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REPORT ON NLEP TECHNICAL SUPERVISION OF
16 HEALTH FACILITIES OF
RAIPUR DISTRICT, CHHATTIGARH STATE
OBSERVATION BY
SLO’S/DLO’S OF 9 STATES (64 Nos.) IN
FOUR BATCHES (29 Nov 2010 – 11 Feb 2011)
Coordinated by- Regional Office of Health and Family Welfare
and Regional Leprosy Training and Research Institute,
Lalpur, Raipur (C.G.)
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1) First Batch Supervisory Visit
a) Accompanied Officer: Dr SV Gitte, Assistant Director,Dr Mukesh Soni, MO
Dr Prasant Sahu, MO, Mr S. Dhruw, Mr I Mashi, PMW
b) Date of Visit: 29
th Dec to 03
rd Jan 2011
c) List of visited health facilities and officer of differ rent state
Sr No Name of Health
Facilities Name of Officers State
A Bhatagaon PHC Dr H Taki, Dr T. Darung,
Dr T C Khirme, Dr SR Jadhav,
Arunanchal Pradesh, Assam, MP,
Maharashtra
B Raipura HSC
Dr K C Shukla, Dr M C Das,
Dr D S Das, , Dr S S Thakur,
Dr G.S Tomar
Arunanchal Pradesh, Assam, MP, Punjab
Maharashtra
C
BoriyakalaPHC
Dr A. Singh, Dr Jagroop Singh,
Dr Murari Lal, Dr Mukul Ray,
Dr Abhay Das
Arunanchal Pradesh, Assam, MP,
Maharashtra
D Manabasti HSC Dr C M Tripati, , Dr MC Vyas,
Dr V K Jain, Dr P B Das
Arunanchal Pradesh, Assam, MP,
Maharashtra
Second Batch Supervisory Visit
a) Date of Visit:: 10th
to 14th
Jan 2011
b) Accompanied Officer: Dr SV Gitte, Assistant Director,
Dr Mukesh Soni, MO, Mr S. Dhruw, Mr I Mashi,PMW
Sr No Name of Health Facilities Name of Officers State
1 Leprosy Home and
Hospital, Raipur
Dr Tarik Talom,Dr Manjit Kaur,Dr O
P Yadhav,Dr N D Deshmukh,
Dr A Haldar
Arunachal Pradesh
Punjab, Uttar-Pradesh
Maharashtra
2 Labnandih PHC Dr P Rakshit,Dr(Mrs) Sangita
Singh,Dr Chandrajit Sanwale,
Dr D B Mote
Arunachal Pradesh
Punjab, M.P.
Maharashtra
3 Mandir Hasaud PHC Dr Gumjom Ete,Dr Gyandra
Sharma,Dr Atul Choudhury,
Dr R.B.Mugade
Arunachal Pradesh
Punjab, M.P., Maharashtra
4 ChandKhuri Dr M Mati,Dr A K Ghose
Dr Kesri Prasad,Dr Ganpati Das,Dr
P.Y Gaikwad, Dr PK Gupta
Arunachal Pradesh
West Bengal
MP, Maharashtra,
Uttar Pradesh
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2) Third Batch Supervisory Visit:
a) Date of Visit:: 17th
to 21th
Jan 2011
b) Accom Officer: Dr SV Gitte, Assistant Director,Dr Mukesh Soni, MO, Mr S.
