Leprosy: Action Plan For The Year 2007- 2008. Problem Statement:
The recorded number of Leprosy cases declined from 62 at the beginning of the project in 2001 to 16 in January 2007. The prevalence rate declined from 0.69 per 10,000 population in 2001 to 0.16 per 10,000 population in January 2007.Out of the current 16 cases of Leprosy under MDT Treatment, 10 are MB cases and 6 are PB cases of Leprosy. The proportion of cases with Grade II deformity was zero from the beginning of the project till now. Annual case detection rate (ANCDR) has declined from 0.29 at the beginning of the project in 2001 to 0.2 in January 2007. RFT percentage has increased from 35.8 % in the beginning of the project to 55.55% in January 2007. It may be mentioned that Leprosy cases in Mizoram is mostly found in inter-state and international border area especially at the Indo-Bangladesh border. This maybe due to migratory or floating of the people either from International border with Bangladesh and Myanmar Borders or from highly-moderately endemic states like Bihar, Jharkhand etc. The Leprosy cases detected near and around the capital are mainly floating population from highly/moderately endemic state and Country who contribute more than 90% of the disease burden during this current NLEP Project .As this being the major Problem in the State, Surveillance system constantly demands heavy work load to the Health Care provider.
Brief Report On The Current Status of Leprosy In Mizoram
There are16 cases of Leprosy under MDT Treatment in the State of Mizoram as on 31 st January 2007. Out of these, 10 are MB Cases and 6 are PB cases with a Male to Female Ratio of 11:5. Although Mizoram State is categorized as “Low Endemic Area”, the prevalence of Leprosy is constantly present in the State. This may be due to the fact that the State of Mizoram hosts floating population near Indo-Bangladesh borders at all times, where the Leprosy prevalence is mainly present. In addition to this, the year 2006-2007 have observed detection of new Leprosy cases in the areas and population other than that belong to the border areas and where Leprosy have not been seen for decades which have made us to suspect hidden cases among population other than that belong to the floating population along the International Borders as well. Therefore, there are plans to have Intensified Case Detection Drives and Campaign for Case Detection as a part of our Plan of Action not only in the Border Areas but also throughout Mizoram State during this year 2007-08. Objectives &Target:-1) To maintain the status so far achieved
in the State 2) To eliminate Leprosy by bringing down the prevalence rate to 0 (Zero) by the end of the year 2007-2008(i.e.31st March 2008)
Strategies:-To achieve the above Objectives, the following Strategies will be adopted: -
Infrastructural Strengthening and maintenance of existing infrastructure Intensified case detection drives and campaign for case detection. Capacity building for health personnel IEC Supports Review Meetings Observation of Anti-Leprosy Day Observation of Anti-Leprosy Week Infrastructural Strengthening and Maintenance of Existing Infrastructure:-This Plan of action is drawn up for sustainance of on going programme implementation. 1. At State level, for functioning of State Leprosy Society: a) Salary of Contractual Staff and DA/TE to Contractual Staff – i) BFO Cum Accountant: Rs.14300/month ii) Epidemiologist (SSAU): Rs.22000/month iii) Salary of DEO: Rs.7150/month iv) Salary of contractual Driver: Rs.3850/month
2.
