D. Disease Control Programs - RRC-NE

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D. Disease Control Programs

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D.1 :NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME.

The National Vector Borne disease Control Programme (NVBDCP) is an Umbrella

programme for prevention and control of Malaria and other Vector Borne diseases

like Dengue, Filaria, Kala Azar, Japanese Encephalitis and Chikungunya with

special focus on the vulnerable groups of the society. Under the programme, it

ensures that the disadvantaged and marginalized section benefit from the delivery of

service so that the desired National Health Policy and Rural Health Mission Goals

are achieved.

THE OBJECTIVE OF THE PROGRAM

- To reduce morbidity due to Malaria and other vector borne diseases.

OUTCOME OF THE PROGRAMME UNDER NRHM

- Malaria mortality reduction rate 50% up to 2010, additional 10% by 2012.

- Kala Azar to be eliminated by 2010.

- Filaria/Microfilaria reduction rate: 70% by 2010, 80% by 2012 and

elimination by 2015.

- Dengue mortality reduction rate: 50% by 2010 and sustaining at that level

until 2012.

- Japanese Encephalitis mortality reduction rate: 50% by 2010 and sustaining

at that level until 2012.

OUTCOME OF THE PROGRAMME (STATE)

- Kala- Azar to eliminate by 2015.

- Filaria/ Microfilaria to eliminate by 2015.

- Malaria case reduction rate- 50% by 2012

THE MAIN ACTIVITIES UNDER THE PROGRAMME

- Early diagnosis and prompt and complete treatment.

- Integrated vector control.

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- Community based health education.

- Training and capacity building of various cadres of medical and paramedical

staff for prevention, management and control of vector borne disease.

- Effective monitoring, supervision and surveillance.

ORGANISATIONAL SETUP

The NVBDCP wing of the health department is situated at Head Quarter, Gangtok

having overall responsibilities of the implementation of programme. In the East

district – District NVBDCP office and store is situated at Singtam old Hospital

Complex, where insecticides, anti malarial drugs, spray items etc is stored. There is

no NVBDCP Office at North, South and West district; the programme is

implemented under the supervision of District Malaria Officer / CMOs.

MALARIA

DEMOGRAPHIC PROFILE

1) Area – 7096 Sq. Kms.

2) Population – 540498

3) District – 4

4) Sub Division – 9

5) PHC – 24

6) PHSC – 146

7) Population under NVBDCP – 1.83 Lakhs

8) Malaria Clinics - 10

9) FTD – Nil

10) DDC – Nil

11) Spray Activities – 15th April to 15th September

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Status of Health facilities:-

Sl. No Health Facility Numbers

1 State Hospital 1

2 Medical College.

(private) 1

3 CHC 2

4 District Hospital 4

5 PHC 24

6 PHSC 146

7 FTD Nil

8 DDC Nil

9 ASHA 637

10 RRT-Formed yes

Human Resource

Sl. No Health facility Sanctioned In place Trained

1 DMO (Full

time)

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All CMOs are acting as

DMOs

- -

2 AMO 2 - -

3 MO (State) - 168 50

4 Lab Tech. - 48 State level

5 Health

Assistant(M) 9 3 Nil

6 MPW (M) 213 183 80

7 ASHA 665 637 150

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Sikkim is a small mountainous State having total population of 540493. The valley

of Southern and Eastern Sikkim are hot and humid throughout the year except in

winter and these areas at and below 3500ft falls under Malarial Zone of the state.

Approximate Pop. Of malarial zone – 1.83 Lakh

Problem of malaria in Sikkim is due to :

* Labour population migrated from malaria endemic areas to work in the

Project areas and construction sites.

* Army personnel transferred from malaria endemic areas.

* Local population in the lower belt of the State.

The cases of malaria in the state of Sikkim is due to the huge influx of labour

population from our neighboring state like West Bengal, Bihar, Orissa, Assam and

neighboring countries like Nepal, Bhutan and Bangladesh to work in the massive

construction sites and projects areas like NHPC and also several new upcoming

projects. Since Vector of Malaria and other vector borne disease are present in low

lying areas of the state there is always threat of outbreak of vector borne disease in

the State.

Statements showing Malaria Situation from 2005- 2010

State- Sikkim

YEAR Population BS

Collection

Total

Positive

Cases

No. of

Pf Cases

No. of

Death

ABER

(%)

SPR

(%)

Pf

(%) API

SFR

(%)

2005 148210 8319 69 31 3 6 0.82 44.9 0.46 0.37

2006 151987 7956 93 31 nil 5.2 1.1 30 0.61 0.38

2007 163081 6259 48 07 nil 4 0.76 14.5 0.29 0.1

2008 175209 6164 38 10 Nil 3.5 0.6 26 0.2 0.16

2009 179586 6688 42 16 01 4 0.63 38 0.23 0.24

2010

183993 6526 49 14 Nil 3.5% 0.75 28.5 0.26 0.21

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No outbreak of malaria was reported during 2010 ,

The state of Sikkim does not have specific District, PHC or Sub Centers having

Pf cases.

National Vector Borne Disease Control Programme

District wise B. S Collection and Examined -2009.

District Population

(Malarial Zone)

B. S Collection &

Examined

Total

Positive P.V P.F

East 76026 5110 39 23 16

West 35423 0 0 - -

North 13032 250 0 - -

South 55105 1328 3 3 -

Total 179586 6688 42 26 16

National Vector Borne Disease Control Program

District wise B. S Collection and Examined during 2010

District Population

(Malarial Zone)

B. S Collection &

Examined

Total

Positive P.V P.F

East 77846

5334 38 30 08

West 36308

06 06 01 05

North 13357

220 0 - -

South 56482

966 05 04 1

Total

1,83,993

6526 49 35 14

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INDOOR RESIDUAL SPRAY -2010

In the State of Sikkim we are still using DDT as vector control tool. As per the

guidelines of the programme, DDT has to be sprayed in the areas having API

(Annual Parasitic incident) 2 and above. In our State there is no PHC and district

having API 2. Still we are using DDT in the project areas, Labour huts, River

belt areas and foothill bordering West Bengal. This year the first and second

round of DDT spray Programme in all four districts of State has been completed.

This year DDT is not supplied to the State of Sikkim. 20 bags of DDT is supplied

by West Bengal on request.

DDCs and FTDs –

The State had 19 DDCs and 31 FTDs but presently all are non- functional, as sub

centers are near to village so they are functioning as DDCs and FTDs.

R.D. Kit

1000 RD Kit for Malaria has been received from West Bengal.

R.D. kit was procured during emergency from State Health Society (NVBDCP)

fund and State Budget.

Insecticidal Treated Bed net

The State of Sikkim has not received any Insecticidal treated Bed net till date.

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DENGUE

Outbreak of Dengue Fever occurred at Jorethang, South District of Sikkim

during 2004.

Total No. of reported fever cases – 4500.

Death – 1

Out of 50 blood samples tested at Micro Lab. of NICD, Delhi 12 was

found positive for DF.

07 imported cases of Dengue have been reported during the month of

October & November 2010.

KALA AZAR -

STATEMENT SHOWING DISTRICT WISE DISTRUBATION OF

CASES OF KALA-AZAR FROM 2006 – 2010

Sl. No Year East West North South Total

1 2006 1 2 Nil 2 5

2 2007 Nil Nil Nil Nil Nil

3 2008 1 Nil 1 2 4

4 2009 2 Nil Nil 3 5

5. 2010 01 Nil Nil 02 3

Five cases of Kala Azar were reported during 2006 out of which 2 were

indigenous and rest imported from Bihar / Nepal

No cases were reported during 2007.

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Five cases were reported during 2008.

One death reported from North District (2008)

5 cases were reported during 2009.

3 cases were reported during 2010.

FILARIA

One imported case (Army personnel) of filaria has been reported from East

district of Sikkim during Jan 2010.

One indigenous case has been reported from Bardang, East Sikkim during

2008.

During a filarial survey conducted by a team from NICD, Delhi during

August 2008 at Singtam and surrounding areas (East Sikkim)– out of 3428

night blood sample collected 42 were found positive for microfilaria.

1 case of Filarial has reported from East district during 2009.

1 case of Filarial has reported from East district during 2010.

Since, most of the case of Kala- Azar, Dengue & Filaria reported to the State are

imported one. Hence, strategy planned for 2011-12 for prevention and control of

Kala- Azar, Dengue & Filaria are as follows-

Early case detection.

To strengthen surveillance system.

More emphasize will be made to screen the migratory labour population

especially in the project areas.

Continuous IEC activities for Kala- Azar, Dengue & Filaria.

Training of Medical and Para Medical Officials for detection, prevention &

control of Kala- Azar, Dengue & Filaria.

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There are no reported cases of JE and Chikungunya till date.

STATEMENT SHOWING VECTOR BORNE DISEASE SITUATION

FROM – 2005 TO OCTOBER 2010.

YEAR MALARIA FILARIASIS KALA - AZAR DENGUE

2005 69 NIL NIL NIL

2006 93 NIL 05 NIL

2007 48 NIL NIL NIL

2008 38 02 04 NIL

2009 42 1 5 Nil

2010

49 01 03 07

STRATEGY FOR THE YEAR -2011-12

Early case detection and complete treatment of all vector borne diseases.

Vector control and personal protective method including insecticides treated

mosquito nets.

Increase in ABER more than 8% of the population of malarial zone.

More emphasis will made to screen the migratory labour population

especially in the project areas.

Strengthening of continuous IEC activities for malaria, Kala Azar and filaria

including observation of Anti Malaria month (June) / Anti Dengue Month

July.

Epidemic planning and rapid response.

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Training of all categories of health personnel including Anganwadi workers

and ASHAs for early case detection, prevention and control of all vector

borne diseases.

TRAINING

Training proposed during 2011-2012

IEC activities Proposed during 2011-12 under NVBDCP

Sl.No. Categories of

staff

To be trained

during

(2011-12)

Fund Requirement

for training ( 2011-

12)

Remarks

1 Medical

Officers 30 1.20 lakh

Newly appointed under

State/NRHM

2 Lab.

Technician 40 1.50 lakh

Re-orientation training

for four District of

State

3 MPHW (M/F) 60 0.90 lakh Re-orientation training

4 ASHA 200 1.00 lakh

50 from four district

From malarial Zone

5 Anganwadi

workers 100 0.50 lakh From malarial Zone

TOTAL 5.10 lakh

Sl

No Activities Proposed Remarks

1 Health awareness Camp 40 4 / District,

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7. Printing and Distribution of Posters/ Leafleted/ Calendar on

Prevention of Vector Bond Disease

BUDGET ALLOCATION OF CASH AND KIND FOR 2010-11

Name of the activity Allocation in

10-11 (in lacs)

Cash assistance

received (in lacs)

Remarks

Malaria/IEC/Training 16.50 10.74 Received during Sept.2010

Assistance for decentralized commodities which include Chloroquine, Peimaquine etc

0.23

Commodity support by GOI for VBD

5.12

Total 21.85 10.74

FUND RECEIVED UNDER NATIONAL VECTOR BORNE DISEASE

4 - State

2 School quiz Competition 10 2 / District

2 - State

3 Advocacy to Panchayat, NGO 14 3 / District

2 - State

4 Advertising local Paper 4

5 Installation of Hoarding at malarial Zone 10 Malarial Zone

6 Advertising through F.M.Radio,T.V

Channel 4

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CONTROL PROGRAMME FOR THE YEAR 2008- 09 to 2010-2011.

YEAR FUND RECEIVED EXPENDITURE BALANCE

REMARKS

2008-09

6.50 Lakhs

6.50 Lakh

Nil

2009-10 7.80 Lakhs 6.80 Lakhs 1.00

2010 - 11 10.74 lakhs 4.15 Lakhs 6.59

TOTAL

25.04 Lakh

17.45 Lakh

7.59 Lakh

FUND PROPOSED FOR THE YEAR -2011-2012

Components Activities & Calculation Norms

Planned amount 11-12 (In Lakhs)

IEC (Malaria, Kala Azar & Filarial)

1.50 lakhs each for State, East & South & 1.00 lakh each for

North & West. 6.50

Training (Malaria,Kala Azar & Filarial)

As per NVBDCP norms. 5.10

Spray Wages (I/c Focal Spray)

Rs. 115/-per day for six month for workers 2.66

Maintenance Annual maintenance of computer supplied by NVBDCP. 1.50

Establishment (SHS & DHS)

Rs. 100000/-per district &Rs. 100000 for State 5.00

Grand Total 20.76

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D.2 RNTCP Annual Plan for Programme Performance & Budget for the year

1st April 2011 to 31st March 2012 State: Sikkim

Objectives: 1. To achieve and maintain a cure rate of at least 85% among newly detected infectious (new

sputum smear positive) cases, and 2. To achieve and maintain detection of at least 70% of such cases in the population

This action plan and budget have been approved by the STCS. Signature of the STO__________ _______ Name: Dr. Rinzing Dorjee Section-A – General Information about the State

1 State Population (in lakh) please give projected population for next year 6.26 2 Number of districts in the State 04 3 Urban population 104,449 4 Tribal population 125,732 5 Hilly population 553,609 6 Any other known groups of special population for specific

interventions (e.g. nomadic, migrant, industrial workers, urban slums, etc.)

-

(These population statistics may be obtained from Census data /State Statistical Dept/ District plans)

No. of districts without DTC: NIL

No. of districts that submitted annual action plans, which have been consolidated in this state plan: 4

Organization of services in the state: SL.No.

Name of the District Projected Population (in Lakhs)

Please indicate number of TUs of

each type

Please indicate no. of DMCs of each type in the district

Govt NGO Public Sector*

NGO Private Sector ̂

1. DTCS North 0.47 01 0 02 0 0 2. DTCS South 1.53 1 0 6 0 0 3. DTCS East 2.87 02 00 08 00 02 4. DTCS West 1.39 1 0 5 0 0 Total 6.26 5 0 20 0 2 *Public Sector includes Medical Colleges, Govt. health department, other Govt. department and PSUs i.e. as defined in PMR report ^ Similarly, Private Sector includes Private Medical College, Private Practitioners, Private Clinics/Nursing Homes and Corporate sector

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RNTCP performance indicators: Important: Please give the performance for the last 4 quarters i.e. Oct.’ 2009 to September’ 2010

Name of the District (also

indicate if it is notified hilly or

tribal district

Total number of

patients put on

treatment*

Annualised total case detection

rate (per lakh

pop.)

No of new

smear positive

cases put on

treatment *

Annualised New smear

positive case

detection rate (per

lakh pop)

Cure rate for cases

detected in the last 4

corresponding

quarters

Plan for the next year Proportion of TB

patients tested for

HIV

No. of MDR

TB suspect

s identified and subjects

to C/DST

of sputum

No. of MDR

TB cases

diagnosed &

put on treatme

nt

Annualized NSP case

detection rate

Cure rate

DTC EAST 893 328.3 250 91.9 84.5 90 86 50 101 52 DTC SOUTH 346 236.9 104 71.2 87.7 80 90 50 18 33 DTC WEST 245 178.8 104 75.9 90.5 75 90 50 08 18 DTC NORTH 157 348.8 35 77.7 85.2 75 86 50 09 14 Total 1641 273.5 493 82.1 86.9 75 90 50 136 117

* Patients put on treatment under DOTS regimens only are to be included.

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Section B – List Priority areas at the State level for achieving the objectives planned:

S.No. Priority areas Activity planned under each priority area 1. RNTCP training & Retraining a) Training of newly appointed M.O. (Regular

& contractual) b) Training of newly appointed supervisory staff. c) Retraining of staff

2. ACSM a) Sensitization of private practitioners b) Involvement of local political bodies, Schools c) Patient provider meetings d) Involvement of NGO’s e) Interaction of sputum collection centres.

3. DOTS Plus Activities a) Initialization & accreditation of IRL b) Initialization of DOTS-Plus in state c) ACSM of DOTS Plus activities d) Starting of DOTS Plus ward.

Priority Districts for Supervision and Monitoring by State during the next year

S No

District Reason for inclusion in priority list

1. East Decease in the cure rate of NSP cases. Increase in the no. of MDR positive cases.

There are pockets of MDR-TB cases which needs to be assessed.

The 2nd line TB treatment given by the state are to be followed up.

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Section C – Consolidated Plan for Performance and Expenditure under each head, including estimates submitted by all districts, and the requirements at

the State Level

1. Civil Works

Activity No. required as per the norms in the state

No. already upgraded/ present in the state

No. planned to be upgraded during next financial year

Pl provide justification if an increase is planned in excess of norms (use separate sheet if required)

Estimated Expenditure on the activity

Quarter in which the planned activity expected to be completed

(a) (b) (c) (d) (e) (f)

IRL/ STBC

1 1 - Maint. of IRL/ STBC

97,500

DOTS Plus Site

1 0 - New site proposed

13, 00,000

DTCs 4 4 - Maint of DTCS

23,400

TUs 5 5 - Maint of TUs 8,450

DMCs 19 19 - Maint of DMCs

26,000

TOTAL 14, 54,050

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2. Laboratory Materials

Activity Amount permissible as per the norms in the state

Amount actually spent in the last 4 quarters

Procurement planned during the current financial year (in Rupees)

Estimated Expenditure for the next financial year for which plan is being submitted

(Rs.)

Justification/ Remarks for (d)

(a) (b) (c) (d) (e)

1) Purchase of Lab Materials for Districts

2) Lab materials for EQA activity at STDC (eg. Lab consumables for trainings, preparation of Panel slides etc)

1, 33,848 180,955 300,000 350,000

Lab materials & consumables for Culture/DST activity at IRL and other Accredited Culture & DST labs in Govt. sector including Medical Colleges

100,000 100,000

TOTAL 450,000

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3. Honorarium



Expenditure (in Rs) planned for current financial year


(Rs.)


(a) (b) (c) (d) (e)

Honorarium for DOT providers (both tribal and non tribal districts)

133,333 148,250 170,000 180,000

Honorarium for DOT providers of Cat IV patients

30,000 30,000

Total 210,000

No. presently involved in RNTCP

Additional enrolment proposed for the next fin. year

Community volunteers in all the districts*

384 50

* These community volunteers are other than salaried employees of Central/State government and are involved in provision of DOT e.g. Anganwadi workers, trained dais, village health guides, ASHA, other volunteers, etc.

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Annual Action Plan Format Advocacy, Communication and Social Mobilization (ACSM) for RNTCP 1) Information on previous year’s Annual Action Plan

Budget proposed in last Annual Action Plan: 6,95,000/- 2) Permissible budget as per norm : 7,11,521/- (including districts) 3) Budget for next financial year for the district as per action plan detailed below:

Program Challenges to be tackled by ACSM during the Year 20010-11

WHY

ACSM Objective

For WHOM Target Audience

WHAT

ACSM Activities

When

Time Frame

By

WHOM

Monitoring and Evaluation

Budget

Based on existing TB indicators and analysis of communication challenges (Maximum 3 Challenges )

Desired behavior or action (make SMART: specific, measurable, achievable, realistic & time bound objectives)

Activities Media/ Material Required

Q1

Q2 Q3 Q4 Key implementer and RNTCP officer responsible for supervision

Outputs; Evidence that the activities have been done

Outcomes: Evide-nce that it has been effective

Total expenditure for the activity during the financial year

Challenge 1. Advocacy Activities Increase NGO,

PP participation Increase PHI referrals

NGOs, PPs, CMEs, meetings, presentations, One to one interactions, PHI visits, meetings.

Printed Materials, AV presentations,

DTOs, IEC Officer, MO-TCs

Reports, Feedback reports

Documented Participation, Quarterly reports.

60,000/- 25,000/- DTOs,

Specialists MOs, MPHWs.

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Communication Activities Increase

Treatment adherence. Increase understanding of MDR-TB Increase awareness and availability and accessibility of services.

Patients, families, general public, DOT providers General Public, susceptible pockets.

Meetings, counseling sessions, family camps, melas. Awareness camps, meetings

Posters, Hoardings, Print and electronic media. Print materials, Hoardings, TV and Radio transmissions

STSs, IEC Officer. DTOs, IEC Officer

Reports Reports

1,50,000/- 1,00,000/- 1,50,000/-

20,000/- 60,000/- 55,000/- 45,000/-

Social Mobilization activities Involvement of

Community Volunteers for DOT provision and awareness generation

Panchayats, organizations and general public.

Meetings, camps, plays

Hoardings, TV-Radio, Print Media

IEC Officer, Health Educators.

Reports Reports 35,000/-

Total Budget : 7,00,000/-

Comments, if any:- Prepared by:-

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5. Equipment Maintenance:

Item No. actually present in the state


Amount Proposed for Maintenance during current financial yr.


(Rs.)


(a) (b) (c) (d) (e)

Computer

(Maintenance includes AMC, software and hardware upgrades, Printer Cartridges and Internet expenses)

05 202,133 195,000 195,000 As per Norms

Binocular Microscopes (RNTCP)

29 0 56,000 56,000 As per Norms

STDC/ IRL Equipment 40,000 40,000 For CST equipment. This is tentative estimate as actual cost is known to CTD, DGHS, New Delhi

Any Other (pl. specify)

TOTAL 291,000

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Training:

Activity No. in the state

No. already trained in RNTCP

No. planned to be trained in RNTCP during each quarter of next FY (c)


Estimated Expenditure for the next financial year

(Rs.)

Justification/ remarks

Q1 Q2 Q3 Q4

(a) (b) (d) (e) (f)

Training of DTOs (at

National level)

04 04 00 00 00 00 00 00

Training of MO-TCs - - - - - - -

Training of MOs (Govt

+ Non-Govt)

157 105 18 08 11 - 30,550 101,750

Training of LTs of

DMCs- Govt + Non

Govt

16 16 - - - - - -

Training of MPWs 561 520 - - - 13 11,856 22,000

Training of MPHS,

pharmacists, nursing

staff, BEO etc

57 26 08 08 - - - 7,200

Training of Comm

Volunteers

594 391 25 45 55 48 - 84,000

Training of Pvt

Practitioners

16 16 - - - - - -

Other trainings # - - - - - - - -

Re- training of MOs 155 103 - - 10 10 85,480 20,000

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Re- Training of LTs of

DMCs

23 23 - - - - 7,540 -

Re- Training of MPWs 561 360 - 20 20 20 19,480 30,000

Re- Training of MPHS,

pharmacists, nursing

staff, BEO

67 26 - - - - - -

Re- Training of CVs 594 209 50 45 57 - 10,000 92,400

Re-training of Pvt

Practitioners

- - - - - - -

TB/HIV Training of MO-

TCs and MOs

157 23 - - 20 - 37,000 21,000

TB/HIV Training of STLS,

LTs , MPWs, MPHS,

Nursing Staff, Community

Volunteers etc

47 30 - 10 10 - 19,656 20,000

TB/HIV Training of STS 04 03 - - - - - -

Training of DTO’s and MO-

TC on DOTS Plus for

management of MDR TB

06 06 - - - 06 - 180,000

Provision for Update

Training at Various Levels #

-

-

01

04

5

-

-

95,000

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Review Meetings at

State Level

1

1 1

1 50,000 50,000

Any Other Training Activity

# Please specify TOTAL Rs. 723,350/-

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7. Vehicle Maintenance:

Type of Vehicle

Number permissible as per the norms in the state

Number actually present

Amount spent on POL and Maintenance in the previous 4 quarters



(Rs.)


