Disability Management

SEAROProgramme Managers Meeting

JakartaSeptember 23-24 2014

GPELF Progress

• 60 countries are implementing MDA • 4.9 billion doses delivered to 1 billion people

since 2000• 15 countries are under post-MDA surveillance• 29 countries have reported morbidity

management activities

Why manage morbidity and prevent disability?

• Integral to elimination programmes

• Main reason is to relieve suffering

• Patients with clinical and social consequences have a right to health care

• May increase community cooperation in MDA

Morbidity management and prevention

• Evidence base for interventions– Role of hygiene, secondary bacterial infections– Hydrocele surgery

• Foot care programme is– Sustainable– Economically feasible– Acceptable to patients

• Effective in reducing– Frequency & severity of ADLA

• Improves quality of life

Morbidity Management and PreventionApproaches

Lymphoedema• Kiribati: House-to-house education to patients and their

relatives by health workers• India: Provision of kits and training of patients• Indonesia and Bangladesh: Self care groups for leprosy

and lymphedema patients• Africa: Self-care groups provide opportunities for

monitoring & follow-up, building capacity, and empowering participants

• Haiti: Hope Clubs • Hydrocele Surgery– Camp approach

Home-based Management

• Family home-based care, – family member in training, follow-up and

monitoring of the lymphoedema patient• Community home-based care– integrated with services that include care of

patients with other chronic diseases • Primary health care system, – integral part of the primary health care system.

What is MMDP?

• ADLA, lymphoedema and hydrocoele • Lymphoedema and elephantiasis – hygiene and skin care to prevent ADLA, – proper wound care, – exercise, – elevation of the affected limb – proper footwear

• Hydrocoele - surgery • Psychological and social support

MMDP development

• WHO 2010 Consultation• WHO Strategic Plan 2010-2020• WHO Position Statement• WHO April 2013 Consultation• Aide Memoire for Programme managers • Tool Kit• August 2014 Consultation

Mapping MDAPost-MDA

Surveillance1. MDA

2. MMDP

VC/IVM

Situationanalysis

Plan Minimum package of MMDP care

Situationanalysis

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MMDP and rehabilitation

integrated into health services

M&ETAS

Management of morbidity and disability prevention (MMDP)

Goals and aim of MMDP

• Minimum package of care –Treating episodes of ADLA –Preventing episodes of ADLA and

progression of lymphoedema–Providing access to hydrocoele surgery–Providing antifilarial medicines

An Aide Memoire forNational ProgrammeManagers

How to build Programmes

MMDP Tool Kit

• Situation Analysis – Collect indicators

• Strategic Plan – Development and costing

• Burden assessment – Options , standardized protocol

• Clinical management – Wound care, ADLA referrals, pain management

MMDP Tool Kit

• Hydrocele management– Techniques, community health worker

• Implementation– Guidelines-clinical and operational

• Monitoring– Indicators for minimum package

• Evaluation– Assess impact of MMDP

What will success look like?(2020)

• Full geographical coverage with MMDP in national programmes in all endemic areas;

• Access to basic recommended care for all people with hydrocoele, lymphoedema or elephantiasis

• Reduction in the frequency and intensity of episodes of ADLA for people with lymphoedema;

• No new cases due to lymphatic filariasis.

Challenges

• Lymphedema– Choice of model– Sustainability

• Hydrocele surgery– Cost range varies– Techniques vary– Can it be monitored?

• Role of Incentives• Social and psychological barriers

Challenges

• M & E– Indicators• Input, Process, Impact• Quality of life

• Access vs. availability, Usage• Reporting– Formats

• Validation issues

An Integrated Approach

Resources