Initiatives in promoting Urban Leprosy services in Tamilnadu

Urban areas pose great challenge for leprosy programme in terms of characteristics and attitude. GLRA-India being the ILEP coordinator for Tamilnadu took the initiatives in mobilizing the stakeholders to work in close coordination with the Government by implementing the urban strategy brought out by the Government of Tamilnadu. Steps were taken to implement the following methodology by involving the NGO partners in the State :

A review meeting was organised at Chennai involving the NGO partners, The State Leprosy Officer and the NLEP Consultant to assess the progress of the NGO facilitation in promoting urban leprosy work. It is quite gratifying to note that out of the 30 Districts 19 Districts the urban leprosy elimination work is in operation and the NGO based facilitation service is in place. The Regional Secretary for Southern Region, GLRA, presented a report on the feedbacks after the District sensitisation meetings conducted in various Districts. The Zonal coordinators of GLRA could play a helping role in linking the NGO partners with the urban health system. Special efforts have been made to operationalise this programme in the remaining Districts.

A project Planning workshop was convened by the Southern Regional office at Trichy involving the Supported NGO partners of Tamilnadu on 5th August, 2003. Functionaries of the Southern Regional Office, the representatives from the Central office, the NLEP Consultant for Tamilnadu were present to facilitate the deliberations. The primary objective of this workshop was to sensitise the projects on the support role to be played in promoting urban leprosy work in general health facilities. Modalities of NGO facilitation, formation of District Sub committees, reporting formats, financial planning etc, were discussed at length. This exercise has brought greater clarity in the role of projects in the different urban areas and the type of reorganisation they have to do in their respective projects.

Based on the agreement with the Government of India, the NLEP State Consultant was appointed by GLRA-India. Dr. Andrew Deenabandhu, a senior Leprologist has taken over as the NLEP Consultant. During his visits to the Districts he could appraise and acquaint the epidemiological situation of leprosy in Tamilnadu and assess the progress of various elimination measures taken by the State/District/NGOs as per the guidelines of the Government . His consultancy and technical inputs have contributed a lot in bringing acceleration in the elimination process and quality in integrated services.

GLRA-India coordinated with the Government of Tamilnadu in organising a training programme for those Medical Officers posted at the urban areas and who have not received any training in leprosy. This was a 3 days programme and the faculties were drawn from the Government and GLRA-India.

A formal inauguration was held on 17th December at Chennai in the presence of about 200 persons belonging to all walks of life.

The programme was inaugurated by the joint Secretary for Health. Government of Tamilnadu and the function was presided by Mrs. Sarah Chanda the Chairperson of Gremaltes. Dr.Suniti Solomon, Director of YRG Care, Dr. Narayanan, Director of TB Institute, Chennai, Fr. Kurian Thomas, Director Asha Nivas, Dr. Thomas Abraham, Mr. Pius and Mr. Devadas spoke on this occasion. A press conference was held along with this and there was good media coverage on this programme.

An orientation programme was organised on 28th of November, 2003 to provide the basic information on the policies of the Government in tackling the problem of HIV/AIDS and the scope of NGO participation in this field. Dr. Senthamizhan, Joint Director of TANSACS explained the different aspects of this programme and emphasised the importance of NGO participation in countering this formidable challenge caused by the disease. He has also dispelled the unfounded beliefs and fears attributed with the care of HIV/AIDS patients in the hospital situation.

A review meeting of the Southern Districts in Kerala was conducted at Kollam in the month of November, 2003 by the Government. GLRA officials took part in this meeting. The State Leprosy Officer interacted

with the District Leprosy officers, District Medical Officers and NGO representatives in the Districts. Role of GLRA as a support agency in the state was explained to the participants. Progress of the IEC campaign and District level SER activities were discussed in detail.

As part of integration promotion in the state the recently passed students of medical colleges were oriented on NLEP and its activities in four-hour module. The department of Dermatology and Community Medicine faculties participated in the following Medical Colleges.

Dr. J. Konig, Deputy CEO, DAHW along with the Director, Deputy Director, Medical Coordinator GLRA India and State Leprosy Officer Kerala, visited this sanatorium on 28th February 2003. He was appraised about the situation of the hospital and held discussions with the Hon. Minister of Health, Kerala, Health Secretary and Director of Health Services. A vision statement has been prepared by the Health Secretary regarding the need for the above hospital.

Advocacy programme at Trivandrum

The Kerala Coordination unit has organised an advocacy programme keeping in mind the pivotal role of GLRA as a support agency in the state in the NLEP and RNTCP programme. A press conference was organised on 18th November which was attended by the GLRA-India officials and most of the important news papers carried the news as part of the advocacy programme. Interviews were also telecasted by the different TV channels as a part of this programme.

A Review meeting was convened on 5th November 2003 involving the ILEP partners to review the progress of DTST activities with the participation of the State Leprosy Officer.

Certain remarks appeared in the LEM Report were clarified and necessary remedial measures were suggested. The State Leprosy Officer has given the plans for implementing the MLEC by the beginning of February, 2004 and requested the co operation and support from DTSTs in successfully conducting this exercise.