(a) (b) (c) (d) (e) (f)

Four Wheelers 05 5 504,937 850,000 910,000

Two Wheelers 05 5 115,741 162,500 162,500

TOTAL 10, 17,500 8. Vehicle Hiring*:

Hiring of Four Wheeler

Number permissible as per the norms in the state

Number actually requiring hired vehicles

Amount spent in the prev. 4 qtrs


Estimated Expenditure for the next financial year for which plan is being submitted (Rs.)


(a) (b) (c) (d) (e) (f)

For STC/ STDC

1 1 7,100 20,000 20,000 For IRL team visit and for IRL microbiologist

For DTO - - - - -

For MO-TC

5 5 56,100 81,400 230,220

TOTAL 250,220 * Vehicle Hiring permissible only where RNTCP vehicles have not been provided

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9. NGO/ PP Support: (New schemes w.e.f. 01-10-2008)

Activity No. of currently involved in RNTCP

Additional enrolment planned for this year

Amount spent in the previous 4 quarters



(Rs.)


(a) (b) (c) (d) (e) (f)

ACSM Scheme: TB advocacy, communication, and social mobilization

05 05 7500 40,000 45,000

SC Scheme: Sputum Collection Centre/s

- - - - -

Transport Scheme: Sputum Pick-Up and Transport Service

- - - - -

DMC Scheme: Designated Microscopy Cum Treatment Centre (A & B)

- - - - -

LT Scheme: Strengthening RNTCP diagnostic services

- - - - -

Culture and DST Scheme: Providing Quality Assured Culture and Drug Susceptibility Testing Services

- - - - -

Adherence scheme: Promoting treatment adherence

- 01 - 24,000 24,000

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Slum Scheme: Improving TB control in Urban Slums

- - - - -

Tuberculosis Unit Model - - - - -

TB-HIV Scheme: Delivering TB-HIV interventions to high HIV Risk groups (HRGs)

- - - - -

TOTAL 69,000 10. Miscellaneous:

Activity* e.g. TA/DA, Stationary, etc

Amount permissible as per the norms in the state




(Rs.)


(a) (b) (c) (d) (e)

TA/DA, stationery, office expenses, telephone bills, carriage of drugs, etc.

511,680

528,757 700,000 750,000 High expenditure due to: 1. TA/DA to contractual Staff for tour. 2. TA/DA to DTO and STO for attending meeting outside the State. 3. payment of telephone bills, internet bills and other office expenses.

TOTAL 750,000 * Please mention the main activities proposed to be met out through this head

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11. Contractual Services:

Category of Staff

No. permissible as per the norms in the state

No. actually present in the state

No. planned to be additionally hired during this year


Expenditure (in Rs) planned for current fin. year


(Rs.)


(a) (b) (c) (d) (e)

MO-STCS 1 1 - 298,800

378,000

369,000

State Accountant

1 1 - 225,900

226,800

237,600

State IEC Officer 1 1 - 230,400

226,800

237,600

Pharmacist 1 1 - - 144,000

147,600

Secretarial Asst 1 1 - 107,250

107,100

112,200

STS 5 5 - 855,440

816,000

792,000

STLS 5 5 - 848,560

816,000

786,600

TBHV 1 1 - 165,550

109,800

114,600

DEO (including DEO at IRL)

6 5 1 596,700

554,400

700,800

Accountant – part time

4 4 - 164,100

151,200

154,800

Contractual LT

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Driver 4 4 - 386,550

352,800

369,600

Asst Programme Officer/Epidemiologist

1 1 - - 480,000

492,000

DOTS Plus Site Sr. Medical Officer

1 - 1 - - 270,000

DOTS Plus site Statistical Assistant

1 - 1 - - 135,000

Sr. DOTS Plus& TB/HIV Supervisor (district level)

4 - 2 - - 270,000

Sr. LT at IRL 3 3 - - 450,000

369,000

Store Assistant (State Drug Store)

- - - - - -

Any other contractual post approved under RNTCP Consultant Microbiologist

1 - 1 - - 480,000

TOTAL 60,38,400

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12. Printing:





(Rs.)


(a) (b) (c) (d) (e)

Printing-State level:*

12,168 82,460 70,000 100,000 Printing of formats training manual for different category of staffs and doctors, Registers, Drug treatment cards.

Printing- Distt. Level:*

1, 21,680 45,119 130,000 150,000

Total 250,000 * Please specify items to be printed in this column

13. Research and Studies (excluding OR in Medical Colleges):

Any Operational Research projects planned (Yes/No) NO Estimated Total Budget: Nil 14. Medical Colleges

Activity Amount permissible as per norms

Estimated Expenditure for the next financial year(Rs.)


(a) (b) (c)

Contractual Staff: MO-Medical College (Total

approved in state Nil) STLS in Medical Colleges

(Total no in state 05) LT for Medical College

(Total no in state 01 ) TBHV for Medical College

(Total no in state 02)

01

01

112,200

114,600

Remuneration to TBHV at medical college and lab technician is paid from Medical College

35

Research and Studies: Thesis of PG Students Operations Research

20,000

200,000

20,000

200,000

Travel Expenses for attending STF/ZTF/NTF meetings

- -

IEC: Meetings and CME planned

- 50,000

Equipment Maintenance at Nodal Centres

- -

Total 496,800 15. Procurement of Vehicles:

Equipment No. actually present in the state

No. planned for procurement this year (only if permissible as per norms)



(a) (b) (c) (d)

4-wheeler ** 5 3 16,80,000 North District, South District and West District Four wheeler has completed 150,000 km and the vehicles are more than 9 years old.

2-wheeler 5 0 -

Total 16,80,000 ** Only if authorized in writing by the Central TB Division

36

16. Procurement of Equipment:

Equipment No. actually present in the state

No. planned for this year (only as per norms)



(a) (b) (c) (d)

Computer 5 1 50,000 Work load in State TB Cell necessity the use of two computers since with MDR-TB programme and appointment of APO for data management detail studies. The computer may preferably be a laptop.

Photocopier 5 - -

OHP 5 - -

Binocular Microscope Digital

-

Total 50,000

37

Section D: Summary of proposed budget for the state –

Category of Expenditure Budget estimate for the coming FY 2011- 2012

(To be based on the planned activities and expenditure in Section C)

1. Civil works Rs. 14,54,050 2. Laboratory materials Rs. 4,50,000 3. Honorarium Rs. 2,10,000 4. IEC/ Publicity Rs. 13,09,700 5. Equipment maintenance Rs. 2,91,000 6. Training Rs. 7,23,000 7. Vehicle maintenance Rs. 10,17,500 8. Vehicle hiring Rs. 2,50,000 9. NGO/PP support Rs. 69,000 10. Miscellaneous Rs. 7,50,000 11. Contractual services Rs. 60,38,400 12. Printing Rs. 2,50,000 13. Research and studies 0 14. Medical Colleges Rs. 4,96,800 15. Procurement –vehicles Rs. 16,80,000 16. Procurement – equipment Rs. 50,000 Total Rs. 1,50,39,450/-

Rupees One crore ,fifty lakhs, thirty nine thousand, four hundred and fifty only.

38

Annexes -1 District Compiled IEC Plan

Annual Action Plan Format Advocacy, Communication and Social Mobilization (ACSM) for RNTCP

1) Permissible budget as per norm : Rs. 60,217/- 2) Budget for next financial year for the districts as per action plan detailed below:

Program Challenges to be tackled by ACSM during the Year 2010-11

WHY

ACSM Objective

For WHOM Target Audience

WHAT

ACSM Activities

When

Time Frame

By

WHOM

Monitoring and Evaluation

Budget

Based on existing TB indicators and analysis of communication challenges (Maximum 3 Challenges )

Desired behavior or action (make SMART: specific, measurable, achievable, realistic & time bound objectives)

Activities

Media/ Material Required

Q1

Q2

Q3

Q4

Key implementer and RNTCP officer responsible for supervision

Outputs; Evidence that the activities have been done

Outcomes: Evidence that it has been effective

Total expenditure for the activity during the financial year

Advocacy Activities North Stude

nt, Teachers, Patients Provider, Panchyat, staff &

Quiz, P.P. meeting, sensitization World TB Day

Flipchart, Booklets, Leaflets, Banners

2 2 2 6 DTO’s 24000/- South 1 3 4 3 97,000/- East 1 1 1 1 60,000/- west 2 1 1 2 100000/-

39

NGO Communication Activities North AW

W/ ASHA, Pts. Providers

Quiz, Mela, World TB Day, meeting

Flipchart, wall painting, Hoarding Banners

2 2 2 2 DTO’s 16000/-

South East 4 7 6 5 70,000/- west 2 1 1 0 75,000/- 7 7 7 7 64,000/-

Social Mobilization activities North PPs,

Schools, General Public, ASHA

Sensitization meeting

Chart, Banners, Leaflet, AV

1 1 1 1 DTO’s 12,000/- South 0 1 5 2

2 63700/-

0 1 1 2 20,000/- East -

0 8 0 8 8,000/-

west

TOTAL BUDGET

609700/-

Comments, if any:-

Revised National TB Control Programme PIP 2011-12

Replies to Observations: 1. The budget has been prepared as per the financial norms. The current

increase in proposed budget for 2011-12 is due to :- a. Purchase of new Vehicles for DTOs – Rs. 16.80 lakhs b. Establishment of DOTS Plus Site – Rs. 13.00 lakhs c. Operational Research – Rs. 4.00 lakhs d. Recruitment of new staffs for DOTS Plus site and

Sr. TB HIV supervisor – Rs. 9.00 lakhs - Rs. 42.80 lakhs

e. For the remaining activities a nominal increase of 5% against projection of2010-11.

f. The proposal fro PIP 2010-11 was – Rs. 126.67 lakhs and current proposal is – Rs. 154.64 lakhs

2. Our expenditure is Rs. 60.00 lakhs upto January’2011. Also, there is an

advance of Rs. 4.5 lakhs which will be adjusted within the financial year. 3. The expenditure in the first Qtr. Of 2010 – 11 was less because we received

the first installment of fund in mid June’2010 and the carried over balance

40

was only Rs. 1.90 lakhs. The recruitment of new staff was delayed in the first and second quarter due to local elections and administrative delays which affected the expenditure under the contractual services head. Subsequently, in 2nd and 3rd quarter expenditure there has increased substantially. Also the expenditure was affected by payment of loan of Rs. 6.00 lakhs to NRHM for previous year of 2009-10. At present we have not received the 2nd installment for 2010-11 till date of submission of this reply. Further we have taken a loan of Rs. 45.00 lakhs from NRHM to meet the expenditure upto March’2011. A copy of consolidated SOE upto Dec.’2010 is enclosed.

4. The IRL Lab has been completed. But installment of equipment is under process and furniture’s for IRL is yet to be procured.

5. The renovation for 50 bedded TB Block was projected for admission of seriously ill TB-patients and MDR-TB patients. Further this renovation was required in view of proper ventilation and Air way maintenance for Air bone infection control.

Conclusion:- Therefore we have re-examined the proposed budget and reduced the 3 months salary of new staff proposed to be recruited for DOTS Plus sites as the recruitment process will taken some time subsequent to approval and also Rs.2.00 lakhs from Research head of Medical College. However, the remaining part of the proposed budget is unchanged.

41

D.3 NPCB INTRODUCTION

National Programme for Control of Blindness (NPCB) was launched in

the year 1976 as a 100% centrally sponsored scheme with the goal of reducing the prevalence of blindness. The goal set for the terminal year of the 10th Plan is to reduce the prevalence of blindness to 0.8% by 2007. The State Ophthalmic Cell and State Blindness Control Society (SBCS) located at STNM Hospital, Gangtok, is responsible for implementation of National Programme for Control of Blindness in the State of Sikkim. Due to shortage of Ophthalmologists, Ophthalmic Nurses and Ophthalmic Assistants (O.As) in the State, Consultant Ophthalmologist with the help of O.T. nurses and Ophthalmic Assistants posted at STNM Hospital mobilizes himself periodically to hold Eye Screening clinics and Cataract Operation Camps in the districts with prior approval of competent authorities. This practice has shown good results and has been successfully conducted with the cooperation of Chief Medicals Officers and Medical Officers in the Primary Health Centres. Medicines, logistics, instruments, equipments etc are procured by SHS, NPCB,. IEC activities are organized by the State Blindness Control Society (SBCS).Post of Account Officer, Data Entry Operator, Administrative Assistant, Ophthalmologist, PMOA sanctioned during 2007-08 & 2008-09 has been filled-up. During 2010-11 proposal for appointment of one Ophthalmologist and one PMOA is complete. Due to the lack of space,local skilled man-power and required infrastructure we are unable to start Eye Banking during the eleventh plan. Once the requirements are fulfilled we will begin eye collection and Eye Banking, Corneal transplanting etc. Appointment of 3 PMOA’s sanctioned post of 4 during 2009-10 will be complete by the end of the current financial year. Ten more trained Ophthalmic Assistants will have to be appointed in Vision Testing Centres at PHCs to conduct cataract screening, School Eye Screening (SES), and attend regular OPD’s in District Hospitals. Currently the State has three Ophthalmologist, two appointed under NRHM from 06-07 to 08-09, and one Ophthalmologist under NPCB appointed during 2010-11 on contract basis. These two NRHM appointee Ophthalmologist have to be transformed from NRHM and to pay their remuneration under NPCB is one of the proposal during FY. 2011-12. A Ophthalmologist is yet to be appointed in North District Hospitals during 2011-12, hence the proposal for the same is mention in the PIP. Therefore, contractual appointment of 4 Ophthalmologist and ten Ophthalmic Assistants during 2011-12, will have to be given priority for smooth functioning of District Blindness Control Societies (DBCS) and efficient

42

implementation of NPCB in the State of Sikkim. The detail action plan for 2011-12 under NPCB is given below for approval and further orders. The main objectives of the Programme are: a) To reduce the backlog of blindness by identifying and providing services to the affected population. To expand coverage of eye care services to the underserved area b) To provide high quality eye care services to the affected population; c) To develop institutional capacity for eye care services by providing support for equipment and material and training personnel. d) These objectives are routinely implemented by developing the following strategies : • Decentralized implementation of the scheme through DBCS; • Reduction in the backlog of blind persons by active screening of population above 50 years, organizing screening eye camps and transporting operable cases to eye Care facilities; • Involvement of voluntary organization in various eye care activities; • Participation of community and Panchayat Raj Institutions in organizing services in rural areas. • Development of eye care services and improvement in quality of eye care by training of personnel, supply of high tech equipments, strengthening follow up services and monitoring of services; • Screening of school going children for identification and treatment of Refractive Errors; with special attention in under served areas. • Public awareness about prevention and timely treatment of eye ailments. • Special focus on illiterate women in rural areas. For this purpose, there should be Convergence with various ongoing schemes to cover women and children. To make eye care comprehensive. Besides cataract surgery other Intra Ocular surgical operations for treatment of Glaucoma, Diabetic Retinopathy etc. may also be provided free of cost to the poor patients through government as well as qualified non government organizations.

43

FUNCTIONAL STRUCTURE OF NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS.

SPO (NPCB)

DPMs MOs Ophthalmic Nurses

Ophthalmic Assistants

Data Entry Operator

Administrative Assistants

L.D.C

AWWs MPHWs

CMO (4 Dists.) A.O

ASHAs

CONSULTANT-OPTHALMOLOGIST

OPHTHALMOLOGIST

MD (NRHM)

44

SITUATION ANALYSIS TILL 2009-10 ACTIVITIES

Indicators 2007-08 2008-009 2009-10

Target Achievement Target Achievement Target Achievement Cataract Operation with IOL Implantation

600 530 600 698 800 609

School Eye Screening

3000 8082 2857 3258 3500 2024

Teachers trained

114 60 23

Children detected with Refractive Error

294 179 63

Training of MOs

60 19 _

Training of Staff Nurse

12 2 _

Training of PMOAs

06 2 _

45

MANPOWER (Skilled & Administrative)

LOCATION IN POSITION REQUIRED REGULAR CONTRACTUAL CONTRACTUAL

a) SHS/S.T.N.M Hospital, State

Eye Surgeon 2 Nil PMOA 2 1 Nurses Nil Nil Required 4 Staff

Nurses for DHS & Mobile Eye Unit & Eye Camps

A.O 1 L.D.C 1 Administrative Assistant

1

Data Entry Operator 1 b) DHS/District Hospitals.

b.1.) EAST: Ophthalmologist Nil 1 PMOA 1 Require 10

PMOAs for PHCs/DHS

b.2.) WEST: Ophthalmologist Nil 1 PMOA 1 Nil b.3.) NORTH: Ophthalmologist Nil Nil 1 PMOA 1 Nil b.4.) SOUTH: Ophthalmologist Nil 1 PMOA 1 Nil

46

PROPOSAL FOR 2011-12

The following Activities are proposed to undertake during the financial year 2011-12 for implementation of NPCB in Sikkim.

1.1. CATARACT OPERATION:

Camps are usually organized for three to four days. This year at least one camp in Each district, three Mega Camps for the whole state and one camp in STNM Hospital are tentatively fixed.

Cataract Screening Clinics

Cataract Screening is done one month prior to cataract camps by the Para Medical Ophthalmic Assistants in the district where the camp is proposed to be held. For the Mega Camps screening for cataract is done all over the state. Wherever possible Ophthalmologists also go for cataract screening. Then accordingly, the screened patients are called to the camp site or transported after completing the investigations required

Pre Camp Visit:- The camp site is visited at least fifteen days prior to camp by the State Programme Officer, Para Medical Ophthalmic Assistant and Ophthalmic Nurse. A meeting is held with the DPM-cum-CMO of the district to make an arrangement for stay there through out the camp days, preparation of Operation Theatre, cleaning/ fumigation etc so that accordingly we can send the microbiologist for swab testing to check the sterility of Operation Theatre and post operative wards.

Activities involved in Cataract Camps:

I. IEC activities including Print Media, local cables, All India Radio, F.M, Miking/Public Announcement System, Banners, Posters, Leaflets etc. for State-wide publicity & Awareness campaign.

II. Eye Screening by Ophthalmic Technicians.

III. TA/DA of Ophthalmic Assistant.

IV. Patient transportation to & fro the Camp site.

V. Honorarium to ASHAs @ Rs.175/- per eye operated.

VI. Pre-Camp visit by Eye Surgeon & O.T Nurse, one month prior to Cataract Camps.

47

VII. Organization of Cataract Camp.

VIII. Accommodation, Food, Refreshment for Eye Camp Team.

IX. Procurement of Medicines, IOL, Surgical Instrument s & Logistics etc. required for

Cataract Operation Camp.

X. TA/DA, Accommodation, Food etc. for additional Eye Surgeon from outside the

State, as we have only one operating Eye Surgeon in the State.

XI. Contingencies 10% of the total Budget on Cataract Camp. XII. Post-Camp visit by Ophthalmologist & Ophthalmic Technicians for follow-up of

Operated Patients one month after the operation. XIII. Inaugural & Valedictory functions in Mega Camp. XIV. Photography & Report Preparation.

Post Operative Visits:-

Follow up of the operated cases are done after one month. Locally stationed PMOAs examine the patients and on need basis they are referred to the Ophthalmologist, Spectacles are prescribed after one month of operation.

1.2. MEGA CAMP IN SOUTH, WEST & EAST DISTRICT:

NPCB has proposed to conduct three Mega Camp in South, West and East districts in the State. Experiencing the composite number eye cases in these districts, each Mega Camps will be held in these three districts. The cost of budget mentioned in PIP is drawn after considering the finance requirement for procurement of medicine & logistics, transportation cost for team of Medical Officers, accommodation cost, food, miscellaneous Expenses, etc. Activities involved in Mega Camps: i. IEC activities including Print Media, local cables, All India Radio,

F.M, Miking/Public Announcement System, Banners, Posters, Leaflets etc. for State-wide publicity & Awareness campaign.

ii. Screening by Ophthalmic Technicians. ii. TA/DA of Ophthalmic Assistant.

48

iii. Patient transportation to & fro the Camp site. vi. Organization of Cataract Camp. vi. Accommodation ,Food, Refreshment for Mega Camp Team.

v. Procurement of Medicines, IOL, Surgical Instrument s & Logistics etc. required for

Camp. vi. TA/DA, Accommodation, Food etc. for Eye Surgeon & team. vii. Contingencies 10% of the total Budget on Cataract Camp.

viii. Post-Camp visit by Ophthalmologist & Ophthalmic Technicians for follow-up of

Operated Patients one month after the operation. ix. Inaugural & Valedictory functions in Mega Camp. x. Photography & Report Preparation

1.3. SCHOOL EYE SCREENING:

Sr. Medical Officer and PMOAs working in State Ophthalmic Cell or District Hospitals has to be deployed for SES. The PMOAs have to examine the eyes of children up to the age of 14 years for refractive error and correct them, detection of blinding eye ailments and referral and train one teacher for each class. The poor children with BPL card will be provided free spectacles according to GOI norms In the districts, only East district Hospital does not have a regular PMOA. So, the contractual appointment of Para Medical Ophthalmic Assistants (PMOAs) is of paramount importance. During the year 2011-12 proposal for appointment of 2 PMOAS in each districts will cover their respective Vision Centres in PHCs, sub-divisions and district Hospitals. The District PMOAs should visit Vision Centres and ICDS centres also to detect blinding ocular disorders in pre-school children, like amblyopia, Vit.A deficiency, congenital cataract, refractive error etc. Expenditure incurred during School Eye Screening includes, IEC activities, Providing spectacles, TA/DA to Ophthalmic Assistant, transportation cost, Other expenses, etc.

