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Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 1
I Background and Justification 3-5
II Specific Objectives 6
III Method and approaches
7-14
IV Epidemiological Profiles and Human Resources
15
V Timeline of Activities - Gantt Chart 16-18
VI Training Curriculum and schedule
19-21
VII District and Block wise Training Report
22-25
VIII Advocacy meetings 26
IX Monitoring of Activities and Follow-up 28
X LESSONS LEARNT AND CONCLUSIONS 29
xi RECOMMENDATIONS FOR THE NEXT
PHASE OF PROJECT
30
TABLE OF CONTENTS
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 2
APW Agreement for Performance of Work
ANCDR Annual New Case Detection Rate
ASHA Accredited Social Health Activist
ANM Auxillary Nurse Midwife
BMO Block Medical Officer
CHC Community Health Centre
CMO Chief Medical Officer
DPMR Disability Prevention and Medical Rehabilitation
DEO Data Entry Operator
HA (M) Health Assistant (Male)
HA (F) Health Assistant (Female)
HSC Health Sub Centre
ILEP International federation of Anti Leprosy Association
MPW Multi Purpose Worker
NRHM National Rural Health Mission
NLEP National Leprosy Eradication Programme
NGO Non Governmental Organization
PR Prevalence Rate
PHC Primary Health Centre
PAL Patient Affected with Leprosy
RD Regional Director
RLTRI Regional Leprosy Training and Research Institute
SHRC State Health Resource Center
SPO (L) State Programme Officer (Leprosy)
ABBREVATIONS USED
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 3
Despite program activities like intensive monitoring through the District Leprosy
Officers, prevalence has continued to remain high (more than 2) in Raipur and Bilaspur
districts of Chhattisgarh and cases are also detected relatively late as evidenced by the
high level of deformities among cases when first detected. Based on the available
evidence, innovative strategies to enhance awareness of vulnerable people and
strengthen delivery of comprehensive services to leprosy affected people needs to be
developed. Organizations/ Forum of people affected by leprosy can be involved,
consulted and made responsible for this. The guidelines developed during the Manila
conference of people affected by leprosy on the 9th & 10th June 2010
encourages/introduces the participation of persons affected by leprosy in leprosy
services. There are many things that the person affected by leprosy can do in the area of
IEC and enhanced risk communication.
The capacity of the existing system of health care needs to be strengthened through
ongoing and regular trainings in leprosy for peripheral health workers and ASHAs.
Supervisory personnel of organizations & People affected by leprosy would also be
sensitized and trained on supportive supervision and monitoring of programme
implementation at the sub-district level.
Program management functionaries at the state and district level require a level of
experience and expertise in the disease control activities. WHO intends to support the
training program of a select group of program personnel in selected states to develop a
sustainable long term training model to improve technical competence of program staff
in the high endemic areas and retain technical competence of program staff in the low
endemic areas. With depleting expertise, a pool of trainers is needed at different levels
that need regular update.
BACKGROUND AND JUSTIFICATION
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 4
The priority areas like disability prevention and medical rehabilitation (DPMR),
community approaches to disability care and rehabilitation needs emphasis in the
training. Partnership with ILEP and other governmental and non-governmental
agencies need to be established.
In order to represent the central Government in the states and to monitor the progress
of the centrally funded health programs, the Central Ministry of Health and Family
Welfare (MoHFW) has placed officers in all the regions of the country. These officers are
known as Regional Directors. They are mainly concerned with coordinating with the
state Governments and ensuring the progress of the National Rural Health Mission.
These officers could be oriented in leprosy and in the activities of the NLEP. They could
then be the local focal points for the project in the concerned districts of the states
where the project activities was undertaken.
Health workers exclusively for the leprosy programme delivered services when the
programme was vertical. However with the integration of leprosy services into general
health care, leprosy work was delegated to the existing peripheral health workers.
