf cg';f/ SR n] /f=If=s]= dfkm{t PR sf] cg'dlt lnO{ dfl;s ?kdf outreach worker lgo'lQm

u/L sfd nufpg].

sfo{qmd lzif{s M

hf]lvdo'Qm ;d'x (Refugee camps, slum areas, Internally Displaced People (IDP) & others) df

Ifo/f]usf] l:s[lgª

p2]Zo z+sf:kb Ifo/f]usf la/fdLx?df Ifo/f]u lgbfg u/L pkrf/df Nofpg] .

nlIft ;d'bfo Refugee camps, slum areas, Internally Displaced People (IDP) / cGo TB

vulnerable groups


23

sfo{qmd sfof{Gjogsf

dfkb08

of] sfo{qmd ;+rfng x'g] lhNnfdf /x]sf Refugee camps, slum areas, Internally

Displaced People (IDP) / cGo TB vulnerable groups sf] mapping ;DalGwt

lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo;Fusf] ;dGjodf ug'{ kb{5 .

Mapping ubf{ pQm ;d'x sf] location, d'Vo ;/f]sf/jfnf cu'jfx?, ;Dks{ gDa/,

cg'dflgt hg;+Vof, pknAw >f]t ;fwg cflbsf] af/]df hfgsf/L lng' kb{5 .

Outreach Workder lgo'Qm ul/ Ifo/f]usf] l:s[lgª, ;Defljt lj/fldsf] vsf/

;+sng tyf lhg PS;k6{ ;]G6/df vsf/ 9'jflg, lgbfg ePsf lj/fldsf] :jf:Yo

;+:ydf btf{ u/fO{ pkrf/ u/fpg] sfo{ ug]{ . lo outreach worker cfjZostf

cg';f/ lo :yfgx?df l:s[lgª x'g] lbg eGbf cGo lbgdf SR n] cGo Ifo/f]usf

lgbfgfTds sfo{df ;xlhs/0f sfo{df nufpg] .

sfo{qmd ;+rfng k"j{ pQm ;d'xsf cu'jfx?nfO{ sfo{qmd ;DalGw hfgsf/L

cled'lvs/0f a}7sdf lbg' kb{5 ;fy} SofDk ;+rfngsf] lbgdf cfjZostf cg'?k

:jf:yosld{ tyf :jo+ ;]jsx? kl/rfng ug]{ .

Ifo/f]usf] :s[lgªdf kQf nfu]sf ;Defljt Ifo/f]usf lj/fldsf] vsf/ gd'gf ;+sng

ul/ glhssf] lhg PS;k6{ ;]G6/ af6 kl/If0f u/fpg] .

Ifo/f]usf] :s[lgª SofDk x/]s b'O{ dlxgfsf] cGt/fndf ug]{ .

sfof{Gjog k|s[of

lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf] ;dGjodf sfo{qmd

;+rfng ug]{ If]q÷hg;+Vofsf] mapping u/L SofDk ;+rfngsf] nfuL Ps hgf

;+of]hs 5gf}6 ug]{ .

SofDk ;dGjo tyf ;+rfngsf] nflu ;xof]ufy{ kqfrf/ ug]{ .

;DalGwt sfo{qmdsf] nflu cfjZosLo sfo{of]hgf tof/ ug]{

;DalGwt lgsfo ;Fu Ps lbg] cled'lvs/0f uf]i7L a}7s ;+rfng u/L SofDk

;+rfngsf] nflu :jo+ ;]jsx?sf] 5gf}6 ug]{ ;fy} SofDk ;+rfng ug]{ lbg tf]Sg] .

5gf}6 ul/Psf] :jo+ ;]jsx?sf] nflu Ps lbg] sfof{zfnf uf]i7L ;+rfng ug]{ .

SofDk ;+rfng ug'{ k"j{ -slDtdf Ps xKtf cuf8L_ ;DalGwt 7fpFdf SofDk ;DalGw

awareness campaign ug]{, awareness campaign df ;DalGwt IEC materials x?

ljt/0f ug]{, SofDk x'g] lbg, ;do, :yfgsf] af/]df hfgsf/L lbg] ;fy} lgdGq0ff klg

ug]{ .

SofDk ;+rfngsf] nflu cfjZosLo ;fdfu|L, pks/0f, kmd{ km/Dof6 cfbL sf] Joj:yf

ug]{ .

tf]lsPsf] lbgdf SofDk ;+rfng ug]{ .

Ifo/f]u klxrfgsf nfuL pkl:yt ;]jfu|fxLnfO{ l:s[lgª u/L ;+efljt Ifo/f]u

la/fdLx?sf] vsf/sf] gd'gf lhg PS;k6{ hfFrsf nflu Pp6f gd'gf ;+sng ug]{ .

;+sng u/]sf] vsf/ plrt tl/sfn] glhssf] lhg PS:k6{ ;]G6/df :jo+;]jssf]

kl/rfng ul/] lhg PS;k6{df kl/If0f u/fpg]

vsf/ kl/If0fdf Ifo/f]u lgbfg ePdf ;DjlGwt Ifo/f]usf] k|sf/ cg';f/ JolQmnfO{

Ifo/f]u ;DalGw :jf:Yo lzIff lbO{ pkrf/sf] nflu lj/fldsf] kfOs kg]{ glhssf]

Pd=l8=cf/= pkrf/ s]Gb|÷86\; s]Gb|af6 pkrf/sf] ;'lgZrttf u/fpg] .

ck]lIft pknlAw Ifo/f]usf] lgbfgx'g af6 5'6]sf JolQmdf Ifo/f]u lgbfg eO{ pkrf/df cfpg]5g\ .


24

cfly{s afF8kFmf8




;d]t ug]{ _

SR sfo{s|dsf] detail budget sheet df pNn]v jf afF8kmfF8 eP cg';f/ cfjZos sfuhftx? tyf

k|s[of k'/f u/L sfo{s|d ;DjlGw cf]l/PG6];g ug]{ .

SofDksf xsdf cfjZo ;+Vofdf SofDk ;+rfng ug]{ lbgsf nflu ljlgof]hg ul/Psf] ah]6 dWo]af6 PR

sf] k'j{ l:js[lt lnO{ outreach helath worker lgo'Q ug]{ / Ifo/f]usf] lgoldt :s[lgª Pj+

kl/If0f u/fpg] / cGo lbgdf :jf:Yo ;+:yfx?df Ifo/f]usf] lgbfgsf nflu ;+rfng ul/Psf cGo

sfddf ;xlhs/0fsf nflu k|of]u ug]{ .

ah]6df sfo{s|d ;+rfng :jf:Yosld{sf] ;+nUgtfdf dfO{s|f];sf]lks SofDk ;+rfg ug]{ elg ah]6

;djlgwt lzif{sx?df ah]6 af8kmf8 ePtfklg sfo{s|dsf] k|efjsf/Ltf / Ifo/f]u sfo{s|dsf]

PNuf]l/bddf Ifo/f]usf pRr hf]lvddf ePsf JolQmdf Ifo/f]usf] lgbfg lhg PS;k6{af6 ug]{ lglt

cg';f/ of] sfo{s|ddf ;+rfngsf] ks[ofdf s]lx kl/dfh{g ePsf] 5 .

sfo{qmd lzif{s

sf/fu/ (Prison) df Ifo/f]usf] l:s[lgª

p2]Zo ;+efljt Ifo/f]usf la/fdLx?df Ifo/f]u lgbfg u/L pkrf/df Nofpg] .

nlIft ;d'bfo sf/fuf/df /x]sf s}bLx? jf y'g'jfx?

sfo{qmd sfof{Gjogsf

dfkb08

lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf] ;dGjodf lhNnfdf

/x]sf sf/fuf/x?sf] mapping ug'{ kb{5 . Mapping ubf{ sf/fuf/sf] location, d'Vo

;/f]sf/ JolQmx?, ;Dks{ gDa/, cg'dflgt s}bLx?sf] ;+Vof, pknAw >f]t ;fwg cflb

sf] af/]df hfgsf/L lng' kb{5 .

;DalGwt sf/fuf/sf] cflwsfl/s lgsfonfO{ SofDksf] ;+rfng af/]df, SofDksf]

cf}lrTo, dxTj tyf cfjZos ;xof]usf] af/]df hfgsf/L lbg'kb{5 .

sfof{Gjog k|s[of

lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf] ;dGjodf sfo{qmd

;+rfng ug{ sf/fuf/sf] mapping ug]{ .

SofDk ;dGjo tyf ;+rfngsf] nflu ;xof]ufy{ kqfrf/ ug]{ .

;DalGwt sfo{qmdsf] nflu cfjZosLo sfo{of]hgf tof/ ug]{ .

