Health Action - January 2012

New Approaches To Address Disability In Leprosy

Dr Akshay Kumar Mishra* & John Kurian George**

To supplement the efforts of the Government of India to give necessary care for the affected people with disabilities, Swiss Emmaus India (now known as FAIRMED) had taken up Prevention of impairment & Deformity (POID) service in the form of DISPEL (Disability Prevention and Education in Leprosy) in 6 districts of Andhra Pradesh through the support of 2 NGOs i.e.Rural India Self Development Trust(RISDT),Kathipudi, and Gretnaltes, Tenali, and services like ulcer care, provision of Self Care Kits, MCR and supportive medicine were provided.

Implemented in partnership with the State and District Leprosy Programme, the project supported the NLEP programme in reduction/prevention of disabilities and direct provision of care. The project was implemented from 2001 in some districts while in the others it was scaled in 2004.

The project demonstrated impressive success in reducing the burden of the disability in the project areas. It was suggested that the project build on a sustainable and more integrated concept for persons affected with leprosy (POID), work towards encouraging more self­ care by the persons affected with leprosy (PAL) and promote the integration of POID into the district health services. Based on the recommendations, in Jan 2010, a POID workshop was organized to develop the project proposal and it was launched in September 2010 after getting approval from FM headquarters.

Goal:

To improve physical and social wellbeing of persons affected with leprosy.

Project highlights Emphasis on early case detection:

The project gives importance to the ANMs and ASHA workers as first contact persons in the community and envisages their training in various forms of case-presentation, warning signs for early detection of complications, referral, follow­ up, home-based self-care practice, health education of leprosy cases, contract tracing and examination. A documented system of case-reporting and follow-up has been developed to make it more evidenced-based and reliable. The innovation this project brings in is the development of the linelisting of all the people affected with leprosy in the community from 2 districts, which will be generated by the ANMs with the help of the ASHAs and will be updated periodically and verified/ certified by the MO/DMHO/DLO. Later, this will be further consolidated at the district level and will fotm the basis for all the interventions required for people affected with leprosy.

Strengthening the primary health care

Under the project, a senior PHC staff has been identified as the Government Officer-in-charge ofPOID (GOPOID). He I she will oversee the leprosy-related activities under the overall guidance of the PHC Medical Officer who has been trained in counselling, case management, referral and reporting. Two mobile action teams have been put in place to cover 110 PHCs I service delivery points in each district, which will counsel the patients identified under the PHC jurisdiction, provide ulcer care and training on self-care and supply MCR footwear I splints provided by the DLO.

Project coverage

The project provides POID services to approximately 6,500 affected persons in two high prevalent districts (East Godavari & Guntur) of Andhra Pradesh including the newly detected patients and ensures MDT treatment, referral, follow-up and supply of MCR I splints. The project is being implemented with synergetic collaboration of 4 partners (Fairmed, Government, RISDT, Kathipudi and Gretnaltes, Morampudi). A steering committee has been constituted with the involvement of all the partners, State ILEP Coordinator and SLAP (State Society for Leprosy affected persons) to provide strategic direction to the project.