Volunteers known as Accredited Social Health Activists (ASHA) known as MITANIN in
CHHATTISGARH assist the peripheral health workers in delivering health care to the
community in the National Rural Health Mission (NRHM). Though initiatives have been
undertaken to involve ASHAs in the delivery of leprosy services, technical & supportive
supervisory support provided to them to carry out basic leprosy services like
identification and referral of leprosy cases has been sub-optimal. Capacity building,
monitoring and supervision is necessary till they become fully equipped to taken on this
responsibility.
These initiatives are also expected to contribute to reduction in deformity and create
awareness about leprosy and its consequences.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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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.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 6
The immediate objectives of the proposed activity, show the
relevance of these objectives to the programme area(s)/ Work
Plan, and identify the expected outcomes/outputs.
1. Capacity building of health workers in leprosy to suspect,
diagnose, treat, record and report patients as per their
level of expertise.
2. Monitoring and supervisory training for supervisory staff
of general health care at all levels.
3. Programme advocacy at different levels including people
affected by leprosy as potential partner.
4. Review the programme for impact and feedback into the
system.
Orientation training of Self help Group Akaltara, Janjgir champa
The main aim is to build the capacity of different levels of
SPECIFIC OBJECTIVES METHODS AND APPROACHES USED
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 7
health care staff in the high-endemic districts of Chhattisgarh in order to stream line
leprosy case detection, and thereby reduce leprosy burden at sub-national levels. This
can significantly affect the monitoring and supervision of the leprosy programme which
will be strengthened by empowering the supervisory staff. A part from this, advocacy
for the programme will be initiated at all levels by training people affected by leprosy
with potential involvement at all levels.
BRIEF TIMEFRAME OF ACTIVITIES:
1. Identification of training needs of health care staff in leprosy at SC, PHC, CHC and
district level.
2. Preparation of curriculum, training materials and leprosy kits for different levels of
staff (including refresher course).
3. Develop an action plan of participants, resource persons with date and venue.
4. Monitor the training activities for uniformity and quality.
5. Bi-monthly programme review to assess impact at different levels.
TECHNICAL STAFF SUPPORT:
Two districts were supported by one medical officer (MO) who was engaged in all
training related activities. Monthly reports of the activities and the developments in the
project were submitted to the DLO / RLTRI / SLO and WHO. The main job of the MO was
to get the needed support from the DLO / BMO to carry out his routine activities.
Moreover, there were two field workers (one for each district) who assist the medical
officer in data collection, organising trainings, follow-up etc.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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Chhattisgarh Map Showing the leprosy endemicity as per districts (PR <1 and >1 per 10,000 population)
EPIDEMIOLOGICAL PROFILE AND HUMAN RESOURCE IN PROJECT AREAS
The Chhattisgarh state is
endemic for leprosy and
still lags behind the WHO
target of elimination as a
public health problem. This
state with less than 22 % of
country’s population holds
about 6% of new leprosy
case load. Out of 18
districts, 11 are having PR
above 1 per 10,000
populations (Minimum
0.46- maximum 8.44 as on
July 2011)
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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a) Epidemiological Aspects (NLEP) of Raigarh District
Particulars
Year
2007-08 2008-09 2009-10 2010-11 2011-12 up to Dec
2012
New cases detected 872 920 921 830 551
Prevalence rate (PR) 4.69 4.86 4.5 3.93 3.61
ANCDR 64 63.7 62.7 55.6 36.9
MB (%) 52.8 63.1 62.5 56.2 52
Female (%) 31.76 36.8 37.7 35.3 38.8
Child (%) 6.3 7.8 5.9 6.8 5.9
Deformity Grade I (%) 4.58 9.5 5.2 7.2 7.9
Deformity Grade. II (%) 2.4 4.8 6 5.9 6.1
No of cases detected by ASHA
NA 2 out of 6 53 out of 90
34 out of NA
NA
The population of the district is 14, 92,013 having 435 villages and 50 health Sub
Centres. The Prevalence rate has dropped from 4.69 per 10,000 populations to 3.93 per
10,000 populations in the year 2010-11. The MB proportion is above 50%. The number
of suspected leprosy cases detected from community by ASHA is still low (<10% of total
suspected). The number of cases reported voluntarily is not available and also not
recorded. The mitanin population ratio is 1: 400 inhabitants.