;DalGwt lgsfo ;Fu a}7s ;+rfng u/L SofDk ;+rfngsf] nflu team 5gf}6 ug]{ ;fy}

SofDk ;+rfng ug]{ ldtL / ;do tf]Sg] .

SofDk ;+rfngsf] nflu cfjZosLo ;fdfu|Lx?, pks/0f, kmd{ km/Dof6 cfbL sf]

Joj:yf ug]{ .

tf]lsPsf] lbgdf SofDk ;+rfng ug]{ .

Ifo/f]u klxrfgsf nfuL pkl:yt ;]jfu|fxLnfO{ l:s[lgª u/L ;+efljt

Ifo/f]usf] la/fdLx?sf] lhg PS;k6{df vsf/ hfFrsf nflu Pp6f gd'gf

;+sng ug]{]{ .

;+sng u/]sf] vsf/ plrt tl/sfn] glhssf] lhg PS:k6{ ;]G6/df nlu

kl/If0f u/fpg]

vsf/ kl/If0fdf Ifo/f]u lgbfg ePdf ;DjlGwt Ifo/f]usf] k|sf/ cg';f/

JolQmnfO{ Ifo/f]u ;DalGw :jf:Yo lzIff lbO{ pkrf/sf] nflu lj/fldsf] kfOs

kg]{ glhssf] Pd=l8=cf/= pkrf/ s]Gb|÷86\; s]Gb|df ;dGjodf pkrf/sf]

;'lgZrtf ug]{ . ck]lIft pknlAw sf/fuf/df /x]sf z+sf:kb Ifo/f]u la/fdLdf Ifo/f]u lgbfg eO{ pkrf/df cfpg].


25

cfly{s afF8kFmf8




;d]t ug]{ _

SR sfo{s|dsf] detail budget sheet df pNn]v jf afF8kmfF8 eP cg';f/ cfjZos sfuhftx? tyf k|s[of

k'/f u/L ah]6sf] Joj:yfkg ug]{ .

sfo{qmd lzif{s

:jf:YosdL{x?nfO{ ANC / IMCI df cfPsf ue{jtL dlxnfx?sf] Ifo/f]u l:s[lgª af/] cled'lvs/0f

p2]Zo ue{jtL dlxnfx?df Ifo/f]u lgbfgsf] nflu :jf:YosdL{x?sf] Ifdtf clej[l¢ ul/

Ifo/f]usf] lgbfg ug]{ .

nlIft ;d'x ANC÷IMCI / DOTS Center df sfd ug]{ :jf:yosld{x?

sfo{qmd sfof{Gjogsf

dfkb08

of] sfo{s|d ;+rfng ubf{ lhNnfdf /x]sf :jf:Yo ;+:yfx? -s'kf]lift afnaflnsfdf

Ifo/f]u lgbfg ug]{ sfo{s|d /x]sf] :jf:Yo ;+:yfx? ;d]t_ sf] ;'lr tof/ ug]{

/ t'ngfTds?kdf ANC ;]jf w]/} lng] :jf:Yo ;+:yfx?nfO{ k|fyldlss/0f ubf}{

tf]lsPsf] nIo cg';f/sf :jf:Yo ;+:yfsf pNn]lvt nlIft ;d'xsf :jf:Yo sld{nfO{

cled'lvs/0f ug]{ .

of] sfo{s|d kl/jf/, dft[lzz' sfo{s|d;+usf] ;dGjo tyf ;xeflutfdf ug]{ .

cled'lvs/0f kZrft lo :jf:Yo ;+:yfx?df ANC ;]jfsf nflu cfPsf cfdfx?df

Ifo/f]usf] lrGx tyf nIf0fsf cfwf/df l:s[lgª ul/ ;Defljt Ifo/f]usf lj/flddf

Ifo/f]usf] lgbfg ug]{ jf lgbfgsf nflu cGo :jf:Yo ;+:yfdf /]km/ ug]{ .

sfof{Gjog k|s[of

SR n] lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf] ;dGjodf

ANC / IMCI ;]jf ePsf :jf:Yo ;+:yfx?sf] ;'lr ljj/0f tof/ u/L

cled'lvs/0fsf] ldtL / ;do tf]Sg] ;fy} ;xefuLtfsf] nflu kqfrf/ ug]{ .


Ifo/f]us sfo{s|dsf] kmf]sn JolQm jf kl/jf/÷dft[lzz' :jf:Yo sfo{s|dsf kmf]sn

JolQmnfO{ cled'lvs/0f ;xhstf{sf ?kdf k|of]u ug]{ .

ANC ;]jf lng cfPsf cfdfx?df Ifo/f]usf] l:s[lgª, lgbfg tyf k|]if0f / o; ;DjlGw

/]sl8{ª l/kf]l6{ª Pj+ ue{jlt dlxnfx?klg Ifo/f]usf] hf]lvddf kg{ ;Sg] sf/0f cflb

ljifodf cled'lvs/0f ug]{ .

cled'lvs/0fdf :jf:YosdL{x?n] :jf:Yo ;+:yfdf cfPsf ue{jtL dlxnfx?df

Ifo/f]usf] l:s[lgª u/L lgbfg ug]{ jf lgbfgsf nflu ;DalGwt 7fpFdf k]|if0f ug]{ /

o; sfo{sf] ;Dk'0f{ ljj/0f tf]lsPsf] /lhi6/df cWofjlws ug]{ / o; sfo{sf] k|ult

ljj/o0f ;DjlGwt lgsfonfO{ pknJw u/fpg] .

SR n] cled'lvs/0f kZrft\ ;f] sf] hfgsf/L kmnf]ck ug]{ .

ck]lIft pknlAw ue{jtL dlxnfx?df Ifo/f]u lgbfgsf nflu :jf:YosdL{x?sf] Ifdtf clej[l¢ x'g]5 /

Ifo/f]u ;dodf lgbfg eO{ s]; gf]l6lkms];gdf j[l¢ x'g]5 .

cfly{s afF8kFmf8


cfly{s Pg lgodsf] clwgdf


;d]t ug]{ _




26

sfo{qmd lzif{s

Ifo/f]u lgbfg, pkrf/ tyf s]; gf]l6lkms]zgdf lghL :jf:Yo ;+:yfnfO{ d'n k|jfxLs/0fdf Nofpg] (Pay for

Perfornace to Private Doctors)

p2]Zo lghL :jf:Yo ;+:yf tyf lSnlgsdf df lgbfg tyf pkrf/df /x]sf Ifo/f]u

lj/fdLx?nfO{ d'n k|jfxLs/0f u/L Ifo/f]usf] s]z gf]l6lkms];gdf yk ug]{ .

nlIft ;d'bfo lglh :jf:Yo ;+:yf tyf lSnlgsdf sfd ug]{ / t'ngfTds?kdf Ifo/f]usf] w]/} lgbfg

ug]{ lrlsT;sx?

sfo{qmd sfof{Gjogsf

dfkb08

of] sfo{s|d dxfgu/kflnsf tyf pkdxfgu/kflnsfdf jf SR nfO{ tf]lsPsf lhNnfdf

ug'{ kb{5 .

o; sfo{s|dsf nflu 5gf}6 x'g] lrlsT;sx? cf};tdf k|lt dlxgf $÷% hgf Ifo/f]u

lgbfg ug]{ x'g'kb{5 .

o; sfo{s|ddf cfj¢ x'g] lrlsT;snfO{ lgbfg tyf pkrf/df /x]sf x/]s Ifo/f]usf

lj/fldnfO{ o; sfo{sf nflu lasf; ul/Psf] online software dfkm{t notification

ug'kg]{ s'/fsf] hfgsf/L lbg'kb{5 .

;DalGwt lrlsT;s jf p:n] tf]s]sf] JolQmn] lgoldt online reporting ug'{kb{5 /

;f] sf] lgoldt kmnf]ck SR sf] kmf]sn Joltmaf6 ePsf] x'g'kb{5 .

sfof{Gjog k|s[of

dxfgu/kflnsfdf !) hgf / pkdxfgu/kflnsf tyf tf]lsPsf cGo gu/kflnsfdf %

hgf lrlsT;s 5gf}6 ug]{ .

pk{o'St lrlsT;sx?sf] klxrfg ;DjlGwt lhNnfsf Ifos'i7 kmf]sn k;{g jf lo

lrlsT;x?sf af/]df hfgsf/L ePsf JolQm jf ;+:yfx?, dxfgu/kflnsf tyf

pkdxfgu/kflnsfsf :jf:Yo ;+of]hs cflbsf] ;dGjo tyf k/fdz{df ug]{ .

klxrfg ePsf lrlsT;x?nfO{ SR n] Ifos'i7 kmf]sn k;{g jf :yflgo lgsfosf :jf:Yo

;+of]hs ;lxt ;DjlGwt lrlsT;ssf]df u} o; sfo{sf nflu pknAw u/fOPsf] ;]jf

;'ljwfsf] ;fy} sfo{sf] cf}lrTo, dxTj tyf cfjZostfsf] jf/]df hfgsf/L u/fpg] .

o; sfo{s|ddf cfj¢ x'g rfxg] lrlsT;s / p:sf] ;xof]lu 5gf}6 ul/ online

software ;DjlGw tflnd lbg] / oL lrlsT;s af6 Ifo/f]usf] lgbfg tyf pkrf/sf]

ljj/0f o;} software dfkm{t u/fpg] .

