National Leprosy Eradication Programme, India

NLR India Projects

ANNUAL REPORT-2009State: Jharkhand

Prepared by: Dr. S.P.SoodDesignation: ILEP Sate Co-ordinator

State: JharkhandContents

Index

NLR India Projects..........................................................................................................................1List of Abbreviations.......................................................................................................................3Executive Summary.........................................................................................................................51. Introduction..................................................................................................................................73. Analysis of activities..................................................................................................................11

3.1 District Level Activities Completed for Year 2009.............................................................113.2 State Level ILEP Supported Activities for the Year 2009..................................................123.3 Analysis of SCG activities, district wise.............................................................................133.4 Unplanned Activities...........................................................................................................14

4. Other Developments..................................................................................................................154.1 Visitors to the State..............................................................................................................154.2 Training & Meeting /Conference attended..........................................................................15

5. Conclusion & Recommendations:.............................................................................................166. Annexes.....................................................................................................................................17 Annexes Ann 1Staff position of Jharkhand State.........................................................................................17Ann 2 District wise Treatment completion rate.............................................................................18Ann 3 List of Stakeholders............................................................................................................19Ann 4 Map of Jharkahdn...............................................................................................................20

Table Table 1 Health Services...................................................................................................................7Table 2 Leprosy Situation of the last six years of Jharkhand State.................................................8Table 3 Essential Indicators for Jharkhand State as on March 2009...............................................8Table 4 District level activities completed for Year 2009.............................................................11Table 5 State Level ILEP Supported Activities for the Year 2009...............................................12Table 6 Analysis of SCG activities, district wise..........................................................................13Table 7 Unplanned Activities........................................................................................................14

FigureFigure 1 Status of leprosy for the last seven years in Jharkhand.....................................................9Figure 2 Trends of MB & Child......................................................................................................9Figure 3 Trends of Disability Gr-II...............................................................................................10Figure 4 Case load as on Mar 09...................................................................................................10

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List of Abbreviations

ANCDR Annual New Case Detection RateANM Auxiliary Nurse MidwifeASHA Accredited Social ActivistAWW Angan-Wadi WorkerBLAC Block Level Awareness CampaignBCP Blister Calendar PackBEE Block Extension EducatorBSS Bharat Sewa Ashram SanghCHC Community Health CentreCMO Chief Medical Officer CBR Community Based RehabilitationCR Country RepresentativeDDG (L) Deputy Director General (Leprosy)DLS District Leprosy SocietiesDLO District Leprosy OfficerDLP Disabled Leprosy PersonDN District NucleusDPMR Disability Prevention & Medical RehabilitationDDRO District Disability Rehabilitation OfficerEHF Score Eye, Hand, Feet Disability ScoringGHC General Health CareGHS General Health ServicesGOI Government of IndiaILEP International Federation of Anti-Leprosy AssociationsIEC Information, Education, CommunicationINR Indian RupeeLAP Leprosy Affected PersonLFA Logical Framework ApproachLT Laboratory TechnicianMO Medical OfficerMO I/C Medical Officer InchargeMB Multi BacillaryMDT Multi Drug TherapyMOU Memorandum of UnderstandingMPWs Multi Purpose WorkersMLEC Modified Leprosy Elimination CampaignNGO Non-Government OrganizationNLEP National Leprosy Eradication ProgrammeNLR Netherlands Leprosy ReliefNMA Non Medical Assistant NMS Non -Medical SupervisorPR Prevalence Rate

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PB Pauci BacillaryPHC Primary Health Centre POD Prevention of DisabilityPOWD Prevention of Worsening of DisabilityPIP Project Implementation PlanPMW Para Medical WorkerPR Prevalence RatePT PhysiotherapistRCS Reconstructive SurgerySC Sub Centre (catering to a population of 5,000 attended by a ANM or MPW)SCG Self Care GroupSHG Self Help GroupSLO State Leprosy OfficerSTST State Level Support TeamSIS Simple Information SystemWHO World Health Organization

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Executive Summary

Jharkhand State, which has 24 districts, was part of Bihar till 2000. State having an area of 79714 Sq.Kms., population 3,17,51,928 projected for the year 2009, bordered by Bihar in north, Chhattisgarh in West, and Orissa in South and West Bengal in the east. State has the largest deposits of minerals and covered by forests.