Dhruw, Mr I Mashi,PMW
Sr No Name of Health Facilities Name of Officers State
A Dharsiwa Block CHC Dr N Ninu Arunachal Pradesh
Dr D Bagra
B Chausada HSC Dr India Modi Arunachal Pradesh
Dr B Bay
C
Birgaon PHC Dr Prinejeet Singh Punjab
Dr Ashwani Gupta
D Urla PHC Dr Arjun Singh Sarang Uttar Pradesh
Dr B Tokue Arunachal Pradesh
3) Forth Batch Supervsiory Visit
a) Date of Visit: 7 th to 11th Feb 2011
b) Accompaning Officer: Dr SV Gitte, Assistant Director,Dr Mukesh Soni, MO,
Dr Prasant Sahu Mr S. Dhruw, Mr I Masih,PMW
Sr No Name of Health Facilities Name of Officers State
A Abhanpur Dr Dhirendra Nath Hazarika
Dr S J Dhawan
Dr Shyamali Rudra
Dr Sankar jyoti deb
Assam
Punjab,
West Bengal
Arunachal Pradesh
B Manikchouri Dr Bijoy Hasda
Dr Suresh Kumar
Dr Hage Tabyo
Dr Jaj prabha Moktan
Assam
Punjab,
West Bengal
Arunachal Pradesh
C
Nayapara Dr Tenjing Doma,
Dr.O. Megha
Dr M Purkayastha
Dr Abdul Awal
Assam
Punjab,
West Bengal
Arunachal Pradesh
D Rajim Dr G.C. Brahma, Dr K.P. Shah
Dr Rana Verma
Assam
Punjab,
West Bengal
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Report of Supervisory Visit of SLO/DLO Training
First Batch (29 November – 3 December 2010)
Health facilities visited – Bhatgaon & Boriyakala PHC, Raipura & Mana basti HSC
Findings of Bhatagaon PHC-
1) DPMR activities are not implemented in the visited health facility and officials
working there are also not aware about DPMR activity. The Nerve function test/VMT
is not done at PHC.
2) New LF - 1 card are filled properly in cases of categorization of treatment; patients
were usually referred from RLTRI for continuation of treatment. MPR were not
submitted regularly and within time. The diagnostic ability of the clinician is low.
3) The Stock of MDT drugs are available as per guidelines and were adequate.
4) No MCR records available.
5) Prednisolone medicine was not found in the stock for the treatment of neuritis and
reaction cases.
6) Health Workers posted there require training in NLEP and DPMR.
7) IEC displayed were inadequate. No Hoarding or wall painting or posters related to
Leprosy observed.
8) Monitoring of NLEP activity need to be improved for which proper planning is
required.
9) Diagnosis classification and stock register were well maintained but cleanliness of
premises was very poor.
10) MDT drugs were indented timely & stored properly. Record maintenance of the
MDT Stock registers was proper. No expiry date MDT found.
5
a) Visit to Raipura HSC: Group 2 visited to Raipura HSC they met with ANM posted
their findings were:
1) She is involved in leprosy work and keeps records of leprosy patients.
2) She is referring the suspected cases which were confirmed by MO-I/c.
3) With the help of ASHA she ensures completion of MDT treatment.
4) As per the advice of supervisor she gives counseling and informs patients about
possible side effects of drugs but information was incomplete, she requires re-
orientation training.
5) Leprosy awareness through IEC material was not observed and Inter Personal
Communication (IPD) was also not done. IEC materials were inadequate in HSC.
6) She is neither contacting family of Patient Affected with Leprosy (PAL) nor their
neighbors. She do not examine or provide counseling to the family members of the
PAL and his neighbours.
7) Counseling services are lacking in all aspects.
C) Findings of Boriyakala PHC:
1) MO was not present during our visit despite of our prior intimation. PMW/NMS (NLEP
record keeping staff) was present during the time of visit.
2) DPMR activities are not implemented and officials posted in the health facility are not
aware about DPMR activity. The Nerve function test/VMT was not done at PHC, POD
and self care activity were also not available.
3) New LF 1 cards were not filled properly in cases of categorization of treatment; patients
were usually referred to RLTRI for confirmation of leprosy. MPR were not submitted
regularly and within time. This referral records directly indicate that there is need to
improve the diagnostic ability of the Medical Officer through regular training and for
the benefit of the PAL so that they can avail the treatment at their door step.
4) The Stock of MDT drugs is adequate & available as per guidelines.
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5) No MCR records available.
6) Prednisolone medicine was not available for the treatment of neuritis and reaction cases.
7) Health workers posted in the visited health facility needs training in NLEP and DPMR
activity.
8) IEC displays were inadequate. No Hoarding, wall painting or posters related to Leprosy
observed.