SR n] k|lt dlxgf lrlsT;sx?nfO{ e]6 ul/ nIo cg'?k sfo{ eP gePsf] 5nkmn ug]{

. lrlsT;sx?n] u/]sf] Ifo/f]usf] gf]l6lkms];g tyf pkrf/ u/]sf] Plsg ul/ k|dfl0ft

x'g] cfjZos 8s'd]G6 ;+sng ul/ sfo{s|dn] tf]s]sf] /sd pknJw u/fpg] .

lrlsT;sn] Ifo/f]u lgbfg ePsf] JolQmnfO{ cfkm\g} lgu/flgdf pkrf/ u/fPdf pQm

lj/fldnfO{ /fli6«o Ifo/f]us sfo{s|d cGt{ut lglZrt ul/Psf] pkrf/sf] dfkb08

cg';f/ pkrf/ k'/fu/fPdf dfq sfo{s|ddf tf]lsPsf] /sd pknJw u/fpg] .

ck]lIft pknlAw lglh lrlsT;sx/af6 Ifo/f]u lj/fdLsf] ljj/0f /f=If=sf= df l/kf]{6 eO{ s]z gf]l6lkms]zgdf

a[l4 x'g] .

cfly{s afF8kFmf8

ah]6 nfO{g @)$ /

@)&


! Ifo/f]u lj/fdL lgbfg u/L pkrf/ u/]sf]

online reporting df l/kf]{6 -gf]l6lkms];g_ u/]

k|lt

lj/fdL @)) ! @))


27




;d]t ug]{ _

jfkt

@

pkrf/ u/]sf] Ifo/f]u lj/fdLsf] pkrf/ glthf

;xLt online reporting df kmnf]ck l/kf]{6 -

gf]l6lkms];g_ u/] jfkt

k|lt

lj/fdL $)) ! $))

sfo{qmd lzif{s

dfOqmf]:sf]kL s]Gb|x?df k'j{fwf/ ljsf;sf] nflu ;xof]u sfo{qmd

p2]Zo dfOqmf]:sf]kL s]Gb|x?sf] k'j{fwf/ ljsf; u/L Ifo/f]u lgbfg sfo{nfO{ k|efjsf/L agfpg

;xof]u k'/\ofpg] .

nlIft ;d'bfo Sputum transportation sf] nflu ;dflxt -link_ ePsf dfOqmf]:sf]kL s]Gb|x?

sfo{qmd sfof{Gjogsf

dfkb08

SR sf] kmf]sn JolQmn] lhNnfdf ePsf] dfOqmf]:sf]kL s]Gb|x?sf] ;'lr ljj/0f tof/ ug{]

.

dfOqmf]:sf]kL s]Gb|x?sf] cg';'lr ^ ;+nUg ul/Psf] Assessment kmf/d k|of]u ul/

Assessment ug{] .

Assessment sf] cfwf/df lhNnf :jf:Yo/hg:jf:Yo sfo{fno jf :yflgo lgsfo;Fusf]

;dGjodf k'jf{wf/ ljsf;sf] nflu dfOqmf]:sf]kL s]Gb|x?sf] k|fyldlss/0f ug]{ .

k|fyldstfsf cfwf/x? oL x'g ;S5g\ M

dfOqmf]:sf]lk s]Gb|df Ifo/f]u lgbfg hfFrsf] nf]8

dfOqmf]:sf]lk s]Gb|sf] cfjZostf

dfOqmf]:sf]lk s]Gb| sputum transportation df link ePsf]

dfOqmf]:sf]lk s]Gb|df sd{rf/Lsf] lgoldt pknAwtf sf] ;fy} functional ePsf]

dfOqmf]:sf]lk s]Gb| /f=If=sf= df ;+nUg ePsf] cflb .

sfof{Gjog k|s[of

SR sf] kmf]sn Joltm n] lhNnf :jf:Yo/hg:jf:Yo sfo{fno jf :yflgo lgsfo;Fu

;dGjo u/L lhNnfdf ePsf dfOqmf]:sf]kL s]Gb|x?sf] k|fylds/0f u/L ;'lr ljj/0f tof/

ug]{ .

SR sf] kmf]sn Joltmn] ;'rL ljj/0f cGt{utsf dfOqmf]:sf]kL s]Gb|x?sf] cg';'lrdf

;+nUg ul/Psf] kmf/d k|of]u ul/ assessment ug]{ .

Assessment af6 kQf nfu]sf] cfjZostf tyf jh]6df ePsf ;fdu|Lx?sf] tfnd]n

ldnfO{ lhNnf :jf:Yo/hg:jf:Yo sfo{fno jf :yflgo lgsfo;Fusf] ;dGjodf ul/

k'jf{wf/ ljsf;sf] nflu l;kmfl/; lng] .

l;kmfl/;sf] cfwf/df cfjZos ;fdu|Lx? SR n] cfjZos k|s[of cg'?k vl/b ul/

;DjGwLt dfOqmf]:sf]kL s]Gb|nfO{ x:tfGt/0f ug]{ .

pknAw u/fO{Psf] ;fdu|Lx? lhNnf :jf:Yo/hg:jf:Yo sfo{fno jf :yflgo lgsfo jf

;DjGwLt dfOqmf]:sf]kL s]Gb|df bflvnf ePsf] s'/f SR sf] kmf]sn Joltmn] ;'lglZrt

ug]{ .

;fdfg vl/b ubf{ SR n] cfkm\gf] vl/b lgb]{lzsf jf PR n] pknAw u/fPsf] lgb]{zg

cg';f/ ug]{ .

ck]lIft pknlAw dfOqmf]:sf]kL s]Gb|x?df k'j{fwf/ ljsf; eO{ Ifo/f]u lgbfgdf ;xof]u k'Ug]5 .


28

cfly{s afF8kFmf8

ah]6 nfO{g !#(




;d]t ug]{ _


! k'jf{wf/ ljsf; tyf ;+s|d0f lgoGq0fsf] nflu

;fdfgx? Eof6 afx]s

dfOqmf]:sf]lk

;]G6/ &%,@@! ! &%,@@!

sfo{qmd lzif{s

ljBfnox?df ljBfyL{x?sf] nfuL Ifo/f]usf] cled'lvs/0f

p2]Zo ljBfyL{x?df Ifo/f]usf] af/]df hgr]tgf clej[l4 x'g]5 .

nlIft ;d'bfo sIff *, (, !), !! / !@ sf ljBfyL{x?

sfo{qmd sfof{Gjogsf

dfkb08


sfo{qmd ;+rfng ug'{kg]{ lhNnfx?df /x]sf ljBfnox?sf] mapping u/L ;'rL ljj/0f

tof/ ug'{ kb{5 .

cled'lvs/0fsf] nflu Ifo/f]usf] case load w]/} ePsf :yflgo ljBfnox?nfO{

k|fylds/0fdf /fVg'kb{5 .

cled'lvs/0fsf] nflu ;xhstf{ ;DalGwt :s'n ePsf] kflnsfsf] ;+of]hs/;x ;+of]hs

cyjf glhssf] :jf:Yo ;+:yfsf :jf:YosdL{ x'g' kb{5 .

sfof{Gjog k|s[of

SR n] lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fu ;dGjo ul/

cled'lvs/0fsf] cfjZos tof/L ug]{ . cfjZos tof/Ldf ;xhstf{sf ;fy} logistics,

kmd{ km/d]6 tyf IEC materials klg Joj:yfkg ug]{ .

sfo{qmd ;+rfngsf] nflu ;DalGwt ljBfnox?;Fu ;dGjo u/L cled'lvs/0fsf] lbg

tf]Sg] .

cled'lvs/0fsf] sfo{tflnsf agfO{ ;+rfng ug]{ ;fy} cled'lvs/0fdf ljBfyL{x?nfO{

cfjZos IEC materials klg ljt/0f ug]{ .

cled'lvs/0fdf ;xefuL ljBfyL{x?nfO{ Ifo/f]usf] hfgsf/L cfkm\gf] 3/kl/jf/ tyf

;d'bfodf lbg k|f]T;fxg ug]{ ;fy} ljBfnosf] :jf:Yo lzIff ;DaGwL sfo{qmdx?df

Ifo/f]usf] hfgsf/L lgoldt ?kdf lbgsf] nflu ljBfnonfO{ ;Nnfx lbg] .

ck]lIft pknlAw ljBfyL{x?df Ifo/f]usf] af/]df hgr]tgfsf] clej[l4 x'g]5 .

cfly{s afF8kFmf8




;d]t ug]{ _



sfo{qmd lzif{s M

lghL :jf:Yo ;]jf k|bfosx?;Fu /fli6«o Ifo/f]u sfo{qmd ;DaGwL hfgsf/Ld"ns cGt/lqmof sfo{qmd

p2]Zo lghL :jf:Yo ;]jf k|bfosx?nfO{ /fli6«o Ifo/f]u sfo{qmdsf] lgbfg tyf pkrf/

protocol ;DaGwL hfgsf/L u/fO{ k|efjsf/L ;/sf/L lghL ;fem]bf/L sf] partnership

modality (PPM) sf] af/]df hfgsf/L lbg]

nlIft ;d'bfo Ifo/f]u ;]jf k|jfxdf ;+nUg s'g} klg lghL ;]jf k|bfosx?


