TABLE OF CONTENTSrltrird.cg.gov.in/pdf/Research projects/WHO project...There is shortage of the MO...

Intensified leprosy activities in the high endemic districts of Raipur and Bilaspur to reduce leprosy burden at sub-national levels 1

Sr

No

Contents Page No

I Background and Justification 3-5

II Specific Objectives 6

III Method and approaches 7

IV Epidemiological Profiles and Human

Resources

8-14

V Timeline of Activities - Gantt Chart 15

VI Training Curriculum and schedule 16-18

VII District and Block wise Training Report 19-23

VIII Advocacy meetings 24-27

IX Monitoring of Activities and Follow-up 28

X Conclusion and Recommendations 29-30

TABLE OF CONTENTS


APW Agreement for Performance of Work

ANCDR Annual New Case Detection Rate

ASHA Accredited Social Health Activist

ANM Auxillary Nurse Midwife

BMO Block Medical Officer

CHC Community Health Centre

CMO Chief Medical Officer

DPMR Disability Prevention and Medical Rehabilitation

HA (M) Health Assistant (Male)

HA (F) Health Assistant (Female)

HSC Health Sub Centre

ILEP International federation of Anti Leprosy Association

MPW Multi Purpose Worker

NRHM National Rural Health Mission

NLEP National Leprosy Eradication Programme

NGO Non Governmental Organization

PR Prevalence Rate

PHC Primary Health Centre

PAL Patient Affected with Leprosy

RD Regional Director

RLTRI Regional Leprosy Training and Research Institute

SHRC State Health Resource Center

SPO (L) State Programme officer (Leprosy)

ABBREVATIONS USED


Despite program activities like intensive monitoring through the District Leprosy Officers,

prevalence has continued to remain high (more than 2) in Raipur and Bilaspur districts of

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

deformities among cases when first detected. Based on the available evidence, innovative

strategies to enhance awareness of vulnerable people and strengthen delivery of

comprehensive services to leprosy affected people needs to be developed. Organizations/

Forum of people affected by leprosy can be involved, consulted and made responsible for

this. The guidelines developed during the Manila conference of people affected by leprosy on

the 9th

& 10th

June 2010 encourages/introduces the participation of persons affected by

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

in the area of IEC and enhanced risk communication.

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

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

personnel of organizations & People affected by leprosy would also be sensitized and trained

on supportive supervision and monitoring of programme implementation at the sub-district

level.

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

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

of a select group of program personnel in selected states to develop a sustainable long term

training model to improve technical competence of program staff in the high endemic areas

and retain technical competence of program staff in the low endemic areas. With depleting

expertise, a pool of trainers is needed at different levels that need regular update.

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

approaches to disability care and rehabilitation needs emphasis in the training. Partnership

with ILEP and other governmental and non-governmental agencies need to be established.

BACKGROUND AND JUSTIFICATION


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

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

(MOHFW) has placed officers in all the regions of the country. These officers are known as

Regional Directors. They are mainly concerned with coordinating with the state Governments

and ensuring the progress of the National Rural Health Mission. These officers could be

oriented in leprosy and in the activities of the NLEP. They could then be the local focal

points for the project in the concerned districts of the states where the project activities was

undertaken.

Health workers exclusively for the leprosy programme delivered services when the

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

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

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

assist the peripheral health workers in delivering health care to the community in the National

Rural Health Mission (NRHM). Though initiatives have been undertaken to involve ASHAs

in the delivery of leprosy services, technical & supportive supervisory support provided to

them to carry out basic leprosy services like identification and referral of leprosy cases has

been sub-optimal. Capacity building, monitoring and supervision is necessary till they

become fully equipped to taken on this responsibility.

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

awareness about leprosy and its consequences.

Regional Leprosy Training and Research Institute (RLTRI), Raipur was established in 1979

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

Raipur district covering 200,000 (2 Lakhs) populations for monitoring, technical supervision

& research activities on leprosy services were placed under RLTRI. At present out of 80


posts 19 were vacant and field operation areas were handed over

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

services. The in–patient service regularly admit and treats leprosy

patients and a number of reconstructive surgeries are carried out

regularly at institute and camps at district level within state and

neighbouring state for various type of leprosy deformities in the

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

problematic, complicated and intractable cases. It also works as a

nodal training and research centre particularly programme related

research activities in the region for the cause of leprosy

elimination.