9) Monitoring of NLEP activity needs to be improved with proper planning.
10) MDT drugs were indented timely & stored properly. Record maintenance of the MDT
Stock registers was proper. No expiry date MDT found.
11) Many columns were kept blank by supervisors in checklist so findings were not
appropriate.
D) Visit to Mana basti HSC:
1) ANM posted in the health facility is involved in leprosy work and keep records of leprosy
patients.
2) She is referring the suspected cases which were confirmed by MO-I/c. Sometimes she also
advises patients to go to RLTRI for confirmation.
3) With the help of ASHA she ensures completion of treatment. There are no defaulters or
irregular patients in her register.
4) As per the advice of Health Supervisor, she gives counseling and informs patients about
possible side effects of drugs.
5) She is involved in Leprosy awareness campaign through IEC material, Inter Personal
Communication (IPC) to the community.
6) She is not contacting family of patients and his neighbors.
7) Suspected patient register were not found.
8) Referral slip was available but not used.
9) Contacts were not checked.
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Report of Supervisory Visit of SLO/DLO Training
Second Batch (10 January – 14 January 2011)
Health facilities visited – Leprosy Home & Hospital, Raipur, PHC Labhandi,
Mandir Hasaud PHC, Chandra khuri PHC
Supervisory Visit to Health Facility
b) Findings of leprosy home and hospital (urban leprosy centre) Health
Facilities
1. Addresses on the LF1 cards are not properly mentioned; supervisory team
suggested that address column should be filled carefully, they should also mention
nearest landmark to identify the area easily.
2. The concerned health staffs at the ULC are not able to make correct diagnosis and
classification of leprosy patient. They are not practicing nerve function test
routinely; all the health staff should be provided reorientation training for
improving early diagnosis and treatment.
3. MDT stock is inadequate as per current NLEP guidelines and registers are not
maintained properly.
4. IEC materials displayed at the ULC are not adequate, they should display more
messages related to stigma in leprosy.
5. Prednisolone Tablets are not available for treatment of Lepra reaction and
neuritis, health staff are usually referring such cases to higher centre for further
case management, visited team suggested that capacity building for managing of
such cases should be developed for officials of ULC for better patient compliance.
6. The Physiotherapist is posted at ULC but his knowledge is very limited in
prevention of disability. His services are also under-utilized. The
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physiotherapist should be provided refresher course in leprosy either at Regional
Leprosy Training and Research Institute, Raipur or any other suitable training
center. Facilities for Physiotherapy, RCS and DPMR activity are not available at
the visited ULC, although adequate staffs are available at the centre.
7. All the health staff should be motivated to deliver output, although they are
enthusiastic and determined, but they are not performing their work up to the
mark.
8. As the visited centre is an apex Institute they should set an example and
provide good facility for ulcer care and counseling, team felt that this section
needs improvement.
9. Referral system exists on records only, as revealed by the team.
Visit to PHC Labhandi:
Group 2 visited to Labhandi PHC they met with MO in charge, there findings were:
1. The centre is making diagnosis and classification of leprosy patient and also
performing nerve function test but they are not accurate as per the NLEP
guidelines are concern. The visited team felt that reorientation training is required
for them.
2. MDT stock is not adequate as per NLEP guidelines, Prednisolone tablets are not
available at the centre; they used to refer reaction and neuritis cases to higher
centre for treatment and management.
3. Stock register are not properly maintained and not up-to-date.
4. Primary DPMR register & Record of deformity Grade-II reaction not maintained
properly.
5. IEC materials not at all observed, they should have adequate IEC materials,
especially in hyper endemic state like Chhattisgarh.
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6. Patient diagnosed and classified with Disability Grading at RLTRI, Raipur
were referred back to centre are not registered for further follow-up.
7. Lack of manpower observed in the visited health facility, steps to be taken to fill
the vacant post soon to ensure better health care facility.
8. There should be improvement in self care practice and counseling of patient
affected with leprosy
9. . Suggestions are-
a. Improve DPMR activity.
b. Proper maintenance of all register and filling of format.
c. Timely updation of stock register.
d. To train staff by reorientation training.
e. Improve POD, self care and counseling part.