29

/fli6«o Ifo/f]u sfo{qmddf ;+nUg eO{ ;xof]u ug{ OR5's ;]jf k|bfosx?

sfo{qmd sfof{Gjogsf

dfkb08

SR n] ;DalGwt lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo;Fusf]

;dGjodf lhNnfdf /x]sf gu/kflnsf jf pk gu/kflnsf jf dxf gu/kflnsfdf /x]sf

;]jf k|bfosx?sf] ljj/0f tof/ kfg'{kb{5 .

tof/ ul/Psf] ljj/0f af6 Sensitization a}7sdf ;xefuLtfsf] nflu nlIft ;d'xdf

pNn]v ePsf] ;]jf k|bfosx?nfO{ 5gf}6 ug'{kb{5 .

a}7sdf p7]sf ljifoj:t'x?sf] tyf partnership modality (PPM) sf] ;'emfjx?

;+sng u/L SR n] /fli6«o Ifo/f]u s]Gb| nfO{ PR dfkm{t l/kf]{6 pknAw u/fpg' kb{5 .

sfof{Gjog k|s[of

SR n] ;DalGwt lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo;Fusf]

;dGjodf ;xefuLx? 5gf}6 u/L a}7ssf] lbg tf]Sg] .

tf]lsPsf] lbgdf a}7ssf] nflu ;DalGwt ;]jf k|bfosx?nfO{ ;xefuLtfsf] nflu

;DaGlwt lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo dfkm{t kqfrf/ ug]{ .

a}7s ;+rfngsf] nflu cfjZosLo sfo{of]hgf tof/ ug]{ ;fy} cfjZos ;fdfu|Lx?sf]

klg pknAwtf ;'lgZrt ug]{ .

;DalGwt lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfosf] g]t[Tjdf a}7s

;+rfng ug]{ .

/fli6«o Ifo/f]u sfo{qmddf ;+nUg eO{ ;xof]u ug{ OR5's ;]jf k|bfosx?sf] ;'lr a}7s

kZrft\ tof/ u/L ;DalGwt lgsfo;Fu link u/fO{ ;+nUg u/fpg cfjZos kxn ug]{ .

ck]lIft pknlAw lghL ;]jf k|bfosx? /fli6«o Ifo/f]u sfo{qmddf ;+nUg eO{ Ifo/f]u cGTosf] nIo k|fKtLsf]

nflu ;xof]u ug]{5g\ .

cfly{s afF8kFmf8




;d]t ug]{ _



sfo{qmd lzif{s M

sf/fuf/df sfd ug]{ :jf:YosdL{x?sf] nflu Ifo/f]u ;DalGw b'O{ lbg] tflnd

p2]Zo z+sf:kb Ifo/f]uLsf] ;dod} lgbfg u/L pkrf/df Nofpgsf] nflu ;DalGwt

:jf:YosdL{x?sf] Ifdtf clej[l¢ ug]{ .

nlIft ;d'bfo sf/fuf/df sfd ug]{ :jf:YosdL{x?

sfo{qmd sfof{Gjogsf

dfkb08

SR n] ;DalGwt lgsfo;Fusf] ;dGjodf lhNnfdf /x]sf] sf/fuf/sf] hfgsf/L

tyf listing ug'{kb{5 .

;xefuL :jf:YosdL{x? sf/fuf/sf] :jf:Yo ;'wf/df sfo{/t x'g'kb{5 .

sfof{Gjog k|s[of

SR n] ;DalGwt lgsfo;Fusf] ;dGjodf lhNnfdf /x]sf] sf/fuf/sf] hfgsf/L tyf

listing ug'{kb{5 .

sfo{qmdsf] nflu lhNnf :jf:Yo/hg :jf:Yo sfof{no tyf :yfgLo lgsfo ;Fusf]

;dGjodf tflndsf] lbg tf]sL ;DalGwt sf/fuf/nfO{ kqfrf/ ug]{ .

tflnd ;+rfngsf] nflu ;xhstf{ ;fy} >f]t JolQmsf] 5gf}6 u/L cfjZosLo

tof/Lsf] nflu ljifoj:t'sf] af/]df hfgsf/L lbg] .

tflndsf] nflu cfjZos sfo{of]hgf tof/ ug]{ ;fy} cfjZos ;fdfu|Lx?sf]


30

pknAwtf klg ;'lgZrt ug]{ .

tf]lsPsf] lbgdf tflnd ;+rfng ug]{

tflnd kZrft\ z+sf:kb Ifo/f]uLsf] ;dod} lgbfg u/L pkrf/df Nofpgsf] nflu

;DalGwt :jf:YosdL{x?nfO{ k|f]T;fxg ug]{ .

ck]lIft pknlAw z+sf:kb Ifo/f]uLsf] ;dod} lgbfg u/L pkrf/df Nofpgsf] nflu ;DalGwt

:jf:YosdL{x?sf] Ifdtf clej[l¢ x'g]5 .

cfly{s afF8kFmf8




;d]t ug]{ _


k|s[of k'/f u/L ah]6sf] Joj:yfkg ug]{ .

sfo{qmd lzif{s M

sf/fuf/df sfo{/t gfOs] tyf efO{ gfOs] x?nfO{ Ifo/f]u ;DaGwL Ps lbg] cled'lvs/0f

p2]Zo Ifo/f]u ;DalGw cled'lvs/0f ug]{ .

nlIft ;d'bfo sf/fuf/df sfo{/t gfOs] tyf efO{ gfOs]x?

sfo{qmd sfof{Gjogsf

dfkb08

SR n] ;DaGlwt sf/fuf/sf] cflwsfl/s lgsfo ;Fusf] ;dGjodf cled'lvs/0fsf]

of]hgf agfpg'kb{5 .

cled'lvs/0f sf/fuf/df sfo{/t :jf:YosdL{x?nfO{ lbOg] tflnd kZrft ug'{ kb{5

;fy} sfo{qmd ;xhstf{ ;DalGwt sf/fuf/df sfo{/t tflnd k|fKt :jf:YosdL{ x'g'

kb{5 .

sfof{Gjog k|s[of

SR n] ;DalGwt sf/fuf/sf] cflwsfl/s lgsfo ;Fu sf] ;dGjodf cled'lvs/0fsf]

lbg tf]Sg] .


;dGjodf cled'lvs/0fsf] nflu ;DalGwt sf/fuf/nfO{ kqfrf/ ug]{ .

cled'lvs/0fsf] nflu cfjZos sfo{of]hgf tof/ ug]{ ;fy} cfjZos ;fdfu|Lx?sf]


tf]lsPsf] ldtL / ;dodf cled'lvs/0f ;+rfng ug]{

tflnd kZrft\ z+sf:kb Ifo/f]uLsf] ;dod} lgbfg u/L pkrf/df Nofpgsf] nflu

;DalGwt ;xefuLx?nfO{ k|f]T;fxg ug]{ .

ck]lIft pknlAw ;xefuL gfOs] tyf efO{gfOs]x? n] z+sf:kb Ifo/f]uL kQf nufpg ;Sg]5g\ ;fy}

z+sf:kb Ifo/f]u la/fdLx?nfO{ ;dod} lgbfgsf] nflu /]km/ ug]{5g\ .

cfly{s afF8kFmf8




;d]t ug]{ _



sfo{qmd lzif{s

:yflgo lgsfosf ;Dks{ Joltm tyf k|ltlgwLx?nfO{ Ifo/f]u sfo{s|d ;DjGwL tflnd -cled'lvs/0f_

p2]Zo ;xefuLx?nfO{ /fli6«o Ifo/f]u sfo{s|dsf] gLlt, /0flglt tyf sfo{s|d jf/]

hfgsf/L k|bfg ug]{ .