State leprosy Officer is supported by NLEP consultant and Coordinator from ILEP (at state level). The state had DTST support till March 2007. District Nucleus Team is in place in the districts and are trained. There are four NGO institutions participating in leprosy control.

Leprosy programme is well integrated. Cases are detected through self-reporting or referral and managed at health facilities. PHCs are able to manage leprosy cases including reactions. Diagnosis already is good, supervision is being done by D.N. P.O.D component is being given importance through self-care groups.

ANCDR and PR are constant. MB proportion is increasing. Child proportion among new cases is declining but still it is high (9.4%) in comparison to National level. Disability Gr. II has slightly increased in comparison to last year. Disability Gr I reporting still require improvement. Disability assessment and reporting needs improvement. Female ratio is almost constant. Disability Gr.I is 2.5% and TCR for cohort year 2006-07 for MB-91.9%, 2007-08 for PB-96.8%.

Activities planned were done. These were to strengthen District Nucleus and referral system. Some activities were not completed due to State constrains.

Unplanned activities like Decentralized Planning were completed to improve planning on request of State.

Follow- up of L.F.A results in decentralized planning, supervision by D.N. with A.T.P, Supervisory Checklist and reports (Feedback) etc. will improve the services and programme performances.

Visit of Dr. M. A. Arif & Mr. J. Dogger to the State help in improvement of SCG and for Vocational Training of Children of PAL Home.

Dr. S. P. Sood, ILEP State Coordinator, Jharkhand attended several Trainings and Meetings (CME Review Meeting & others) to strengthen the programme.

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Major Challenges:- following are the issues to be focused:

Functioning of DN:- Supervision – Use of ATP / Checklist/ Visit Reports.

Referral System:- L.T to be trained to strengthen Secondary level Care.- Orientation of MOs of District Hospital for Secondary level care.- Involvement of Sahiya (ASHA) for Referral of Suspect & follow up of Treatment.

RCS: Each District to refer Cases for RCS.

SCG: To motivate PALs not to go for begging, by involving them in other ways of earning. (Vocational Training etc.)

Major Achievements:- Each District planned the Action Plan for 2010-11 after the Workshop on Decentralized

Planning.- Development of SCG in four Districts covering 13 PAL Homes. Majority of Patients are

doing Self Care practices .Ulcers are cured & Dry Skin became soft.- RIMS Ranchi, MGM Medical College Jamshedpur, Radha Rani Hospital Ranchi &

Belatar Mission Hospital Deori District Giridih are doing RCS and are recognized by CLD.

- Sensitization of Sahiya (ASHA) for suspecting & referring cases .

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1. Introduction

The Jharkhand State, which has 24 districts, was part of Bihar till November 2000.A beautiful state with green forests, having large deposits of minerals. About 40% of the total minerals in the country are available in this state. It has good road, rail and telecommunication network. State, covering an area of 79714 Sq.Kms. having population 31751928 projected for year 2009, bordered by Bihar in north, Chhattisgarh in west, Orissa in south and West Bengal in the east. It is home to the largest steel plant in the country at Bokaro; apart from Jamshedpur being the city of TELCO and TISCO steel industries.

The State Leprosy officer is supported by NLEP consultant and Coordinator from ILEP (at State level). Out of the 24 districts DLO is posted in 11 and a senior officer is made in charge of leprosy in the remaining13 districts. Medical officer as part of the District Nucleus is available in 13 districts, NMS in all and PT in 8 districts. All are trained. There is vehicle available in all the districts. The State had DTST support till March 2007. There are four NGO institutions participating in leprosy control BSS Jamshedpur Vivekananda Leprosy Mission Jamshedpur, Damien Social Welfare Centre, Dhanbad and Claver Social Welfare Centre, Amda Saraikela.

Leprosy programme is well integrated. Cases are detected through self- reporting or referral and managed at health facilities or at patients’ residence. PHCs are able to manage leprosy cases including reactions. Diagnostic accuracy was good (of the 3687 cases seen by district teams 33 (0.89%) were of wrong diagnosis. 36 (0.97%) were old cases, and 15 (0.4%) were wrongly typed). Treatment completion Rate was 96..8% for PB (07-08) and 91.9% for MB (2006-2007). Supervision is still a problem. Though visits are made by DN, nonuse of checklist, absence of ATP or supervisory report renders the process less effective. A total of 206 reactions were reported by the state in 2008-2009 of which 175 were managed by PHCs and 31 by district hospitals. Prevention of disability component has been initiated only recently.