1.4. MANAGEMENT OF STATE HEALTH SOCIETY:

State Blindness Control Society has been established in April 2008. Supporting staff, like Account Officer, Data Entry Operator and Administrative Assistants have been appointed on contractual basis during

49

2009-10, according to GOI norms. Contractual appointment of 1 Ophthalmologist during 2010-11, has been completed. Appointment of four PMOAs has been sanctioned in the year 2009-10 & appointment procedure is undertaken.

At the State Ophthalmic Cell (SOC): The State Programme Officer is

supported by Consultant-Ophthalmologist, the Deputy Director (Sr.M.O.), Account Officer, LDC, Data Entry Operator, Administrative Assistants and Peon under NPCB.

Ophthalmologist: There are only four Ophthalmologists in the State at

present. The Consultant Ophthalmologist NPCB, stationed at State Referral Hospital, two Ophthalmologist appointed under National Rural Health Mission (NRHM) and one Ophthalmologist appointed under NPCB on contractual basis. They are stationed at Singtam Hospital, East and Namchi Hospital, South and Gyalsing Hospital, West, who put their outmost dedication and sincere service for better Eye Care Services and visit periodically on scheduled Eye Camps. They are also involved as members of Disability Screening Board.

PMOAs:There are three PMOAs in the State Referral Hospital, two are serving

as regular and one appointed by NPCB on contract basis during 2010-11. Ophthalmic Assistant. Appointment of 4 PMOAs sanction during the year 2009-10 is reaching its completion.

1.5. MANAGEMENT OF DISTRICT HEALTH SOCIETY: District Health Society is headed by Chief Medical Officer cum District

Programme Manager in the respective District Hospitals. Every CMO is supported by Ophthalmologist, Senior Medical Officer, Medical Officer, District Accounts Manager, Ophthalmic Nurses, PMOAs, ASHAs & Anganwadi Workers. In Sikkim only East, West & South district Hospitals have Ophthalmologist on contractual basis. Whereas, North District Hospitals is in need of Ophthalmologist too, hence the proposal for 1 Ophthalmologist for North district Hospital have mention in the PIP observing the inability of Ophthalmologist of other district Hospitals to attend the district every day.

1.6. TRAINING OF MOs, PMOAs & NURSES:

Our Eye Surgeon is trained outside at the central level. We propose to train our Ophthalmologist during various Eye Camps and in various Training Centre outside State directed by GOI on different speciality.

D.P.Ms (District Programme Managers) and Sr. Medical Officer, NPCB also have to undergo a short course training at the central level. Dates will be fixed after discussing with Additional Director General Ophthalmology, New Delhi.

50

Medical Officers are oriented on Community Ophthalmology at the State level by Consultant Ophthalmologist. Their training period according to GOI is three days. After training they have to train the MPHWs, AWW, ASHAs, and teachers from PHCs and Districts.

Nurses are trained for one month in state hospital by the Consultant Ophthalmologist in Ophthalmic nursing.

Para Medical Ophthalmic Assistants (PMOAs) are trained for seven days in the State Hospital by the Consultant Ophthalmologist.

N.B. Medical Officers- Medical Officers (from PHCs & District Hospitals) training

will be conducted in two batches CMO/DPMs are requested to release the M.Os for training to held at State Referral Hospital or DHS.

- Nurses from PHCs, where vision centres will be opened, the training is must in addition to two selected from district hospitals by the CMO/DPM. All together 23 nurses shall be trained (15+8). - The training venue is State Ophthalmic Cell, STNM Hospital, Gangtok. 1.7. IEC/BCC ACTIVITIES:

IEC activities go on throughout the year and whenever necessary. Both State Health Society (NPCB) and District Health Society (NPCB) are responsible for IEC activities. During the National Fortnight for Eye Donation in the month of August and World Sight Day in the month of October, radio & TV talks will be given by the Ophthalmologist. As directed by the GOI banners, hoardings, posters etc. will be displayed; pamphlets will be distributed in health institutions all over Sikkim and articles or messages shall be printed in the local newspaper. For public awareness, banners will be displayed, announcement through AIR , wherever possible will be done. The messages shall be telecast and public announcement will be done through PAS. Behavioural change will be brought about mainly by personnel communication with the public, school teacher’s, students, panchayats and they will be informed about the cataract camps. Our health workers like MPHW, AWW, ASHAs shall be involved in BCC. Both SBCS and DHS-NPCB will be responsible for the IEC. Pamphlets received from GOI will be translated in local language for better understanding by the local people. Jingles and audio visual messages also will be translated in local language and then distributed to the Districts. AIR and local cable T.V. also will be given one CD each for broadcasting/telecasting on payment basis.

1.8. PROCUREMENT OF OPHTHALMIC EQUIPMENT FOR STATE MEDICAL COLLEGE/S.T.N.M HOSPITAL:

51

During the year 2011-12 Ophthalmic Equipments especially for Diabetic Retinopathy and other major Eye Equipments are proposed to acquire under NPCB. Below is list of Equipments required for State Capital. SL.No. Name of Equipments. Existing position Qty.required

1. Goldmann 3 mirror gonioscope Nil 1 2. Refraction unit Nil 1 3. Foldable IOLs, Hydrophilic

with Hydrophobics coating Nil 1

4. Streak Retinoscope Nil 1 5. Surgeon Chair Nil 1 set

Lack of modernise Eye Equipments in State Referral Hospital has been a hindrance in complete success of NPCB in Sikkim. Installation of adequate Eye Equipments/Instruments will enhance various Eye care services.

1.9. OPHTHALMIC EQUIPMENTS/INSTRUMENTS FOR 4 DISTRICT HOSPITALS:

All districts Hospitals except North DHS, have been appointed each Ophthalmologist who runs regular Eye OPD and O.T. Supply of basis equipments/minor surgical instruments, disposable items is been done regularly for smooth functioning of Eye OPD. However, for efficient functioning of O.T in the district Hospitals installation of important Eye equipments is of prior importance. Below is the list of Eye Equipments proposed to purchase for DHS under NPCB during F.Y. 2011-12. SL.No. Name of Equipments. Existing

position Qty.required

1. Lensometer Nil 4 2. Surgeon Chair Nil 3 3. Goldmann 3 miror

gonioscope Nil 6

4. Tonopen Nil 4 5. Fumigation machine Nil 4 6. O.T. Table Nil 7 7. Refraction unit Nil 4 8. Ultrasonic Micro-

Surgical instrument cleaner with dryer

Nil 4

9. Haag Streit Slit Lamp BQ 900

Nil 1

Procurement of equipments for 2011-12 is included in PIP as for State & `20 Lakhs each for four districts as per GOI guidelines. Two of the Districts Hospitals have been upgraded with separate Dedicated Eye Wing and Eye O.T in the State during 2008-09 & 2009-10. Installation of Eye Equipments in these

52

Hospitals is now a prime importance so as to run the Eye Wing/O.T properly. Financial requirement for Ophthalmic Equipments for 4 District Hospitals/CHCs in the State is enclosed with the PIP write-up.

1.10. MAINTENANCE OF OPHTHALMIC EQUIPMENTS (SHS, NPCB):

Fund for maintenance of Ophthalmic Equipments under State Health Society, NPCB, Sikkim has been proposed in the PIP 2011-12, considering the nature of non- recurring expenses on maintenance within NPCB guidelines.

1.11. POL & MAINTENANCE OF MOBILE OPHTHALMIC UNIT: Fund for procuring Mobile Ophthalmic Unit has been approved in the PIP 2009-10.

The process of procurement has been initiated and the task will be completed by the end of current financial year. Hence, POL & Maintenance for Mobile Ophthalmic Unit has been ascertain for maximum of 100 litres per month & `1 lakhs for maintenance expenditure during the year has been decided.

1.12. HONORARIUM TO SPO:

Honorarium to State Programme Officer is paid @`2000/- per month as per GOI norms, has been mentioned in PIP 2010-11.

1.13. HONORARIUM TO 4 DPMs:

Honorarium to 4 District Programme Manager in four district of Sikkim is paid @`2000/- per month as per GOI norms.

1.14 HONORARIUM TO ACCOUNTANT:

Honorarium to Accountant serving as honorary staff under SHS, NPCB is paid @ `1500/- per month as per norms.

1.15. GIA FOR PRIVATE PRACTITIONERS: Proposed fund for Private Practitioners in the PIP 2011-12 is as per GOI guidelines.

53

1.16. TRAVELLING EXPENSES:

Expenditure on conveyance & travelling has been decided as `70,000/- for each district & `2,00,000/- for State during the year 2011-12.

1.17. STATIONERY EXPENDITURE:

Fund for purchase of stationery during 2011-12 has been proposed as `25,000/- for each district & `36,000 for State.

1.18. REVIEW MEETING:

The Consultant Ophthalmologist and SPO, NPCB will organise and attend the meetings according to the schedule prepared and directives received from the State and Central Govt. from time to time. Meetings are mostly called through State NPCB Office. The break-up for budget is `20,000/- expenditure for each districts & `24000/- for State.

1.19. SALARY TO EXISTING OPHTHALMIC SURGEON:

Presently there are 5 Ophthalmologist in the State. Two Ophthalmologist is serving under State Government on regular basis, and three serving on contract basis, appointed under NRHM and NPCB. From the year 2011-12, NPCB has proposed to include the NRHM appointee Ophthalmologist under NPCB umbrella and have proposed to pay Salary for the 3 (three) Ophthalmic Surgeon from NPCB fund during. The salaries for two of them are paid by NRHM while one Ophthalmic Surgeon appointed during 2010-11 on contractual basis in West district Hospitals is paid@ `50,000/- p.m.by NPCB.

1.20. REQUIREMENT OF 1 OPHTHALMIC SURGEON:

There are only five Ophthalmologists in the State at present. The State Eye Surgeon is the Consultant Ophthalmologist to NPCB with the other Ophthalmologist serving on regular basis under State Government, functioning at State referral Hospital. Two Ophthalmologist has been appointed under National Rural Health Mission (NRHM) on contractual basis. They are stationed at Singtam District Hospital and Namchi District Hospital. One Ophthalmologist is appointed during 2010-11 under NPCB on contractual basis at West District Hospital. They visit North District Hospital periodically on scheduled dates for Eye Care Services and also as members of Disability Screening Board.

54

Now only North District Hospital is without an Ophthalmologist. As such proposal for appointment of One Ophthalmologist at North District Hospital on contractual basis under NPCB is forwarded.

1.21. SALARY TO ACCOUNT OFFICER: Account Officer appointed on contractual basis under NPCB, State Health Society, during 2009-10 is being Paid`24000/- p.m. as Salary. 1.22. SALARY TO OPHTHALMIC ASSISTANT: Appointment of four Ophthalmic Assistant in East District Hospital, is initiated. Salary for the four Assistant has been paid `12000/- p.m. as per GOI guidelines. 1.23. SALARY FOR REQUIRED 4 OPHTHALMIC ASSISTANT:

Proposal is for appointment of 4 Ophthalmic Assistant on contract basis under NPCB during the year 2011-12. This O.A will be appointed in 4 Vision Centres each in PHCs under each districts. The salary to this four Ophthalmic Assistant will be paid ` 8000/- p.m. as per NPCB norms.

1.24. SALARY TO DATSA ENTRY OPERATOR:

Data Entry Operator has been appointed on contractual basis under NPCB, State Health Society during 2009-10. Salary is paid `12000/- p.m. as per GOI guidelines. 1.25. SALARY TO ADMINISTRATIVE ASSISTANT: Administrative Assistant appointed on contractual basis under NPCB, State Health Society, is been paid `12000/- p.m. as per sanctioned guidelines. 1.26. OPHTHALMIC NURSE UNDER SHS:

NPCB, State Health Society has proposed for appointment of 4 Ophthalmic Nurse under State Health Society for Mobile Eye Unit and for special cases. Since the State attached Nurses cannot be mobilised every time during Districts Eye Camps, the requirement of separate dedicated Nurses is seen mandatory. These Nurses will be deputed especially for Mobile Eye Unit facility and O.T.

55

cases under NPCB. Salary has been demanded as `8000/- p.m. in the PIP 2011-12.

1.27. DIVER SALARY FOR RUNNING OPHTHALMIC MOBILE VAN:

GOI has sanctioned a GIA for purchase of Mobile Ophthalmic Unit Driver’s Salary & POL maintenance in the ROP 2009-10. The Process of Procurement of Mobile Unit & appointment of Driver is at its conclusioin. Driver Salary of ` 7000/- for running Mobile unit (included under PIP for 2011-12.

1.28. CONSTRUCTION OF DEDICATED EYE WING AT STATE REFERRAL HOSPITAL:

The State does not have a separate Dedicated Eye Wing at State Referral Hospital. The State run Eye Clinic and General O.T. capacity is much more smaller in comparison to the rising number of Eye Patients inflow. As such, construction of separate Eye Wing will ease the space constrains problem and more Eye Patients can be admitted/treated at a time resulting in success of NPCB. Hence, NPCB has planned to establish a Dedicated Eye Wing at State Capitall Hospital during financial year 2011-12. The fund demanded is as per the NPCB norms.

WORK PLAN NPCB 2011-12

ACTIVITY/SUBACTIVITY TIME FRAME (Quarterly) 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr A.1.Cataract Operation Camps:

1. Pre-Camp Visit for 5 Camp. 2. Cataract Screening. 3. Schedule for Cataract Camp 4. Post-Operative Visit 1.2. Mega Camp: 1. East District. 2. South District.

56

1.3. School Eye Screening. 1.4. Management of State Health Society.

1.5. Management of District Health Society.

1.6. Training:

1. Training of PMOAs, MOs & Nurse 1.7. IEC/BCC Activities(Campaign for National Eye Donation Fortnight & World Sight Day.

1. IEC for National Fortnight Day for Eye Donation.

2. World Sight Day 1.8. Procurement of Equipment for S.T.N.M. Hospital.

1.9 Procurement of Ophthalmic Equipments for 4 District Hospitals.

1.10. Maintenance of Ophthalmic Equipments(SHS, NPCB)

57

1.21. Salary to Accounts Officer 1.22. Salary to 4 Ophthalmic Assistant

1.23. Ophth. Asstt.(required 4 nos. for 4 PHCs, one each for Dists.)

1.24. Salary to Data Entry Operator.

1.25. Salary to Administrative Asstt.

1.26. Appointments of Ophth. Nurse for Mobile Ophthalmic Unit.

1.27. Driver's Salary for running Mobile Ophthalmic Van

1.28. Establishment of Dedicated Eye Wing at State Referral hospital

1.11. POL & Maintenance of Mobile Ophthalmic Unit

1.12. Honorarium to S.P.O

1.13. Honorarium to 4 DPMs

1.14. Honorarium to Accountant

1.15. GIA for Private Practitioners

1.16. Travelling Expenses

1.17. Stationery.

1.18. Review Meeting .

1.19. Salary to existing Ophthalmic Surgeon 1.20. Salary to Ophthalmic Saurgeon for North DHS

58

Physical and financial targets under the programme for the year 2011-12. Man-power appointment under NPCB, 2011-12

District Ophthalmic

surgeon Operating surgeon

PMOA (Contactual)

Ophthalmic Nurses

East Nil Nil 2 Nil West Nil Nil 2 Nil North 1 Nil 2 Nil South Nil Nil 2 Nil STNM Hospital

Nil Nil 2 4(for Mobile Ophthalmic Unit)

List of District Hospital where dedicated Eye O.T are to be constructed:- District Hospital South – Eye Ward & O.T has been constructed but they need to be furnished and equipped after vertical expansion of the Wards/OPD. District Hospital East, Singtam: Eye ward/OT construction is nearing completion.

* Training status of eye surgeons and Paramedical Ophthalmic Assistants:- Eye Surgeon –4 PMOA - 10

* Status of equipments supplied under NPCB and further equipment for district hospital and medical college hospital:-

Requirement for District Hospital (enclosed) Medical College Hospital (enclosed)

* Status of Vision Centres:-Target -nil. Achievement: - 24 centres.

* School Eye Screening Programme:- PMOA go to school and train the teacher, Vision chart * Medicines and logistics for cataract operations for camps and regular cataract Operations conducted at STNM Hospital are procured by State Blindness Control Society (SBCS) as and when required and given to the Districts during camps. The fresh quotation for medicine, IEC, equipment & Instrument has to be initiated for

59

year 2011-12. * Status of Mobile vans under NPCB:- Procurement of Mobile van,

appointment of Diver under NPCB is nearing completion. * Cataract surgery with a special focus of low/poor performing districts:- all

are equal performers as they are covered by S.T.N.M Hospital by the SPO, Consultant Surgeon & team.

* Month wise performance 2011-12, April 2011 to March 2012. Construction of Dedicated Eye Wing at State Referral Hospital during

2011-12. Timely submission of Audited Financial Accounts & Utilisation Certificate for

2010-11.

NB. Until adequate skilled manpower are posted in all the 4 District Hospitals,

success of NPCB in Sikkim depends upon the Mobile Eye Camp approach. It was initiated

by the Consultant Ophthalmologist stationed at State Referral Hospital (STNM) since April’06. comprising of the lone operating surgeon, PMOAs & OT Nurses. However, the OT Nurses, being regular staff posted at STNM Hospital, their services are shared by General Surgery & ENT. Hence,their mobilization for Eye Camps & Mobile Ophthalmic Unit as per NPCB schedule under annual action plan for delivery of eye care services to remote and rural areas becomes extremely difficult . Therefore, 4 dedicated Ophthalmic Nurses have to be employed under State Health Society(NPCB)on contractual basis for smooth

implementation of the program as a special case .

60

D.4: NATIONAL LEPROSY ERADICATION PROGRAMME

BACKGROUND:

In the year 2007 State Leprosy Society and District Leprosy Society was merged under NRHM and redesignated as State Health Society (NLEP) and District Health Society (NLEP). The programmme is being implemented as planned towards achieving the programme goals & objectives and as per guidelinesas issued by leprosy division of G.O.I. Financial management of the programme has become more efficient with the introduction of NRHM.

Since 2002-2003 the prevalence rate of leprosy in Sikkim has been below 1/10,000 population. Therefore, we have been able to sustain the elimination trend till now. However, leprosy services are still being mostly delivered by the nucleus team alone with little involvement by the general health staff. Declining leprosy burden in the midst of competing priorities renders leprosy programme difficult to stay in the picture. EPIDEMIOLOGICAL SITUATION:

YEAR NEW CASE

DETECTION

RATE/10,000

PR/ 10,00

0

DEFORMITY MB FEMALE PROPORTIO

N

CHILD PROPORTIO

N GRADE I

GRADE II

1997-98

0.9 2.4 Nil Nil 35.8% Nil Nil

1998-99 1.8 2.6 3.5% 2.3% 51.7% 41% Nil 1999-00 0.58 1.0 3.7% 3.7% 66.6% 44% Nil

2000-01 0.98 1.2 6.5% 3.7% 69.5% 34% 4% 2001-02 1.56 1.2 4.1% 2.7% 45.2% 26% Nil 2002-03 0.5 0.7 8.3% 4.1% 45.8% 41% 8% 2003-04 0.8 0.6 4.2% Nil 61.7% 4% 2% 2004-05 0.66 0.4 5.1% 10.2% 48.7% 7% Nil 2005-06 0.59 0.5 Nil Nil 51.3% 16% 3% 2006-07 0.29 0.2 5.2% 10.5% 68.4% 21% 5% 2007-08 4.10 0.4 3.7% Nil 51.8% 11% 3% 2008-09 4.40 0.45 3.4% 6.9% 86.2% 20.7% 3.44% 2009-10 2.87 0.32 10% Nil 60% 30% Nil

DEMOGRAPHIC PROFILE:

61

Sl.No. Population (census

2001)

Sikkim North East South West

Population (2001)

Total persons

540851 41030 245040 131525 123256

GENERAL STATISTICS OF SIKKIM: Decadal Population Growth rate (%)

1991-2001 32.98 1981-91 28.47

HEALTH STATUS IN SIKKIM: Sl.No INDICATORS SOURCE PRESENT

STATUS ALL

INDIA 1 Crude Birth Rate(CBR) SRS 18.4 22.8 2 Crude Death Rate(CDR) SRS 5.2 7.4 3 Infant Mortality Rate(IMR)

(per 1000 population) SRS 33 53

STATE HEALTH INFRASTRUCTURE IN SIKKIM: SL. NO.

HEALTH INSTITUTION

EAST WEST NORTH SOUTH STATE

1 STATE REFERRAL HOSPITAL/STNM

HOSPITAL

1 - 1

2 COMMUNITY HEALTH CENTRE

1 1 1 1 4

3 PRIMARY HEALTH SUB-CENTRE

48 41 19 39 147

4 PRIMARY HEALTH CENTRE

8 7 3 6 24

5 DISTRICT TUBERCULOSIS

CENTRE, NAMCHI

- 1 1

6 CENTRE REFERRAL HOSPITAL

MANIPAL TADONG (PVT.)

1 1

7 TOTAL 59 49 23 47 178 Organizational Structure of NLEP:

NRHM Mission Director State Leprosy Cell

62

Programme Officer District Leprosy Cell District Leprosy Officer District Nucleus staff NMLO/NMS PHC NMS (Leprosy) MPHWs/ANMs/PHN/LHV PHSC MPHWs/ANMs Village Level ASHA/AWW Components of NLEP:

1. Decentralization & Institutional Development: The programme is fully decentralized with Leprosy control unit’s at all four districts. Funds are also transferred directly into the accounts of the District health society.

2. Strengthening & Integrations of Service Delivery: Almost all field workers have been integrated into general health services since year 2000. All categories of health staff are being trained for delivering quality leprosy services from diagnosis, treatment, management of reactions or referral of difficult cases. Although most GHS have been trained, their involvement in delivery of MDT services is negligent. Therefore we need to sustain our efforts to make them realize that they are equally responsible for the success of the programme.

3. Disability Care, Prevention & Rehabilitation: Trainings have been earlier conducted on DPMR. This is also included in all trainings for all categories of health staff. The district nucleus team is required to regularly follow up the patients for early detection of nerve impairment. Due to regular monitoring & assessment of leprosy patients, only 1 deformity cases has been recorded in the last 5 yrs.