/fli6«o Ifo/f]u sfo{s|dsdf :yflgo lgsfosf] ;xof]u k|fKt ug]{ .


31

;xefuL hDdf ;xefuL ;+Vof !% hgf

of] sfo{qmd ;+rfng gePsf lhNnfsf] kflnsfsf k|d'v, pkk|d'v, k|d'v k|;f;lso

clws[t, :jf:Yo ;+of]hs, :jf:Yo ;x ;+of]hs, j8f cWoIfx? dWo] :jf:Yosf

hfgsf/ ;xefuL x'g]5g\ .

of] sfo{qmd ;+rfng eO;s]sf lhNnfx?df :jf:Yo ;x-;+of]hs tyf j8f cWoIfx?

dWo] s]xL ;xefuL x'g]5g\ .

;xhstf{ Ifos'i7 clws[t/;'k/efOh/ / SR sf] lhNnf kmf]sn Joltm,

cjwL ! lbg

sfo{qmd sfof{Gjogsf

dfkb08

SR n] of] sfo{qmd k|b]z/If]q / lhNnf :jf:Yo/hg:jf:Yo sfo{fno tyf :yflgo

lgsfo;Fu ;dGjo u/L sfo{s|d ;+rfng ug{' kb{5 .

sfo{qmd ;+rfng ug{' Ps xKtf k'j{ :yflgo lgsfo;Fu ;dGjo u/L ;xefuLx?nfO{

hfgsf/L u/fpg' kg]{5 tyf cGo cfjZos ;fdu|Lx?sf] Joj:Yffkg ug{' kg]{ 5 .

cled'lvs/0fsf] ljifo j:t'x?sf] k|:t'lts/0f tof/ ug{' kb{5 .

cled'lvs/0fsf ljifo

j:t'x?

g]kfndf tyf ;DjGwLt lhNnf / kflnsfdf Ifo/f]usf] cj:yf, /li6«o Ifo/f]u

sfo{s|dsf] gLlt, /0flglt, pb]Zo, txut lhDd]jf/Lx?, :yflgo lgsfodf ePsf

Ifo/f]usf sfo{s|d -Red book tyf SR dfkm{t_, :yflgo lgsfosf] e'ldsf /

cfjZostf cg';f/ cgo ljifoj:t'x?

sfof{Gjog k|s[of

cled'lvs/ofsf Ps xKtf k'j{ cfjZos sfo{of]hgf tof/ ug]{ ;fy} cfjZos

;fdfu|Lx?sf] pknAwtf klg ;'lgZrt ug]{ .


;dGjodf cled'lvs/0fsf] ldlt tyf :yfg tf]sL kqfrf/ ug]{ .

tf]lsPsf] lbgdf cled'lvs/0f ;+rfng ug]{

cled'lvs/0fjf6 p7]sf 5nkmsf ljifx? l6kf]6 ul/ ;DaGwLt lgsfo;Fu 5nkmn

ug]{ tyf PR nfO{ klg hfgsf/L u/fpg] .

ptm cled'lvs/0fsf] k|ltj]bg tof/ ul/ ;DjGwLt lgsfonfO{ pknAw u/fpg] .

ck]lIft pknlAw :yflgo lgsfosf k|ltlgwLx?df Ifo/f]u sfo{s|d ;DjGwL r]tgf clej[4L x'g]5 .

:yflgo lgsfon] Ifo/f]u sfo{s|dnfO{ rflxg] cfjZos ;xof]u pknAw ug]{5 .

cfly{s afF8kFmf8




;d]t ug]{ _



sfo{qmd lzif{s

sf/fuf/df Ifo/f]uLsf] nflu /0fgLlt tyf tflndsf] kf7\oqmd lgdf{0f ;DaGwL uf]li7

p2]Zo sf/fuf/df Ifo/f]u lgbfg, pkrf/ Joj:yfkg tyf ;+s|d0f /f]syfd ;DjGwL

/0fgLlt lgdf{0f ug{' .

sf/fuf/df Ifo/f]u lgbfgsf] nflu cfjZos tflndx?sf] kf7\oqm lgdf{0f ug{' .

;xefuL hDdf ;xefuL ;+Vof @% hgf

s]lGb|o sf/fuf/sf k|d'v, :jf:YosdL{ tyf cGo cfjZos sd{rf/L tyf k|ltgLlw,

sf/fuf/df Ifo/f]us tyf cGo /f]u Joj:yfkg u/]sf ;+3 ;+:yfx?sf k|ltgLlw,

Ifo/f]u ljz]if1x?


32

;xhstf{ /fli6«o Ifo/f]u s]Gb|sf lgb]{zs tyf lj1 k|ltlgwLx?

cjwL ! lbg

sfo{qmd sfof{Gjogsf

dfkb08

SR n] of] sfo{s|d ;+rfng ug{ /fli6«o Ifo/f]u s]Gb|;Fu ;dGjodf ug{' kb{5 .

sfo{s|d ;+rfng ug{' Ps xKtf k'j{ /fli6«o Ifo/f]u s]Gb|;+u ;dGjo u/L

;xefuLx?nfO{ hfgsf/L u/fpg' kg]{5 tyf cGo cfjZos ;fdu|Lx?sf] Joj:Yffkg

ug{' kg]{ 5 .

uf]li7df 5nkmn ul/g] ljifo j:t'x? cu|Ld tof/L u/]/ 5nkmn ug{' kb{5 .

cled'lvs/0fsf ljifo

j:t'x?

sf/fuf/df Ifo/f]u lgbfgsf k|s[of, Ifo/fuLsf] pkrf/ Joj:yfkg, cfjZos

tflndx? ;+rfng k|s[of, Ifo/f]usf] lgoldt :s[lgª, Ifo/f]u ;+s|d0f lgoGq0f

k|s[of tyf pkfo cflb

sfof{Gjog k|s[of

uf]li7sf] Ps xKtf k'j{] cfjZos sfo{of]hgf tof/ ug]{ ;fy} cfjZos ;fdfu|Lx?sf]


sfo{qmdsf] nflu /fli6«o Ifo/f]u s]Gb| ;Fusf] ;dGjodf uf]li7sf] ldlt tyf :yfg

tf]sL kqfrf/ ug]{ .

tf]lsPsf] ldltdf uf]li7 ;+rfng ug]{

uf]li7df p7]sf 5nkmnsf ljifox? l6kf]6{ ul/ ;DaGwLt lgsfo;Fu 5nkmn ug]{

tyf PR / ;/f]sf/jfnfx?nfO{ o;jf/]df hfgsf/L u/fpg] .

ptm cled'lvs/0fsf] k|ltj]bg tof/ u/L ;DjGwLt lgsfonfO{ pknAw u/fpg] .

ck]lIft pknlAw sf/uf/df Ifo/f]usf] lgbfg tyf Joj:yfkgsf] /0flglt tof/ x'g]5 .

sf/fuf/df Ifo/f]u ;DaGwL tflndsf] kf7\os|d lgdf{0f x'g]5 .

cfly{s afF8kFmf8




;d]t ug]{ _



sfo{qmd lzif{s

:jo+;]jsx?nfO{ d'Vo /0fgLlts sfo{of]hgf ;DalGw Ps lbg] tflnd p2]Zo :jo+;]jsx?n] sfo{s|dn] tf]s]sf JolQmz?df Ifo/f]usf l:s[lgª ug{ ;Ifd x'g]5g\ .

;xefuL SR dfkm{t ;+rfngx'g] sfo{s|d ;+rfngsf nflu 5gf}6 ePsf :jo+;]jsx? -

dlxnf :jo+;]ljsf cfdf ;d"xsf] ;b:o, ;fd'bflos 86\; ;]jf k|bfos jf Ifo/f]u

lgsf] ePsf] JolQm , ;fdflhs kl/rfns, lzIfs , :yflgo ;]jf k|bfos ;+:yf jf

Ifo/f]u af/] cled'lvs/0f lnPsf JolQm_

;xhstf{ :jf:Yo ;+:yf sf] kmf]sn JolQm / SR sf] lhNnf kmf]sn Joltm,

cjwL ! lbg

sfo{qmd sfof{Gjogsf

dfkb08

SR n] of] sfo{qmd lhNnf :jf:Yo hg:jf:Yo sfo{fno tyf :yflgo lgsfo;Fu

;dGjo u/L SR dfkm{t sfo{s|d ;+rfngsf nflu 5gf}6 ePsf :jo+;]jsx?sf]

;'lr tof/ ug]{ / ;xefuLx?nfO{ sfo{s|dsf af/]df hfgsf/L u/fpg' kg]{5 tyf

cGo cfjZos ;fdu|Lx?sf] Joj:Yffkg ug{' kg]{ 5 .