Table 1 Health Services

Total population (Projected 2009) 3,17,51,928No. of Districts 24Literacy rate of Jharkhand 56%Literacy rate of Male 67.94Literacy rate of Female 32.06No. of PHC 193No. of APHC 368Health Sub-Centre 4179Sub divisional Hospital 14Sadar Hospital 08ANM Training School 08Nursing Training Centre 04Total no. of Schools (Middle & High) 5045

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2. Epidemiological Development

Table 2 Leprosy Situation of the last six years of Jharkhand State

Year Population(31st

March)

Balance

cases as on 31st

March

Total no. of new cases

detected during

the year

Total no. of MB cases

among new cases

Total no. of child

cases among

new cases

Total no. of G-II

among new cases

Total no. of female cases

among new cases

2003-04 28078955 11636 17719 7440(41.9%)

2864(16.2%)

253(1.4%)

6215(35%)

2004-05 29230572 7823 19131 7850(41.03%)

3121(16.3%)

290(1.5%)

7531(39.3%)

2005-06 29841489 3912 7357 3393(46.1%)

918(12.4%)

110(1.4%)

2581(35.08%)

2006-07 29841489 4236 7672 3659(47.6%)

982(12.7%)

220(2.8%)

2863(37.3%)

2007-08 31101898 3460 6799 3364(49.4%)

746(10.9%)

182(2.6%)

2446(35.9%)

2008-09 31101898 2941 5181 2613(50.4)%

485(9.3)%

152(2.9)%

1820(35.1)%

Source NLEP reports-2008-09

Table 3 Essential Indicators for Jharkhand State as on March 2009State Cases on

record as on March 2009

Prevalence rate per 10000 Popln.

New cases detected from April 08 to

Mar 09

Proportion among new cases

PB MB Total MB Female Child Gr.II

% % % %Jharkhand 2941 0.94 2568 2613 5181 50.4 35.1 9.3 2.9

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Figure 1 Status of leprosy for the last seven years in Jharkhand

Trends of PR & NCDR in State Jharkhand

6.6

4.1

2.68

1.3 1.4 1.1 0.95

10.5

6.2 6.5

2.5 2.6 2.8

1.6

0

2

4

6

8

10

12

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09

PRNCDR

Source: NLEP reports.Note: NCDR and PR are constantly declining.

Figure 2 Trends of MB & Child

Trends of MB% & Child % in State Jharkhand

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42.4 41.03

45.7

52.2 53.250.04

16 16.1 16.3112.9

11.2 11 9.4

0

10

20

30

40

50

60

2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09

MBChild

Source: NLEP reportsNote: (1) MB Proportion is increasing, (2) Child Proportion is declining.

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Figure 3 Trends of Disability Gr-II

Source: NLEP reports.Note: Increase in disability Gr.II is due to less absolute number of patients.

Figure 4 Case load as on Mar 09

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3. Analysis of activities

3.1 District Level Activities Completed for Year 2009

Table 4 District level activities completed for Year 2009

SN Districts Activities BatchesPlanned

BatchesCompleted

Total No Trained

Yet to be trained

Remark

1 Ranchi MDT Management One Batch Completed 15 NIL Good Trg.

W’shop on Supervision

Three Batches

One Batch 15 Two BatchesDue to Election

Qtrly. meeting/CME of NLEP staff

OneBatch

Completed 13 NIL Need based Trg.

2 Bokaro W’shop on Supervision

One Batch Completed 32 NIL DN was also facilitator

3 Ramgarh W’shop on Supervision

One Batch Completed 10 NIL MO from SSAU was involved.

4 Khunti W’shop on Supervision

One Batch Completed 16 NIL SLO supervised Trg.

MDT Management One Batch Completed 12 NIL Good Trg.

5 Dhanbad W’shop on Supervision

One Batch Completed 35 NIL Good Trg.

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3.2 State Level ILEP Supported Activities for the Year 2009

Table 5 State Level ILEP Supported Activities for the Year 2009S.No. Planned Activities for 2009 Completed

Till Dec. 09 Y/N

If not reasons

1 Coordination Meeting(SLO,WHO &

ILEP)

Yes

2 Workshop on decentralized planning & supervision for DN

Yes

3 DLO’s Review Meeting Yes

4 Rehabilitation activities(SCG) Yes

5 W’shop on Decentralized Planning for DLO’s & M.O’s

Yes

6 One day Symposium of Dermatologist & Physicians

No Due to State reasons as LT to be trained first.

