Associazione Italiana Amici di Raoul Follereau

" Support to the Leprosy Control Program in Manica Province, Mozambique."

ACTIVITY REPORT YEAR 2015

March 2015

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1. Short description of the project

Location: Mozambique, Manica Province, all 12 Districts.

General objective: to support the Leprosy Control Program in Manica Province, Mozambique, in order to reduce the burden of leprosy in the communities.

Specific objectives 1. To improve the capacity of health personnel and community volunteers on leprosy suspicion,

diagnosis, correct treatment, complications and the prevention of deformities. 2. To improve the conditions of persons with disabilities caused by leprosy through rehabilitative

surgeries 3. To provide to people affected by leprosy members of the Self Help Groups with information

and skills about disability prevention methods (self-care) 4. To increase the information and awareness among the communities about leprosy

Local Partners: Provincial Health Directorate of Manica (DPS) – Ministry of Health;

IDEA Mozambique (Association of persons affected by leprosy) – AMPAL.

Duration: from 1st January to 31st December 2015

Budget: 50.000,00 Euros

A SHG working in agriculture as IGA

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2. Situation analysis

Location covered (Districts):

• 12 Distritos (100%)

• Population: 1.933.522 people

• Health Unit Number: 112, among whom: 1 HPC and 4 HDs

LEPROSY INDICATOR IN MANICA PROVINCE

2014

2015

Prevalence rate

0,2/10.000 hab

0,2/10.000 hab

Detection Rate

1,7/100.000 hab

2,1/100.000 hab

New cases

34

40 (14 MB; 16 PB)

Children under 15 years among new cases

2,9% (1 child)

42,5 % (17 children)

Grade 2, deformities

37,5% (15 people)

15% (6 people)

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3. Realized Activities

Activity Indicators

1.a Training courses.

1 Training Course in Leprosy Prevention and Disability Rehabilitation (early diagnosis and treatment, disability prevention) for Leprosy Supervisors and his/her team, for a total of 18 public health caregivers coming from 4 districts (4 District Supervisors, 4 additional district supervisors, 2 physiotherapy technicians, 3 ophthalmologist, 1 medical doctor, 4 nurses in charge for leprosy) for 3 days in June in Guru.

1 Training Course in Leprosy Prevention and Disability Rehabilitation (early diagnosis and treatment, disability prevention) for Leprosy Supervisors and his/her team for a total of 23 public health caregivers coming from 8 districts (7 District Supervisors, 4 additional district supervisors, 4 physiotherapy technicians, 3 ophthalmologist, 1 medical doctor, 4 nurses in charge for leprosy) for 3 days in July in Gondola.

1 training course in suspect and treatment for leprosy and TB for 39 public health caregivers (14 medical doctors, 12 medical technicians, 1 school educator, 12 nurses in charge for TB and leprosy, coming from 12 districts, for 3 days in November in Vanduzi.

1 training course for leprosy and TB laboratory diagnosis for 16 laboratory technician from 12 districts, for 3 days in November in Gondola.

3 training courses on leprosy suspect, treatment and follow up for 60 community volunteers (Agentes Polivalentes Comunitarios de Saúde) from 3 districts, for 2 days in December.

Number of persons participating to the training courses (target: 95 persons): 156.

% of staff turnover among the trained personnel (target: <20%): 0

% of the trained staff able to apply properly what

learned (target: >80%): NA, because most of training was from July to November and the time was not enough for a proper evaluation during the supervisions

Number of new cases detected

% of children among the new cases: 42,5%

% of new cases with grade disability 2 (compared to the previous year): 15% in 2015 vs 37,5% in 2014

% of patients who worsen the degree of disability after treatment: N.A.

1.b Field Supervisions

In order to monitor the performance of the trained personnel, a DPS Health Equip (composed by 4 people among Provincial Supervisor, Dermatologist, Medical Doctor, Nurse and Physiotherapist) with AIFO Project Manager conducted regular field supervisions in all 12 Districts, reaching 22 villages. Each district visit took 2 days. During the supervisions the equipes provided on-the-job training to local health staff and to community volunteers. In addition they researched actively new cases among the patients contacts. They checked 109 people, discovering 14 new leprosy cases.

A meeting at Provincial level was realized in Chimoio at the end of the year for a balance of leprosy and TB activity, with 21 participants included the District Supervisors from the 12 districts and the 2 Provincial Supervisors for Leprsy and TB, for 2 days.

During the project, 12 coordination meetings were realized among AIFO and the partners.

Number of Number of field visits per year for each district: 2

(24 supervisions realised in 12 districts)

Number of new cases detected in the districts: 14.

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2.a Rehabilitative surgeries.

During the field supervision the equip realized small rehabilitative chirurgical intervention for the cleaning of the ulcers and for ophthalmologic problems, to 26 patients, all of them active in the Self-Help-Groups.