:jo+;]jsx?n] ug{'kg]{ sfo{ h:t} : ;Dks{ kl/If0f, vsf/sf] 9'jflg, IPT cflb

af/] hfgsf/L u/fpg] .


33

cled'lvs/0fsf] ljifo j:t'x?sf] k|:t'lts/0f tof/ ug{' kb{5 .

cled'lvs/0fdf ;dfa];

ul/g] ljifo a:t'

:jo+;]js 5gf}6 ul/ ;+rfng ul/g] sfo{s|dsf] nflu k|of]u ul/g] /]sl8{ª tyf

l/kf]{l6ª, sfo{s|d ;+rfngsf nflu ul/g] ljlw / ks[of, sfo{s|dsf] pb]Zo, nIo /

sfo|sdn] tf]s]sf nlIft ju{ cflbsf af/]df .

Ifo/f]u sfo{s|dsf tyf /f]usf af/]df ;fdfGo lrgf/L Pj+ Ifo/f]usf lrGx tyf

nIf0f

:jo+;]jssf] tf]lsPsf sfo{s\ddf plgx?sf] lhDd]jf/L Pj+ e'ldsf ;fy} sfo{s|ddf

tf]lsPsf ;]jf tyf ;'ljwfsf af/]df

sfof{Gjog k|s[of


;dGjodf cled'lvs/0fsf] ldlt tyf :yfg tf]sL kqfrf/ ug]{ .

cled'vLs/0f df ;dfa]z ul/g] laifoa:t'sf] l6kf]6 ul/ ;xhstf{n] cfjZos

ljifoa:t' ;d]l6 cled'lvs/0fsf] tof/L ug]{ .

ptm cled'lvs/0fsf] k|ltj]bg tof/ ul/ ;DjGwLt lgsfonfO{ pknAw u/fpg] =

ck]lIft pknlAw ;Defljt Ifo/f]usf la/fdLx?sf] ;dod} klxrfg eO{ Ifo/f]u lgbfg eO{ case

gf]l6lkms]zg df a[lb x'g]5

cfly{s afF8kFmf8




;d]t ug]{ _

SR sfo{s|dsf] detail budget sheet df pNn]v jf afF8kmfF8 eP cg';f/ cfjZos

sfuhftx? tyf k|s[of k'/f u/L ah]6sf] Joj:yfkg ug]{ .

sfo{qmd lzif{s

Active Case Finding sf nflu If]q, lhNnf, SDPs x?df sfo{qmd ;+rfng sf nflu cg'udg

/ ;'kl/j]If0f p2]Zo Active Case Finding sf ls|ofsnfk sfof{Gjog tyf nflu ;xhLs/0f ug]{

nlIft sd{rf/L sfof{qmd;+u k|ToIf ;+nUg sd{rf/Lx?

sfo{qmd sfof{Gjogsf

dfkb08

sfo{s|d ;Fu ;DjlGwt e|d0fx?sf k|s[lt cg';f/ ;d'lxs/0f ul/ e|d0fsf]

sfo{tflnsf agfO{ cfkm\g] ;+:yfaf6 k|dfl0ft ug]{ / ;f] Ps k|ltlnlk PR nfO{

pknJw u/fpg] .

e|d0f kZrft tf]lsPsf] 9fFrfdf e|d0f k|ltj]bg agfpg' kg]{ .

cg'udg tyf d'Nof+sgsf nflu ePsf] e|d0fsf] tf]lsPsf] r]s lni6sf] clgjfo{

k|of]u ePsf] x'g'kg]{ .

sfof{Gjog k|s[of

sfo{qmdsf] sfof{Gjog tyf cg'udg d'Nof+sgsf nflu e|d0f ul/g] :yfgsf]

sfo{tflnsf agfpg]. cfj:os checklist tof/ ul/ cg'udg sf] of]hgf ug]{

;'k]l/j]If0f tyf cg'udg jf sfo{ ;+rfng e|d0f k'j{ lhNnf Ifos'i7 kmf]sn JolQm,

:yflgo lgsfosf :jf:Yo ;+of]hs, Pj+ :jf:Yo ;+:yfsf ;DjlGwt sd{rf/L ;Fu

;dGjo /flv ;DjlGw :jf:Yo ;+:yfdf e|d0f ug]{ .

sfo{s|dsf] k|efjsfl/tf tyf cg'udg d'Nof+sgsf nflu cfjZostf cg';f/ lhNnf

tyf :yflgo lgsfosf ;DjlGwt sd{rf/LnfO{ :jf:Yo ;+:ydf ul/g] e|d0fdf


34

;xeflu agfpg] / cfjZos ePdf g]kfn ;/sf/sf] xfn k|rlnt b}=e|= eQf

lgodfjln cg';f/ e'Qmflg ug]{ .

lkmN8 df cg'udg / ;'kl/j]If0fsf] cfwf/df checklist el/ cfj:os ;Nnfx

;'emfa lbg] / sfo{ of]hgf agfpg]

ck]lIft pknlAw sfo{s|dn] tf]s]sf nIox? pb]Zo cg'?k k|fKt ug{ ;lsg] .

sfo{s|dsf] u'0f:tl/otf lglZrt x'g] .

cfly{s afF8kFmf8

-g]kfn ;/sf/sf]

k|rlnt cfly{s P]g

lgodsf] clwgdf /lx


;d]t ug]{ _



sfo{qmd lzif{s

:jf:YosdL{ x?nfO{ d'Vo /0fgLlts sfo{ of]hgf ;DalGw ! lbg] tflnd

p2]Zo Ifo/f]usf] lgbfgsf nflu :jf:Yo sdL{x?sf] Ifdtf clej[bL x'g] 5

;xefuL sfo{s|d ;+rfng ul/g] :jf:Yo ;+:yfsf ;DjlGwt :jf:Yosld{x?

sfo{qmd sfof{Gjogsf

dfkb08

of] sfo{qmd ;+rf+ng lhNnf :jf:Yo tyf hg:jf:Yo sfo{no tyf :yfglgo lgsfo

;Fu cfjZos ;dGjo ul/ sfo{s|d ;+rfng ul/g] ;a} :jf:Yo ;+:yfsf ug]{ .

cled'vLs/0fdf :jf:yo ;+:ydf sfof{Gjog ul/g] ls|ofsnfkx? h:t} contract

tracing, sputum currier IPT, Childhood TB, TB screening

among malnourished chlidren cflb ljifo a:t' ;dfj]z ul/ ug]{ .

o; ;DjlGw klxnf tflnd glnPsf :jf:Yosld{nfO{ k|fyldstf lbg] .

sfof{Gjog k|s[of

SR n] lhNnf :jf:Yo /hg :jf:Yo sfof{no tyf :yfglgo lgsfo ;Fu ;dGjo

ul/ tflnd ;+rfng sf nflu cfjZos tof/L ug]{ h:t} batch cg';f/ :jf:Yo

;+:yf sf] ln:6 tof/ ul/ tfnLd sf] lbg tf]ls ;xefuLtf sf] nflu kqfrf/ ug]{

SR n] lhNnf :jf:Yo / hg :jf:Yo sfof{no tyf :yfglgo lgsfo ;Fu ;dGjodf

sfo{qmd ;xhstf{sf] Aoa:yfkg ug]{ ;fy} cled’lvs/0fdf ;dfa]; ul/g] laifo

a:t’ x?sf] l6kf]6 ul/ ;xhstf{nfO{ cfj:os tof/Lsf] sf] nflu ;’lrt ug]{

cled’vLs/0fdf rflxg] cfj:os logistic sf] pknAbtf ;’lgl:34 tug]{

cled’vLs/0f sfo{qmdsf] sfo{tflnsf lgdf{0f ul/ ;f] cg’;f/ ;+rfng ug]{

cled’vLs/0fdf :jf:YosdL{x?n] ug{ ‘kg]{ sfo{ s] s;l/ ug]{ eGg] hfgsf/L u/fpg]

/ SR n] cled’vLs/0f kZrft sfo{qmdx? :yfgLo:t/df ;+rfng ug]{

ljifo a:t' sG6\ofS6 6 «]l;ª, :k'6d s'l/o/, s'kf]lift afnaflnsfdf Ifo/f]u lgbfg, cfO{=lk=l6=

cflb sfo{s|dsf] af/]df lgDg ljifo a:t'df cled'lvs/0f ug]{ .

sfo{s|dsf] kl/ro

sfo{s|dsf] pb]Zo

sfo{s|dn] tf]s]s nlIft ju{

sfo{s|d ;+rfng ljlw Pj+ k|s[of

sfo{s|dsf] /]sl8{ª tyf l/kf]l6{ª


35

ck]lIft pknlAw ;Defljt Ifo/f]usf la/fdLdf Ifo/f]u lgbfg eO{ pkrf/df btf{ x'g] / Ifo/f]usf] s];

gf]l6lkms]zgdf a[lb x'g]

cfly{s afF8kFmf8


cfly{s P]g lgodsf]

clwgdf /lx s/ s§L

nufotsf sfo{ ;d]t ug]{

_



sfo{qmd lzif{s

Nepal Chemist and Drug Association (NCDA) ;+u Ifo/f]u sfo{s|d ;DjlGw uf]i7L .

p2]Zo kmfd]{l; tyf lglh :jf:Yo ;+:yfdf lgbfg tyf pkrf/df /x]sf Ifo/f]u la/fldx?nfO{

Ifo/f]u sfo{s|dsf] l/kf]l6{ªsf] d"n k|jfxLs/0fdf NofO{ s]; gf]l6lkms];g j[l4 ug]{ .