7 Reorientation for DN Teams for old DNT : (1 day) 3 BatchesFor Newly posted (3 days) 1 Batch

No Due to State reasons( There was no SLO for five months)

8 Advocacy Meeting(CS,ACMO& DLO) from one Distt.+ RDD in 5 Regions.

No do

9 Advocacy Meeting( DLO & Med.Supdt. of Distt. Hospital 2 Batches

No do

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3.3 Analysis of SCG activities, district wise

Table 6 Analysis of SCG activities, district wiseRanchiILEP Code

Description of Activities

Dates of performance

No. of Participants

Comments

Stakeholders meeting

18.4.09 22 Outcome was that Stakeholders support the SCG with Tubs, Blankets & Vocational Trg.to PAL & Spouse.

Monitoring of SCG

19.3.0912.6.0913.10.09

173 PAL

32 Ulcer healed out of 73

Group Leaders Trg

2.7.09 30 By demonstration Plastic Tubs provided by PNB

BokaroMonitoring of SCG

27.3.0920.6.0914.9.0915.9.09

112 25 Ulcer healed out of 53

Group Leaders Trg.

17.9.096.11.09

2218

By demonstration Plastic Tubs provided by NLR

PalamauStakeholders Meeting

10.9.09 11 BPL Card provide to PAL Stakeholders assured for support

Monitoring of SCG

17.6.0910.9.099.12.09

10 Status of Skin softed

DhanbadGroup Leaders Trg.

8.7.0912.11.09

61 By demonstration Plastic Tubs by Society & NLR

Monitoring of SCG

17.10.09 23 3 Ulcer healed out of 13

Note: Self care group was developed in districts: Ranchi, Palamau, Bokaro & Dhanbad (11 PAL Home out of 33) by DLO Staff by support of NLR. NMS or Physiotherapist from DLO Office are Facilitators. They are responsible for supervision of activities of SCG. Outcome of Cohort as per the No. of months compiled. 49 Ulcer healed 99 & rest is healing observed.

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3.4 Unplanned Activities

Table 7 Unplanned Activities

Unplanned Activities Who initiated this activity

Reasons for theactivity

Which ILEP Head

Workshop on decentralized Planning for DLOs & MO of DN.

Director In-Chief / WHO Coordinator

There was no SLO.So no one was authorized for Fund withdrawal. It was discussed with C.R and he approved it.

2.5 Training.

This Workshop was organized region wise i.e. at Deoghar & Ranchi. Outcome of the Workshop was all the district prepared need based Action Plan & submitted to SLO Office.

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4. Other Developments

1. SLO Office shifted to the New Building in Directorate of Health Services.2. Decentralized Planning for 2010-11 done by each District.3. NLEP is well integrated at State as well as District level. Action Plan will go through

NRHM & Fund will come through NRHM.4. Training on DPMR completed to all DN.Training is being provided to MOs on DPMR.5. RIMS Ranchi, MGM Medical College, Jamshepur, Radha Rani Hospital Ranchi &

Belatard Mission Hospital, Giridih has been recognized as RCS Centres by G.O.I.6. Self Care groups developed in 13 PAL Homes. Six persons from these Homes are taking

Vocational Training in Govt. Recognized Centre. More PAL Home will follow SCG practices soon.

7. Parliament Election in April & May & Assembly Election in Nov & Dec. has obstructed field visits & Activities.

8. Strike called by Naxals also affected the Activities.9. Retirement of SLO in June and delayed posting of SLO in November affected the

Activities.

4.1 Visitors to the State

1. Dr.M.A.Arif, Country Representative, NLR supported the Training on Planning, Supervision & Monitoring as facilitator from 3 rd March to 6 th March 09.

2. Dr. M.A. Arif & Mr. J.Doogar visited on 23 rd March. Discussed with Chhotanagpur Sanskrit Sangh for cooperation in Rehabilitation of PAL of Indira Home, Ranchi. They also visited the Vocational Training Centre run by C.S.S.

4.2 Training & Meeting /Conference attended

Dr.S.P.Sood attended Workshop of SLOs on Planning. Supervision & Monitoring at Jaipur supported by NLR.