b)Available Human Resource of District Raigarh
Sr. No. Post Sanction In position Vacant
1 BMO 9 0 9
2 Medical Officer 126 53 73
3 Health Assistant 08 12 0
4 Lab Technician 53 44 9
5 Health Supervisor (M) 36 28 8
6 Health Supervisor (F) 66 44 22
7 Auxillary Nurse Midwifery 370 309 61
8 Multi Purpose Worker 317 213 104
9 Block Program Manager 9 9 0 10 Block Accountant-cum-Data Assistant 9 6 3
11 Data Entry Operator 13 13 0
There is shortage of the MO and grass root (MPW) health workers across the
peripheral health centres.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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c) Epidemiological Aspects (NLEP) of Block – Loing
Sr. No.
Particulars 2007-08 2008-09 2009-10 2010-11
2011-12 up to Dec
2012
1. New cases detected 76 112 130 103 66
2. Prevalence rate (PR) 4.57 7.35 5.77 4.79 4.38
3. ANCDR 61 79.2 90.4 70.5 45.1
4. MB (%) 61.8 74.1 57.6 55.3 51.5
5. Female (%) 34.2 47.3 31.5 28.1 39.3
6. Child (%) 5.2 12.5 6.9 4.8 3
7. Deformity Gr. I (%) 18.4 20.5 4.6 10.6 4.5
8. Deformity Gr. II (%) 5.2 8.9 7.6 6.7 1.5
The population of the block is 1, 46,074. This block is having 147 villages, 37
HSCs and 10 PHCs. The PR ranges from 4.79 to 7.35 and the new cases detected
is more than 100 per year. There are 407 functional ASHAs in the block.
d) Available Human Resource of Block - Loing
Sr. No. Post Sanction In Position Vacant
1. BMO 0 0 0 2. Medical Officer 20 10 10
3. Medical Officer (Ayush)-Contractual 7 7 0
4. Health Assistant 0 2 0
5. Lab Technician 10 3 7
6. Health Supervisor (M) 6 4 2
7. Health Supervisor (F) 6 6 0
8. Auxillary Nurse Midwifery 50 48 2
9. Multi Purpose Worker 37 26 11
10. Block Program Manager 1 1 0
11. Block Accountant-cum-Data Assistant 1 0 1
12. DEO 1 1 0
At the grass root level, 30% of MPW posts were vacant at health sub center.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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e) Epidemiological Aspects (NLEP) of Pussore
Block
Sr. No.
Particulars 2007-08 2008-09 2009-10 2010-11 2011-12
up to Dec. 2012
1. New cases detected 111 104 124 108 68
2. Prevalence rate (PR) 5.39 5.56 5.81 4.97 4.91
3. ANCDR 83.2 77.3 83.1 73.5 46.3
4. MB (%) 39.6 64.4 61.2 42.5 35.2
5. Female (%) 32.4 34.6 41.9 37.9 54
6. Child (%) 5.4 13.4 4 7.4 10.2
7. Deformity Gr.I (%) 7.2 4.8 5.6 2.7 7.3
8. Deformity Gr.II (%) 2.7 2.8 6.4 3.7 4.4
The population of this block is 1, 46,757 and the block is having 148 villages, 28
HSCs and 7 PHCs. The PR ranges from 4.91 to 5.81, and the new cases detected
are more than 100 per year. There are 415 ASHA (mitanins) functional in the
block.