Only 3 chirurgical interventions were realized in the hospital theatre, because of the surgeon was not available.

Number of patients gotten rehabilitative surgeries (target: 40): 29

% of successfully rehabilitated patients (target 95%): 100%

% of patients active in the Self Help Groups (target: 100%): 100%

3.a Training meetings with Self Help Groups.

9 training meetings about health education and self-care with 10 Self-Help Groups. 5 SHGs are leaded by women. Participants: 105 members. The 105 persons acquired simple skills for self-care and home therapy in order to prevent disabilities (PRID). Each meeting lasted 1 day. During the meetings, the groups will receive health materials for dressing and care.

Monitoring-follow up meetings were realized to 15 old SHGs

1 SHG received support for building simple wooden and sheet metal structures for their meeting and income generating activities.

Number of Self Help Groups participating to the

Training Meetings: 10 + follow up meeting for 15 old SHGs = 25 SHGs (target: 25)

Number of persons attending the meetings: 105 in training meetings + 69 in follow up meetings = 174 persons (target: 250)

% of persons with wounds and ulcers: 22

% of persons worsen their disability (target< 20% ): 16,6%

% of Self Help Groups members included in the IGAs Programme: 100%

4.a Celebration of the World Day of Leprosy.

The celebration involved 12 districts with 5.079 participants, in different days. The celebration included public official meetings with authorities, sport competitions, awards and meetings in the schools.

In Machaze district, it was planned a big official event with the participation of the Provincial Directors and Government members at district level, but the day before an hurricane destroyed the venue and the event was cancelled.

Number of people attending the

celebrations for the World Day of Leprosy: 5.079

Number of districts reached by the events: 12

% of beneficiaries taking active part to the

awareness initiatives within the communities: 140

Number of IEC materials distributed: 100 t-shirts with advocacy messages.

4.b Radio spot

Dissemination of information on leprosy through the broadcast of spots in the local community radio: Radio Mozambique. The radio is public and it reach 6 Provinces.

The spot was broadcasted 3 times a day, once in Portuguese, once in Chimanhica local language and once in Chitewe local language, for a total of 32 spots.

The central jingle was: “ Se tiver manchas claras no corpo do que a pele normal, vai ao Centro de Saúde mais próximo, porque pode ser a lepra. A lepra tem cura e o tratamento é gratuito.”. The message was prepared by a working group composed by Leprosy Provincial Supervisor, the Provincial Person in charge for Health Education and a leprosy consultant.

Number of radio spots delivered: 32

% of beneficiaries taking active part to the spots: 0.

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3. Beneficiaries

Direct beneficiaries:

- 44 people affected by leprosy (4 people ending treatment in 2015 and 40 new cases)

- 29 people with disabilities received small rehabilitative surgeries

- 15 SHGs members (174 people) by training and materials for self-care (PRID)

- District Health Unit staff and volunteers by training courses on leprosy: 156 persons

- 5.079 people attending World Leprosy Day celebration events (including community leaders, local authorities, students, young and women)

Total: about 5.325 people

Indirect beneficiaries:

The 1.000 family members of the direct beneficiaries affected by leprosy.

The entire population of the province of Manica (1.933.521 people) through the actions aimed to improve the management of primary health care programs.

4. Monitoring

The activities were regularly monitored by AIFO Project Manager, who managed the development activities in close collaboration with DPS and other partners. He realized regular supervision visits to the field and regular meetings with the partner.

5. Impact

In the short term:

• Reduced the percentage of new leprosy cases with disability grade 2, from 37% to 15%, through adequate early diagnosis

• Reduced to less than 17% the percentage of patients who worsen the degree of disability after treatment, through rehabilitative surgeries and adequate treatment, with particular attention to complications and leprosy reactions.

• Improved personal hygiene and prevention of wounds of 174 people affected by leprosy.

Impact the mid-term:

• Reduction of discrimination and self-stigma due to deformities. (Indicators: 100% of persons taking part to the Self Help Groups and being active in the group life)

• Reducing of social-economic dependence of people affected by leprosy (Indicators: 82 put of 174 beneficiaries run a proper income generating activity - 47%)

• Reduction of leprosy infection in communities. (Indicator: number of new cases detected; % of children among the new cases)

• Restoration of the dignity of many families of people affected by leprosy (Indicators: 47% of families with leprosy affected members running proper income generating activities in the community and contributing to the family maintenance; 80% of beneficiaries taking active part

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to the awareness and lobby initiatives within the communities (140 people for the celebration of the world leprosy day)

Gender issue:

• 50% of the new SHGs are leaded by women (5 out of 10)

• 86,5% of the beneficiaries running proper IGAs are women (71 out of 82)

Annex

� ILEP B Form 2015

� CD with p2015 hotos

� 1 video produced at local level for dissemination and training purposes

AIFO Italy, March 2016

ILEP meeting in Maputo