Team participated in NLR Review Meeting at Lucknow on 7 th & 8 th April. Dr.S.P.Sood attended Workshop of Facilitators for Decentralized Planning on

16 th June at New Delhi. Team attended Review Meeting at Windsor Hotel, Patna, organized by NLR

from 12-13 August 09. Team attended Workshop on “Resource Mobilization at New Delhi organized

by NLR on 1st Week of Sept. Dr. S.P.Sood attended SLO Conference at BHU Varanasi. Poster on “Self Care

group” were prepared & displayed. Team attended NLR Review Meeting at Jaipur in Dec 09.

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5. Conclusion & Recommendations:

Conclusion Status of DN:

Staff position: Out of the 24 districts DLO is posted in 16 and senior officer is made in charge of leprosy in the remaining 8 districts. Medical officer as part of the District Nucleus is available in 14 districts. NMS in all and PT in 8 districts. All are trained.

Responsibility: Their responsibility is to manage NLEP in the district. Reports: Monthly reports are being sent in time, Visit reports are not being sent.

DPMR Referral system is yet to be established. Placement of L.T. in District Hospital. RCS started in 2 Medical colleges and efforts are on in 3rd Medical College. Reactions are managed at PHC /Hospital level. Self-care group has been developed in three districts. MDT management is satisfactory. Diagnosis is satisfactory as per validation report. Planning is being done to improve Urban leprosy Services.

Recommendations:

I. D.N. to improve in supervision, A.T.P, Visits report to be sent to SLO. Needs orientation (State to take responsibility), Planning to be done by participating /situation analysis.

II. DPMR

Referral system to be established, PHC. DN, District hospital & Medical College to be linked & coordinated by DN.

L.T. to be given responsibility of Skin Smear at district level. Districts without PT should identify senior NMS/NMA to be given short training for

physiotherapy. Support to LAP colonies is needed. DLO/NGO to take responsibilities. DN of district to cover urban leprosy services to involve other resources NGO/Clubs

(Partners) to improve Urban Leprosy Services.

Annexes16

Ann 1NLR Staff position of Jharkhand State

S.No

Leprosy programme advisor

Districts covered NMS Computer Operator

Driver

1 Dr.S.P.Sood,ILEP State Coordinator

Ranchi,Bokaro,Ramgarh & Khunti.

Mr.Arvind Kumar

Mr.R.K.Prajapati

Mr.Markandey Singh.

2 Dr.S.G.Murtaza AshrafiL.P.A.

Jamtara, Pakur, Sahebganj, Dumka, Dhanbad & Giridih

No provision of NMS. -

Mr.Vijay Sharma

3 Dr.Susthir Kumar SinhaL.P.A.

Latehar,Palamau,Chatra, Garhwa,Hazaribagh & Koderma

No provision of NMS -

Md. Ali

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Ann 2 District wise Treatment completion rate

Sl.No. Name of District Treatment completion rate

PB (2006-07) MB (2005-06)

1 Ranchi 97.01% 92.1%

2 Hazaribagh Wrongly calculated Wrongly calculated

3 Garhwa NA NA

4 Khuntee 98.3% 83.3%

5 Palamau 100% 100%

6 Giridih 96.8% 93%

7 Bokaro NA NA

8 Dhanbad 100% 100%

9 Koderma NA NA

10 Latehar NA NA

11 Chatra NA NA

12 Ramgarh NA NA

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Ann 3 List of Stakeholders

The Central Leprosy Division of the Ministry of Health & Family Welfare is the nodal Organization to manage the National Leprosy Eradication Programme (NLEP) of India. The State programme is managed by a State Leprosy Officer (SLO) and in the districts the programme is managed by the District Leprosy Officers (DLOs). At peripheral level the General Health Care (GHC) system provides leprosy services. To function properly, the programme has partners with whom to share information (Coordination Partners-talking together) and partners with whom it has to work together (Cooperation Partners-working together). These are as follows:

Coordinators Partners Cooperation partners1. Department of social Welfare &Empowerment

1. Health Secretary

2. Ministry of information 2. District Administration 3. Ministry of Education 3. District PRO

4. WHO/ILEP5. SAHIYA6. Medical College7. Training Centre8. Private Practitioner9. Private Hospital10. Traditional healer11. Department of ICDS12. Shoemakers13. Podiatry14. Health social NGOs15. Municipalities etc.16. Public and private sectors undertaking Coalmines, steel plants, ESI, Mecon etc.

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Ann 4 Map of Jharkahdn

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