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INTEGRATION OF DISEASE CONTROL PROGRAMMES

INTEGRATION OF DISEASE CONTROL PROGRAMMES. … Lessons from Leprosy and Malaria. Changing Concept of Health Care Delivery. Comprehensive Health Care Basic Health Care Primary Health Care Equitable Distribution Community Participation Inter-sectoral Co-ordination Appropriate technology

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INTEGRATION OF DISEASE CONTROL PROGRAMMES

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  1. INTEGRATION OF DISEASE CONTROL PROGRAMMES … Lessons from Leprosy and Malaria

  2. Changing Concept of Health Care Delivery • Comprehensive Health Care • Basic Health Care • Primary Health Care • Equitable Distribution • Community Participation • Inter-sectoral Co-ordination • Appropriate technology • National Rural Health Mission

  3. Integration • Integration means day to day management, recording and reporting of the disease by general health care staff • Does not mean that specialist expertise disappears from the general health service • Expertise required within GHS at central & intermediate levels for planning & evaluation , provision of training, technical advice, referral services and research

  4. Integration • Equity & accessibility • Improved cost effectiveness • Long term sustainability • Reduction of stigma & discrimination

  5. Dynamics of Integration

  6. Basic Principles for Successful Integration • Every health facility should provide MDT services on all working days • At least one trained staff should be available in every health facility • Adequate amount of MDT drugs should be available free of cost

  7. Basic Principles of Successful Integration • IEC materials should be available for the patient and their family members • A simple treatment register should be available • Referral services should be available and accessible, and general health staff should know where and how to refer patients

  8. Integration in leprosy means… • The ability of peripheral general health workers to suspect leprosy & refer patient to a referral unit • Good linkages of peripheral level staff with referral units • Referral units including district hospital should diagnose and treat leprosy • Good linkages of referral level staff with specialist clinics • Continuation of treatment delegated to peripheral health facility

  9. Evolution of NLEP

  10. Trend of PR & ANCDR

  11. Programme Objectives • Further reduce leprosy burden in the country • Provide quality leprosy services through GHC system • Enhance Disability Prevention & Medical Rehabilitation services • Enhance advocacy to reduce stigma and discrimination • Capacity building of GHC staff • Strengthening monitoring & supervision

  12. Health Care Delivery System in NLEP NLEP is an integral part of National Rural Health Mission MOH and FW/ DGHS ↓ Central Leprosy Division ↓ State Health Societies ↓ District Health Societies ↓ District Nucleus ↓ PHCs/CHCs ↓ Sub-Centre ↓ Village (AWW,ASHA) Village Health and Sanitation Committee

  13. Integration of NLEP with GHC System • NLEP remained a vertical programme from 1983-84 till 2001-02 • Process of integration started with second NLEP project in 2002-03 • 27 States/UTs started integration in the 1st year itself ie. Year 2002-03 • 8 States (Bihar, Jharkhand, UP, Uttaranchal, MP, Orissa, Chhattisgarh & West Bengal) completed the Integration process in March 2004.

  14. Process of Integration …Contd… • Capacity building of GHC staff started in year 1998-99 • 75% of the leprosy staff handed over to the GHC system in 2002-03 • 25% of the staff retained as vertical component to establish district nucleus to provide backup technical support to GHC staff • Leprosy Control Units closed down & service delivery started through primary health care

  15. Process of Integration …Contd… • Temporary hospitalization wards (THW) handed over to the district hospital authorities, keeping 10 beds for leprosy affected persons (LAP) with complications • Urban leprosy centres continued to work under overall supervision of the District Leprosy Officers • Structural integration took time for different states to relocate the staff

  16. Process of Integration • SLO and DLO in most places look after one or two programmes • Programme planning remained with the state and district Leprosy units • Integrated decentralised bottom up planning under NRHM started from 2007-08

  17. Simplified NRHM Annual Planning Process • 1st installment of funds is received by the states only in July/August for activities to be undertaken from April of the year • For timely release of funds in next year, the planning process should start in August of current year

  18. July Planning guidelines sent to States & Districts Stakeholder Consultations per District August Drafting District action plans Progress reporting September Budget release from State to District Progress reporting April Submission of Districts plans to NRHM State Progress reporting October NPCC budget release to States Progress reporting March Submission of State plans to NPCC November NPCC discussions with States; budget approval Planni0ng January Monitoring Simplified NRHM Annual Planning Process

  19. Lessons learnt from Leprosy …Contd... • Vertical mindset among staff – possessiveness • Resistance from GHC staff • Apprehension among programme managers about loosing focus & priority to programme • Lack of awareness in community about availability of services through primary health care

  20. Lessons learnt from Leprosy • Inadequate capacity building of health care staff • Inadequate staff due to addition of new national health programmes • Poor monitoring & supervision • Inadequate addressal of cultural & physical barriers • Centralized planning

  21. New Paradigms: Integration …Contd… • Communitization – • Village Health & Sanitation Committee • ASHA • Involvement of PRI • Rogi Kalyan Samiti

  22. New Paradigms: Integration …Contd… Flexible Financing - • Untied grants • NGOs as implementers • Risk pooling – money follows patient • More resource for more reforms Improved management through capacity – • FMG/DPMU/Accountants • NGOs in capacity building • NHRC/SHRC/DRG/BRG • Continuous skill development support

  23. New Paradigms: Integration Monitor progress against standards - • IPHS standards • Facility surveys • Independent monitoring committees Innovation in human resource management - • Additional manpower • Emergency services • Multiskilling

  24. Challenges • Accessibility of Services • Meaningful involvement of Community in the: • Planning • Implementation • Support of health services • Planning with other sectors for Inter-sectoral coordination • Human resources and development • Long term sustainability of the Services • Simplified monitorable indicators by the community

  25. Time and Patience are valuable and well appreciated! Thank You!

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