National Consultation workshop

Service Delivery

Experiences of LEPRA India

Dr.P.V.Ranganadha Rao,

Chief Executive, LEPRA India

to restore health, hope and dignity

Our Approach

• Direct participation in TB control

• Capacity building

• Research activities – Field/laboratory• Research activities – Field/laboratory

• Advocacy Communication and Social

Mobilization (ACSM)

• Involvement of people affected

• Publications

Participation in TB controlThematic

Areas

What? Where ? Partners

Direct

Participation

in TB control

Microscopic

center

33 DMCs in 4 States RNTCP

SCC 252 SCCs in 2 states –

Orissa & MP

RNTCP

Orissa & MP

C & DST (BPHRC) 4 Districts in AP RNTCP

DOTS Plus 3 Districts in AP RNTCP

DOTS providers Above 3900 RNTCP

Patients reached 5500 RNTCP

DMCs and SCC in AP

DMCs and SCC in Bihar and Orissa

Service Delivery – Key Points• Hard to reach/needy areas in rural, tribal and Urban

population

• Sputum collection centers to improve access

– (1998, Koraput , Odisha –Supported by DFID)• TB HIV co-infection addressed

– Integration of VCTC and DMCs– Integration of VCTC and DMCs

– Introduction of ORWs

• Patient friendly services with enabling atmosphere. – Patient Charter translated in Oriya, Hindi and Telugu

• Data review and management – Analysis of performance indicators

– Regular review of performance and progress of DMCs

• Mobilizing communities and Advocacy

MLAs MLAs sensitization in MPsensitization in MP

CM of MP addressing the sessionCM of MP addressing the session

Signature Signature campaign by MLAs campaign by MLAs

to to support TB control activitiessupport TB control activities

Programme – Outcomes

• Case detection rate – 65 – 80%

• New Sputum Positive Cases 50-60%

• Sputum Conversion rate 89 – 94%

• Cure rate 82 – 92%• Cure rate 82 – 92%

• Deaths 3- 7%

• Defaults 3-8%

True Income lies in True Income lies in True Income lies in True Income lies in

SmillionsSmillionsSmillionsSmillions (Smiles of Millions ) (Smiles of Millions ) (Smiles of Millions ) (Smiles of Millions ) of people of people of people of people

Monitoring Performance

Dash Board – An useful tool

tbhtml1.swf

Study of TB CASES - SOURCE OF

REFERRAL 4 DMCs in Hyderabad

2008-09

2%

11%

13%

6%

6%

39%

11%

12%

By Survey

IEC Activity

By PMPs

By Volunteers

By UHP Staff

By CDs

Oth.NGOs

Others

Challenges – Performance

• Migration

• Patient receiver of services

• Concurrent diseases/conditions

• Continued stigma against the disease • Continued stigma against the disease

• Health/Treatment seeking behaviour

• Gender specific strategies - Access

• Influence of Private Practitioners

• Social factors

– Poverty, Alcoholism,

Challenges – Service Delivery

• Timely disbursement of funds

• Attitude towards NGOs – Misplaced Trust

• Drug supply from state to DOTS facilities• Drug supply from state to DOTS facilities

• Supportive Supervision in certain TUs

Operational issues – out reach/mobility

• Policies on Private Medical Practice

• Pharmacies and Private labs

Sputum Collection Centre (SCC)A strategy for remote and inaccessible areas

1998 – DFID supported

Operational Aspects of SCC

SCC Strategy – Outcomes - 2009-10

1609 NSP in 2009 -

Koraput

210 sputum positive

cases reported

through SCCs,

i.e. Contribution of

13.5% to RNTCP.

Particulars YEAR

2009 2010 Total

No of SCC 180 180 180

No of Chest symptomatic

reported to SCC

1140 1946 3086

Sputum positive cases diagnosed 210 373 583

Follow Up Sputum 252 1164 1416

13.5% to RNTCP.

Partnership of LEPRA India BPHRC with

RNTCP-A success story

C & DST - Sputum from TB patients

transported from periphery to BPHRC

Flow of Specimen and test reportsFlow of Specimen and test reports

BPRCDISTRICT TB

OFFICE

Specimen transportation kit

Specimen

Reports

UMEED DMC/PHI

Specimen

transportation

kit

Transport of specimens

to the collection center

Specimen

collection

DOTS PLUS CLINICAL SITE

At Guntur

ReportsPatients

Green Light Committee and Global Lab Initiative

team along with State TB officer visits BPHRC as

a model PPP in RNTCP-August, 2009

240 MDR Cases were reported out of 625 suspects tested during June,09 and

November,10

91

240 74

4134

GUNTUR KISHNA E.G W.G TOTAL

Consortium Partners

Donors

Auto Drivers (Union) Sensitization Program at Narsinghpur

Sen Samaj (Barber Union) Sensitization Program at Narsinghpur

Auto Drivers (Union) Sensitization Program at Narsinghpur

Community meetings, PRI sensitization

ASHA/ ANM sensitization

IEC Material

For the opportunity to

serve people in reducing TBserve people in reducing TB