4. I.E.C/BCC: All the activities are being performed based on GOI guidelines and PIP.

5. Training of all categories of health staff too is being given as per guidelines.

1. Situational Analysis: SWOT analysis: Opportunities:

63

Involvement of PRI, RKS, VHSC in intersectoral coordination, under NRHM

can be helpful for organizing camps, surveys, creating awareness to remove stigma & discrimination & also for community monitoring.

N.G.Os & local clubs who are committed to help in improving the health status of the people especially in rural areas can be very helpful for the success of the programme.

Threats:

Increased influx of migrant population from neighbouring states of Bengal, Bihar, Orissa & also Nepal with poor living standards is a great threat to local population especially since the defaulter rate is highest among them & they are not easily traceable

Poor participation by, Villagers, Panchayats in any health activities. Lack of intersectoral coordination Illiteracy, cultural beliefs & traditions.

Strengths:

Since the last few years, we are receiving clearly defined policy,objectives & guidelines . Also, there is no frequent change of reporting formats like in the past creating confusion for reporting staff.

Detailed training modules for M.Os has helped to impart quality training Improved coordination & cooperation between Dermatology Deptt has

resulted in better follow up of patients & improved DPMRservices Flexibility to plan as per resources available , local situations Good ,cooperation by district CMO & DMS , DPM & others in organizing

trainings & any other programmes The appointment of ASHAs at village level will help in detection of hidden

cases & also better drug compliance among the patients. Provision for borrowing of funds from NRHM during delays in disbursement

of funds from GOI has helped in carrying out the activities in time. Weaknesses:

The P.M.Ws who had been integrated into general health care services & posted at PHCs are mostly not doing any leprosy related work. Some are engaged in birth & death registration, some are doing some account work etc. Since they also do not draw their salary from NLEP they have alienated themselves from the programme.

Patients from PHCs or who fall under PHSCs have to be followed up by the nucleus team. Neither the PMWs nor the health workers take this job seriously. Also they do not submit any reports from the PHCs inspite of many attempts. .

Most of the leprosy cases are detected in state referral hospital- skin OPD.

64

Either some of these patients are going undetected at PHCs or they are not visiting PHCs or district hospitals as there are no dermatologist posted.

To impart quality training, there should be adequate resources which are lacking .All D.L.Os should have a laptop each.

Supervisory work is not satisfactory partly due to vehicles being very old with insufficient fund for POL& Maintenance. Funds for TA/DA are insufficient.

Standard of education among most of the ASHAs seem to be quite low. 2. Performance under NLEP

3. Infrastructure & Manpower available:

Sl. No

Infrastructure

Manpower Regular Contractual

Sanctioned

In position

Vacant

Sanctioned

In position

Vacant

1 State Health Society

PO 1 1 0 NMLO 0 1 0 Office helper/Peon

2 2 0

BFO 1 1 0 DEO 1 1 0 Adm Asstt. 1 0 1

2 DLO 1 1 0

Sl.No.

Indicator

2006-07 2007-08

2008-09 2009-10 2010- Upto

September 1 P.R /10000 15

(0.23) 26

(0.4) 30

(0.4) 22

(0.3) 14

(0.2) 2 A.N.C.D.R/100000 19

(3.0) 27

(4.2) 29

(4.4) 20

(2.9) 8

(1.1) 3 Deformity Gr.II %

among new cases Nil Nil Nil 01 01

4 Treatment Completion rate

26/43 (60)

15/22 (55)

8/22 (36.4)

22/34 (64)

22/34 (64.7)

5 Reconstructive surgery conducted

Nil Nil Nil Nil Nil

65

DHS East

NMLO 1 Above NMLO also over sees East District

1

ULA 1 1 0 NMS 1 1 0 Driver 2 2 0

3 DHS West

DLO 1 1 0 NMLO 1 0 1 NMS 1 1 0 Drivers 2 2 0

4 DHS North


5 DHS South


Training Report for the year 2009-10/ 2010-11

S.No Categories of Health Staff

2009-2010 2010-11

MO(phcs) 26 Nil MPHWs Nil Nil HS Nil Nil Pharmacist Nil Nil MO(Urban Health Facilities) Nil Nil 2 days training MPHW 41 Nil MOs 23 Nil MPHWs 55 98 HS Nil Nil Pharmacist Nil Nil ANM 30 Nil Programme Officers and District Leprosy officers Nil Nil Medical officers Nil Nil Non Medical Leprosy Officers Nil Nil Non Medical Supervisors Nil Nil Paramedical Worker Nil Nil Lab. technician 30 22 DLOs Nil Nil MO(DNT) Nil Nil

66

NMS Nil Nil ASHA Nil 172

IEC Activity implemented during – 2009-2010 Sl.No Activities Activities undertaken during April

2009 to March 2010 1 School Quiz 05 2 Health Mela/Exhibition/Haats/Bazors 07 3 Rallies & Banner/out door publicity 02 4 Wall painting 12 5 Meeting with Zilla Parishads 01 6 Folk show/puppet shows/street plays 02 7 School IEC 28 8 Village IEC 19 9 Health Camp 01

10 Skin camp 01 11 Quiz with teachers & parents 02 12 IEC with teachers & general public 01 13 Anti leprosy day celebration 03

I.E.C. Activities Report 2010-11 (Till 2nd quarter)

S.No Activities East West North South Total

1 Hoardings Nil Nil Nil Nil Nil 2 Bus Pannel Nil Nil Nil Nil Nil 3 Posters/Pamphlets Nil Nil Nil Nil Nil 4 Wall Paintings Nil Nil Nil Nil Nil 5 Rallies &

Banners/outdoor publicity

Nil Nil Nil Nil Nil

6 School quiz Nil Nil Nil Nil Nil 7 Flok Show/ Puppet

Show/ Street Play Nil Nil Nil Nil Nil

8 I.P.C. Workshop for MOs/ HWs/

Advocacy meeting

Nil Nil Nil Nil Nil

9 Meeting with Zilla Parishad

Nil Nil Nil Nil Nil

10 Orientation for NGOs/ SSG/ MM

Nil 2 Nil Nil 1

11 Health Mela/ Exhibition/ Haat

Nil Nil Nil Nil Nil

67

Bazar 12 IPC meeting at

Block Level for Teacher/ Govt. Official & ASHA

Nil Nil Nil Nil Nil

13 Village IEC Nil 4 Nil Nil 3 14 Public quiz Nil Nil Nil Nil Nil 15 School IEC/quiz Nil 11 Nil Nil 4 16 Health Camp Nil Nil Nil Nil Nil 17 Skin Camp Nil Nil Nil Nil Nil

DPMR: Important activities under DPMR are: 1. Regular monitoring of patients by sensory and VMT to detect early nerve damage and prevention of disability. 2. Referral of reaction cases to referral centers. 3. Regular training of leprosy nucleus staff and general health workers in DPMR. 4. Management of patients with ulcers. 5. Procurement of MCR footwears, aids and appliances. Current DPMR Status: S.No

DPMR Activities 2010-11 PB MB Total

1 No. of reaction cases recorded - 05 05 2 No. of reaction cases managed at PHC - - - 3 No. of reaction cases referred to District

Hospital & other institute - 01 01

4 No. of suspected relapse cases and referred by PHCs

- - -

5 No. of relapse confirmed at District Hospital 01 - 01 6 No of cases developed new disability after MDT - 01 01 7 No. of patients provided with footwear - - - 8 No. of patients provided with self care kit - - - 9 No. of patients referred for RCS at tertiary

institute - - -

10 No. of institute providing RCS - - - 11 No. of cases referred for skin smear 02 07 09 12 No. found positive for AFB - 05 05

68

NLEP Monitoring & Review:

Data collected from monthly reports from PHCs, District Hospital & from STNM hospital and data from MDT stock registers, treatment register & disability registers are used for monitoring the programme to see if it is going in the right direction towards fulfillment of programme objectives.

The important elimination indicators being used in Simplified information system: A. Elimination Indicator:

B. Quality of MDT service C. Integration of MDT services with general health staff:

Sl.No Indicators 2010-11 till date

1 Proportion of health subcentres providing MDT 03/147 2 Proportion of existing facilities having stocks of MDT 07 3 Flexibility in delivering MDT

% of Health centres open on all days Accompanied MDT given

All Open

When required 4 Integration to GHS

% where treatment and drug registers are maintained

25%

Sl.No

Indicator

2006-07

2007-08

2008-09

2009-10

2010- Upto

September 1 P.R /10000 15

(0.23) 26

(0.4) 30

(0.4) 22

(0.3) 14

(0.2) 2 A.N.C.D.R/100000 19

(3.0) 27

(4.2) 29

(4.4) 20

(2.9) 8

(1.1) 3 Deformity Gr.II %

among new cases Nil Nil Nil Nil Nil

4 Treatment Completion rate

26/43 (60)

15/22 (55)

8/22 (36.4)

22/34 (64)

22/34 (64.7)

5 Reconstructive surgery conducted

Nil Nil Nil Nil Nil

69

Data analysis result: A. Elimination indicator: Since the last 5 years prevalence rate has remained below 1/10,000. New case detection shows a stable trend with slight decrease in 2008-09 Grade II disability is reportedly nil since 2006 due to better implementation of

DPMR(disability prevention & medical rehabilitation) B. Quality of MDT service: The quality of MDT service is not very satisfactory as MDT is not available in most health centres of the state. C. Integration of GHS: Although all health centres are open throughout the week, health workers are not very involved in delivering MDT services to the few patients that come to the centres. Very few centres have maintained leprosy treatment and drugs registers. Monitoring & Review: This is done at District and State Level by the PO & DLOs and corrective actions taken. Review meetings are held at State Leprosy Cell to see if there is any deviation of the programme objectives and performance. Vehicle Operation & Hiring: All the vehicles attached to State HQ & District cell are more than 17 year old. Due to the old age of vehicle the consumption of POL & maintenance is high. The roads are not in good condition and due to hilly terrain; the vehicles have suffered frequent breakdowns. Position of vehicle:

H.Q East West North South 01 01 02 02 01

70

Objectives:

1. Improve D.P.M.R services by regular VMT & ST of all leprosy cases especially those at risk thereby leading to complete deformity & disability prevention.

2. Reduce the M.B % from the current (2009-10) 56% to 30% by 2012.

3. The female proportion among newly detected cases should be improved from the

latest 25% % (2009-10) to at least 40 % by 2012.

4. Improvement of Treatment Completion Rate (TCR) from the current 64% to 75% by 2012.

71

Strategic Action Plan for Sikkim 2011-12

Sl No

Priority issues/Problems Solutions Activities to be performed Resource input required

Person responsible Supporting staff

Where to do

1 2 3 4

More then 75% cases diagnosed at STNM & very few at Districts & rarely at PHCs High % M.B cases among new cases Leprosy field workers who were integrated are not motivated to do leprosy work High defaulter rate among migrant patients & also more reaction cases

Quality training of M.Os at peripheries, Nursing staff, health workers , ASHAs , Regular follow up of patients at Hospital

3 days training for new M.Os 2 days Orientation Training for M.Os 2 days Orientation Training for H.W s(3 batches) 2 days Orientation Training for health supervisors Half day training for ASHAs(5 batches) Provide incentive to ASHAs for assisting in new case detection & timely completion of treatment. Follow up of leprosy patients & regular VMT & ST (voluntary

1.Stationaries for trainees 2.Laptop , LCD, 3.Screen ,Vehicle 4.Refreshments 5.Banner 6.P.A system for ASHA training at Hall 7.Patient for practical demonstration

1.Dermatologist, P.O,CMO, D.L.O – for M.O s training 2.D.L.O , N.M.L.O, N.M.S – Health workers, Supervisors, ASHAs

l. BFO 2.DEO 3.Peon 4.Driver

Singtam/ Namchi/ Mangan/ Gyalshing

72

motor test & sensory test ) of patients on MDT at STNM Hospital (at skin OPD) ,district hospitals twice weekly

5 DPMR activities like regular VMT ,ST , treatment of reactions, management of ulcers etc not satisfactory

Training on DPMR especially for leprosy field workers, supervisors, nucleus team & nursing staff of district ,P.H.C & P.H.S.C

1. 3 days training for ANM of P.H.C & P.H.S.C 2. 3 days training for leprosy field workers & nucleus team

1.Stationaries 2.L.C.D ,Laptop 3. Screen 4. Tea & working lunch 5. Banner 6. Camera 7. Patient for demonstration

CMO , P.O, D.L.O, N.M.L.O, N.M.S

l. BFO 2.DEO, 3.Peon 4.Driver

District hospitals

6 Patients with anaesthetic hands & feet, deformities. Old patients with deformities – 8 New patients with deformtites -- 2 Patients with insensitive feet requiring footwear -- 4

Teach patients self care techniques, teach active & passive exercises, RCS for recent deformities, provide appropriate footwear.

4. Procure footwear – 2 pairs / pt i.e 16 pairs Procure walker/ crutch for 2 patients 5. Welfare allowance to BPL patients for RCS

Footwear with thick undersole & straps , Walker or crutches for patients with deep planter ulcers

CMO,P.O, D.L.O, N.M.L.O, N.M.S


District hospitals

7 Procurement of various essential items for effective implementation of programme

Procurement plan for

1.Supportive drugs, Lab material like slides, blades ,reagents Printing of registers forms.

Prednisolone, clofazimime, NSAID, antibiotics, eye drops,ointmentsetc

D.L.O l. BFO 2.DEO, 3.Peon 4.Driver

District hospitals

8 Patients from villages prefer to take their MDT

Awareness programmes in

10-10 ft hoarding at Dist. Hospital & 4-4 ft small

I.E.C materials like posters, pamphlets,

P.O D.L.O

l. BFO 2.DEO,

All over Sikkim

73

from referral hospitals, district hospital instead of going to PHC or PHSC possibly due to fear of stigma & discrimination.

villages, health camps to

hoarding at all 8 PHCs IPC meetings at all 8 PHCs with panchayat leaders, teachers etc & Advocacy meeting at District Hospital. Celebration of Anti leprosy day at all 8 PHCs & at District Hospital Skin camps with BCC twice monthly at villages & during health melas BCC during VHND at 3 villages /month at Anganwadi centres. 10.Printing of posters & pamphlets 11.Folk shows Workshops with MOs, NGOs.

Audio visual on leprosy & presentation on status in Sikkim, Vehicles, refreshments, Banner, I.E.C material, A.V , vehicle, refreshments Medicines & ointments, stationery, I.E.C materials , refreshments, Vehicles I.E.C material, refreshments, vehicles, Material for printing

M.O/I.C, C.M.O, N.M.L.O D.H.E.O P.O. M.O, C.M.O, D.L.O, NMLO ,D.M.S Dermatologist,M.O, D.L.O D.L.O, M.O,LHV,ASHA Press,D.L.O

3.Peon 4.Driver

District hospitals, PHCs

74

Rally on Anti Leprosy day. Quiz competitions at schools. Wall painting.

9 Leprosy field workers are more into other work & less involved with delivery of leprosy services , monthly reports & registers are not being maintained at PHCs properly, integration of MDT services with general health services not satisfactory

Regular monitoring & supervision to bring the leprosy field workers on track & ensure their full involvement, also to encourage general health staff in delivering leprosy services in the absence of lep. Workers.

1. Regular visits to PHCs & PHSCs to 1. to see if leprosy field worker is present & to check the treatment registers, MDT stock registers , 2.To interact with general health staff & see if they have enough knowledge about leprosy & whether they are helping in delivering MDT services 3. To find out if leprosy workers are doing field visits for contact surveys, for defaulter retrieval 4. Attend monthly review meetings at Districts, PHCs 5. Attend Quarterly review meetings at State

Checklist for supervision, vehicle

CMO,P.O, D.L.O, N.M.L.O, BFO

1.DEO, 2.Peon 3.Driver

District hospitals.PHCs

75

4. Training Plan

Training Plan for the 1st quarter (2011-12)

Activities East District West District North District South District 2 Days Training

for Health Inspectors and

Supervisors

1batch 1 batch 1 batch 1 batch

3 days training for Leprosy field workers/nucleus

team

1 batch

Training Plan for the 2nd quarter (2011-12)

Training Plan for the 3rd quarter (2011-12)

Activities East District West District North District South District 3 days training

for MOs 1 batch 0 1 batch 1 batch

3 days training for nursing staff

& ANMs on DPMR

1 batch 1 batch 1 batch 1 batch

Half day training for

ASHA


Activities East District West District North District South District 2 days refresher

training for MOs

2 batches 1batch

2 days orientation training for

MPHW


76

Training Plan for the 4th quarter (2011-12)

1. BCC/IEC Plan:

IPC & folk media:

Activities State (H.Q)

East District

West District

North District

South District

IPC meetings with political leaders and representatives

1 1 2 1

IPC meetings with Teachers and Block Officers

8 2 2 2

Folk Shows -- 8 8 -- Workshop with NGOs

-- 4 -- --

Rural & outdoor media:


East District

West District

North District

South District

Hoardings 9 1 2 7 Leaflets and pamphlets

5000nos 2000 nos 2000 nos 3000 nos

Posters 500nos 300 nos 200 nos 300 nos Village IEC , health camps

04 04 04 04

BCC during village health and nutrition day

12 8 8 8

Wall painting -- -- 19 7

Activities East District West District North District South District 1 day training

for pharmacists 1 batch

2 days training for newly

appointed lab technicians

1 batch 1 batch

77

Rallies -- 1 -- -- School IEC and Quiz 12 2 8 6 Newspaper advertisement on Anti-Leprosy day

06 - - - -

Mass Media:


East District

West District

North District

South District

Local TV show 1 week - 12 months -- -- Local F.M. Radio 1 week 1 week -- -- Slide show in Cinema Hall

2 halls -- -- -- --

Anti-Leprosy Day celebration

1 1 HQ , 7 PHCs

1 HQ, 6 PHCs

1 HQ, 4 PHCs

1 HQ, 7 PHCs

Health melas:


East District

West District

North District

South District

Health melas 01 01 01 01 01 Procurement Plan (Materials & Supplies):

Supportive medicines like Prednisolone, Clofozamine, aspirin, eye drops and ointments etc are puerchased by the respective Districts for PAL. Also, printing of forms, purchase laboratory reagents, glass slides etc is done by the Districts.

78

Procurement plan: Sl No

Item to be purchased

Total no per District Requirement per District

Rate (Rs) Total

East West North South 1 Public

addressal system

1 Rs.20,000/- 20,000/-

2 Printing of reporting forms

3000 3000 3000 3000 Rs. 3/- 36,000/-

3 Blades for Laboratory diagnosis

4 Pkt 2 Pkt 2 Pkt 2 Pkt Rs. 100/- 1,000/-

4 Reagents to give PHCs

8 sets 7 sets 4 sets 7 sets Rs. 1,000/- 24,000/-

5 Glass slides for PHCs

18 boxes

10 Boxes

8 boxes 10 boxes

Rs. 200/- 9,200/-

6 Purchase of Prednisolone,

98 tabs/ patients

X 7 patients

98 tabs/

patients X 4

patients

98 tabs/ patients

X 2 patients

98 tabs/ patients

X 4 patients

Rs. 100/- per course

1,700/-

7 Dressing materials (POP), cotton, savlon, first aid box, scissors, massage oil etc

8 sets 4 sets 4 sets 5 sets Rs. 400/- 8,400/-

8 Supportive Medicines (antibiotics, ointments, NSAID etc) also required during skin camps

Rs. 30,000/- per District

1,20,000/-

Total 2,20,300/-

79

Services through ASHA

Activity East West North South Total Training status

167

No. of ASHAs to be sensitized

50 50 50 50 200

No. of cases likely to be found by ASHA 2011-12

10- MB

05- PB

05- MB

03- PB

05-MB

03-PB

08- MB

05- PB

28- MB

16- PB

NLEP Monitoring/ Supervision & Review Plan:

Activities Place Person Responsible Frequency State Level Review meeting with District nucleus team

Gangtok P.O/ NMLO/ BFO Quarterly

Monthly meeting at District HQ

Districts CMO/ DLO/ MO/ NMLO Monthly

Supervisory visits to PHC/ PHSC

PHCs/ PHSC of all Districts

PO/ DLO/ MO/NMLO/NMS Throughout the year

Financial Supervision of District Leprosy units

All Districts

BFO Once monthly

Data collection from PHCs

All Districts

MO/NMLO/ NMS Monthly

Compilation of data All Districts & HQ

PO/ DLO/ NMLO/ DEO Monthly

80

WORK PLAN Sl No

Activity/Components TIME FRAME Remarks 1st

quarter 2nd

quarter 3rd

quarter 4th

quarter

1 Four days training of M.Os at Gtk

Difficult to adhere to exact work plan due to delay in fund release

2 Two days O.Training for M.Os

3 Two days O.T for H.workers

4 2 days O.T for H.Supervisors

5 Half day Training for ASHAs

6 Two days training for leprosy field workers

7 3 days training for nursing staff of PHC& PHSC in DPMR (2 batches)

8 3 days training for district nursing staff

9 Procurement of footwear ,crutch, S,Drugs, lab materials

10 Printing of forms, pamphlets, posters etc

11 Mass Media for Anti leprosy week

12 Outdoor media like hoardings

13 Advocacy meetings at P.H.Cs & at District

14 Celebration of Anti leprosy day & week at 8 PHCs & at District

15 Skin camps with BCC twice monthly

16 BCC during VHND 3

81

villages /month at Anganwadi centers

17 Monitoring & supervision

18

Follow up of patients & contact surveys of family members

19 Follow up of leprosy patients for any complications & DPMR activity

82

Budget proposal for the Training: (2011-12)

Sl. No.