f) Available Human Resource of Block Pussore
Sr No Post Sanction In Position Vacant
1. BMO 1 0 1
2. Medical Officer 21 5 0
3. Medical Officer (Ayush)-Contractual 7 7 0
4. Health Assistant 2 2 0
5. Laboratory Technician 9 9 0
6. Health Supervisor (Male) 7 0 7
7. Health Supervisor (Female) 7 7 0
8. Auxillary Nurse Midwifery 35 35 0
9. Multi Purpose Worker 29 17 12
10. Block Program Manager 1 1 0
11. Block Accountant-cum-Data Assistant 1 1 0
12. DEO 1 1 0
The regular post of BMO is vacant, and all post of health supervisor (Male) was
vacant both at the PHC and block level. At the grass root level, 40% of MPW posts
were vacant at health sub center.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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g) Epidemiological Aspects (NLEP) of District Janjgir Champa
SN Particulars 2007-
08 2008-
09 2009-
10 2010-
11 2011-
12
1 Annual new case detected 490 797 703 581 496
2 Prevalence Rate(PR) 2.29 4.12 4.65 2.28 1.54
3 Annual new case detection rate(ANCDR)
33.68 53.97 46.85 38.40 32.40
4 MB (%) 47.03 58.97 59.03 56 47.78
5 Female (%) 32.72 31.87 34.71 35.40 37.78
6 Proportion of child 10.43 6.02 6.83 6.80 4.11
7 Deformity Grade. I (%) 4.70 3.51 11.09 4.40 2.32
8 Deformity Grade. II (%) 2.86 4.02 6.4 6.30 4.02
9 No of cases detected through ASHA
13 117 112 125 180
10 No of cases detected through voluntary reporting
244 398 312 281 240
The population of the district is 15, 34,634 having 913 villages and 266 health sub centres and 45 PHCs.
The Prevalence rate has dropped from 4.65 per 10,000 populations to 1.54 per 10,000 populations in the
year 2011-12. The MB proportion is above 50%. The number of suspected leprosy cases detected from
community by ASHA is 36% of the total in the year 2011-12. The number of the cases reported
voluntarily is near about 50% of total detected. There are 3611 ASHA working at the village level in the
district.
h) Available Human Resource of District Janjgir
Champa
Sr. No. Post Sanction In Position Vacant
1. Medical Officer 124 63 61
2. Lab Technician 30 5 25
3. Health Supervisor (M) 54 20 34
4. Health Supervisor (F) 62 41 21
5. Auxillary Nurse Midwifery 317 261 56
6. Multi Purpose Worker 274 160 114
7. Block Program Manager 9 9 0 8. Block Accountant-cum-Data
Assistant 9 7 2
9. Data Entry Operator 13 11 2
The District Nucleus Team (DNT) medical officer post is vacant and almost 50% post of the medical
officers is vacant. At the grass root level, 41% of MPW posts were vacant at health sub centre.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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i) Epidemiological aspects (NLEP) of Pamgarh
Block
SN Particulars 2008-09 2009-10 2010-11 2011-12
up to Dec. 2012
1. New cases detected 46 46 98 72
2. Prevalence rate (PR) 3.1 3 4.35 2.3
3. ANCDR 33 32 60 46
4. MB (%) 55 60 62 60
5. Female (%) 30 32 30 29
6. Child (%) 12 4.2 6 8
7. Deformity Gr.I (%) 0 0 5 2.2
8. Deformity Gr.II (%) 8 4.2 6 5.6
9. No of cases detected through ASHA
- 8 12 21
10. No of cases detected through voluntary reporting
46 38 86 51
The population of the block is 1, 56,530. The PR ranges from 4.35 to 2.3 per 10,000 population in 2011-
12, and the new cases detected is more than 72 in the same time period. There are 415 ASHA (mitanins)
functional in the block.