C) Findings of MANDIR HASAUD PHC:
1. As no pharmacist was available, all the records and MDT drugs are kept by NMA,
he is not fully acquainted with the record-keeping and he explained and informed
us that only 8 case of PBA and 8 case of MBA are under treatment.
2. MO in charge is trained in leprosy and he is having good knowledge of
diagnosis of case, classification of patient, he is also managing reaction and
neuritis cases, however, other staff requires reorientation training.
3. IEC materials displayed are inadequate, awareness activities are not done properly
and regularly.
4. All register such as Master register, Treatment and Referral register and stock
register are maintained but not updated timely.
5. All the reports are timely prepared by NMA but reports are not seems to be
accurate.
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D) Visit to Chandra khuri PHC
The PHC is diagnosing and classifying the cases of leprosy but not in very correct
manner as per the guidelines, so visiting team felt that reorientation training is very much
required for them.
There should be improved and increased POD activity, self care practice and counseling
for patient affected with leprosy.
All register are maintained but not in correct manner, DPMR formats are not filled
correctly by concerned health staff.
Health Centre is handling and managing all type of Lepra reaction and neuritis cases,
prednisolone tablets is also available in their stock.
The reporting system is not proper and visiting team observed lot of under and over
reporting.
Medical Officer-I/c is looking after this PHC, is also attached to CHC.
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Report of Supervisory Visit of SLO/DLO Training
Third Batch (17 January – 21 January 2011)
Health facilities visited – Dharsiwa CHC, Birgaon PHC, Urla PHC, Chaurada PHC
A) Findings of Dharsiwa Health Facilities
1) The team reached the health facility at about 02:35 P.M. NLEP record keeping
staff (PMW/NMS) was not available although prior intimation regarding our visit
was given. The other NLEP staffs went to attend a meeting at some other place.
After requesting to BMO, they were called back.
2) DPMR activities are not implemented and the officials were not well aware about
DPMR activity. The Nerve function test/VMT is not done at block as well as
peripheral health facilities.
3) New LF 1 cards are not filled properly in case of categorization of the leprosy
cases and discrepancy is noted in the sampled forms and it needs to be updated
regularly. Filling up of case cards (LF1) is improper, it is filled up by ANM not
by Medical officers. The two NLEP staff (NMS/NMA) were kept for filling of the
monthly reports only.
4) The MDT Stock is not found as per guidelines. The drug management needs to be
done at each level as per guidelines.
5) MCR records not available.
6) Prednisolone medicine is not available for the treatment of neuritis and reaction
cases since last 2 months.
7) Health workers of all categories need to be provided orientation training in NLEP
and DPMR activity.
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8) IEC displays were inadequate. No Hoarding or wall painting or posters related to
Leprosy observed.
9) The monitoring and supervision of NLEP is lacking and needs to be improved by
proper planning.
10) The disability register should be properly filled in all aspects.
B) Visit to Birgaon PHC:
1) After interaction with the Medical Officer I/C of the PHC, the team comes to
know that, he has not undergone any NLEP training. The team observed that
his knowledge is not up to the mark regarding the diagnosis and treatment of the
Leprosy.
2) Record keeping on the proper format not observed they also do not have format
with them.
3) IEC material was not displayed in any form.
4) They do not have LF2 and LF3 registers, they are keeping the patient record on a
plain register.
5) There seems to be no coordination with district leprosy Society or tertiary leprosy
institute.
6) Neither DPMR activities are observed nor any records related to DPMR &
disability grading register available at visited health facility.
C) Visit to Urla PHC:
1) Medical officer is not trained in leprosy; the other supportive staff was also not
available during the time of the visit.
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2) The staff present did not provide NLEP register (LF2 and LF3) for
supervision.
3) LF 1 forms not filled properly.
4) IEC activities not observed.
5) Everybody shifted their responsibility to other service providers in
integrated health setup.
6) DPMR records are not available.
D) Visit to Chaurada PHC:
1) IEC material not observed at health facilities.