Activities East West North South Total Expenditure

(Rs.) 1 3 days training for newly

appointed MOs

D.A to trainees: 10 X 3days X 250

7,500/-

7,500/

7,500/-

7,500/

30,000/- T.A to trainees: 10 X 3 days X 200

6,000/-

6,000/-

6,000/-

6,000/-

24,000/-

Honorarium to trainers : 3 X 3 days X 500

4,500/-

4,500/-

4,500/-

4,500/-

18,000/-

Tea and snacks: 13 X 3 days X 25

975/- 975/- 975/- 975/- 3,900/-

Working lunch: 13 X 3 days X 150

5,850/-

5,850/-

5,850/-

5,850/-

23,400/-

Stationaries: 10 X 50

500/-

500/-

500/-

500/-

2,000/-

Training hall charges: 500 X 3 days

1,500/-

1,500/

1,500/-

1,500/

6,000/-

Miscellaneous 1,000/-

1,000/-

1,000/-

1,000/-

4,000/-

Sub Total 1,11,300/- 2 3 days training for leprosy

field workers and nucleus team


12,000/-

12,000/-

T.A to trainees: 30 X 3 days X 200

12,000/-

12,000/-

Honorarium to trainers :

3 X 3 days X 500

4,500/-

4,500/-


10,350/-

10,350/-

Stationeries: 20 X 50

1,000/-

1,000/-

83

Miscellaneous

1,000/-

1,000/-

Sub Total 40,850/- 3 2days training for Health

inspector and supervisor


12,000/-

12,000/

12,000/-

12,000/

48,000/-

T.A to trainees: 30 X 2days X 200

12,000/-

12,000/

12,000/-

12,000/

48,000/-

Honorarium to trainers: 3 X 2 days X 300

1,800/-

1,800/-

1,800/-

1,800/-

7,200/-

Tea & Snacks: 33 X 2 days X 25

1,650/-

1,650/-

1,650/-

1,650/-

6,600/-

Working lunch: 33X 2 days X 150

9,900/-

9,900/-

9,900/-

9,900/-

39,600/-


1,500/-

1,500/-

1,500/-

1,500/-

6,000/-

Miscellaneous 1,000 1,000 1,000 1,000 4,000/- Sub Total 1,59,400/-

4 2 days refresher training for MOs East- 2 batches South- 1 batch


30,000/- 15,000/- 45,000/-


24,000/- 12,000/- 36,000/-

Tea & Snacks: 30 X 2days X 25

3,000/- 1,500/- 4,500/-


6,000/- 3,000/- 9,000/-


19,800/- 9,900/- 29,700/-


3,000/- 1,500/- 4,500/-

84

Hall Charge:

500 X 2 days 1,000/- 1,000/- 2,000/-

TOTAL

86,800/- 43,900/- 1,30,700/-

5 2days orientation training for MPHW: East & West & South- 3

batches North- 2 batches


36,000/- 36,000/- 24,000/- 36,000/- 1,32,000/-


36,000/- 36,000/- 24,000/- 36,000/- 1,32,000/-


5,400/- 5,400/- 3,600/- 5,400/- 19,800/-


29,700/- 29,700/- 19,800/- 29,700/- 1,08,900/-

Tea and Snacks: 33 X 25 X 2 days

4,950/- 4,950/- 3,300/- 4,950/- 18,150/-

Stationeries: 30X50

1,800/- 1,800/- 900/- 1,800/- 6,300/-

Miscellaneous 1,000/- 1,000/- 1,000/- 1,000/- 4,000/- Sub Total 4,21,150/-

6 2days training for newly appointed lab technicians


3,000/- 3,000/- 6,000/-


4,000/- 4,000/- 8,000/-


1,800 1,800/- 3,600/-

Tea & Snacks: 10 X 2 days X 25

500/- 500/- 1,000/-


3,900 3,900/- 7,800/-

Stationaries: 10X50

500/- 500/- 1,000/-

Sub Total 27,400/-

7 1 day training for pharmacists

85


1,500/- 1,500/-


2,000/- 2,000/-


900/- 900/-

Tea & snacks: 10 X 25

250/- 250/-

Working lunch: 13 X 150

1,950/- 1,950/-

Stationaries: 10X50

500/- 500/-

Sub Total 7,100/- 8 1 day training for ASHA

East-7 batches West-3 batches North-2 batches South- 5 batches

D.A to trainees: 30 X 1 day X 100

21,000/- 9,000/- 6,000/- 15,000/- 51,000/-


31,500/- 13,500/- 9,000/- 22,500/- 76,500/-


6,300/- 2,700/- 1,800/- 4,500/- 15,300/-

Tea & Snacks: 33 X 25

5,775/- 2,475/- 1,650/- 4,125/- 14,025/-


34,650/- 14,850/- 9,900/- 24,750/- 84,150/-

Stationeries: 30X50

10,500/- 4,500/- 3,000/- 7,500/- 25,500/-

Hall charge @ 500/- 3,500/- 1,500/- 1,000/- 2,500/- 8,500/- Miscellaneous 1,000/- 1,000/- 1,000/- 1,000/- 4,000/- Sub Total 2,78,975/- GRAND TOTAL 11,76,875/-

86

Budget proposal for BCC/ IEC activities for the year 2011-12 2. BCC/IEC Plan:

IPC & folk media:

Activities Expected Exp. For each activity (Rs)

Total no. proposed

Total amount (Rs.)

IPC meetings with political leaders and representatives

10,000/- 5 50,000/-

IPC meetings with Teachers and Block Officers

5,000/- 14 70,000/-

Folk Shows 3,000/- 16 48,000/- Workshop with NGOs

5,000/- 4 20,000/-

Total 1,88,000/-

Rural & outdoor media:


Total no. proposed

Total amount (Rs.)

Hoardings 15” x 10 (4 DHS) @ 15,000/- 4” x 4” for PHCs ( 15 nos) @

8,000/-

19 60,000/- 1,20,000/-

Leaflets and pamphlets

Rs. 2/- 12,000 nos

24,000/-

Posters Rs. 30/- 1,300 nos 39,000/- Village IEC , health camps/skin camps

Rs.10,000/- 16 1,60,000/-

BCC during village health and nutrition day

Rs.2,000/- 36 72,000/-

Newspaper advertisement on Anti-Leprosy day

Half page @ Rs.5,000/- In 2 languages (English/

Nepali)

3 30,000/-

Wall painting Rs.2,500/- 26 65,000/- Rallies Rs.5,000/- 01 5,000/-

87

School IEC and Quiz

Rs.3,000/- 28 84,000/-

Total 6,59,000/- Mass Media:


Total no. proposed

Total amount (Rs.)

Local TV show (scrolling & news flash)

Rs. 1,500/- per day 2 weeks 21,000/-

Local F.M. Radio and All India Radio

Rs.1,000/- per day (F.M) Rs. 1,000/- per day(AIR)

1 week each

14,000/-

Slide show in Cinema Hall

Production charge @ Rs.5,000/-

Charge for display at Cinema hall @ Rs. 50/- day

365 days

23,250/-

Anti-Leprosy Day celebration

State H.Q- Rs. 25,000/- DHS – Rs. 10,000/- each

PHCs- Rs. 5,000 each

01 04 24

25,000/- 40,000/-

1,20,000/-

2,43,250/- Health melas:


Total no. proposed

Total amount (Rs.)

Health melas @ Rs. 10,000/- 05 50,000/- Grand Total for IEC activities- Rs. 11,40,250/-

88

DPMR plan for 2011-12 Sl NO. Activity Total nos. cost Total cost

1. Procurement of footwears, 2 per

person

8X2=16 500 500X16=8,000

2. Crutches 4 1000 1000X4=4000 3. Supportive medicine

including Clofazimine and prednisolone

4 districts 5000 per district

20,000

4. Dressing materials, ointments, first aid box

for patients , savlon etc.

4 districts 5000 per district

20,000

Total Rs.52,000 Welfare allowance to patient for RCS: Sl No. No of

patients for RCS

2 ways T.A to Purulia or Kolkata Leprosy mission hospital

D.A Miscellaneous Total amount

1 4 1000 x 4 x2 = 8000

100/day x 30 days = 3000x 4=12000

Purchase of medicines & other unexpected expenditure= 2000x4=8000

Rs 28,000

Total Rs.28,000 DPMR Trainings:

1 3 days training for nursing staff & ANMs on DPMR


18,000/-

18,000/-

18,000/

18,000/-

72,000/-

T.A to trainees: 30 X 3 days X 200

18,000/-

18,000/-

18,000/-

18,000/-

72,000/-

89


4,500/-

4,500/-

4,500/-

4,500/-

18,000/-


15,300/- 15,300/- 15,300/- 15,300/- 61,200/-

Stationaries: 30 X 50

1,500/-

1,500/-

1,500/-

1,500/-

6,000/-

Miscellaneous 1,000/-

1,000/-

1,000/-

1,000/-

4,000/-

Sub Total 2,33,200/-

Budget Proposal for POL/ Vehicle Maintenance & Hiring: (a) State H.Q

Particulars Purpose Amount Total (Rs) POL Regular MDT activities 90 lt x 12 months = 1,080 litres

1,080 litres x Rs. 52/- 56,160/-

Maintenance Purchase of lubricants, tyres & tubes and other machinery parts

50,000/-

Extra activities

Resource person from GOI, Monitoring etc

20 lt x 12 months = 240 litres 240 litres x Rs. 52/-

12,480/-

Total 1,18,640/- (b) East District


1,080 litres x Rs. 52/- 56,160/-


40,000/-

Hiring Touring to difficult areas where roads are not well maintained.

Rs. 3,000/- x 12 months 36,000/-

Total 1,32,160/-

90

(c) West District


1,080 litres x Rs. 52/- 56,160/-


80,000/-

Total 1,36,160/- (d) North District


1,080 litres x Rs. 52/- 56,160/-


80,000/-

Total 1,36,160/- (e) South District


1,080 litres x Rs. 52/- 56,160/-


40,000/-

Hiring Touring to difficult areas where roads are not well maintained. In the past the old

vehicles with us have had frequent breakdowns during long tours causing great inconvenience to all.

Rs. 30,000/- x 12 months 36,000/-

Total 1,32,160/-

91

Budget proposal for LCD Projector & Laptop: NLEP HQ requires one LCD projector for imparting quality training to MOs & HWs of East District & headquarters. It is also useful during IEC activities, especially during Health Melas, BCC campaigns etc. District Leprosy cells do not have laptops which is now a days a must for all training activities, reporting, etc.

Sl.No Items to be purchased Nos Unit cost Total cost (Rs) 1 LCD projector 01 50,000 50,000/- 2 Laptops 04 40,000 1,60,000/-

92

National Leprosy Eradication Programme

Budget proposal for the financial year 2011-12

(Rs. in lakhs) S.

No.

Activity proposed Amount proposed

1) Contractual Services 9.62 State- 4.24

District – 5.38

2) Services through ASHA/USHA 3.08

Sensitization of ASHA, Incentive to ASHA

3) Office expenses & Consumables 3.40 4) Capacity building (Training)

11.80

4 days training of newly appointed MO (rural & urban)

3 days training of newly appointed health worker & health supervisor

2 days refresher training of MO

5 days training of newly appointed Lab. Technician

5) Behavioral Change Communication (IEC) 11.43

Mass media, Outdoor media, Rural media and Advocacy

6) POL/Vehicle operation & hiring 6.55 1 vehicles at state level & 2 vehicle at district level

7) DPMR

3.12

MCR footwear, Aids and appliances, Welfare allowance to BPL patients for RCS, Support to govt. institutions for RCS

8) Material & Supplies 2.70

Supportive drugs, lab. Reagents & equipments and printing forms

9) Urban Leprosy Control 2.81

Township, Medium cities-I, Medium cities-II & Mega cities

10) Supervision, Monitoring & Review 2.80 Review meetings and travel expenses 11) Cash Assistance 3.00 12) Purchase of Laptop 1.60 13) Purchase of LCD projector 0.50

TOTAL 62.41

93

URBAN LEPROSY CONTROL Till now a separate plan for ULC have not been proposed but now it seems that we need to have the same to tackle Leprosy among the migrants mostly settled at Gangtok. Identified urban areas in Sikkim by G.O.I for separate Action Plan—Nil Total number of Urban leprosy centres in Sikkim = 1(Gangtok) Gangtok being the state capital is most populated region of the state with an estimated population of about 90,348. The influx of migrant population is highest here. Therefore, leprosy cases detected at STNM Hospital & registered is the highest in Gangtok as compared to other districts. Till now, the important components of the programme like Training, IEC, DPMR for Gangtok is being covered by District Health society (NLEP) of East District. The fund provided to each district is about Rs 4000000(four lacks) annually irrespective of the variation in the number of PHCs & population of each district. Therefore , East district with the highest population, largest number of PHC & PHSCs , maximum health manpower and most leprosy cases cannot perform satisfactorily in terms of imparting quality training ,IEC , DPMR ,Monitoring & supervision . Therefore ,we need to have a separate PIP for Gangtok to cover all aspects of the programme properly especially training to M.Os , Health workers, workshop for G.Ps, Specialists , IEC in areas where migrant families are settled, follow up for treatment completion, procurement of supportive medicines for managing reaction & complicated cases. . LEPROSY STATUS IN GANGTOK SL.NO PROGRAMME

INDICATORS 2006-07 2007-08 2008-09 2009-10 2010-11

PB MB PB MB PB MB PB MB PB MB 1 Total new cases

detected 5 8 5 13 1 21 7 9 3 3

2 MB % among new cases

61.5% 72.2% 95.4% 56.2% 50%

94

3 Total cases made RFT

18 9 8 15 8

4 Grade II deformity detected

01 01

5 No of reaction cases detected

6 Total cases deleted

(defaulters)

10 1 5 6 6

Strategic action plan for Urban Leprosy Control (Gangtok) Sl No

Priority issues/Probl

ems

Solutions

Activities to be performed

Resource input required


Where to do

1 All cases detected at STNM are from dermatology dept. & some cases from Manipal Hospital but rarely from medical , paediatrics ,& general practioners

Sensitization of specialists, general practioners, doctors from Army,gref O.Training of medical officers of STNM & Manipal Hospital, nursng staff, ASHAs ,

1.4 days training for new M.Os 2. 2 days O.Training for M.Os 3. Workshop for specialists, G.P, Doctors of Army & Gref 5. half day training for ASHAs(1 batche) 6. Provide incentive to ASHAs for assisting in new


1.Dermatologist, P.O, D.L.O – for M.O s training 2.D.L.O , N.M.L.O, N.M.S – Health workers, Supervisors, ASHAs 3. Resource persons from G.O.I, Dermatologist, P.O, D.L.O.


Gangtok

95

case detection & timely completion of treatment . 6. Follow up of leprosy patients & regular VMT & ST (voluntary motor test & sensory test ) of patients on MDT at STNM Hospital (at skin OPD) ,district hospitals twice weekly

2 Reaction & complicated leprosy cases referred from districts are to be managed in STNM & Manipal .

DPMR activities like regular VMT ,ST , treatment of reactions,management of ulcers etc not satisfactory Training on how to do dressings of wounds & ulcers of PAL

1. 2 days training for nursing staff (2 batches) of Hospital.STNM hospital


Dermatologist, ,Orthopedic surgeon,P.O, D.L.O, NMLO,NMS


Gangtok

3 Patients with anaesthetic hands & feet , deformities. Old patients

1Patients with insensitive feet requiring footwear -- 2

Teach patients self care techniques, teach active & passive exercises, RCS

PO,DLO,NMLO Gangtok

96

with deformities – 2 New patients with deformtites --,

for recent deformities, provide appropriate footwear. 4. Procure footwear – 2 pairs / pt i.e 4 pairs 5. Welfare allowance to BPL patients for RCS-1 Patient Footwear with thick undersole & straps ,

4 Most of the cases(above 50%) from Gangtok are among the migrant workers who default regularly. Also the proportion of local cases affected with leprosy is slowly increasing . .

Intensive IEC thorough various mediums to create awareness and remove stigma

1. Radio jingles on AL (Anti leprosy week) for 1 week on A.I.R & F.M Radio. 3.½ page advertisement in two languages for 3 days Anti leprosy week 4.T.V spot for 1 week in cable T.V 5. 10-10 ft hoarding at STNM hospital and Manipal hospital

Material for R.J Develop Message to be printed To produce material

PO,DLO,BFO,NMLO,DE A.I.R, F.M.station, D.L.O News paper editor, Nayuma,


Gangtok

97

6. IPC meetings with Municipality representatives ,distribution of pamphlets during melas and exhibitions, 7. Celebration of Anti leprosy day and observing Martyrdom day of Mahatma Gandhi by inviting political leaders 8. Health camps at urban slums with BCC, angandwadi centres , schools .

I.E.C material, refreshments, Banner, I.E.C material, A.V , vehicle, refreshments

WORK PLAN FOR URBAN LEPRSOY CENTRE GANGTOK

Sl No

Activity/Components TIME FRAME Remarks 1st quarter 2nd quarter 3rd quarter 4th quarter



2 Two days O.Training for M.Os

98

in DPMR (2batches) 3 Two days O.T for Nursing

Staff





13 Advocacy meetings with Municipality representatives


16 BCC during VHND 3 villages /month at Anganwadi centers


18


19 Workshop for Specialist , general practitioners.

99

100

I.E.C. ACTIVITIES AT URBAN AREAS

ON THE OCCASION OF ANTI-LEPROSY DAY -31ST JANUARY SL.NO

DATAILS RATE COST

1

Broad casting of jingles on All India Radio

Rs.1000 X 7 days

7,000/-

2

Scrolling news spot in television (NAYUMA)

Rs.1000 X 7 days

7,000/-

3 News paper advertisement on leprosy topic. Rs.4500 X 3days 13,500/-

Total

27,500/-

HOARDING SL.NO

DETAILS RATE COST

1 Display of two hoardings matter related to sign & symptom of leprosy & its treatment (size 10’X10’) metal framed.

Rs.15,000 X 2nos.

30,000/-

Total

30,000/- I.P.C. MEETING SL.NO

DETAILS RATE COST

1 I.P.C. meeting with M.L.A.’s, conveners, teachers, Ex-Panchyats, Ex-Politicians etc.

a) Banner

Rs, 800

800/-

b) Tea & snacks

Rs. 50 X25 persons

1,250/-

c) Stationeries

Rs. 50 X25 persons

1,250/-

d) working lunch

Rs.150 X25 persons

3,750/-

101

e) Meeting hall charges Rs.1200 1,200/-

f) Miscellaneous Rs. 2000

2,000/-

Total 10,250/-

HEALTH MELA SL.NO

DETAILS RATE COST

1 Health Mela: Opening of stall & display of banners, posters, folders, hand bills, lecturing leprosy topic etc.

Rs. 10,000/-

10,000/-

2 Screening for leprosy by hoarding, skin camp and distributing medicines and ointments

Rs.15,000/- 15,000/-

Total 25,000/- HEALTH CAMPS WITH B.C.C. SL.NO

DETAILS RATE COST

1 BCC and health camps at schools and Anganwadi centres

3,000/- X 12 36,000/-

102

CAPACITY BUILDING/TRAINING OF URBAN AREAS, (1) ESTIMATE FOR EXPENDITURE OF ONE DAY ORIENTATION TRAINING FOR MEDICAL OFFICERS OF S.T.N.M. HOSPITAL AND CENTRAL REFFERAL HOSPITAL,TADONG. SL.NO. PARTICULAR

COST

1 D.A. to trainees – 30 MOs X 250 7,500/- 2 T.A. to trainees – 15 MOs X 100 1,500/- 3 Honorarium to trainers 3 X 500 1,500- 4 Tea & snacks – 33 X 25 825/- 5 Working lunch - 33 X 150 4,950/-

6 Stationeries – 30 X 100 3,000/-

7 Training hall charges 500 500/- 8 Miscellaneous - 1500 1,500/-

Total

21,275/-

(2) 3 DAYS TRAINING FOR NEWLY APPOINTED MEDICAL OFFICERS OF S.T.N.M. HOSPITAL AND CENTRAL REFFARAL HOSPITAL, MANIPAL, TADONG

SL. NO.

PARTICULAR COST

1 D.A. to trainees – 20 MOs X 3 days X 250 15,000/-

2 T.A. to trainees – 10 MOs X 3days X 100 3,000/-

3 Honorarium to trainers – 3 X 3 days X 500 4,500/-

4 Tea & snacks – 23X 3 days X 25 1,725/- 5 Working lunch – 33 X 3 days X 150 14,850/- 6 Stationeries – 20 X 50 1,000/- 7 Training hall charges 500 X 3days 1,500/-

8 Miscellaneous – 1000/- 1,000/- Total 42,575/-

103

(3) HALF DAY RE-ORIENTATION TRAINING OF ASHAs OF URBAN AREAS SL.NO PARTICULARS

COST

1 D.A. to trainees – 30 ASHAs X 100 3,000/- 2 T.A. to trainees – 30 X 100 3,000/- 3 Tea & snacks – 30 X 25 750/-

4 Working lunch – 33 X 150 4,950/-

5 Hon. to trainers – 3 X 300 900/- 6 Stationeries – 30 X 50 1,500/- 7 Training hall charge – 500 500/- 8 Misc. 1,000/-

Total 15,600/-

(4) WORKSHOP FOR SPECIALIST OF S.T.N.M. HOSPITAL AND GENERAL PRACTITIONERS. AND DOCTORS OF ARMY & GREF SL.NO PARTICULARS COST

1 Tea & snacks – 30 X 100 3,000/- 2 Working lunch – 30 X 500 15,000/- 3 Hon. to trainers – 3 X 1,000 (From outside Sikkim) 3,000/- 4 Stationeries – 30 X 150 4,500/- 5 Training hall charges – 2000/- 2,000/-

6 Misc. – 5,000/- 5,000/-

Total

32,500/-

104

(5) 3 DAYS TRAINING FOR NURSING STAFF & ANMs on DPMR

Sl.No Activity Amount

1 D.A to trainees: 30 X 3days X 200

18,000/-

2 Honorarium to trainers: 3 X 3 days X 500

4,500/-

3 Working lunch: 34 X 3 days X 150

15,300/-

4 Stationaries: 30 X 50

1,500/-

5 Miscellaneous 1,000/-

Total 40,300/-

105

Strategic action plan for Urban Leprosy Control (Gangtok) Sl No

Priority issues/Probl

ems

Solutions

Activities to be performed

Resource input required


Where to do

1 All cases detected at STNM are from dermatology dept. & some cases from Manipal Hospital but rarely from medical , paediatrics ,& general practioners

Sensitization of specialists, general practioners, doctors from Army,gref O.Training of medical officers of STNM & Manipal Hospital, nursng staff, ASHAs ,

1.4 days training for new M.Os 2. 2 days O.Training for M.Os 3. Workshop for specialists, G.P, Doctors of Army & Gref 5. half day training for ASHAs(1 batche) 6. Provide incentive to ASHAs for assisting in new case detection & timely completion of treatment . 6. Follow up of leprosy patients & regular VMT & ST (voluntary motor test & sensory test ) of patients on MDT


1.Dermatologist, P.O, D.L.O – for M.O s training 2.D.L.O , N.M.L.O, N.M.S – Health workers, Supervisors, ASHAs 3. Resource persons from G.O.I, Dermatologist, P.O, D.L.O.