There are nine District Leprosy Societies functioning independently in all the nine Health Administrative Districts: -
DA/TE to Contractual Staff: v) DA to Epidemiologist for SSAU Tour: Rs.120/day for 15 days / month vi) DA to DEO (SSAU): Rs.90/day for 15days /month vii) DA to Driver: Rs.55/day for b) Recurrent Cost: i) Hiring of Vehicle of SSAU tour Rs.1500/day x 15 days ii) Maintenance charges of Office expenditure like Photocopier, Computer, Fax Machine including charges of telephone, Internet etc. Rs.6000/months x 12 months. iii) Procurement of Materials and Supplies (Xerox paper etc.) Rs.2000/months x 12 months. iv) Procurement of Professional Services Rs.25,000. v) Other Contingency charges 1500/months x 12 months. At District Level for Functioning of District Leprosy Society: -
a) a)
Infrastructural Strengthening and maintenance of existing infrastructure: Contractual Staff: -
Name of Post No. of Post Salary/ Month 1) Driver 2 Rs.3850/month 2) Honorarium to Cash Handler 1 Rs.400/month b) Recurrent cost: 1) Maintenance of Vehicle including POL at 9 District Rs.1500/month. 2) Office Operation: Procurement of Materials and Supplies Rs.1000/month. 3) Office Expense: Telephone Bills etc-Rs.1000/ month. 4) Leprosy Patients Welfare- Rs.50,000 5) Maintenance of 10 Bedded Leprosy Hospital at Tlabung – Rs.1,00,000
B.
Intensified Case Detection Drives and Campaign for Case Detection: -
Intensified Case Detection Drives and Campaign are usually carried out in areas presumed to have high hidden caseload. The previous year 2006-2007 have observed New Case Detection at areas where Leprosy Prevalence have been absent for a long time. In these circumstances the coverage of MDT services is still poor, awareness about the disease is low and the negative images traditionally associated with Leprosy persist. These factors have prevented patients from coming early for diagnosis and treatment thus increasing the risk of their becoming disabled and transmitting the disease to others. Intensified case detection drives and campaigns are needed to focus attention and change this situation as quickly as possible. This plan of action have the following objectives: 1) Capacity building of general health worker to provide MDT services to the communities they serve. 2) Raising community awareness and encouraging participation, to provide self-reporting and remove negative perception about the disease. 3) Ensuring that all cases of leprosy are diagnosed and that patients receive a full course of treatment. This campaign targets population groups such as: 1) Rural areas:- Where MDT services are not operating effectively and there are indication that large numbers of undetected (hidden) cases exists (migrant labourers) 2) Difficult to access/border areas: - where MDT services are not available or easily accessible for certain population groups living under difficult conditions (Minority groups, tribal groups, displaced people, refugees). 3) Urban/Peri-urban/urban slum areas- in these areas stigma generally is huge, awareness about the disease is relatively low, and MDT services coverage is poor due to the inadequate enrolment of both general health care system and private sector.
C.
Capacity Building for Health Personnel: -
For effective implementation of the Programme at various level of workers. It is planned to conduct training for the following Health Personnel:1) One Day Leprosy Orientation Training for Medical Officers of PHC at District Headquarter:-It is proposed to hold One day Leprosy Orientation Training for Medical Officers of PHC at District Headquarters with the objectives of capacity building and for remotivating these workers for long term sustainability and continuity of the ongoing NLEP Implementation Programme. This Training is being proposed to be held during the month of June 2007 with 60 participants in each District with District Leprosy Officer or Chief Medical Officer (CMO) and Person from the State headquarter as Resource persons. Expenditure amounting to Rs.65,000. 2) One Day Leprosy Orientation Training for Health Supervisors (M&F) from Main Centres at District Headquarter: -
It is proposed to conduct Leprosy Training for Health Supervisors (Male & Female) from main Centres with the objective of capacity building and training for diagnosing suspected Leprosy cases and motivating them to create awareness among the general population which is very essential for sustainability and continuity of the ongoing NLEP Implementation process in the state even after the end of the project. It is planned to conduct this training consisting of 20 participants in each Batch with the District Leprosy Officer or Chief Medical Officer (CMO) as the core trainer assisted by one Resource Person from the State headquarters. It is proposed to hold this training during the month of July 2007.with expenditure amounting to Rs.1,71,450. 3) One Day Leprosy Orientation Training for Health Workers (M&F) at District Headquarter For better and effective Implementation of the Programme as well as constant motivation of these workers who are the grass root level workers and who are in constant touch with the General Population, It is proposed to hold this One day Leprosy Orientation training for Health Workers (M&F) at District Headquarter with expected attendance of 90 in each districts. The District Leprosy Officer or Chief Medical Officer (CMO) as the core trainer assisted by one Resource Person from the State headquarters. It is proposed to hold this Training during the month of August 2007 with expenditure amounting to Rs.60,250. 4) POD Camps: With approval from the Govt of India, it is proposed to hold POD Camps at each District headquarters with 50 participants in each district with DLO and expert from the State Headquarter as Resource persons with expenditure amounting to Rs.1,01,250. D IEC Supports: -
This IEC activity play important role for the success of programme implementation, from state level and to the peripheral (grass root) level, keeping in view that NLEP Phase II Project is likely to end in the near future the following IEC activities are planned for implementation during the year 2007-2008.