;xefuL NCDA ;+u cfa4 ;b:ox¿ .

sfo{qmd sfof{Gjogsf

dfkb08

NCDA sf ;b:ox?nfO{ Ifo/f]usf] lgbfg, /]km/n ;DjGwdf cf}lrTo, dxTj

tyf cfjZostfsf] af/]df hfgsf/L u/fpg] .

Ifo/f]usf] lgbfg, pkrf/ tyf /]km/n sf nflu ;xeflux?sf] NCDA sf]

lhDd]jf/L tyf st{Josf af/]d 5nkmn u/fO{ plgx? Aff6 x'g ;Sg]

of]ubfgsf] ;'lr tof/ ug]{ .

plgx?n] k'of{pg ;Sg] of]ubfgnfO{ ;'lglZrt ug{ Ifo/f]u sfo{s|d af6 s]

s:tf ;xof]u cfjZos 5g\ ;f] sf] ljj/0f tof/ ug]{ / ;f]sf] hfgsf/L

/f=If=s] tyf PR lbg] .

;xdlt ePsf ljifoa:t' tyf Ifo/f]u lgbfg tyf pkrf/df cf}iflw k;nx?n]

Ifo/f]u Joj:yfkgsf nflu ug'{ kg]{ sfdst{Jo sf af/]df ljleGg lhNnfsf

cf}iflw k;nx?nfO{ NCDA dfkm{t kqfrf/ ug{ nufpg] .

;fy} cf}iflw k;nx?n] Ifo/f]usf ;Defljt lj/fldx?sf] lgbfg tyf

pkrf/sf nflu /]km/ ul/Psf tyf pkrf/df /flvPsf lj/fldsf] /]sl8{ª tyf

l/kf]{l6ª sf nflu km/d]6sf] lasf; Pj+ ;f] cg';f/ lj/fldsf] ljj/0f

cWofjlws u/fpg NCDA dfkm{t kqfrf/ ug{ nufpg] .

sfof{Gjog k|s[of

s]G›df /x]sf ;/f]sf/jfnf ;Fu ;Djgo ul/ cfjZo \s tof/L ul/

;xeflutfsf nflu kqfrf/ ug]{ .

dfly pNn]lvt dfkb08 cg';f/ pb]Zo kl/k'lt{sf nflu uf]li7df 5nkmn

ul/g] ljifo tof/ ul/ ;f] cg';f/ uf]li7 ;+rfng ug]{ .

lgdf{0f ePsf] sfo{of]hgf cg';f/ sfd eP gePsf] cg'udg ug]{ k|0flnsf]

ljsf; ug]{ / ;f]sf] ljj/0f cWofjlws ul/ PR nfO{ hfgsf/L u/fpg] .

ck]lIft pknlAw cf}iflw k;nx?af6 Ifo/f]u la/fdLsf] /]km/n tyf s]; gf]l6lkms];g eO{ s];

gf]l6lkms];gdf a[l4 x'g] .

cfly{s afF8kFmf8




36

cg';'rLx?

cg';'rL !: Sputum transportation sfo{df ;+nUg :jf:Yo ;+:yfx?sf] ljj/0f matrix

/fli6«o Ifo/f]u sfo{s|d

vsf/ 9'jfgL -Sputum Transportation_ sfo{df ;+nUg :jf:Yo ;+:yfx?sf] ljj/0f

lhNnfM

क्र.स. प्रयोगशालाको

नाम

सम्पकक व्यक्तिको नाम

(प्रयोगशालाकर्मक)

सम्पकक

नं

Link भएको

स्वास्थ्य

संस्थाको नाम

क्षयरोग

फोकल

व्यक्तिको नाम

सम्पकक

नं

स्वा. सस्थावाट

प्रयोगशाला

सम्मको दुरी

(र्क.र्म)

खकार ढुवार्नको लार्ग

यातायातको माध्यम (१.

पैदल २. सवाररसाधन)

प्रयोगशाला

पुगे्न लागे्न समय

(र्मनेट/घण्टा/

र्दन)

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खकार ढुवार्न

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खकार

ढुवार्न

गने र्दन

कैर्फयत

gf]6M of] kmf/d :jf:Yo ;+:yfx?;Fusf] cled'lvs/0fsf] j]nf cWofjlws ug{' kb{5 .


37

cg';'rL @: TB screening questionnaire

/fli6«o Ifo/f]u sfo{s|d

Index cases sf] ;Dks{df /x]sf JolQmdf Ifo/f]usf] screen ug{ ul/g] k|Zgx?

d ===========-gfd_======================== x'F . d /fli6«o Ifo/f]]u sfo{s|d cGt/ut o; lhNnfdf

Ifo/f]usf lj/fdL kQf nufpg v6]sf] :jo+d ;]js÷;]ljsf x' . d tkfO{+ h:t} w]/}

JolQmx?nfO{ Ifo/f]u ;DaGwL s]xL k|Zgx? ug]{ ub{5' . olb Ifo/f]usf] z+sf nfu]df d

Ifo/f]usf] lgbfgsf nflu vsf/ k/LIf0f / Ifo/f]u b]lvPdf g]kfn ;/sf/sf] pkrf/ s]Gb|df tkfO{x?sf] dGh'/L ;lxt pkrf/sf] nflu /]km/ ug]{5' .

ldlt M

:o+d ;]jssf] gfd M

gfd M

lnË M pd]/ M

hDdf kl/jf/ ;+Vof M

7]ufgf M ufpFkflnsf÷gu/kflnsf M j8f g+= M

ufpF÷6f]n M ;Dks{ g+= M

!. tkfO{+nfO{ @ xKtf jf a9L ;do b]lv vf]sL nfu]sf] 5 < 5 5}g

@. tkfO{+nfO{ @ xKtf jf a9L ;do b]lv ;fFemkv jf ;'Tg]a]nfdf dGb

Hr/f] / kl;gf cfpm5 <

5 5}g

#. tkfO{+nfO{ @ xKtf jf a9L ;do b]lv vfg ?rL sd ePsf] 5 < 5 5}g

$. tkfO{+sf] ljut $ xKtf b]lv tf}n 36]sf] 5 < 5 5}g

%. tkfO{+sf] vsf/df ljut @ xKtf jf a9L b]lv /ut b]vf k/]sf] 5 < 5 5}g

^. tkfO{+sf] s'g} Ifo/f]uL;+u ljut # dlxgf b]lv ;Dks{ ePsf] 5 < 5 5}g

&. tkfO{+nfO{ ut @ jif{ leqdf Ifo/f]u nfu]sf] Oltxf; 5 < 5 5}g

gf]6M dflysf] k|Zg & afx]ss'g} klg k|Zgdf 5 eGg] pQ/ cfPdf lghnfO{ sfo{s|d ;+rfng

lgb]{lzsf jdf]lhd vsf/ kl/If0fsf] Joj:yf ug{' kb{5 .