Gangtok

106

at STNM Hospital (at skin OPD) ,district hospitals twice weekly

2 Reaction & complicated leprosy cases referred from districts are to be managed in STNM & Manipal .

DPMR activities like regular VMT ,ST , treatment of reactions,management of ulcers etc not satisfactory Training on how to do dressings of wounds & ulcers of PAL

1. 2 days training for nursing staff (2 batches) of Hospital.STNM hospital


Dermatologist, ,Orthopedic surgeon,P.O, D.L.O, NMLO,NMS


Gangtok

3 Patients with anaesthetic hands & feet , deformities. Old patients with deformities – 2 New patients with deformtites --,

1Patients with insensitive feet requiring footwear -- 2

Teach patients self care techniques, teach active & passive exercises, RCS for recent deformities, provide appropriate footwear. 4. Procure footwear – 2 pairs / pt i.e 4 pairs 5. Welfare allowance to BPL

PO,DLO,NMLO Gangtok

107

patients for RCS-1 Patient Footwear with thick undersole & straps ,

4 Most of the cases(above 50%) from Gangtok are among the migrant workers who default regularly. Also the proportion of local cases affected with leprosy is slowly increasing . .

Intensive IEC thorough various mediums to create awareness and remove stigma

1. Radio jingles on AL (Anti leprosy week) for 1 week on A.I.R & F.M Radio. 3.½ page advertisement in two languages for 3 days Anti leprosy week 4.T.V spot for 1 week in cable T.V 5. 10-10 ft hoarding at STNM hospital and Manipal hospital 6. IPC meetings with Municipality representatives ,distribution of pamphlets during melas and exhibitions, 7. Celebration of Anti leprosy day and observing Martyrdom day

Material for R.J Develop Message to be printed To produce material I.E.C material, refreshments, Banner, I.E.C material, A.V , vehicle,

PO,DLO,BFO,NMLO,DE A.I.R, F.M.station, D.L.O News paper editor, Nayuma,


Gangtok

108

of Mahatma Gandhi by inviting political leaders 8. Health camps at urban slums with BCC, angandwadi centres , schools .

refreshments

WORK PLAN FOR URBAN LEPRSOY CENTRE GANGTOK

Sl No

Activity/Components TIME FRAME Remarks 1st quarter 2nd quarter 3rd quarter 4th quarter



2 Two days O.Training for M.Os in DPMR (2batches)

3 Two days O.T for Nursing Staff



109



13 Advocacy meetings with Municipality representatives


16 BCC during VHND 3 villages /month at Anganwadi centers


18


19 Workshop for Specialist , general practitioners.

110

I.E.C. ACTIVITIES AT URBAN AREAS

ON THE OCCASION OF ANTI-LEPROSY DAY -31ST JANUARY SL.NO

DATAILS RATE COST

1

Broad casting of jingles on All India Radio

Rs.1000 X 7 days

7,000/-

2

Scrolling news spot in television (NAYUMA)

Rs.1000 X 7 days

7,000/-

3 News paper advertisement on leprosy topic. Rs.4500 X 3days 13,500/-

Total

27,500/-

HOARDING SL.NO

DETAILS RATE COST

1 Display of two hoardings matter related to sign & symptom of leprosy & its treatment (size 10’X10’) metal framed.

Rs.15,000 X 2nos.

30,000/-

Total

30,000/- I.P.C. MEETING SL.NO

DETAILS RATE COST

1 I.P.C. meeting with M.L.A.’s, conveners, teachers, Ex-Panchyats, Ex-Politicians etc.

a) Banner

Rs, 800

800/-

b) Tea & snacks

Rs. 50 X25 persons

1,250/-

c) Stationeries

Rs. 50 X25 persons

1,250/-

d) working lunch

Rs.150 X25 persons

3,750/-

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e) Meeting hall charges Rs.1200 1,200/-

f) Miscellaneous Rs. 2000

2,000/-

Total 10,250/-

HEALTH MELA SL.NO

DETAILS RATE COST

1 Health Mela: Opening of stall & display of banners, posters, folders, hand bills, lecturing leprosy topic etc.

Rs. 10,000/-

10,000/-

2 Screening for leprosy by hoarding, skin camp and distributing medicines and ointments

Rs.15,000/- 15,000/-

Total 25,000/- HEALTH CAMPS WITH B.C.C. SL.NO

DETAILS RATE COST

1 BCC and health camps at schools and Anganwadi centres

3,000/- X 12 36,000/-

112

CAPACITY BUILDING/TRAINING OF URBAN AREAS, (1) ESTIMATE FOR EXPENDITURE OF ONE DAY ORIENTATION TRAINING FOR MEDICAL OFFICERS OF S.T.N.M. HOSPITAL AND CENTRAL REFFERAL HOSPITAL,TADONG. SL.NO. PARTICULAR

COST

1 D.A. to trainees – 30 MOs X 250 7,500/- 2 T.A. to trainees – 15 MOs X 100 1,500/- 3 Honorarium to trainers 3 X 500 1,500- 4 Tea & snacks – 33 X 25 825/- 5 Working lunch - 33 X 150 4,950/-

6 Stationeries – 30 X 100 3,000/-

7 Training hall charges 500 500/- 8 Miscellaneous - 1500 1,500/-

Total

21,275/-

(2) 3 DAYS TRAINING FOR NEWLY APPOINTED MEDICAL OFFICERS OF S.T.N.M. HOSPITAL AND CENTRAL REFFARAL HOSPITAL, MANIPAL, TADONG

SL. NO.

PARTICULAR COST

1 D.A. to trainees – 20 MOs X 3 days X 250 15,000/-

2 T.A. to trainees – 10 MOs X 3days X 100 3,000/-

3 Honorarium to trainers – 3 X 3 days X 500 4,500/-

4 Tea & snacks – 23X 3 days X 25 1,725/- 5 Working lunch – 33 X 3 days X 150 14,850/- 6 Stationeries – 20 X 50 1,000/- 7 Training hall charges 500 X 3days 1,500/-

8 Miscellaneous – 1000/- 1,000/- Total 42,575/-

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(3) HALF DAY RE-ORIENTATION TRAINING OF ASHAs OF URBAN AREAS SL.NO PARTICULARS

COST

1 D.A. to trainees – 30 ASHAs X 100 3,000/- 2 T.A. to trainees – 30 X 100 3,000/- 3 Tea & snacks – 30 X 25 750/-

4 Working lunch – 33 X 150 4,950/-

5 Hon. to trainers – 3 X 300 900/- 6 Stationeries – 30 X 50 1,500/- 7 Training hall charge – 500 500/- 8 Misc. 1,000/-

Total 15,600/-

(4) WORKSHOP FOR SPECIALIST OF S.T.N.M. HOSPITAL AND GENERAL PRACTITIONERS. AND DOCTORS OF ARMY & GREF SL.NO PARTICULARS COST

1 Tea & snacks – 30 X 100 3,000/- 2 Working lunch – 30 X 500 15,000/- 3 Hon. to trainers – 3 X 1,000 (From outside Sikkim) 3,000/- 4 Stationeries – 30 X 150 4,500/- 5 Training hall charges – 2000/- 2,000/-

6 Misc. – 5,000/- 5,000/-

Total

32,500/-

114

(5) 3 DAYS TRAINING FOR NURSING STAFF & ANMs on DPMR

Sl.No Activity Amount

1 D.A to trainees: 30 X 3days X 200

18,000/-

2 Honorarium to trainers: 3 X 3 days X 500

4,500/-

3 Working lunch: 34 X 3 days X 150

15,300/-

4 Stationaries: 30 X 50

1,500/-

5 Miscellaneous 1,000/-

Total 40,300/-

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D.5 NIDDCP 1. Situational Analysis Sikkim lies in a severely iodine deficient region in the eastern Himalayas and constitutes a large number of people having different consequences of iodine deficiency. Presently the severity has come down to mild form. The important intervention measure adopted by the State was use of iodized salt. The sale of non-iodized salt was banned in the state of Sikkim under the provision of Food Adulteration Act 37 of 1954 since September 1985. The goal is to reduce the prevalence of IDD to <10% by 2012 and 100 % of household consume adequately iodised salt by 2012.

Prevalence of IDD in Sikkim Year of Survey Goiter (%) Cretinism (%) 1982 (ICMR) 56.6 - 1989-91 (State) 54.03 3.46 1998-99 16.08 1.8 2006-07 14.17 Cretin free state since

2003-04 2009-10 13.37 2. Main Objectives ;- 2.1. To reduce prevalence of IDD from 13.37% to < 10% by 2012. 2.2. To increase percentage of households consuming adequately iodized salt from 78.3% (NFHS-3) to 80% by 2012. 2.3. Periodic IDD Survey after every 5 years to assess the impact of use of iodized Salt taking goiter as indicators 3. Strategies/ Interventions & Activities 1. All health functionaries including ASHAS & AWWS trained for spot testing of salt samples at the households levels during VHN days and reporting on monthly basis 2. Continue extensive IEC activities through Publicity & Health Education for community awareness during Village Health and Nutrition Days 3. Capacity building of salt retailers & PRIs at various levels through Convergence. 5. Development of IEC materials highlighting the proper method of storage.

116

6. Continue monitor quality of iodated salt at both household and retailers level. 7. To continue with salt sample analysis and Urinary Iodine Excretion Estimation for quality control. 4. Physical progress 1.Salt Sample analysis Consumer and Retailers (Grand Total) state report

Year Consumers and Retailers Total Remarks (%) >15 ppm <15 ppm

2005- 06 1675 245 1920 87.23 2006- 07 2412 238 2650 91.0 2007- 08 2205 225 2430 90.7 2008- 09 2233 167 2400 93 2009- 10 1824 76 1900 96 2010- 11 1752 48 1800 97.3 ( end 3rd qtr) The percentage of households consuming adequately iodized salt and at retailers as per sample analysis report from monitoring laboratories is 97.3% for 2010 -11. 2.Salt Sample testing report with use of STK by ASHA during VHND:

With the receipt of Spot Test Kit (STK) from GoI the ASHA from all the districts and Urban were

trained for testing of household salt sample during Village Health and Nutrition Days (VHND). The

salt testing by the ASHA started since October 2009. A total of 20 samples are being tested by

ASHA with STK during VHND. Reports are being forwarded to IDD Cell through DRCHO/DPM

which is further forwarded to GoI on quarterly basis

Details of Salt sample testing by ASHAs using Spot testing kit 2009-10

District/No of ASHA

1st Qtr 2nd Qtr 3rd Qtr

4th Qtr Total

Iodine Iodine Iodine Iodine Iodine Yes No Yes No Yes No Yes No Yes No

East/202 - - 1150 10 1126

nil 1200 15 3476 25

West/205 - - - - 1000

25 - - 1000 25

North/81 - - 101 - 285 04 282 04 654 14

117

South/153 - - 1375 01 2870

01 1757 01 6002 03

Details of Salt sample testing by ASHAs using Spot testing kit 2010-11

District/No of ASHA/666

1st Qtr 2nd Qtr 3rd Qtr

4th Qtr Total

Iodine Iodine Iodine Iodine Iodine Yes N

o Yes No Yes No Yes No Yes No

East/202 4015 24 3662 22 1677 5 9354 51 West/205 3849 61 3802 50 6648 64 14299 175 North/81 247 nil 876 1 660 1 1783 2 South/153 3545 8 3275 13 3316 12 10136 33 Total 11656 93 11615 86 12301 82 35572 261

3. UIE estimation report 2009-10

With establishment of IDD Monitoring laboratory and after the training of TO at NICD,New Delhi

the UIE estimation has been taken up since April’ 2010 and forwarded to GoI on monthly basis.

Details of UIE estimation report 2010-11

Method of Testing - Digestion Method (Sandell-Kolthoff) using Perchloric Acid:

Median Value µ/dl From April 2010 till

December’10

Remark

0.0 – 5.0 99

A total of 100 sample is

being collected and

analysed 9 April – 80

samples)

5.0 – 10.0 395

10.0 – 15.0 294

15.0 – 20.0 63

20.0 to 25.0 9

>= 300 Nil

118

Total 860

4.Health education and Publicity: Publicity and Health education is being carried out with an objective to generate awareness among general population regarding consequences of iodine deficiency disorders and to educate the general masses on improving storage of iodized salt and to promote the consumption of iodated salt. A week long Global IDD Prevention Day starting on 21st October is celebrated every year. This day is celebrated to create awareness about the importance of regular consumption of iodized salt in prevention of Iodine Deficiency Disorders. In addition to Global IDD Prevention Day Celebration, Orientation Training Camp Programme is conducted for all the health functionaries by the cell. Details of No. Of OTC held Year No. Of OTC Held No. of Health Functionaries trained. M.O H.W Others

ASHA/AWW 2005-06 4 11 60 2006-2007 18 39 554 2007-2008 9 12 141 2008-2009/ 2009-2010

29 - - 605 / 85

2010- 11 6 30

90

Being conducted ( 4 conducted)

Details of Global Iodine Deficiency Disorder Prevention Day Year Total No of Post Place of Celebration

2005-06 5 Posts 1 HQ & 4 districts 2006-07 18 Posts 2 HQ, 4 districts & 12 PHCs 2007-08 18 Posts 2 HQ, 4 districts & 12 PHCs 2008-2009 30 Posts 2 HQ, 4 district & 24 PHC 2009-2010 54 Posts 2 HQ, 4 district, 24 PHCs & 24 PHSCs 2010 - 11 58 Posts 2 HQ, 4 district, 26 PHCs & 26 PHSCs ( all

Conducted)

119

5. Surveys and resurvey: The last survey was conducted in the year 2006-07 where in the prevalence of goiter was fopund to

be 14.17% and the resurvey was carried out during 2009-10 in all the four districts. Where in the

prevalence of goiter is found to be 13.37%.

A district is said to be endemic if the goitre rate is above 5% in children of age group 6 to 12 years

surveyed. Therefore this means that the state as a whole is still endemic for IDD.

6.Implementation of PWD Act under NIDDCP

A survey of children with Mental Retardation less than five years was carried out in the south district

under the PWD – Act 95 as a special project in 1006-07 from GoI.

The prevalence of MR in south district of Sikkim was found to be 0.34% (<1%).

A similar project is being carried out in East district (100% State funded). The survey is in its second

phase. A total of 30,000 children less than five years were screened for mental retardation. The

second phase of assessment of children with suspected MR is in process.

Financial Progress. 2009-10/2010-11

Year 1st Qtr

2nd Qtr

3rd Qtr

4th Qtr Proposed/Approved PIP/ROP

Fund released

Unspent 0f the previous year

Total fund

Expenditure

2008-09

2.27 2.49 5.85 17.79 40.00 39.83 .17 40.00 28.40

2009-10

4.30 2.65 7.73 3.75 38.00 10.30 11.60 21.90 18.43

2010-11

3.25 2.96 8.41 16.00 ( Committed Expenditure)

38.00 34.53 03.47 38.00 14.62 (till 3rd Qtr)

2011 -12

- - - - 38.00 - 7.38 - -

Physical and Financial Target for 20011-12 S. Sections Activities Timeframe Total

120

No 1 IDD Cell

State Headquarters

Salary (TO,SA,LDC)

1st qtr 2nd qtr 3rd qtr 4th qtr 6.80

1.70 1.70 1.70 1.70

O.E. Cont./Stat.

.30 .30 .30 .30 1.20

Total

7.00

2. IDD Monitoring Laboratory Gangtok

Salary Lab.Tech. & Lab. Assistant

.75 .75 .75 .75 3.00

Reagents and chemicals

1.00 1.00

Total 4.00

3 Publicity & Health Education

Trainings of health workers ( 2State/4 Districts) @ 25000/- /30 per batch

0.50

0.25

0.50

0..25

1.50

Workshop/Advocacy ( State/4 districts @ 50000/-)

1.00 0.50 0.50 0.50 2.50

Making of Hanging Flex Posters with IDD message & development of IEC material

2.3 2.3

Global IDD Prevention Day

6.0

6.0

Awareness camp during VHNDs @2000 for 660VHNDs

3.30 3.30 3.30 3.30 13.20

Making pf ASHA diary with IEC message

1.00 1.00

Total

26.50

4 Resurvey

- -

- - .50

Total 38.00 (Rupees thirty eight lakhs )only

121

D.6 IDSP BACKGROUND: The Government of India has launched a decentralized State based integrated disease surveillance project (IDSP) in the country in the phased manner. This project would be able detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner. It is also expected to provide essential data to monitor progress of on going disease control programs and helps allocate health resources. Sikkim is included during the III phase of the project i.e. in 2006. OBJECTIVE

* To establish a decentralized State based system of surveillance for communicable and non-communicable disease, so that timely and effectively public health action can be initiated in response to health challenges in the country at the State and national level.

* To improve the efficiency of the existing surveillance activities of disease Control program and facilities sharing of relevant information with the health administration, community and other stakeholders so as to detect disease trends over time and evaluate control strategies. COMPONENTS (1) To establish and to operate a state level disease surveillance unite: Under this project the state has to establish a new disease surveillance unit at the State level to help co-ordinate and decentralize disease surveillance activities. The new unit will support and complement the state disease surveillance efforts. Integrate and strengthen disease surveillance at the state and district level: This components address the constraints having imposed by lack of coordination at the sub-national level, the limited use of modern technology and data management techniques the inability of the system to act an information and the need for inclusion of other stakeholder. It will integrate and strengthen disease surveillance at the state and district and district levels, and involve communities and other stakeholder in Particular, the Private sector. IMPROVE LABORATORY SUPPORT This components will consists of – (a) Upgrading laboratories at the state level, in order to improve laboratory support for

surveillance activities. Adequate laboratory support is essential and reliable confirmation of suspected cases, monitoring drug resistance and monitoring changes in disease agents.

(b) Introduction a quality assurance system for assessing and improving the quality of laboratory data. TRAINING FOR DISEASE SURVEILLANCE AND ACTION- The changes envisaged under the components will require a large and co-ordinate training effort to reorient health staff to and integrated surveillance system and provide the new skills needed. Training program will include represent active from the private sector, NGOs and community groups. MAJOR ACTIVITIES

(i) It will monitor a limited number of conditions based on state perception including 13 cores and

5 state priority conditions for which public health response is available.

122

(ii) District, State and Central surveillance unite will be set-up so that the programme is able to

respond in a Timely manner to surveillance challenges in the country including emerging

epidemics.

(iii) It will integrate surveillance activities in the country under various programme and use existing

infrastructure for its function.

(iv) Private Practitioners/ Private Hospitals/ Private Laboratories will be inducted into the program

as sentinel unites.

(v) Active participation of medical colleges in the surveillance activities.

(vi) The project will ensure uniform high quality surveillance activities at all level by:

I. Reducing overload at the periphery, by limiting the total nos of disease under surveillance.

II. Developing standard case definitions.

III. Developing formats for reporting.

IV. Developing user friendly manuals

V. Providing training to all essential personnel, and

VI. Setting a system of regular feedback to the participants on the quality of surveillance activity.

(vii) District public Health Laboratory will be strengthening to enhance capacity for diagnosis and

investigation of epidemics and confirmation of disease condition.

(viii) Use of information technology for communication, data entry, analysis, reporting feedback

and action. A national level surveillance network will be established up to the district

level.

DISEASE CONDITION UNDER THE SURVEILLANCE PROGRAMME-

1) REGULAR SURVEILLANCE- Vector Borne Disease (1) Malaria Water Borne disease (2) Acute diarrheal Disease. (Cholera) (3) Typhoid Respiratory Disease (4) Tuberculosis Vaccine Preventable Disease (5) Measles Disease under eradication (6) Polio Other conditions (7) Road Traffic Accidents (Link up with police computer) Other international commitment (8) Plague

123

Usual clinical syndrome (9) Menigoencephalitis/ Respiratory Undiagnosed condition SENTINEL SURVEILLANCE- Sexually transmitted disease/ Blood borne other (10) HIV/HBV, HCV Condition (11) Water quality

(12) Outdoor air quality (large urban area)

REGULAR PERIODIC SURVEY- NCD Risk factors (13) Anthropometry, Physical Activity,

Blood Pressure, tobacco, Nutrition Blindness.

Additional state Priorities- Each state may identify up to five additional conditions for surveillance. The following four disease have been identified for which surveillance will be initiated- (1) Acute Respiratory disease (Pneumonia) (2) Scrub Typhus (3) Diabetes Mellitus (4) Alcoholic Liver Disease (5) Cardio Vascular Disease JUSTIFICATION FOR SELECTION OF STATE SPECIFIC DISEASES- Acute Respiratory Diseases (Pneumonia)/ Community acquired Pneumonia-) community acquired Pneumonia- Infection of respiratory tract are most common condition, they are a substantial cause of mortality and morbidity among young children and the elderly. State has also been facing with the problem affecting all age groups. Disease Outbreaks detected in the state of Sikkim from 2008 to 2010.

Disease Outbreaks detected 2008-09

Source of data for identification of these outbreaks

Outbreaks investigated by State /District RRT

Remarks

Focal Outbreak Measles detected in June 2008

Reported by health worker STNM Hospital Gangtok

State RRT Report from NICD Delhi 24 may out of 11 samples 9 (+ve) for measles Outbreak controlled

Focal Outbreak Measles detected in August 2008

Reporting by MO Phodong PHC North District and DSU North

District RRT West Controlled in time

Focal Outbreak Measles detected in Sept 2008

Reporting by MO Phodong PHC North District and DSU North

District RRT North & MO PHC in coordination with State RRT

Report from NICD Delhi 6th oct out of 9 samples 7(+ve) for measles Outbreak under control.

Fever cases with Generalized Debility (Sept) ’08.

Reported from Namchi and STNM by Health Staff.

Blood Sample sent to NICD Delhi on 26th Sept for confirmation of Diagnosis.

Out of sample sent to NICD Delhi 8 came + for Scrub Typhus. Fever under control.