This institute also imparts National Level training to State

Leprosy Officers (SLO)/District Leprosy Officers (DLO)/Block

Medical Officers (BMO) of state like Maharashtra, Gujarat,

Rajasthan, Haryana, Punjab, Uttar Pradesh, Madhya Pradesh,

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

Nicobar Island and Chhattisgarh

This institute is also working as Regional Directorate of Health &

Family Welfare (ROHFW). It technically supervises and monitors

all health programmes from month of August 2005.


The immediate objectives of the proposed activity, show the relevance of these objectives to

the programme area(s)/ Work Plan, and identify the expected outcomes/outputs.

1. Capacity building of health workers in leprosy to suspect, diagnose, treat, record and

report patients as per their level of expertise.X

2. Monitoring and supervisory training for supervisory staff of general health care at all

levels.

3. Programme advocacy at different levels including people affected by leprosy as potential

partner.

4. Review the programme for impact and feedback into the system.

ASHA (Mitanins) holding banner regarding leprosy eradication from state

The main aim is to build the capacity of different levels of health care staff in the high-

endemic districts of Chhattisgarh in order to stream line leprosy case detection, and thereby

reduce leprosy burden at sub-national levels. This can significantly affect the monitoring and

supervision of the leprosy programme which will be strengthened by empowering the

SPECIFIC OBJECTIVES METHODS AND APPROACHES USED


supervisory staff. A part from this, advocacy for the programme will be initiated at all levels

by training people affected by leprosy with potential involvement at all levels.

BRIEF TIMEFRAME OF ACTIVITIES:

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

district level.

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

(including refresher course).

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

4. Monitor the training activities for uniformity and quality.

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

TECHNICAL STAFF SUPPORT:

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

related activities. Monthly reports of the activities and the developments in the project were

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

needed support from the DLO / BMO to carry out his routine activities. Moreover, there were

two field workers (one for each district) who assist the medical officer in data collection,

organising trainings, follow-up etc.


Chhattisgarh Map Showing the leprosy endemicity as per districts (PR <1

and >1 per 10,000 population)

Map showing Hyper endemic district (Raipur and bilaspur) of Project

a) Epidemiological Aspects (NLEP) of

EPIDEMIOLOGICAL PROFILE AND HUMAN RESOURCE IN PROJECT AREAS

The Chhattisgarh state is

endemic for leprosy and still

lags behind the WHO target

of elimination

as a public

health problem. This state

with less than 22 % of

country’s population holds

about 6% of new leprosy

case load. Out of 18

districts, 11 are having PR

above 1 per 10,000

populations (Minimum 0.46-

maximum 8.44 as on July

2011)


Raipur District SN particulars 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

1 Annual new case detected 1912 1768 1839 1655 1679 1501

2 Prevalence Rate(PR) 3.22 3.03 3.73 3.15 3.28 3.36

3

Annual new case detection

rate(ANCDR) 58.5 58.2 49.52 49.01 48.94 43.49

4 MB (%) 51.57 49.38 NA 46.16 46.63 48.9

5 Female (%) NA NA 35.34 35.05 37.82 33.44

6 Proportion of child 7.37 6.67 6.42 8.34 9.05 8.99

7 Deformity Grade. I (%) NA NA NA NA 3.93 2.8

8 Deformity Grade. II (%) 2.62 2.43 4.61 5.44 4.82 4.33

NA- Not available

The population of the district is 4,062,160 having 1214 villages and 537 health Sub Centres.