38

cg';'rL #: sfo{qmd ;xhstf{sf] lhDd]jf/Lx? -s'kf]lift afnaflnsf_

s'kf]lift tyf s8f :jf;–k|:jf; ;+s|d0f ePsf afnaflnsfdf Ifo/f]u lgbfg ug{sf] nfuL

5gf}6 ul/g] sfo{qmd ;xhstf{sf] sfd, st{Jo tyf lhDd]jf/Lx?

d'Vo c:ktfndf ug'{kg]{ sfdx?sf] b}lgs / dfl;s sfo{ of]hgfx? agfpg] .

laleGg :jf:Yo ;+:yfaf6 d"Vo c:ktfndf l/km/ eO{ cfPsf s'kf]lift Pj+ s8f :jf; k|:jf; ;+s|d0f ePsf

afnaflnsf la/fdLx?nfO{ cfjZostf cg';f/ -lrlsT;ssf] ;Nnfx cg';f/_ ;xof]u / ;xlhs/0f ug]{ -h:t}M

PS;-/] ug{, dG6' 6]i6 ug{ ;fy} Uofli6 ̭s nfefh / cGo ;]jfsf nflu_ .

c:ktfnsf] cf]=lk=l8=, O{d/h]G;L, afn lSnlgs, jf8{, kf]if0f k'g{:yfkg s]Gb|÷u[x tyf cGo jf8{df cfPsf

aRrfx? ljz]if u/L s'kf]lift, s8f :jf;–k|:jf; ;+s|d0f ePsf afnaflnsfdf Ifo/f]usf] l:s|lgª tyf lgbfg

sfo{ ug]{ s'/fdf ;xof]u / ;xlhs0f ug]{ .

d"Vo c:ktfndf x'g] Joj:yfkg ;ldltsf] dfl;s j}7sdf Ifo/f]usf] s]z gf]l6lkms]zg sf] cj:yfjf/] ;ldIff

tyf of]hgf lgdf{0fdf ;xof]u ug]{ .

d"Vo c:ktfndf ;+rfng x'g] Ifo/f]u lgoGq0f ;DjGwL ljleGg tflnd, uf]li7 tyf ldl6Ëdf ;xof]u ug]{ /

;xefuL x'g] .

lhNnf kl/of]hgf ;+of]hs / d'Vo c:ktfn ljz]if u/L l6=la= kmf]sn k;{gn] lgb]{lzt u/]sf sfo{s|dx?

sfof{Gjog ug{ dbt ug]{ .

dlxnf :jf:Yo :jo+ ;]ljsf, lgsf] ePsf Ifo/f]lu tyf :jo+ ;]jsx?nfO{ kl/rfng ul/ d"Vo c:ktfnsf]

Catchment Area df ePsf Ifo/f]usf Pulmonary Bacteriologically Confirmed lj/fdL !$ jif{ d'gLsf

jfnjflnsf Ifo/f]usf lj/fdLsf] kl/jf/ df sG6\ofs 6«]l;ª u/fpg] .

d'Vo c:ktfnsf ;a} sd{rf/Lx?, :jf:Yo ;+:yf ;+rfng tyf Joj:yfkg ;ldltsf kbflwsf/Lx?,

gu/kflnsfsf :jf:Yo ;+of]hsx?;+u /fd|f] ;DjGw sfod u/L sfo{sd k|efjsf/L ?kdf ;+rfng ug]{ .

laleGg :jf:Yo ;+:yfaf6 Sputum Courier System dfkm{t ;+sng u/]sf vsf/sf gd"gfx? plrt lsl;dn]

;+sng eO/x]sf] 5 5}g Plsg ug]{ .

lrlsT;s, Nofj k|fljlwsx?, la/fldx? tyf cGo ;/f]sf/jfnfx?n] lgodfg';f/ kfpg'kg]{ /sdx? kfP gkfPsf]

;'lglZrt ug]{ .

cfkm";Fu ePsf] cfly{s lx;falstfa r':t / b'?:t /fVg] / ;dod} ;DaGwLt lgsfodf a'emfpg] .

dfl;s ?kdf ul/Psf sfo{x?sf] clen]v cWofjlws /fVg] .

o; sfo{sf] /]sl8{ª l/kf]{l6ª b'?:t /flv lhNnf :jf:Yo sfof{no/ :yflgo tx tyf kl/of]hgf clws[tnfO{

dfl;s ?kdf k|ltj]bg k]z ug]{ .

of] sfo{s|d c:ktfn ;+rfng ePsf] x/]s lbgug'{ kg]{ .

cfaZostf cg';f/ cGo sfo{ yk ePdf cfkl; ;dembf/Ldf ug]{ .


39

cg';'rL $: sfo{qmd ;xhstf{sf] lhDd]jf/Lx? -FAST strategy_

c:ktfnx?df Ifo/f]u ;+s|d0f /f]syfd tyf lgbfgsf] nflu FAST /0fgLlt

cjnDag ug{sf] nflu 5gf}6 ul/g] sfo{qmd ;xhstf{sf] sfd, st{Jo tyf

lhDd]jf/Lx?

d"Vo c:ktfndf ug'{kg]{ sfdx?sf] b}lgs / dfl;s sfo{ of]hgfx? agfpg] .

d'Vo c:ktfnsf] OPD sf8{ jgfpg] zfvf ;Fu ;dGjo ul/ cf]=lk=l8df ;]jf lng cfPsf lj/fdLx?df vf]sL

nfu]sf] eP lghsf] k'hf{df FAST sf] :6fDk nfufpg ;xof]u ug]{ .

c:ktfn k|zf;g;Fu ;dGjo ul/ FAST /0flglt cg';f/ e]l6Psf ;Dk'0f{ vf]ls nfu]sf] lj/fdLnfO{ 5'§} sf]7fdf

j:g] Joj:yf ldnfpg] .

To:tf lj/fdLx?df Ifo/f]usf cGo lrGx nIf0fx? :s[lgª ug]{ tyf Ifo/f]usf] ;+efljt lj/fld ePsf]df lghsf]

vsf/ ;+nUg ul/ FAST /0flglt cg';f/ kl/If0fsf] Joj:yf ldnfpg] .

FAST /0flglt sf] sfo{s|d ;+rfng lgb]{lzsfdf pNn]v eP jd]flhd cGo sfo{ ug]{ .

d"Vo c:ktfndf x'g] Joj:yfkg ;ldltsf] dfl;s j}7sdf Ifo/f]usf] s]z gf]l6lkms]zg sf] cj:yfjf/] ;ldIff

tyf of]hgf lgdf{0fdf ;xof]u ug]{ .

d"Vo c:ktfndf ;+rfng x'g] Ifo/f]u lgoGq0f ;DjGwL ljleGg tflnd, uf]li7 tyf ldl6Ëdf ;xof]u ug]{ /

;xefuL x'g] .

lhNnf kl/of]hgf ;+of]hs / d'Vo c:ktfn ljz]if u/L l6=la= kmf]sn k;{gn] lgb]{lzt u/]sf sfo{s|dx?

sfof{Gjog ug{ d4t ug]{ .

dlxnf :jf:Yo :jo+ ;]ljsf, lgsf] ePsf Ifo/f]uL tyf :jo+ ;]jsx?nfO{ kl/rfng ul/ d'Vo c:ktfnsf]

Catchment Area df ePsf Ifo/f]usf Pulmonary Bacteriologically Confirmed lj/fdL !$ jif{ d'gLsf

jfnjflnsf Ifo/f]usf lj/fdLsf] kl/jf/ df Contact Tracing u/fpg] .

d'Vo c:ktfnsf ;a} sd{rf/Lx?, :jf:Yo ;+:yf ;+rfng tyf Joj:yfkg ;ldltsf kbflwsf/Lx?, kflnsfx?sf

:jf:Yo ;+of]hsx?;+u /fd|f] ;DjGw sfod u/L sfo{sd k|efjsf/L ?kdf ;+rfng ug]{ .

laleGg :jf:Yo ;+:yfaf6 Sputum Courier System dfkm{t ;+sng u/]sf vsf/sf gd"gfx? plrt lsl;dn]

;+sng eO/x]sf] 5 5}g Plsg ug]{ .

lrlsT;s, Nofj k|fljlwsx?, la/fdLx? tyf cGo ;/f]sf/jfnfx?n] lgodfg';f/ kfpg'kg]{ /sdx? kfP gkfPsf]

;'lglZrt ug]{ .

cfkm";Fu ePsf] cfly{s lx;fa lstfa r':t / b'?:t /fVg] / ;dod} ;DaGwLt lgsfodf a'emfpg] .

dfl;s ?kdf ul/Psf sfo{x?sf] clen]v cWofjlws /fVg] .

o; sfo{sf] /]sl8{ª l/kf]{l6ª b'?:t /flv lhNnf :jf:Yo sfof{no/ :yflgo tx tyf kl/of]hgf clws[tnfO{

dfl;s ?kdf k|ltj]bg k]z ug]{ .

of] sfo{s|d c:ktfn ;+rfng ePsf] x/]s lbg ug'{ kg]{ .

cfaZostf cg';f/ cGo sfo{ yk ePdf cfkl; ;dembf/Ldf ug]{ .


40

cg';'rL %: dfOqmf]:sf]lk s]Gb|sf] nflu Assessment checklist

dfOqmf]:sf]kL s]Gb|x?sf] nflu assessment ug{ k|of]u ul/g] r]slni6


41

cg';'rL ^: Fast Stratergy Framework

:

Yes


42

cg';'rL &: /]sl8{ª tyf l/kf]l6{ª kmf/fd

gf]6: oxfF pNn]lvt /]sl8{ª tyf l/kf]l6{ª kmf/fdx? Excel Sheet df pknAw u/fO{;s]sf] x'bfF ;f]lx cg';f/ k|of]u ug]{ .

Date post:	08-Aug-2020
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