Focal outbreak measles detected in Oct 2008

Reported by MO Dikchu PHC East Sikkim

MO PHC and District RRT / State RRT

Controlled in time

124

Filarial Survey done by NICD Delhi Oct 08

NICD Delhi / NVBDCP Routine Survey Out of 3428 serums samples 44+ve for Micro filarial

Avian influenza outbreak in month Jan 2009

Animal Husbandry and Dept District RRT

Animal Husbandry Dept Central /State and District RRT

Poultry death recorded. No human came detected although controlled in time

Fever with Hepatosplenonegaly.

STNM Hospital 13 samples sent to NCDC New Delhi on 7th September to rule out scrub typhus.

10 positive for scrub typhus.

Focal outbreak of measles detected in 2010

Reported by MO Mangalbaria West Sikkim

MO PHC and District RRT and CMO West

Controlled in Time.

SCRUB TYPES: Since last few years there is a reported case of fever with rashes and multiple systemic involvements from all four districts of the state, with high mortality and morbidity. All the hematological and biochemical test were found negative. 13 samples were sent in September 2009 out of which 10 came positive for Scrub typhus from STNMH. Cases of scrub typhus are uncommon in the sate.

125

Work plan

Strategy / Activity

Timeline

Responsibility

2010-11

2011-12

Infrastructure 1.1.1 Development of District Labs

State

Capacity Building and MIS 1.1.2 Two days training newly appointed MOs, one day training for medical supervisor, DM/DEO/ASHA, orientation for MOS.

State

Supply and MIS 1.1.3 Supply adequate reagents and

equipments for district priority Laboratory

State

1.1.4 Stock register updation District 1.1.5 Publishing state performance report State Maintenance and MIS 1.1.6 Maintenance of all laboratory

equipments and updating of registers

District

Surveillance of core disease 1.1.7 Regular and effective surveillance

of following core diseases:

• Vector borne disease – Malaria, Kala-Azar

• Water borne disease – Cholera, Typhoid

• Respiratory disease – TB, ARI

• VPD – Measles

• Disease under eradication – Polio

District/State/ PHC

Sentinel Surveillance & regular surveys

126

1.1.8 Effective Sentinel and Active Surveillance of following:

• RTI/STD/Blood borne –

State/District/ PHC

Strategy / Activity

Timeline

Responsibility

2010-11

2011-12

HIV/HBV/HCV

• Other conditions – water quality, Outdoor air quality (Mangan town area), road traffic accidents

• Regular periodic surveys of district specific diseases – ARI, Scrub Typhus, DM, Alcoholic liver diseases etc

Convergence and Surveillance 1.1.9 Symptomatic identification of

diseases covered under IDSP and refer ton nearest health facility

District

1.1.10 Symptomatic detection of TB cases by ANMs, AWWs, ASHAs, PRIs and refer to nearest DOTS

District

1.1.11 Response action initiated by medical officers of PHCs

District/PHC

1.1.12 District and state surveillance units to follow up the response taken by Medical officers of PHCs

District

BCC 1.1.13 Awareness development at

Community l e v e l r e g a r d i n g s i g n s and symptoms of reportable diseases for early detection, isolation, seeking treatment.

District

1.1.14 Developing and dissemination of IEC material, including leaflets and

District

Strategy / Activity

Timeline

Responsibility

2010-11

2011-12

posters 1.1.15 IPC through convergent approach District 1.1.16 Surveillance meeting at State and

District Level

State/District

1.1.17 State to develop IEC/BCC materials and distributed to district

State

1.1.18 Recruitment of contractual staffs, epidemiologist Microbiologist, entomologist, lab tech. lab assistant, lab attendant, cleaner.

State

1.1.19 Office equipment like purchase of fax in all PHCs, computer, etc

State

1.1.20 Out break investigation and response, like ASHA incentive, consumables for district labs, collection and transportation etc

State

1.1.21 Analysis and usage of data like IDSP report including forms, printing of reporting forms, computers maintenance etc

State

JUSTIFICATION FOR BUDGET PROPOSAL FOR 2011-12 1. Contractual services a. One epidemiologist and one entomologist will be appointed at the state surveillance unit

and one microbiologist at the district hospital Mangan, north Sikkim.

Proposal for increase in the salary of Financial Consultant, Data Manager, Data Entry Operator as per the NRHM norms:

1-2 years – 10% 2-3 years- 20% 3 year & above – 30% on existing salary.

The staffs i.e. Financial Consultant, Data Manager, Data Entry Operator, have served the IDSP state and district for more than three years and hence the increment of salary @30% on existing salary is proposed.

b. Honorarium for account work at DSU: As there is no accountant at the district surveillance office, the account works are mainly done by the data managers and district programmes manager NRHM.

2. Manpower The administrative work load is increasing in the state surveillance office, appointment of office assistant from the NRHM additionalities is proposed.

3. Operational cost For the effective functioning of surveillance unit following operational expenditure incurred specially for implementing the project. a) Office expenses including stationeries, office consumables items, telephone, electricity. b) Operation and maintenance of equipment purchased under the project. c) Operation and maintenance of facilities renovated under the project. d) Expenditure on maintenance of hardware, e) Domestic travel cost and per diem as per state rates.

4. Office equipment To improve the efficiency of the existing surveillance activities of disease control program and facilities sharing information with the health Administrative community and other stake holders so as to detect disease trend overtime and evaluate control strategies. For timely reporting from the primary health centre, sub centre installation of FAX machine at the primary health centers is proposed Purchase of computer at state surveillance unit: state surveillance unit needs and more computer as the work load at the SSU has increased and one more computer will help to do work more efficiently.

5. Capacity Building Two days training is proposed for the medical officers who will be appointed during the years 2011-12 and those untrained under IDSP during 2010-11, orientation training for the already trained Medical Officers PHC/district, Medical Supervision, Data Manager, Data entry Operator (IDSP) and one day sensitization workshop for the ASHAs are proposed.

6. IEC During disease outbreaks, epidemic in the district and state, awareness, printing of pamphlets and hoarding with advertisement in media, TV, Radio , etc are required hence the budget under IEC for district and state is proposed.

7. Outbreak investigation and Response. ASHA who works at the grass root level are the informers of the outbreaks at the block level. Hence fund for collection and transport of samples for ASHA are proposed. Consumables for district laboratories and collection and transport of samples during outbreak at the district, PHC, sub centre, State level are proposed.

8. Analysis and usage of data. Reports are collected in reporting formats from the sub centre, primary health centre and the district surveillance unit. Forms like S- Form, P-form, L-forms needs to be printed in order to distribute it to the reporting centers, i.e. sub centers and PHC of the state. Broad band are connected in the district surveillance unit and state surveillance unit. Bills are paid monthly for the same. Budget proposed for computer maintenances, data centre (computer set, printer, laser, jet scanner, ups) for the state, district and medical college.

9. Development of district lab: Upgradion of laboratories is one of important component of IDSP. Two district laboratories are proposed for up gradation for FY 2011-12 as per the instruction of GOI

a. District laboratory east Singtam hospital in phase I

b. District laboratory south, Namchi hospital in phase 1

Budget proposed as per the instruction by the GOI. 10. Staff salary (recruitment)

Lab technician, lab assistant, lab attendant and cleaner proposed as per the requirement in the district laboratories east and south district of Sikkim

Training Plan for 2011-12

Activities Training Load

Budget Breakup

1st Qtr

2nd Qtr

3rd qtr

4th qtr

Newly Appointed MO 30 30@1667=50000 1batch MO Orientation 80 80@1012=81000 2batch 2batch Medical Supervisory 40 40@1125=45000 2batch

Asha 637 637@624=398000 13 batch

DM/ DEO(IDSP) 11 11@1090=12000 1batch Total 798 Rs. 5.86 lac

Financial Status for the year 2005-06 to 2010-11(Till Dec 2010) Under IDSP

Year Approved Outlay

Opening Balance

Fund Received Total Fund Available col (3+6)

Expenditure Unspent Balance

Central State Total Col 4+5

1 2 3 4 5 6 7 8 9 2005-06 12.80 0.00 12.80 12.80 3.16 9.64 2006-07 9.64 30.00 0.00 30.00 39.64 6.59 33.05 2007-08 43.00 33.05 20.00 0.00 20.00 53.05 14.71 38.34 2008-09 22.93 38.34 0.00 0.00 0.00 38.34 30.92 7.42 2009-10 27.82 7.42 20.40 3.98 24.38 31.80 20.87 10.93 2010-11 48.42 10.93 13.00 0.00 13.00 23.93 14.93 9.00

Physical and Financial Achievement

Integrated Disease Surveillance Project Sikkim State Budget Proposal for 2011-12

S.No Activities & Expenditure State (H.Q)

East District

West District

North District

South District

Total

1 Contractual Services:

Epidemiologist @Rs.30000/- pm for 12 months 3.60 0.00 0.00 0.00 0.00 3.60

Microbiologist @Rs 20000/- pm for 12 month 2.40 0.00 2.40 0.00 0.00 4.80

Entomologist @Rs 20000/- Pm for 12 months 0.00 2.40 0.00 0.00 0.00 2.40

Financial Consultant @Rs 18200/- PM for 12 months(30% increase)

2.18 0.00 0.00 0.00 0.00 2.18

Data Manager @Rs18200/- PM(State), 17550/- PM for 12 months (30% increase)

2.18 2.11 2.11 2.11 2.11 10.62

DEO @Rs.11050/- pm for 12 months (30% increase)

2.65 1.33 1.33 1.33 1.33 7.97

Honorarium for accounts work @Rs.1,000/- per month for 12 months for 4 Districts

0.00 0.12 0.12 0.12 0.12 0.48

Sub Total 13.01 5.96 5.96 3.56 3.56 32.05 2 Man Power ** Recruitment of Office Assistant@ 7000.PM 0.84 0.00 0.00 0.00 0.00 0.84

Sub Total 0.84 0.00 0.00 0.00 0.00 0.84 3 Operational Cost

Office Expenses @6000/- PM (State), @3000/-Pm 0.72 0.36 0.36 0.36 0.36 2.16

Physical Achievement 2010-11 Sl No Budget Heads 1st qtr 2nd qtr 3rd qtr 4th qtr

1 Appointment of Contractual staff

Process of Recruitment of Man power

Recruitment completed of DM/DEO

Recruitment completed of DM/DEO and Entomologist

process for recruitment of epidemiologist and microbiologist

2 Training Nil Training for DM and DEO and Training of hospital pharmacist

One batch of Training for MOS completed.

Second batch in process

3 Operational cost

NIL procurement of stationeries done

4 Outbreak investigation and response

Nil NIL

5 Analysis and use of data

Printing of Report forms

Connection of Broadband

Financial Achievement Sl No Budget Heads 1st qtr 2nd qtr 3rd qtr 4th qtr

3 Contractual staff salary

1.15 5.39 4.83

4 Training cost 0.00 0.00 1.10

6 Operational cost

0.45 0.69 0.64

7 Outbreak investigation and response

0.00 0.00 0.00

8 Analysis and use of data

0.00 0.39 0.29

Total 1.60 6.47 6.86

(District)

Mobility support @1000 per visit x 4 visit per month per district for SSU and @800 per visit x 2 visit per month for 4 districts

1.92 0.19 0.19 0.19 0.19 2.68

Prepaid Voucher @500/- PM(for SSO) 0.06 0.00 0.00 0.00 0.00 0.00

Sub Total 2.70 0.55 0.55 0.55 0.55 4.84 4 Office Equipment Purchase of Fax Machine 0.12 0.96 0.84 0.36 0.72 3.00

Purchase of Computer 0.50 0.00 0.00 0.00 0.00 0.50

Sub Total 0.62 0.96 0.84 0.36 0.72 3.50 5 Capacity Building: 2 days training for Newly Appointed Mos 0.50 0.00 0.00 0.00 0.00 0.50

1 days training for Medical supervisor 0.45 0.00 0.00 0.00 0.00 0.45

1 days Orientation training for MOs 0.81 0.00 0.00 0.00 0.00 0.81

1 days training for DM/ DEO (IDSP) 0.12 0.00 0.00 0.00 0.00 0.12

1 day Training for ASHA 0.72 1.14 0.80 0.50 0.82 3.98

Sub Total 2.60 1.14 0.80 0.50 0.82 5.86 6 IEC

Printing of Pamphlets and Hoardings, Media Advertising

2.00 1.10 1.10 1.10 1.10 6.40

Sub Total 2.00 1.10 1.10 1.10 1.10 6.40 7 Outbreak Investigation and Response Asha Incentive for outbreak Reporting 0.48 0.00 0.00 0.00 0.00 0.48

Consumable for Peripheral Labs 0.00 0.80 0.40 0.40 0.80 2.40

Collection and Transportation of Samples 0.24 0.00 0.00 0.00 0.00 0.24

Sub Total 0.72 0.80 0.40 0.40 0.80 3.12 8 Analysis and usage of Data IDSP Reports including forms 0.30 0.00 0.00 0.00 0.00 0.30

Printing of reporting forms 0.50 0.00 0.00 0.00 0.00 0.50

Broadband expenses 0.24 0.12 0.12 0.12 0.12 0.72

Computer Maintenance Data Center(Computer Set, Printer LaserJet, Scanner, UPS)

0.20 0.10 0.10 0.10 0.10 0.60

Sub Total 1.24 0.22 0.22 0.22 0.22 2.12 9. a Development of District Labs***

Purchase of Equipments 0.00 17.90 0.00 0.00 17.90 35.80

Purchase of Kits 0.00 3.48 0.00 0.00 3.48 6.96

Contingencies 0.00 0.45 0.00 0.00 0.45 0.90

Sub Total 0.00 21.83 0.00 0.00 21.83 43.66 9. b Staff Salary(Recruitment)

Microbiologist 0.00 0.00 0.00 0.00 0.00 0.00

Lab Technicians 0.00 4.32 0.00 0.00 4.32 8.64

Lab Assistants 0.00 1.20 0.00 0.00 1.20 2.40

Lab Attendants 0.00 0.84 0.00 0.00 0.84 1.68

Cleaner 0.00 0.72 0.00 0.00 0.72 1.44

Sub Total 0.00 7.08 0.00 0.00 7.08 14.16 Grand Total 23.73 39.64 9.57 6.52 36.68 116.55

NOTE: *** DEVELOPMENT OF DISTRICT LAB IS PROPOSED FOR THE EAST AND SOUTH IN THE 1ST PHASE FOR FY 2011-12

D.7 NTCP

TOBACCO CONTROL PROGRAMME

INTRODUCTION

Sikkim was one of the few States to have passed the “Sikkim Prohibition of Smoking and Non-Smokers’ Health Protection ACT” in 1997, along with Union Territory of Delhi. Awareness campaigns and No Smoking Signage’s were initiated in some places like Government offices.

However, as per the study done, the scenario in August 2007 was a lot different than what is seen today. People were seen

smoking everywhere; no signages could be seen in the public places and workplaces. Direct observation of smoking at peak activity times, aids for smoking such as ashtrays, matchboxes was plethora. No clear Enforcement and reporting mechanism was available. Smoking was socially acceptable and many did not take any heed to this act. Media and civil society support was not there since “smoking in public places” were not seen as a crime as it is now but gradually things changed as enforcement of COTPA was made strict.

Nevertheless, Sikkim still falls in the high prevalence zone. For this we need to adopt

comprehensive strategies and activities in order to maintain the status of SMOKE FREE Sikkim and Smoke Free in Tobacco Control is very small component. Sikkim is working towards effective implementation of all aspects of Tobacco Control Act of India and also towards comprehensive Tobacco Control. At present only two districts (East and South) is included under District Tobacco Control Programme. However, activities are being undertaken in all four districts. Support for State Tobacco Control Cell and two more Districts (North and West) are required. The State Government is working towards a model for Tobacco Control in India.

ENFORCEMENT OF COTPA

Under the Cigarettes and Other Tobacco Products Act, the following enforcement measures have been adopted: Smoking in public places is fully enforced. The signages are placed in all public places. Anyone found smoking is fined by a notified officer, including the

personin charge of the premises. Compliance of Tobacco Free laws made strict. Conduction of Awareness programme from the grass root level. School Programs are conducted whereby awareness about harmful

effects of tobacco use is given to the students and the faculties. Special emphasis is given to the Ban of Tobacco sale in and around 100 yards of the

school premises. No smoking aids are visible in any public place. Conducting of raids throughout the state. Conducting of quarterly Review Meeting of all the nodal officers of various

departments and various institutions. Such activities are being carried out throughout the state in order to protect and promote healthy lifestyle and to maintain the status of Smoke Free in Sikkim.

COMPLIANCE MONITORING

To assess and measure whether public places conform to smoke free laws. This was done by observing: presence of signage in public places; whether any smoking was taking place during peak activity time of a public place; if there were any cigarette butts or bidi ends as litter or strewn on the ground; if a public place (offices, hotels, rest houses, foyers, lobbies and entrances of buildings etc..) provided any smoking aids like ashtrays and matchboxes etc. Using scientific survey methods, in 1056 public places, premises and buildings, in all four districts of Sikkim, were observed over a period of 10 days in Sikkim. All districts and city of Gangtok were surveyed. The study was conducted under the supervision of Mr. C. Khewa, Deputy Director, Planning, Monitoring and Evaluation wing, Department of Health, Government of Sikkim, with technical and financial support from the International Union against Tuberculosis and Lung Disease. Simple randomised sampling was used to observe public places like offices, rest houses, shops, bus stops, taxi stands, prominent roads and footpaths and other public places. And as a result following observations were made:

OVERALL GRAPHICAL REPRESENTATION OF COMPLIANCE IN THE STATE

92%

94%

96%

98%

100%

PERCENTAGE OF COMPLIANCE IN STATE SIKKIM

COMPLIANCE OF SMOKE FREE LAWS IN STATE SIKKIM

Signage

Absence of aids for smoking

No Smoking at peak activity times

Enforcement & Clear Reporting Mechanism

Media & Civil Support

Public Opinion in support of smoke - free Public Place

Public Places in Sikkim are smoke free 98% of public places observed did not have active smoking. Prominent Smoke free signage’s to inform the public 95% of all public place observed had prominent signage warning against public smoking and

informing public of their rights and Smoke Free act. Absence of Smoking aids Over 97% of public places have no smoking aids Absence of cigarette butts and bidi stubs 98% of public places observed did not have cigarette buds and bidi stubs. It was found that 95% of public places were complying with the Cigarette & Other Tobacco Products Act (COTPA).

BEST PRACTICES OF TOBACCO CONTROL IN SIKKIM

• Total Ban of smoking in all indoor public places. • Total Ban of smoking even in the roads in towns and Rural Marketing Centres where people

gather. • Visibility of people smoking in public places in peak activity time is not there. • No point of sale advertisement is seen. • Visibility of all tobacco products are not there. • Sale of Gutka is banned.

DECLARATION OF SMOKE FREE SIKKIM.

As per the study, the observations validated that

STATE No. Percentage Signage 1003 95% Absence of aids for smoking 1024 97% No Smoking at peak activity times 1035 98% Enforcement & Clear Reporting Mechanism 1035 98% Media & Civil Support 1014 96% Public Opinion in support of smoke - free Public Place 1056 100%

Sikkim qualified as a smoke free State which is first state in India. Following this, the decision to make Sikkim Smoke Free State was taken by the Government. On 31st May 2010, on the occasion of World No Tobacco Day, Sikkim was declared Smoke Free by Shri. D. N Tharkapa, Hon’ble Health Minister of Sikkim. The programme attendant constituted of various Senior Officers from Health Department of Sikkim and other Departments including the Police Department, NGOs, representatives from various educational institutions and the press. Certificates were distributed by the Hon’ble Health Minister and Director General Health Service to those people who have contributed in making Smoke free through their dedication.

ACTIVITIES BEING UNDERTAKEN FOR COMPREHENSIVE TOBACCO CONTROL

Compliance Monitoring of Tobacco Control in all four districts. Massive awareness campaign specially focuses for Tobacco or in routine other

activities. Compliant reporting System. Monthly reporting system whereby reports are submitted by the PHC to the

Districts and then the report is submitted to the State Nodal Officers who then forwards the report to the Central Government.

For better awareness about the Tobacco Laws and Harmful effects of Tobacco use, the Tobacco Control Programme has been incorporated with the Chief Minister’s Comprehensive Annual & Total Check up for Healthy Sikkim (CATCH) to bring about Comprehensive Tobacco Control at the grass root level.

Trainings have been provided to some of the Panchayat, Health workers and teachers. More of such training has to be provided.

Continuous enforcement. Continue to work for more comprehensive tobacco control which has been the

demand of civil society.

BUDGET FOR 2010- 11

NATIONAL TOBACCO CONTROL PROGRAMME 2010-2011 STATE TOBACCO CELL

SL.No COMPONENTS CALCULATION INR MONTHS SUB TOTAL

I. Salaries

1. Consultant : Rs. 20000/- 20000 12 240000 2. Data Entry Officer : Rs. 6500/- 6500 12 78000

II. Training 100000 100000

III. IEC Activity 300,000.00 300,000.00

V. Monitoring of Tobacco Control Laws & Reporting

300,000.00 300,000.00

VI. Equipment (One Time Grant ) 100,000.00 100,000.00 TOTAL 1118000

DISTRICT TOBACCO CONTROL PROGRAMME 2010-2011

NORTH DISTRICT TOBACCO CELL SL.No COMPONENTS CALCULATION

INR MONTHS SUB TOTAL

I. Salaries 1. Psychologist : Rs. 10,000/- 10000 12 120000 2. Social Worker : Rs. 8000/- 8000 12 96000 3. Data Entry Officer : Rs. 6000/- 6000 12 72000

II. Training 200000 III. IEC Activity 300,000.00 300,000 IV.

School Activity 600,000.00 600,000


150,000.00 150,000

VI. Equipment (One Time Grant ) 60,000

TOTAL 1598000

DISTRICT TOBACCO CONTROL PROGRAMME 2010-2011 WEST DISTRICT TOBACCO CELL

SL.No COMPONENTS CALCULATION

INR MONTHS SUB TOTAL

I. Salaries 1. Psychologist : Rs. 10,000/- 10000 12 120000 2. Social Worker : Rs. 8000/- 8000 12 96000

3. Data Entry Officer : Rs. 6000/- 6000 12 72000

II. Training 200000 III. IEC Activity 300,000.00 300,000 IV.

School Activity 600,000.00 600,000


150,000.00 150,000

VI. Equipment (One Time Grant ) 60,000

TOTAL 1598000

Budget Proposed State Tobacco cell-1118000/- North District Tobacco cell- 1598000/- West District Tobacco Cell-1598000/- Total - 4314000/-

TRAINING LOAD AND DETAILS OF TRAINING FOR NATIONAL TOBACCO

CONTROL PROGRAMME

Details No Per Unit

DA TA 500 300 1 150000

Food 500 200 1 100000

Resource 500 250 1 125000

Hall 1500 20 30000

Honorarium 500 20 5 50000

Contingencies 45000

500000

PARTICIPANTS: DESIGNATION NO.