District level Advocacy Meetings were organised at 5 places involving the Zilla Parishad, District Magistrates, CMOH and Supervisors. Such meetings have brought more acceptability to the DTSTs and helped in its efforts to mainstream leprosy at the General Health System.

GLRA India initiated Consultancy services both in Leprosy and TB at the State level in the name of Rajasthan Support Cell with its office at Galta Ashram, Jaipur. State Support Team consisting of one State Coordinator, one NMS cum STS and a Driver began its operation from September, 2003. This cell is providing need-based support to State NLEP/RNTCP.

In view of the change in the Government strategy the active search operation has been stopped in the field projects of KNEUS. (Kusht Niyantran Evum Unmoolan Samiti) situated in Uttar Pradesh, Madhya Pradesh Delhi & Uttaranchal states.

The existing 16 Field units have been reorganised and converted in to 10 Support units. A well thought out IEC Plan has been implemented in all the projects since April, 2003. GLRA Regional Office for North has taken the necessary initiative to down size the staff from 160 to 65 and a restructured Plan of Action was brought out.

As a part of diversification KNEUS has taken up TB. This project has been allotted 6 Microscopic and DOTs centres which are already in operation. Their 25-bedded referral centre at Greater Noida, which is nearing completion, will serve as a referral point for Leprosy/TB and HIV/AIDS.

Indara, which is a Hospital based project in Uttar Pradesh involved in POD/SER has diversified in to general health and educational areas.

This project has the potential to diversify in areas like TB, HIV/AIDS as it has adequate infrastructure. Dr.Rajbir Singh, the Medical Coordinator for North had consultation with the Project Management on the future work plan.

Dr.Rajbir Singh, the Medical Coordinator for the North had discussions with Mr. Kaul and the functionaries of SMK on the reorganisation keeping in view, the change in the work pattern.

Instead of active case finding the project should hereafter concentrate on IEC and support to the District towards integration, POD and SER. This exercise has already been completed.

This project has taken up TB work as per the RNTCP Scheme.

Necessary guidance from the State Support Cell will be offered for the effective implementation of this programme.

The activities of the DTST are being reviewed regularly by the Medical Coordinator, Dr.Rajbir Singh and Dr.Thomas Abraham on a periodical basis. Being the biggest District in Delhi it took some time to take stock of the situation for the Team and with the help of the DLO and the SLO sensitised 75% of the Muncipal Dispensaries and Health Centres of the Delhi Administration. NLEP services are being integrated in these centres and SIS (Simplified Information System) has been introduced in all these units. It is planned to have training on POD and the DTST will co ordinate this programme.

A Project Planning Workshop involving the GLRA supported projects in Maharashtra was organized by the Western Regional Office. The primary objective of this workshop was to sensitize the projects on the support role to be planned in urban leprosy work in General Health facilities and also to combine TB along with Leprosy. This workshop has brought greatest clarity on their future work.

Dr. Dinesh Jain, Medical Coordinator of Western Region presented the strategy paper, which was discussed by the NGO partners. A rough outline of the future course of activities was worked out.

District Technical Support Teams were established in Maharashtra as per the plans approved by the Government of India. A clear working plan with the office of the State Leprosy Officer and the GLRA Western Regional Office developed in the mean time to function for the benefit of the DTST programme. An MOU with TLMI was signed for the smooth working arrangement keeping Dr. Dinesh Jain as the DTST Coordinator for the State.

Central Office Team along with the Medical Coordinator of the Western Region had discussions with the Project holders of Maharashtra on 4th of December, 2003 and the need to change the pattern of work in tune with the changing leprosy situation was discussed. A clear mandate from the Government of Maharashtra to carry out need-based support and strengthen TB support will be obtained by the efforts of the Western Regional office.

In order to mainstream leprosy work, it has been decided to integrate leprosy with general health system in the city of Mumbai. A working strategy has been evolved keeping the NGOs as the support centres. This was appreciated by the DDG (L) during his visit to Mumbai.

In order to assess the progress of integration, Dr.Thomas Abraham visited Dangs District and had seen the impact of the work of the DTST at the PHCs. To initiate the TB programme necessary inputs were given and also advised them to combine the reporting formats for leprosy and TB. PHC staff were interviewed to assess their competency in Leprosy and TB.

A meeting was organised to explain the concept and work plan of SER to the Government functionaries and Mr. Isaac, the Coordinating Rehabilitation Officer explained the same and sought the cooperation and support for the implementation of the programme.

Dr. Jain also gave a picture of the SER services already carried out in the state and informed the scope for further expansion.

During the year 2003, three Regional Review Meetings were conducted, involving the representatives and Medical Coordinators from the regions. Dr. Konig, Dy. Chief Executive and Head of the Project Department, DAHW participated in the meetings held during February and August and Ms. Mann Rosemeier, Project Manager, DAHW, took part in the meeting held during August. During these meetings the progress of activities at the regional level were presented by the respective regional officers. Strategy planning sessions in leprosy and TB were held followed by interactions. Progress of decentralisation of technical and financial areas were discussed with the functionaries of Central office. Local issues pertaining to the implementation of the programmes at the state level were also discussed. Clear work plan and tasks were assigned to the respective functionaries with the time schedule.