national consultation workshop service delivery … the meeting...national consultation workshop...
TRANSCRIPT
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National Consultation workshop
Service Delivery
Experiences of LEPRA India
Dr.P.V.Ranganadha Rao,
Chief Executive, LEPRA India
to restore health, hope and dignity
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Our Approach
• Direct participation in TB control
• Capacity building
• Research activities – Field/laboratory• Research activities – Field/laboratory
• Advocacy Communication and Social
Mobilization (ACSM)
• Involvement of people affected
• Publications
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Participation in TB controlThematic
Areas
What? Where ? Partners
Direct
Participation
in TB control
Microscopic
center
33 DMCs in 4 States RNTCP
SCC 252 SCCs in 2 states –
Orissa & MP
RNTCP
Orissa & MP
C & DST (BPHRC) 4 Districts in AP RNTCP
DOTS Plus 3 Districts in AP RNTCP
DOTS providers Above 3900 RNTCP
Patients reached 5500 RNTCP
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DMCs and SCC in AP
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DMCs and SCC in Bihar and Orissa
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Service Delivery – Key Points• Hard to reach/needy areas in rural, tribal and Urban
population
• Sputum collection centers to improve access
– (1998, Koraput , Odisha –Supported by DFID)• TB HIV co-infection addressed
– Integration of VCTC and DMCs– Integration of VCTC and DMCs
– Introduction of ORWs
• Patient friendly services with enabling atmosphere. – Patient Charter translated in Oriya, Hindi and Telugu
• Data review and management – Analysis of performance indicators
– Regular review of performance and progress of DMCs
• Mobilizing communities and Advocacy
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MLAs MLAs sensitization in MPsensitization in MP
CM of MP addressing the sessionCM of MP addressing the session
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Signature Signature campaign by MLAs campaign by MLAs
to to support TB control activitiessupport TB control activities
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Programme – Outcomes
• Case detection rate – 65 – 80%
• New Sputum Positive Cases 50-60%
• Sputum Conversion rate 89 – 94%
• Cure rate 82 – 92%• Cure rate 82 – 92%
• Deaths 3- 7%
• Defaults 3-8%
True Income lies in True Income lies in True Income lies in True Income lies in
SmillionsSmillionsSmillionsSmillions (Smiles of Millions ) (Smiles of Millions ) (Smiles of Millions ) (Smiles of Millions ) of people of people of people of people
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Monitoring Performance
Dash Board – An useful tool
tbhtml1.swf
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Study of TB CASES - SOURCE OF
REFERRAL 4 DMCs in Hyderabad
2008-09
2%
11%
13%
6%
6%
39%
11%
12%
By Survey
IEC Activity
By PMPs
By Volunteers
By UHP Staff
By CDs
Oth.NGOs
Others
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Challenges – Performance
• Migration
• Patient receiver of services
• Concurrent diseases/conditions
• Continued stigma against the disease • Continued stigma against the disease
• Health/Treatment seeking behaviour
• Gender specific strategies - Access
• Influence of Private Practitioners
• Social factors
– Poverty, Alcoholism,
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Challenges – Service Delivery
• Timely disbursement of funds
• Attitude towards NGOs – Misplaced Trust
• Drug supply from state to DOTS facilities• Drug supply from state to DOTS facilities
• Supportive Supervision in certain TUs
Operational issues – out reach/mobility
• Policies on Private Medical Practice
• Pharmacies and Private labs
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Sputum Collection Centre (SCC)A strategy for remote and inaccessible areas
1998 – DFID supported
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Operational Aspects of SCC
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SCC Strategy – Outcomes - 2009-10
1609 NSP in 2009 -
Koraput
210 sputum positive
cases reported
through SCCs,
i.e. Contribution of
13.5% to RNTCP.
Particulars YEAR
2009 2010 Total
No of SCC 180 180 180
No of Chest symptomatic
reported to SCC
1140 1946 3086
Sputum positive cases diagnosed 210 373 583
Follow Up Sputum 252 1164 1416
13.5% to RNTCP.
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Partnership of LEPRA India BPHRC with
RNTCP-A success story
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C & DST - Sputum from TB patients
transported from periphery to BPHRC
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Flow of Specimen and test reportsFlow of Specimen and test reports
BPRCDISTRICT TB
OFFICE
Specimen transportation kit
Specimen
Reports
UMEED DMC/PHI
Specimen
transportation
kit
Transport of specimens
to the collection center
Specimen
collection
DOTS PLUS CLINICAL SITE
At Guntur
ReportsPatients
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Green Light Committee and Global Lab Initiative
team along with State TB officer visits BPHRC as
a model PPP in RNTCP-August, 2009
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240 MDR Cases were reported out of 625 suspects tested during June,09 and
November,10
91
240 74
4134
GUNTUR KISHNA E.G W.G TOTAL
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Consortium Partners
Donors
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Auto Drivers (Union) Sensitization Program at Narsinghpur
Sen Samaj (Barber Union) Sensitization Program at Narsinghpur
Auto Drivers (Union) Sensitization Program at Narsinghpur
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Community meetings, PRI sensitization
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ASHA/ ANM sensitization
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IEC Material
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For the opportunity to
serve people in reducing TBserve people in reducing TB