National Action Plan Leprosy Control - 2008-2010 Draft-1 : 28 October 2008

1. National Action Plan Leprosy Control - 2008-2010 Draft-1 : 28 October 2008 Izhar M. Fihir

2. National Action Plan • Serves as a guideline for program planning and program development at the district and provincial level • Focus on program framework and management of the action plan • Evidence-based Costing and Resource Allocation calculation

3. Outline of the NAP-1 • Part-1 : Background and Justification • Part-2 : Program Framework • Part-3 : Management of NAC • Part-4 : Costing (Resource Allocation)

4. Outline of the NAP-2 Part-1 : Background and Justification Epidemic Situation Program Response Challenges Committment Justification

5. Outline of the NAP-3 Part-2 : Program Framework Basic Policy, Goal and Objectives Program Framework Program Implementation Program Support

6. Outline of the NAP-4 Part-3 : Management of NAC Role of Subdit Leprosy Partnership Integration of Services Monitoring, Surveillance and Reseach

7. Outline of the NAP-5 Part-4 : Costing (Resource Allocation) Total Estimated Cost Analysis of Resource Gap Resource Allocation

8. Part-1 : Background and Justification - 1 Epidemic Situation (2006) # New detected Cases 17,682 – NCDR 8.18/100,000 # Registered Prevelance 22,176 – Prevalence <1/10,000 Proportion of of MB Cases :80.4 % Proportion of Disability Grade-2 :7.8 % proportion of Child Cases : 9.9 % Indonesia has reached the elimination target of Prevalence <1/10,000 population BUT No decline in # of new detected cases, proportion of MB cases, child cases and cases with disability grade-2. This reflects the pattern for risk for leprosy transmission in the community that remain stable. Leprosy burden in term of efforts to increase case detection and provision MDT treatment is still significant

9. Part-1 : Background and Justification - 2 Program Response Case detection is mainly done by passive case detection (72%) and MDT treatment is provided at the PHC Level. Proporsion of cases with disability grade-2 is about 8% and remain stable for the last 5 years, Early case detection follow the same pattern with no improvementnt. No data on treatment completion rate to assess the performance of MDT treatment Case management mainly done at PHC level with referral to district level hospital and leprosy hospital. Leprosy services at this level is provided by trained general health staff or nurses

10. Number of New Detected Cases

11. Number of Registered Cases and New Detected Cases

12. Proportion of MB, Child Case and Disability Grade-2

13. Part-1 : Background and Justification - 3 Justification for National Action Plan NAP is develop to guide a planning proses for consilidated effort to maintain and improve leprosy services to reduce leprosy burden (new detected cases, proportion of disability grade-2 proportion of child cases shows a stable pattern in the last 5-10 years) NAP is developed in to allign Indonsian leprosy control program with WHO Global strategy 2006-2010 NAP can serve as a advocay tools for policy and financial support from local government and donor agency.

14. Part-2 : Program Framework-1 Basic Policy and Goal Leprosy control program is done through a provision of a comprehensive integrated leprosy services at the “district health service delivery network” with referral services to District hospital GOAL : Maintain and improve leprosy service to further reducing “leprosy burden” and mitigate the impact of leprosy to improve quality of life for PAL .

15. Part-2 : Program Framework-2 Objectives • Maintain and improve service availibity at the PHC level, ensure the availabilty of trained staff, MDT stock and access to referral servces • Maintain and improve access to leprosy service, remove barriers for access to services • Promote utilization of leprosy services through IEC and community participation • Improve quality of services through capacity building and health system development

16. Part-2 : Program Framework-3PROGAM COMPONENTS

17. Part-2 : Program Implementation-1 Coprehensive Integrated Service and PHC network with referral service at District Hopital High Endimicity : Accelerated Leprosy services, full coverage at District and Puskesmas Catchment area Low Endimicity : Maintain Leprosy services at District Catchment area, assigned selected Puskesmas as service delivery point for leprosy service

18. Part-2 : Program Implementation-2 Program Target High Endimicity : # of District and Puskesmas with Accelerated Leprosy services (maintain service availibilty, improved acces and utilization of servise) Low Endimicity : # of District and Puskesmas t that maintain leprosy services. Population of Target : # of Dictrict and Puskesmas in the high and low endimicity area

19. Part-2 : Program Implementation-2 Program Support : • Health System Development • Supervision (Technical and Programming) • Monitoring and Evaluation (as per WHO guide) - Main Indicator (NCDR, Completion Rate, Reg Prevalence) - Additional Indicator (Proprtion of MB, Grade-2 Disabilty, Child, Female - Indicator for Patient Management • Capacity Building (Technical and Programming)

20. Part-3 : Management of NAP-1 Role of Subdit-Leprosy : • Provide Leadership in Program Development and Program Implementation • Coordinate intersectoral efforts, within CDC (TB), within MOH (Medical Treatment) and interdepartment (Social Affair)

21. Part-3 : Management of NAP-2 Promote Partnership : • Local Government : Policy support and resource allocation from local government (ANEK) • Professional Orgs and NGOs : Perdoksi, University Group, Reseach Org • International Orgs : WHO, NLR

22. Part-3 : Management of NAP-3 Program Support : • Monitoring and Evaluation • Surveillance • Operational Research

23. Part-4 : Costing (Resource Allocaton) Evidence-based resource allocation based on epidemic analysis, program expenses (2006 and/or 2007) and program target • Total Cost for High and Low Endemic Provinces/District • Analysis of Resource Gap • Strategic Resource Allocation