j) Available Human Resource of Block Pamgarh
Sr No
Post Sanction In Position Vacant
1. Block Medical Officer 1 1 0
2. Medical Officer 7 3 4
3. Health Assistant 0 1 0
4. Laboratory Technician 1 1 0
5. Health Supervisor (Male) 4 4 0
6. Health Supervisor (Female) 6 6 0
7. Auxillary Nurse Midwifery 33 25 8
8. Multi Purpose Worker 28 15 13
9. Block Program Manager 1 1 0
10. Block Accountant-cum-Data Assistant 1 1 0
11. Data Entry Operator 1 1 0
More than 50% of the posts of medical officer were lying vacant. At the grass root level, 46% of MPW
posts were vacant at health subcenter. There are 400 ASHAs delivering services in the block.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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k) Epidemiological Aspects (NLEP) of Akaltara Block
SN Particulars 2008-09 2009-10 2010-11 2011-12
up to Dec. 2012
1. New cases detected 90 80 98 72
2. Prevalence rate (PR) 4.0 3.02 4.19 2.2
3. ANCDR 50 48 60 45
4. MB (%) 60 50 60 60
5. Female (%) 28 30 35.2 20
6. Child (%) 13 25 6 5.2
7. Deformity Gr. I (%) 6 - 4 1.3
8. Deformity Gr. II (%) 5 5 5 2.6
9. No of cases detected through ASHA NIL 8 12 22
10. No of cases detected through voluntary reporting
90 72 86 50
The population of the block is 1, 60,220. Block constitutes 148 villages, 28 HSCs and 7 PHCs. The PR
ranged from 4.91 to 2.2 per 10,000 population and new cases detected more than 72-98 per year. The
413 ASHA (Mitanin) is functional in the block.
l) Available Human Resource of Block Akaltara
Sr No Post Sanction In Position Vacant
1. Block Medical Officer 1 1 0
2. Medical Officer 12 6 6
3. Health Assistant 6 2 4
4. Laboratory Technician 2 1 1
5. Health Supervisor (Male) 5 5 0
6. Health Supervisor (Female) 5 3 2
7. Auxillary Nurse Midwifery 30 27 3
8. Multi Purpose Worker 30 20 10
9. Block Program Manager 1 1 0 10. Block Accountant-cum-Data Assistant 5 5 0
11. DEO 1 0 1
50% of medical officer posts at primary health centres were lying vacant. At the grass root level, 33% of
MPW posts were vacant at health sub center.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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Sr No Activities
01/10/2011 to
14/10/2011
15/10/2011 to
04/11/2011
05/11/2011 to
17/11/2011
18/11/2011 to
30/11/2011
01/12/2011 to
06/12/201
A) Pre training Activities
1 Staff Recruitment
2 Data collection from district and village
3 Selection of training places and dates
4 Pre training Visit of the staff
5 Preparation and printing of the training module of Supervisory staff and ASHA
B) Training Raigarh and Janjgir Champa district Blocks
7 Raigarh -Pussore block- supervisory staff Training
8 Raigarh -Pussore block- ASHA/PAL Training- 4 batches
9 Raigarh-Loing block- Supervisory Staff Training
10 Raigarh -Loing block- ASHA/PAL Training- 4 batches
11 Jangir- Akaltara block- supervisory staff Training
12 Jangir- Akaltara block- ASHA/PAL Training- 4 batches
13 Jangir- Pamgarh block- supervisory staff Training
14 Jangir- Pamgarh block- ASHA/PAL Training- 4 batches
TIME LINE OF ACTIVITIES - GANTT CHART
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 16
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
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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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
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 18
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
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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Table I: Allotment of project area (blocks) to project staff
Sr no Name of district Selected block Name of
Supervisor
Name of
Medical Officer
1 Janjgir Champa Akaltara Shri G.N. Rathore
Dr. A.K. Mishra Pamgarh
2 Raigarh Pussore Shri M.K. Ansari
Loing
Table II: Number of faculties involved in the trainings for supervisory staff
District Block No of Batches