The Prevalence rate has ranges from 3.03 to 3.36 per 10,000 populations. The MB proportion

is near about 50%. The number of suspected leprosy cases detected from community by

ASHA is still low (<10% of total suspected). The number of cases reported voluntarily is not

available and also not recorded. There are 6303 ASHA working at the village level in the

district.

b) Available Human Resource of District Raipur

Sr. No. Post Sanction In position Vacant

1 BMO 9 0 9

2 Medical Officer 126 53 73

3 Health Assistant 08 12 0

4 Lab Technician 53 44 9

5 Health Supervisor (M) 36 28 8

6 Health Supervisor (F) 66 44 22

7 Auxillary Nurse Midwifery 370 309 61

8 Multi Purpose Worker 317 213 104

9 Block Program Manager 9 9 0

10 Block Accountant-cum-Data Assistant 9 6 3

11 Data Entry Operator 13 13 0

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

peripheral health centres.


c) Epidemiological aspects of NLEP of Simga Block

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

1 Annual new case detected 89 116 64 76 116

2 Prevalence Rate(PR) 2.53 4.13 2.85 3.43 -

3


rate(ANCDR) 48 68 37 45

39

4 MB (%) 40 41 50 53 38

5 Female (%) 33 36 47 46 34

6 Proportion of child 10.11 8.62 12.5 3.94 2.27

7 Deformity Grade. I (%) 0.00 0.00 1.56 1.31 5.55

8 Deformity Grade. II (%) 0.00 0.86 0.00 2.63 0.00

The PR ranges from 2.5 to 4.1 and the new cases detected is 116 per year. The female

proportion was less than 40% .There is 433 functional ASHAs in the block.

d) Available Human Resource of Block - Simga

Sr no Post Sanction In Position Vacant

1 BMO 01 01 00


3 HA 01 0 01




7 ANM 39 36 03

8 MPW 39 21 18

9 BPM 01 00 01

10 BADA 01 01 00

11 DEO 01 01 00

At the grass root level, 47 % of MPW posts were vacant at health sub center.


e) Epidemiological Aspects (NLEP) of Bhatapara Block

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

2011-12

(feb)


2 Prevalence Rate(PR) 5.49 5.69 3.41 2.69 3.7

3


rate(ANCDR) 55 57 34 27 37

4 MB (%) 50 47 60 69 73

5 Female (%) 20 19 33 44 33

6 Proportion of child 9 11 03 01 08

7 Deformity Grade. I (%) 0 0 03 0 03

8 Deformity Grade. II (%) 07 07 13 3 3

The PR ranges from 2.69 to 5.6, and the new cases detected are more than 70 per

year. There are 426 ASHA (mitanins) functional in the block.

f) Available Human Resource of Block Bhatapara


1 BMO 01 00 01


3 HA 01 00 01




7 ANM 27 19 08

8 MPW 27 19 08

9 BPM 01 01 00

10 BADA 01 01 00

11 DEO 00 00 00

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

vacant both at the PHC and block level. At the grass root level, 30% of MPW posts

were vacant at health sub center.


g) Epidemiological Aspects (NLEP) of District Bilaspur

SN Particulars 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

1 Annual new case detected 894 310 1100 855 776 890

2 Prevalence Rate(PR) 1.28 0.9 3.04 2.62 2.59 2.79

3


rate(ANCDR) 41.3 14.1 37.18 38.23 34.15 38.93

4 MB (%) 50 62.58 51.34 55.44 55.8 50

5 Female (%) NA NA 33.25 38.13 37.63 35.96

6 Proportion of child 7.83 13.55 8.92 7.72 7.35 7.75

7 Deformity Grade. I (%) NA NA NA NA 1.55 1.69

8 Deformity Grade. II (%) 2.13 4.52 1.83 1.75 2.32 2.58 NA- Not available

The population of the district is 454000 having 1609 villages and 365 health sub centres and

56 PHCs. The Prevalence rate has increased from 0.9 to 2.79 per 10,000 populations 2011-

12. The MB proportion is above 50%. There are 4108 ASHA working at the village level in

the district.

h) Available Human Resource of District Bilaspur

Sr. No. Post Sanction In position Vacant




4 Auxiliary Nurse Midwifery 470 454 16

5 Multi Purpose Worker 393 233 160

6 Block Program Manager 10 9 01

7 Block Accountant-cum-Data

Assistant

10 10 0

8 Data Entry Operator 13 13 0

The District leprosy officer and district surveillance officer is in place and almost 50% post

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

health sub centre.