2) MDT is available, but not as per guidelines.
3) LF1 cards observed without registration number.
4) Disability registers not available at Health facilities.
5) Referral cards not available.
6) There is difference in supervisory dose date on the NLEP records.
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Report of Supervisory Visit of SLO/DLO Training
Fourth Batch (7-11 February 2011)
Health facilities visited – Rajim CHC, Manikchauri PHC, Abhanpur CHC,
Nayapara
Findings of Rajim Health Facilities (Checklist attached as ANNEXURE-I)
11) DPMR activities are not implemented and officials posted in the health facility are
not even aware of the DPMR activity. The Nerve function test/VMT is not done
at block as well as peripheral health facilities. The supplied DPMR record from
district is not even opened in the visited health facility and still lying in
bundles.
12) The Stock of MDT drugs are not found as per guidelines specifically child blister
packs. Even stock register were not properly maintained. The team has observed
that timely indent of MDT are not made.
13) MCR chappals not distributed to the patient.
14) The disability register is available but need to refer eligible patient for RCS to
RLTRI, Raipur. Some body in the health facility should take responsibility to
demonstrate self care practice to the Patients Affected with Leprosy.
15) The workers at the health facility require NLEP and DPMR training.
16) IEC materials were not available at health facility. No Hoarding or wall painting
or posters related to Leprosy observed.
17) The monitoring of NLEP activity is weak and needs improvement by proper
planning.
15
18) After interaction with Grade II disability patient, team felt that, patient needs
counseling on self care practices and kit, which is totally lacking at the visited
health facility.
19) Improvement in patient counseling is required.
20) Involvement of mitanins in case detection neither observed nor proper incentives
distributed.
21) Prednisolone tablets are available but not properly used.
22) Lack of supervision by DLO/DNT staff observed by the team.
B) Visit to Manikchauri PHC:
1. PHC is running in building of HSC,
2. Most of the post in the visited PHC is lying vacant, which results inadequate
health care facility at PHC, the Medical Officer used to come at PHC only thrice
in a week
3. MDT drugs is available but there is no proper storage facility.
4. Prednisolone tablets are not available, treatment for lepra reaction and neuritis are
not available, they use to refer patients to higher centre for management of these
types of cases.
5. No master register found at PHC.
6. Staffs posted in the health facility are not able to fill DPMR format properly and
correctly.
7. Orientation training for all categories of health staff is necessary to improve early
case detection, treatment and its management.
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8. There should be proper, frequent supervision and monitoring at PHC and
peripheral level to improve health care facility. As per the version of one PHC
staff, BMO visits their health facility once in a month and CMHO used to come
annually for supervision.
C) VISIT TO Abhanpur CHC
Even after prior intimation when the team reached CHC no doctor were found, only few
of the cleaning staff and ward boy were there, after repeated call and long waiting for
about one hour, one medical officer came and tried to transfer his responsibilities to
BMO.
Treatment facility of lepra reaction and neuritis not available at the visited CHC,
prednisolone tablets were also not available.
There is inadequate IEC materials, only 1 or 2 old chart were hanging in the ward
MCR chappal not available for patient.
Team found that some of the MB child blister were broken up from behind and
drugs were exposed to air for long time, it might have happened due to improper
storage and transportation.
All categories of health personnel should be sensitized about DPMR activity.
Team has also heard that one training programme for MPW and ANM was
conducted in CHC.
D) Visit to Nayapara
Inspite of availability of Prednisolone tablets, patients coming with reaction and
neuritis are not treated. They use to refer the cases to the higher centre.
17
The visited team felt that the staff of the health facility should be imparted re-
orientation training for proper implementation of the programme.
The knowledge of classification of leprosy and diagnosing ability found
satisfactory.
Inadequate IEC materials displayed.
DPMR activities are not yet started at health facility
Inadequate knowledge about filling of DPMR format and other formats observed.