Medical officer
Raigarh Pussore 1 4
Loing 1 4
Janjgir
Champa
Akaltara 1 4
Pamgarh 1 4
Total 4 16
Table III: Number of supervisory staff attended training
District Block No. of Batches
No. of Supervisory staff
Raigarh Pussore 1 60
Loing 1 60
Janjgir
Champa
Akaltara 1 60
Pamgarh 1 60
Total 4 240
DISTRICT AND BLOCK WISE REPORT OF THE TRAINING FOR MITAININS AND GENERAL HEALTH CARE STAFF
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 20
Report of supervisory staff training in Raigarh:
1) Block- Pussore
Dates: 05.11.2011
Venue: Community Hall, Pussore
60 ANMs and 10 Supervisors attended. The training programme was conducted by-
1. Dr. R. N. Sabat, Director, RLTRI, Raipur
2. Dr. V. Deodia, DLO, Raigarh
3. Dr. A. K. Mishra, MO, WHO Project
4. Dr. M. K. Patel, BMO, Pussore block
Training of supervisory staff Supervisory staff training
2) Block- Loing
Dates: 26.11.2011
Venue: CHC, Loing
60 ANM and 10 supervisors attended. The training programme was conducted by-
1. Dr. R. N. Sabat, Director, RLTRI, Raipur
2. Dr. V. Deodia, DLO, Raigarh
3. Dr. A. K. Mishra, MO, WHO Project
4. Dr. G.S Paikra BMO, Loing
Report of supervisory staff training in Janjgir-Champa:
3) Block- Akaltara
Dates: 18.11.2011
Venue: CHC Akaltara
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
Page 21
60 ANM and 10 supervisors attended. The training programme was conducted by
1. Dr S.L Gupta, SHRC, Raipur
2. Dr M.K Soni, RLTRI, Raipur
3. Dr. A. K. Mishra, MO, WHO Project
4. Dr C.P Singh, BMO Akaltara
4) Block- Pamgarh
Dates: 1 12.2011
Venue: Community Hall, Pamgarh
60 ANM and 10 supervisors attended. The training programme was conducted by
1. Dr Ravi Rao, RLTRI,Raipur
2. Dr M.K .Soni, RLTRI,Raipur
3. Dr. S.L Gupta,SHRC
4. Dr K K .Dahire, BMO,Pamgarh
Training of supervisory staff Supervisory staff training
A total of 240 supervisory staffs were trained in leprosy in four batches in the identified
four blocks of two high endemic districts in Chhattisgarh. Both theoretical as well as
practical aspects including DPMR activities in brief were covered during the one day
training. The block medical officers (BMO), RLTRI and SHRC faculty and people affected
by leprosy were involved during training. There is significant improvement in the
knowledge and skills before and after training in the selected general health care staff
and ASHA (Mitanin) workers. The Training Kits were distributed among all the
supervisory staff during training session.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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Table IV showing number of ASHA (Mitanin) trained in Raigarh and Janjgir
Champa districts
District Block No of Batches No of ASHA and PAL
Raigarh Pussore 4 198
Loing 4 202
Janjgir
Champa
Akaltara 4 195
Pamgarh 4 205
Grand Total 16 800
District: Raigarh
1) Block- Pussore
Dates: 08.11.2011 and 09.11.2011
Venue: Community Hall, Pussor
2) Block- Loing
Dates: 29.11.11 and 30.11.2011
Venue: CHC, Loing
ASHA (mitanin) training SLO addressing ASHA (mitanin)
District: Janjgir Champa
3) Block- Akaltara
Dates: 16.11.2011 and 17.11.2011
Venue: Satnam Bhavan, Akaltara
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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4) Block- Pamgarh
Dates: 02.12.2011 and 03.12.2011
Venue: Community Hall, Pamgarh
ASHA (mitanin) training ASHA (mitanin) training
A total of 800 ASHA (Mitanins) workers were trained in leprosy in 16 batches in the
select four blocks of Raigarh and Janjgir-Champa districts. Both theory as well as
practical was covered during the training session. The medical officers, BMO and
supervisors of RLTRI, Raipur / State govt. / SHRC, Raipur were involved in the trainings.
There is significant improvement in the knowledge and skills before and after training
in the selected ASHA (Mitanins) workers. The training kits were distributed among the
all mitanins during training sessions.