i) Epidemiological aspects (NLEP) of Kota Block

SN Particulars 2009-10 2010-11 2011-12 march

1 Annual new case detected 70 69 71

2 Prevalence Rate(PR) 3.5 3.8 3.3

3


rate(ANCDR) 34.3 33.4 23.8

4 MB (%) 70 65 65

5 Female (%) 47 23 25

6 Proportion of child 7.1 0 8.4

7 Deformity Grade. I (%) 2.8 1.4 0

8 Deformity Grade. II (%) 1.4 0 9.8

The new cases detected are more than 70 in the same time period. There are 365 ASHA

(mitanins) functional in the block.

j) Available Human Resource of Block Kota


1 BMO 01 01(i/C) 01


3 HA 00 00 00

4 Lab Technician 11 3+6 08



7 ANM 56 42 14

8 MPW 46 27+17 19

9 BPM 01 01 00

10 BADA 01 01 00

11 DEO 01 01 00

Around 50 % of the posts of medical officer were lying vacant. At the grass root level, 41%

of MPW posts were vacant at health subcenter.


k) Epidemiological Aspects (NLEP) of Masturi Block

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


2 Prevalence Rate(PR) 4.79 3.53 3.50 4.32 2.99

3


rate(ANCDR) 58.75 41.9 59.50 60.11 41.69

4 MB (%) 61.76 76.85 56.68 52.02 58.67

5 Female (%) NA NA 40.76 31.79 28.09

6 Proportion of child NA NA 7.64 11.56 8.26

7 Deformity Grade. I (%) NA NA 0.63 0.57 NA

8 Deformity Grade. II (%) NA NA 3.82 1.73 4.95

NA- Not available

The PR ranged from 4.7 to 2.99 per 10,000 population and new cases detected more than 121

per year. The 343 ASHA (Mitanin) is functional in the block.

l) Available Human Resource of Block Masturi


1 BMO 01 01 00


3 HA 00 00 00




7 ANM 64 54 10

8 MPW 53 38 15

9 BPM 01 01 00

10 BADA 01 01 00

11 DEO 01 01 00

56% of medical officer posts at primary health centres were lying vacant. At the grass root

level, 28% of MPW posts were vacant at health sub center.


Sr

No Activities

01/10/2011

to 14/10/2011

15/10/2011

to

04/11/2011

05/11/2011

to

17/11/2011

18/11/2011

to

30/11/2011

01/12/2011

to

06/12/2011

A) Pre-training Activities

1 Staff Recruitment

2

Data collection from district and

village

3

Selection of training places and

dates

4 Pre training Visit of the staff

5.

Preparation and printing of the

training module of Supervisory

staff and ASHA

B)

Training Raipur and Bilaspur

district Blocks

7

Raipur Simga block- supervisory

staff Training

8

Raipur Simga block- ASHA/PAL

Training- 4 batches

9

Raipur Bhatapara block-

supervisory staff Training

10

Raipur Bhatapara Block-

ASHA/PAL Training- 4 batches

11

Bilaspur Masturi block-

supervisory staff Training

12

Bilaspur Masturi block-

ASHA/PAL Training- 4 batches

13

Bilaspur Kota block- supervisory

staff Training

14

Bilaspur Kota block-

ASHA/PAL Training- 4

batches

TIME LINE OF ACTIVITIES - GANTT CHART


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

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

the training modules.

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

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

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

person affected by leprosy (PAL) to take the medicine regularly and complete the course of

MDT. The pictures were added for the better understanding of the patches. ASHAs are the

main persons to disseminate correct information about leprosy to person affected with leprosy

and their families, and to the community in which they live and work. They will visit the

leprosy affected persons, their family members and invite community members for a meeting

and tell them about disease. The role of ASHA workers in the NLEP at village level is also

elaborated in the manual. It also mentions the incentives applicable/paid to ASHA under the

National Leprosy Eradication Programme. At the end of session, open time was given for

question and answers and for clarifications, if any.

ASHA (mitanin) NLEP training module

TRAINING MANUAL – DESIGNING


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

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

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

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

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

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

committee were also integrated in the curriculum.

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

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

the end of session, open time was given for question & answer, and clarifications, if any.

Supervisory NLEP training module with DPMR


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

workers during the training.