Monitoring and supervision is totally lacking
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ANNEX-I
Supervisory checklist:
1. Making correct diagnosis & classification Y/N
2. Making NFA Y/N
3. Doing patient counseling Y/N
4. MDT availability adequate Y/N
5. Referral & feedback system appropriate Y/N
6. Management of Reactions Y/N
7. POD & self-care activities Y/N
8. Capacity building of in-house staff Y/N
9. Master register maintained Y/N
10. Timely submission of MPR Y/N
11. Punctually of staff ensured Y/N
12. Stock register maintained Y/N
13. IEC materials displayed properly Y/N
14. Cleanliness of PHC premises Y/N
Supervisory Checklist for Pharmacist
1. Availability of MDT as per Guidelines Y/N
2. Availability of Prednisolone &supportive medicine for
reactions Y/N
3. Drugs stored appropriately Y/N
4. Distribution of MDT as per time before ED Y/N
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5. Timely indenting of MDT on prescribed format Y/N
6. Counseling of patients for regularity of MDT and
normal side effects Y/N
7. Check physical quantity, ED of medicines Y/N
8. MDT stock register maintained Y/N
Supervisory checklist for ANM
1. Is she involved in Leprosy work Y/N
2. If so, does she keep records of leprosy patients Y/N
3. Does she give counseling to the diagnosed patients & informs patients
regarding side-effects of drugs Y/N
4. Is she:
i. Contacting the family of patients & examining them Y/N
ii. Household visits & proper counseling done Y/N
iii. By the help of ASHA, ensures completion of treatment
Y/N
5. Does she give Leprosy awareness through IEC material etc.to the community on
village health day Y/N
20
Officers interact with the Urban Leprosy Unit, Raipur, Chhattisgarh state
Officers interact with the Leprosy Patient in Urban area
21
Visit to PHC
Officers interact with the Health staff at PHC
22
Officers interact with the Health staff at PHC
NLEP record verification
23
Interaction with medical Officer of PHC
MDT verification by supervisors
24
MINISTRY OF HEALTH AND FAMILY WELFARE
REGIONAL DIRECTORATE OF HEALTH AND FAMILY WELFARE,
CHHATTISGARH
(REGIONAL LEPROSY TRAINING AND RESEARCH INSTITUTE),
LALPUR, POST BOX NO. 112, RAIPUR-492 001 (C.G.)
Ref. No. RLTRI/NLEP/2011/ Dated 10.03.2011
The Deputy Director General (Leprosy),
Directorate General of Health Services,
Central Leprosy Division,
Nirman Bhavan,
New Delhi-110011
Sub: - Report on NLEP Technical Supervision of 16 Health Facilities of Raipur District,
Chhattigarh State.
Sir,
Please find enclosed herewith a brief Report on NLEP technical supervision of 16 Health
Facilities of Raipur district conducted during the four batches of Training Program of State
Leprosy Officers/District Leprosy Officers at this Institute. The first batch of the training
program was conducted during the period from 29 November – 3 December 2010, second from
10-14 January 2011, third batch from 17-21 January 2011 and fourth batch conducted during
the period from 7-11 February 2011.
As a part of our training program we took the trainees to the different health facilities in
the district for supervisory visit. A check list was provided to them to visit the health facilities
and prepare the report.
Based on the observation of the 64 Nos. of trainees participated in the above mentioned
training program from 9 states (Assam, Arunachal Pradesh, Sikkim, Jharkhand West-Bengal,
Uttar Pradesh, Madhya Pradesh, Maharashtra & Punjab) the enclosed report is prepared.
You are therefore requested to kindly go through the report and take necessary action.
Yours faithfully,
[DR. HARISH RATHOD]
DIRECTOR
Copy for information & necessary action to-
The Deputy Director General (RD Cell), Directorate General of Health Services, Nirman
Bhavan, New Delhi-110011.
The Director of Health Services, Chhattisgarh, Behind Secretariat, Raipur (C.G.).
The State Leprosy Officer, O/o Directorate of Health Services, Behind D.K.S. Bhavan,
Secretariat, Raipur (C.G.).
[DR. HARISH RATHOD]
DIRECTOR
TEL. NO. 0771-2412792, 2411427 FAX NO. 2412093, GRAM-RELETIN, [email protected]