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Raigarh: The advocacy meeting took place in district Raigarh on 16/11/2011 as part of
the WHO Project. The purpose of the meeting was to sensitize the district level leaders
on the needs in the field of leprosy and to take recommendations from the local leprosy
experts for the betterment of leprosy programme in the selected district with political
goodwill. The meeting was held at telemedicine room of Kirodimal Government district
hospital, Raigarh under the chairmanship of Director of Regional Leprosy Training and
Research Institute, Raipur.
The Chief Medical & Health Officer (CMHO) of Raigarh was the chief guest of the
meeting. It was attended by Civil Surgeon, District Leprosy Officer, District Health
Officer, Block Medical Officers of Loing & Pussore block, Assistant Director of Education
Department, Doctors from Railway & Police department, members of the Red cross
society, Gayatri parivar, Mitanin Supervisors, local media, State Forum of people
affected by leprosy (PAL). The project medical officer welcomes all the invitees and
narrated the purpose of the meeting. He also presented the epidemiological situation of
the Raigarh district. The DLO spoke on present and future plans to be taken in the
district to reduce leprosy burden in the district.
Advocacy meeting at Raigarh Health officers, Political leader and Media persons etc at advocacy meeting at Raigarh
ADVOCACY MEETINGS
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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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.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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Janjgir Champa District: The Advocacy Meeting took place at Akaltara, Janjgir district
on the 3rd December, 2012 as a part of the WHO Project. The purpose of the meeting
was to sensitize the district level leaders on the needs in the field of leprosy and to take
recommendations from the local leprosy experts for the betterment of leprosy
programme in the selected district with political goodwill. The meeting was held at
meeting hall of Shreeji Hotel under the chairmanship of the Director of Regional
Leprosy Training and Research Institute, Raipur.
Dr. Bhatpahare, State Leprosy Officer (SLO) of Chhattisgarh was the chief guest of the
meeting. The Chief Medical and Health Officer (CMHO) of Janjgir district was the key
speaker. It was attended by DLO, leprosy consultant from state health resource centre
(SHRC), Raipur, BMOs of Akaltara & Pamgarh blocks, Child Development Project Officer
(CDPO) members from the local Municipality, Gayatri parivar, Mitanin supervisors, local
media, leaders from the forum of persons affected by leprosy (PAL). The Consultant
from SHRC, Raipur welcomed all the invitees and narrated the purpose of the meeting.
He also presented the epidemiological situation of the Janjgir district. The DLO spoke on
present and future plans to be taken in the district to reduce the leprosy burden in the
district.
Dr. Ramanath Sabat, Director, RLTRI emphasized on concerted efforts by all
individuals present irrespective of organisations in the elimination and eradication of
leprosy. He requested everybody to spread the key leprosy messages that they have
heard so that the disease can be detected early and completely cured. Dr. Bhatpahare,
State Leprosy Officer described the epidemiological situation of Chhattisgarh state and
the steps he has taken towards it. The CMO is committed to implement the programme
successfully by taking necessary help/involving persons from all organizations.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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All members present in the meeting agreed to be involved in the programme for creating awareness in their jurisdiction and give priority to the programme.
Advocacy meeting at Janjgir Champa Health officers, Political leader and Media persons etc at advocacy meeting at Janjgir Champa
They have also decided to support the special activities like RCS camp, special
campaign, door to door survey etc at all possible levels.
There was an open time to discuss various issues affecting the leprosy programme.
Involvement of the local media to create awareness through printed media was also
discussed and its sustainability was ensured. Many recommendations were made by
different people were noted down. The same will be submitted to the local district
authorities for further consideration.
Advocacy for the programme will be initiated at all levels by training people affected by
leprosy(PAL) with potential involvement at all levels. Significant advocacy tasks still
remain at the district level. The continued involvement of district/block and village
level administrators and implementers remains crucial which will have considerable
impact on the achievement of the program goals.
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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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
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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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
Intensified leprosy activities in the high endemic districts of Raigarh and Janjgir-Champa to reduce leprosy burden at sub-national levels
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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
Recommended