Flash cards for ASHA and health workers


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

Sr no Name of district Selected block Name of

Supervisor

Name of

medical officer

1 Raipur Simga S.K Verma Dr L.N Soni

Bhatapara

2 Bilaspur Masturi Ashish Goswami

Kota

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

District Block No of

Batches

Medical

officer

Raipur Simga 1 4

Bhatapara 1 4

Bilaspur Masturi 1 4

Kota 1 4

Total 4 16

Table III: Number of supervisory staff attended training


Batches

No of

Supervisory

staff

Raipur Simga 1 60

Bhatapara 1 60


Kota 1 60

Total 4 240

DISTRICT AND BLOCK WISE REPORT OF THE TRAINING FOR

MITAININS AND GENERAL HEALTH CARE STAFF


Report of supervisory staff training in Raipur:

1) Block- Simga

Dates: 09/11/2011

Venue: CHC, Simga

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

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

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

3. Shri.S.L Dhruw, RLTRI,Raipur

4. Dr. G.S.Soni,BMO,Simga

Training of supervisory staff Supervisory staff training

2) Block- Bhatapara

Dates: 11/11/2011

Venue: CHC,Bhatapara

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

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

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

3. Dr. R. K. Awasthi BMO,Bhatapara

4. Shri. S.L.Dhruv, RLTRI,Raipur

Report of supervisory staff training in Bilaspur:

3) Block- Masturi

Dates: 28/11/2011

Venue: CHC, Masturi


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

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

2. Dr A.K.Sanyal,BMO,Masturi

3. Shri. S.L.Dhruv, RLTRI, Raipur

4. Dr.R.S.Maravi,Masturi

4) Block- Kota

Dates: 08/12/2011

Venue: CHC,Kota

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

1. Dr Ravi Rao, RLTRI,Raipur

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

3. Dr.A.K.Jha,BMO,Kota

4. Shri. S.L.Dhruv, RLTRI,Raipur

Training of supervisory staff Supervisory staff training

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

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

aspects including DPMR activities in brief were covered during the one day training. The

block medical officers (BMO) and RLTRI faculty and people affected by leprosy were

involved during training. There is significant improvement in the knowledge and skills before

and after training in the selected general health care staff .The Training Kits were distributed

among all the supervisory staff during training session.


Table IV showing number of ASHA (Mitanin) trained in Raipur and Bilaspur districts


Batches

ASHA and

PALs

Raipur Simga 4 200

Bhatapara 4 200


Kota 4 199

Total 16 800

District: Raipur

1) Block- Simga

Dates: 18/11/2011 and19/11/2011

Venue: CHC, Simga

2) Block- Bhatapara

Dates: 16/11/2011 and 17/11/2011

Venue: CHC Bhatapara and PHC Mopka (Bhatapara)

ASHA (Mitanin) training


District: Bilaspur

3) Block- Masturi

Dates: 29/11/2011 and 30/11/2011

Venue: CHC Masturi and PHC Seepat

4) Block- Kota

Dates: 05/11/2011 and 06/12/2011

Venue: CHC, Kota

ASHA (mitanin) training ASHA (mitanin) training

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

four blocks of Raipur and Bilaspur districts. Both theory as well as practical was covered

during the training session. The medical officers, BMO and supervisors of RLTRI, Raipur /

State govt. / SHRC, Raipur were involved in the trainings. There is significant improvement

in the knowledge and skills before and after training in the selected ASHA (Mitanins)

workers. The training kits were distributed among the all mitanins during training sessions.


Raipur: The advocacy meeting took place at two places (one at Bhatapara and another in

Simga) district Raipur on 12/12/2011 as part of the WHO Project.

The purpose of the meeting was to sensitize local leaders on the needs in the field of leprosy

and to take recommendations from the local leprosy experts for the betterment of leprosy

programme in the selected district with political goodwill. At Bhatapara, the meeting was

held at training hall of CHC Bhatapara under the chairmanship of Director of Regional

Leprosy Training and Research Institute, Raipur.

It was attended by District Leprosy Officer, Block Medical Officers of Bhatapara

block, Education Department representative, Doctors from CHC, Bhatapara , members of the

Prem prakash mandal society, Gayatri parivar, Mitanin Supervisors, Department of ICDS

officials and State Forum of people affected by leprosy (PAL) at both places . The second

advocacy meeting was held at the training hall of CHC Simga. It was attended by BMO,

Simga, representative of MLA, Simga, Officials from education department local media,

NCC officials, medical officers of CHC Simga and NSS voluntaries of local colleges.