i) Printing of Leprosy Leaflets /Pamphlets in local and sub local languages: Keeping in view the effectiveness of the IEC materials in spreading awareness among the general population from the past experience, it is proposed to print IEC materials such as leaflets, pamphlets printed in Mizo and Chakma languages to be distributed to the community especially in remote and border areas. ii) Printing of Leprosy Booklets: It is proposed to print booklets on Leprosy in Regional language to be distributed to Schools, Melas etc. iii) Printing Media: It is planned to utilize the service of print media as a part of IEC activities through Daily newspapers and Periodical magazines. iv) Hoardings: -
Hoardings bearing the pictures and messages of Leprosy is being proposed to be made to be erected at the Hospital premises in the Districts. v) Leprosy Calendars: During the last 3 (three) years of NLEP Phase II Project of World Bank support, Leprosy Calendars were printed and distributed upto the level of rural households. It played important role in leprosy case detection especially hidden leprosy cases. Considering the effectiveness it is planned to print leprosy calendar for the year 2008. It may be the last leprosy calendar printed under Phase II Project of World Bank support. vi) OPD Cards: From the past experience, printing of OPD Card bearing messages of leprosy had cost effectiveness in disseminating and in generating mass awareness as the high health seeking behaviour of the community. It is planned to print OPD Cards bearing information about leprosy for use at Govt. Hospitals/CHC/PHC out-patient departments and all sub-centres. E. Review Meetings:-
1) State Level Half Yearly Review meeting:- at Directorate of Health Services, Aizawl Mizoram is being planned to be held during June 2007 and December 2007 for all District Medical Officer and Senior Medical Officer with Principal Secretary, Health & Family Welfare Department, Government of Mizoram, who is the chairman of State Leprosy Society. 2) Quarterly District Level Review Meeting at District headquarter for Medical Officer, Community Health Officer, Health Supervisor and Deputy Commisioner who is the chairman of the District Leprosy Society. F. Observation of Anti –Leprosy Day:-
Anti-Leprosy Day i.e., 30th January 2008 is to be observed in the State. Inauguration function will be organized at State Level and District Level under the Chairmanship of Director of Health Services/Principal Secretary and Principal Secretary/Hon’ble Minister, Health & Family Welfare Department, Govt. of Mizoram as Chief Guest and District Commissioner as Chief Guest in the District respectively. In addition, at State level, message telecast at 3 local channels as well as Speech by Honorable Health Minister through AIR will be telecast. G Observation of Anti –Leprosy Week:-
Anti-Leprosy Week will be observed in the whole State during 31st January to 6th February 2008. At the State Level and District Level is to be observed as follows : i) Electronic Mass Media:- Messages and slogans on Elimination of Leprosy will be telecast/broadcast through AIR/Doordarshan Kendra, and Local Cable TV network in local language. There are three AIR stations in the State that is Aizawl, Lunglei and Saiha, where every 9 (nine) District Headquarters have their own Cable TV network. ii) Message and slogans:- for Elimination of Leprosy will be widely published in the local prominent Newspapers during the Anti-Leprosy Week in the State Capital and District Capitals.