At both the places the Block medical officer welcomes all the invitees and

narrated the purpose of the meeting. DLO presented the epidemiological situation of the

Raipur district. He also spoke on present and future plans to be taken in the district to reduce

leprosy burden in the district.

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

(Raipur District) Advocacy meeting at Simga (Raipur District)

ADVOCACY MEETINGS


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

individuals present irrespective of organisations in the elimination and eradication of leprosy.

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

that the disease can be detected early and completely cured. All members present in the

meeting agreed to be involved in the programme for creating awareness in their area of work

and give priority to the programme. They have also decided to support the special activities

like RCS camp, special campaign, door to door survey etc. at all possible levels.

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

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

and its sustainability was ensured. Many recommendations made by different people were

noted down. The same will be submitted to the local district authorities for further

consideration. Advocacy for the programme will be initiated at all levels by empowering

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

advocacy tasks still remain at the district level. The continued involvement of district/block

and village level administrators, and implementer’s remains crucial which will have

considerable impact on the achievement of program goals.


Bilaspur District: The Advocacy Meeting took place at Hotel East Park, Bilaspur district on

the 9th

December, 2012 as a part of the WHO Project. The purpose of the meeting was to

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

recommendations from the local leprosy experts for the betterment of leprosy programme in

the selected district with political goodwill. The meeting was held at meeting hall of Shreeji

Hotel under the chairmanship of the Director of Regional Leprosy Training and Research

Institute, Raipur.

The state Leprosy Officer (SLO) Chhattisgarh was the key speaker and chief health

medical and health officer was the chief guest. It was attended by DLO,Civil surgeon of

Bilaspur, District health Officer, Block medical Officer of Masturi and Bilha ,representative

of BMO, kota and medical officer /specialist from medical college Bilaspur.

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

individuals present irrespective of organisations/state government departments in the

elimination and eradication of leprosy. He requested everybody to spread the key leprosy

messages that they have heard so that the disease can be detected early and completely cured.

Dr. Bhatpahare, State Leprosy Officer described the epidemiological situation of

Chhattisgarh state and the steps he has taken towards it. The CMO is committed to implement

the programme successfully by taking necessary help/involving persons from all

organizations.

All members present in the meeting agreed to be involved in the programme for creating

awareness in their jurisdiction and give priority to the programme.


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

at

advocacy meeting at Bilaspur

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

door to door survey etc at all possible levels.

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

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

and its sustainability was ensured. Many recommendations were made by different people

were noted down. The same will be submitted to the local district authorities for further

consideration.

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

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

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

administrators and implementers remains crucial which will have considerable impact on the

achievement of the program goals.


PROPOSED ACTIVITIES AFTER TRAINING

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

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

the activity.

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

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

Follow up activities

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

among various categories of health care staff

Regular feedback from staff in sector meetings

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

Discussion with the GHC staff of peripheral health facilities

District data showing number of new leprosy cases with deformities reported through

voluntary reporting and through trained ASHAs

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

MONITORING, EVALUATION AND FOLLOW UP


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

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

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

health care staff and field workers in suspecting and referring patients early. It is

suggested to review the impact of the programme in the next phase after a period

of 1 year.

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

and to give effective attention to individual trainees. It is suggested that the group

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

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

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

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

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

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

sensitisation and programme advocacy at the village level.

5. Had logistics difficulties transportation transporting ASHA training kits from

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

provision for transportation in the project budget.

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

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

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

of resources and would have avoided duplication of resources and activities.

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

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

and other stakeholders, opinion of leaders and the community at large to support

the efforts for improving case detection and treatment completion, combating

stigma and discrimination and empowering people affected by leprosy.

LESSONS LEARNT AND CONCLUSIONS


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

various categories of health care staff

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

impact of the training.

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

NLEP, particularly in high endemic /high focus districts.

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

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

selected area of the districts

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

members.

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

new cases with deformities.

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

stage to the nearest health facility.

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

received during the advocacy meeting.

RECOMMENDATIONS FOR THE NEXT PHASE OF PROJECT

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