STATE

PROGRAMME OFFICERS OF STATE & DISTRICT 30

MO OF STNM DISTRICT 30

SUPERVISOR PARA MEDICAL PERSONNEL 15

PARA MEDICAL & NURSING PERSONNEL 40

115

NORTH DISTRICT

PROGRAMME OFFICERS OF DISTRICT 10

MO OF DISTRICTS, PHCs 30

SUPERVISORY PARA MEDICAL PERSONNEL 15


135

WEST DISTRICT

PROGRAMME OFFICERS OF DISTRICT 15

MO OF DISTRICTS, PHCs 25

SUPERVISORY PARA MEDICAL PERSONNEL 30

PARA MEDICAL & NURISING PERSONNEL 180

250

D.8 NMHP MENTAL HEALTH PROGRAMME IN SIKKIM INTRODUCTION Sikkim is hilly Northeastern State with population of approximately seven lakhs. It has four districts. Health Services is provided by one state referral hospital, four District Hospitals, 24 PHCs, and 147 Sub Centers. Three hundred bedded State Referral Hospital has all specialties including 20 bedded psychiatric Department manned by Director cum Medical Superintendent who is also Head of the Institute, three other Psychiatrist, Psychologists, Psychiatrist Nurses and other staffs. It also has 100-150 bedded four District hospitals and one of them has Psychiatrist. The two Community Health Centers, 10 bedded 24 Primary Health Centers and 147 Sub Centers provides very good primary health Care in the state which is one of the best in India. State has one private Medical College which also has psychiatric Department. Sikkim has seen dramatic changes in social and educational field and she brings laurels as the best performing State in the country in several areas. However, Suicide is one of the major public health problems in Sikkim and the State has been facing the dramatic rise in suicide cases especially in the last decade. Very High Suicide rate indicates serious Mental Health problems. As the District mental health programme was not efficiently run in East district due to some administrative problems which has been sorted out recently and other districts were not covered under DMHP, the Mental Health Services provided in Sikkim was purely institution based and is not able to address the Mental Health Problem of the State. Therefore, there is urgent need for fully functional community based dedicated District Mental Programme in all the districts to address the alarming increase of suicide in Sikkim. SCENARIO OF MENTAL HEALTH & SUICIDE IN SIKKIM:

The World Health Organization (WHO) estimates that about one million people die by suicide every year; this represents a "global" mortality rate of 16 per 100,000. Suicide rates in many developing countries have been steadily rising in recent years and that suicides are an emerging epidemic the world over. The suicide rate in India has not much changed since 2000. Suicide Rate in 2001 for whole of India and Sikkim was almost same. Sudden increase of suicide rate in Sikkim from 2001 is cause of worry. In fact, Sikkim suicide rate is highest among North Eastern States in India. The rate is one of the highest among the Indian states too. The rate has been consistently high. Sikkim has been in top seven states in the country since past few years. In fact NCRB data of 2008, Sikkim ranks first in India with suicide incidence 48.2/100,000 population. The question being asked here is why a state with progressive characteristics like Sikkim shows pronounced self-destructive tendencies. The suicide rate in Sikkim from 2001 to 2009 is as follows: SUICIDE SCENARIO – INDIA AND SIKKIM

YEAR SIKKIM INDIA 2000 12.63 10.8 2001 10.73 10.6 2002 15.04 10.5 2003 15.26 10.4 2004 19.47 10.5 2005 19.01 10.3 2006 25 10.5 2007 20.7 10.8 2008 48.2 10.8 2009 35.28 10.8

* Source: CID Police Department, Government of Sikkim. Suicide Rate given by NCBR of 2006 and 2008 is 25 and 48.2/1, 00,000 respectively.

SUICIDE INCIDENCE IN SIKKIM & INDIA PER 100000

POPULATION.

0 1020

3040

50

2009

2008

2007

2006

2005

2004

INDIASIKKIM

The suicide rates of all the states in India in India and Sikkim in 2008 as per NCRB are as follows: TREND OF SUICIDE FOR THE PAST FOUR YEARS -

Year Population Rate of suicide

Male Female Total M F Total

2006 339016 296742 635758 22.71 12.81 25

2007 350203 306534 656737 24.84 12.07 20.7 2008 354866 310521 665347 60.88 22.86 48.2

2009 364378 318845 683183 33.49 37.32 35.28*

*as per CID data & calculated based on projected population.

Number of Cases: The number of cases reported, suicide cases has increased from 63 in 1998 to 124 in 2007 and 287 & 241 in the year 2008 & 2009 respectively.

05

10152025303540455055606570758085

SUIC

IDE

RATE

IN 1

0000

0 PO

PULA

TIO

N

TREND OF SUICIDE RATE OF SIKKIM OF BOTH SEXES IN DIFFERENT AGE GROUP

50 and above

26-49

16-25

0-15

It is observed that there is over all increase in suicide rate in all age groups. However there is maximum increase in 16 -25 years and >50 years age group compared to other age groups.

0

10

20

30

40

50

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

SUIC

IDA

L R

AT

E P

ER

1000

00

POPU

LA

TIO

N.

CALENDER YEARS

TREND OF SUICIDAL RATE IN BOTH SEES IN SIKKIN IN DIFFERENT AGE GROUPS

0-15

16-25

Source: CID Branch Police Department government of Sikkim.

05

1015202530354045

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

2.381.15 2.79 2.69 4.17

0.5 3.912.84 3.67 3.55

17.2

12.2

36.24

21.1

29.19

23.62 22.92

29.35

40.8844.27

17.623.02

11.43 12.819.15

28.932.72

30.66

19.7816.765.48 5.29

0

8.23 7.994.64

22.4

14.511.24

20.39

Yearwise suicide rate in Sikkim in different age groups.

0-15

16-25

26-50

50 and above

PROBABLE CAUSES OF HIGH SUICIDE INCIDENCE IN SIKKIM Suicides like any other Non Communicable Diseases do not have one cause. There are many Risk Factors which need to be looked into. Understanding risk factors can help dispel the myths that suicide is a random act or results from stress alone. However, there is need for proper research on findings the actual risk factors responsible for such a dramatic increase of suicide in Sikkim. Suicide is attracting attention in Sikkim too as a major public health problem, and one that is growing alarmingly and there is need to explore the reasons why people are succumbing to suicide. The following probable causes or risk factors are on the basis of CID Branch, Police

Department which needs further research as the caused identified are as per the report of police personnel who investigated the incident. Causes of suicide in July to December 2006 in Sikkim as per preliminary study conducted by CID branch Police Department:

No Causes of suicide Percentage 1 Mental illness and depression 36.00 2 Family problems and addictions 14.00 3 Prolonged illness 10.00 4 Failure in examination and love affairs related 5.00 5 Others and causes not known 35.00 Total 100.00

Source: The CID, Police Department Government of Sikkim.

Source: The CID, Police Department Government of Sikkim.

36%

35%

14%

10%5%

SUICIDE IN SIKKIM IN JULY TO DCEMBER 2006

Mental illness and depression

Others and causes not known

Family problems and addictions

Prolonged illness

Failure in examination and love affairs related

Causes of Suicide 2008

CAUSES MALE FEMALE TOTAL % Cancellation, Suspicion, Love affairs

36 14 50 17.42

Family problems 25 16 41 14.28 Bankruptcy or sudden change in socioeconomic status

8 11 19 6.62

Insanity /mental illness 11 6 17 5.92 Other prolonged illness 4 0 4 1.39 Death of dear one 0 4 4 1.39 Drug abuse/ addiction 3 0 3 1.04 Failure in examination 0 3 3 1.04 Other causes 101 15 116 40.41 Causes unknown 28 2 30 10.45

TOTAL 216 71 287 100 *As per CID data Government of Sikkim.

Causes of

Suicide 2009

CAUSES MALE FEMALE TOTAL % Cancellation, Love affairs 13 18 31 12.86 Family problems 8 9 17 7.05

Insanity /mental illness 4 6 10 4.14 Other prolonged illness 3 0 3 1.24 Death of dear one 2 4 6 2.48 Drug abuse/ addiction 5 0 5 2.07 Failure in examination 5 6 11 4.56 Unemployment 3 4 7 2.90 Cancer 7 10 17 7.05 Not Having Children 1 3 4 1.65 Other causes 17 58 75 31.12 Causes unknown 53 5 58 24.06 TOTAL 122 119 241 100

40%

18%

14%

11%

7%6%

1%

1%

1%

1%

CAUSES OF SUICIDE 2008Other causes

Cancellation,Suspicion,Love affairsFamily problems

Causes unknown

Bankruptcy or sudden change in socioeconomic statusInsanity /mental illness

Other prolonged illness

Death of dear one

Drug abuse/ addiction

Failure in examination

*As per CID data Government of Sikkim.

Under Chief Minister’s Comprehensive Annual and Total Check up for Healthy Sikkim Programme(CATCH), assessment of suicidal ideation, suicidal attempt and depression and completed/successful suicide was investigated in twenty wards of East District for the year 2009-10. The findings were as follows:-

SUICIDAL THOUGHT AND ATTEMPT REPORTED IN 20 WARDS

31%

24%13%

7%

7%

4%4% 3%

2% 2%

2%

1%

CAUSES OF SUICIDE 2009

Other causes

Causes unknown

Cancellation,Love affairs

Family problems

Cancer

Failure in examination

Insanity /mental illness

Unemployment

Death of dear one

Drug abuse/ addiction

Not Having Children

Other prolonged illness

NAME OF THE WARD Suicidal Thought Suicidal Attempt Parkha 23.67 5.92 Kambal 36.65 0 Upper Lamaten 10.10 0 Lower Lamaten 0 0 Middle Sumin 84.62 15.38 Beyang 46.78 23.39 Ray Mindu 24.56 3.50 Tumlabong 38.25 0 Assam Linzey 79.47 6.62 Bardang 57.14 4.76 Kopchey 53.57 0 Sawaney 37.97 8.44 DhanBari 36.46 5.21 Pachey 86.96 7.25 Tshalamthang 66 3.3 Duga 81.19 12.82 Mamring 21.86 0 Dochum 75.47 12.58 Reshi 73.68 0 Saku 40.63 21.88 TOTAL PREVALENCE/1000 50.77 7.36

0102030405060708090

Pach

ey

Mid

dle

Sum

in

Dug

a

Ass

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Doc

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Resh

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Kopc

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ng

Saku

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Saw

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Kam

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Dha

nBar

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Ray

Min

du

Park

ha

Mam

ring

Upp

er L

amat

en

Low

er L

amat

en

RATE

/ 10

00

WARDS

Suicidal Thought

Suicidal Thought

MENTAL HEALTH WITH RESPECT TO AGE & GENDER

Sl.No

AGE GROUP

MALE

TOTAL

% FEMALE

TOTAL

% TOTAL

G.TOTAL

%

1. 0 to 14 2 590 3.39 3 638 4.7 5 1228 4.07 2. 15-19 3 169 17.75 9 246 36.59 12 415 28.92 3. 20-24 6 113 53.1 15 234 64.1 21 347 60.52 4. 25-29 3 136 22.06 15 272 55.15 18 408 44.12 5. 30-34 2 140 14.29 18 216 83.33 20 356 56.18 6. 35-39 5 116 43.10 13 187 69.52 18 303 59.41 7. 40-44 1 140 7.14 19 168 113.1 20 308 64.94 8. 45-49 6 124 48.39 11 135 81.48 17 259 65.64 9. 50-54 5 105 47.62 17 127 133.86 22 232 94.83 10.55-59 4 73 54.79 8 89 89.89 12 162 74.07 11.60< 16 244 71.43 16 201 79.60 32 445 71.9

TOTAL 53 1950 27.18 144 2513 57.30 197 4463 44.14

SUICIDAL ATTEMPT

Sl.No.

AGE GROUP

MALE

TOTAL

% FEMALE

TOTAL

% TOTAL

G.TOTAL

%

1. 0-14 0 590 0 0 638 0 0 1228 0 2. 15-19 0 169 0 3 246 12.2 3 415 7.23 3. 20-24 0 113 0 1 234 4.27 1 347 2.88 4. 25-29 1 136 7.35 1 272 3.68 2 408 4.9 5. 30-34 0 140 0 3 216 13.89 3 356 8.43 6. 35-39 0 116 0 2 187 10.7 2 303 6.6 7. 40-44 0 140 0 3 168 17.86 3 308 9.74 8. 45-49 4 124 32.2

5 0 135 0 4 259 15.44

9. 50-54 0 105 0 5 127 39.37 5 232 21.55 10. 55-59 0 73 0 1 89 11.23 1 162 6.17 11. 60 < 2 244 8.19 1 201 4.98 3 445 6.74 TOTAL 7 1950 3.59 20 2513 7.96 27 4463 6.05

0

20

40

60

80

100

120

140

160

0 to 14

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60<

RATE

PER

100

AGE GROUP

CATCH SUICIDAL THOUGHT

MALE

FEMALE

TOTAL

SUICIDAL THOUGHT AND ATTEMPT REPORTED IN 20

WARDS NAME OF THE WARD Suicidal Thought Suicidal Attempt Parkha 23.67 5.92 Kambal 36.65 0 Upper Lamaten 10.10 0 Lower Lamaten 0 0 Middle Sumin 84.62 15.38 Beyang 46.78 23.39 Ray Mindu 24.56 3.50 Tumlabong 38.25 0 Assam Linzey 79.47 6.62 Bardang 57.14 4.76 Kopchey 53.57 0 Sawaney 37.97 8.44 DhanBari 36.46 5.21 Pachey 86.96 7.25 Tshalamthang 66 3.3 Duga 81.19 12.82 Mamring 21.86 0 Dochum 75.47 12.58

S UIC IDAL AT T E MP T DE T E C T E D IN C AT C H S IK K IM P R OG R AMME

0

5

10

15

20

25

30

35

40

45

0 to14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60 <

AGE G ROUP

RA

TE

PE

R 1

000

MA L E

F E MA LETO TA L

Reshi 73.68 0 Saku 40.63 21.88 TOTAL PREVALENCE/1000 50.77 7.36

However, to get real picture of most important risk factors which could be associated with increased incidence of suicide in Sikkim, there is need for thorough research and the organizations in collaboration with WHO, ICSSR and Department of Science and Technology are being

0

10

20

30

40

50

60

70

80

90

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Mam

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Upp

er L

amat

en

Low

er L

amat

en

RATE

/ 10

00

WARDS

Suicidal Thought

Suicidal Thought

0

5

10

15

20

25

Be

yang

Saku

Mid

dle

Su

min

Du

ga

Do

chu

m

Saw

ane

y

Pac

he

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Ass

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inze

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Par

kha

Dh

anB

ari

Bar

dan

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Ray

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Tsh

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than

g

Kam

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Up

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mat

en

Low

er

Lam

aten

Tum

lab

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Ko

pch

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Mam

rin

g

Re

shi

RA

TE/

10

00

WARDS

SUICIDAL ATTEMPT

Suicidal Attempt

approached and is in the process. However it is found that Suicide rates are higher in transition economies (WHO Regional Representative). Risk Factors in order of importance in Sikkim could be as follows: Mental Illness including Depression: Related to many social changes which may be as follows:

Rapid developmental, economic changes, the old certainties of jobs, relationships are being swept away faster than the young can cope.

Loosening of family bonds. Individualistic cultures are leaving people without ideals. There is a loss of a sense of hope and a loss of a sense of the future.

Breach in social supports which were initially there in society. There is sense of hopelessness in youth perhaps due to higher

expectation in the society and inability to fulfill the dreams in younger population group is perhaps one of the important issues in association with Drugs and Alcohol abuse.

Impulsiveness and/or aggressiveness in Sikkim’s society is also perhaps cause of worry.

There is possibility of sense of isolation. Education level has gone up manifold in last few decades and

perhaps the expectation has gone up and there is rat race for getting white color jobs.

There is also pressure to do perform better in study and there are suicidal deaths due to failure in examination also.

Loss of tradition, social cohesion, and spontaneous social support. The lack of role models is intensified, as the age gap between

generations widens, changing roles and smaller family sizes. The rising suicide rate in younger adults and adolescents can itself be

partly explained by the apparent rise in the prevalence of mental illness in the young.

Alcohol and substance abuse disorder Chronic illness Weakening of cultural, Social support and Protective Factors Exposure to (including through the media) and influence

Family History Previous Suicide Attempt. Unavailability of proper planned strategy and little coverage of

Community based Mental Health Services.

ACTIVITIES UNDERTAKEN: The WHO has noted that not all suicides can be prevented, but a majority can. The following initiatives and activities have been undertaken by Mental Health Cell, Non Communicable Diseases Division and District and State Referral Hospital are as follows:- Under Non communicable Diseases Programme: Massive awareness campaign on mental health issues and suicide

prevention. (Pictures enclosed in Annexure I). Sensitization of all types of health care provider from state to village

to provide Mental Health Services through primary health care services. Number of sensitization programs in the educational institutions, work places and PHCs was held, wherein Medical officers, all Nursing and all other health para medical manpower, staffs students, teachers, ASHA, Angan wadi workers, Village Health and Sanitation Committee members and other NGOs were sensitized regarding Emotional/ Mental Health issues and Suicide Prevention. (Pictures enclosed in Annexure II & III).

Addressing Mental Health Programme through Primary Health Care

where all the Primary Health Care personals are being sensitized. Basic Psychiatric and anti-depressant are made available in STNM, District Hospitals. Attempts are being made to provide some of these drugs in Primary Health Care also.

Sensitization of policy makers, administrators, health personnel’s, civil society and general community also through other non communicable programmes.

Breaking of taboo with respect to suicide so that mental health helps be accessible and approachable.

Appropriate registration of deaths by the Birth and Death cell to trace accurate data on number of deaths by suicide which would in turn help in forming accurate database.

Reliability of suicide certification and reporting is being improved. Emergencies services 24X7 help lines in all health institutions using

the telephone line. Community Suicide Prevention Programs initiated under CATCH

SIKKIM Programme which is in pipeline. Issue of Guidelines for Media Reporting, to follow WHO guidelines

of providing no media details of suicidal behavior (e.g. photographs, suicide methods), no sensationalization of suicide, and no stories of blame; and to prevent adoption of "copycat" methods of suicide. Issue of Guidelines for preventing suicide for teachers and other school staffs, General Physicians and Medical Officers, Primary Health Care Workers and starting up of Survivor’s group.

Under CATCH Sikkim Programme: Sensitization of all Health Care Providers on basic

counseling.(Picture enclosed in Annexure VI) Mental Health and suicide is being highest attention by

screening depression, suicidal thoughts and those who have attempted suicide in CATCH Sikkim Programme.

On the spot counseling is provided. (Pictures enclosed in Annexure VI).

Vision for positive mental health was put forward to the community since they would be the harbinger of healthy (Mental, Physical, Spiritual) community which would in turn be the basis of healthy Sikkim.

Community mobilization wherein the community participation and its involvement is very significant.

Involving Psychiatric/Psychological Specialists during the specialists’ health camp at the PHC level Camp.

Universal coverage will be made so that all can be screened. Basic counseling services to be provided at the ward level.

Those who need immediate care will be referred to appropriate centers. Those who will not be able to attend the referral centers, specialist health camps under CATCH programme will be held at each Primary Health Center (PHC).

Appropriate counseling at all levels and referral services in higher centers.

Mental Health and Suicide Prevention was given highest priority in CATCH Sikkim pilot programme held in 20 districts of East Sikkim where in the total population of 3303 (age 12 above), 27 had reported to have attempted suicide and 197 persons to have carried suicidal thought at some point of time during the year. Five persons in total was reported to have committed suicide during the year 2009-2010. The common cause of suicide related activities was reported to be marital quarrels/ dispute, health problem, love affair, parent separation and socioeconomic problems. Screening of Depression Suicidal thoughts and Suicidal Attempt will be done throughout the State through CATCH Sikkim Programme. Those found positive will be referred to district mental health centre in district hospital or will be addressed in PHC level specialist health camp.

To address barrier to access Mental Health care even in areas where psychiatrist’s service is available for treatment of Mental illness and substance abuse, Sensitization workshops are organized for people of various walks of life through Non Communicable Diseases Programme.

Under District Mental Health Programme (DMHP) observed the “World Suicide Prevention Day- Many Places, Many Faces” on the 10’th of Sept 2010 in the European Conference Hall STNM, where many health professional, Medical Officers from all PHCs, NGOs, Media personnel was present. Healthy discussion on all issues of suicide was held. All the strategies and Plan of Action was chalked out with special focus on mental health issues which needs to be addressed right at the PHC level. CATCH Sikkim Programme has

given that platform to address Mental Health and Suicide issues at the ward and community level. On the following day all the local daily newspapers reported this challenging issue with factual queries which in turn helped in building more consciousness among masses as Suicide prevention is gaining highest priority where Mental Health Programme is concerned.

The issue with District Mental Health Programme (DMHP) which is their only for the East District of Sikkim which was launched in 2001. Though some activities like training, massive IEC activities were undertaken proper fund utilization was not done due to unavailability of trained manpower. However, this same programme is revamped in 2010 and all activities are taken up under DMHP.

Mental Health Care is incorporated into Primary Health Care so that promotion of positive mental health, early detection of mental health problems which can be done at Primary Health Centre (PHC).

Appropriate referral mechanism has been developed to address Psychiatrist Illness at appropriate level.

The telephone services which are available at all health institutions will be used as helpline to help those who need the services immediately.

Massive Community Mobilization and ownership of the community will be generated to promote positive mental health, awareness to reduce the consumption of the alcohol and drugs in the society.

Engagement with the Frontline Professionals: Gate Keeper Training Programs: Effective suicide prevention by improving attitudes toward suicidal behavior and increasing clinical knowledge about suicide. Those with suicide ideation could be identified by general practitioners, and intervention or referral services can be offered. Hence Training Primary Care Professionals leading to increased rates of inquiry about suicide risk and referral of suicidal youth to outpatient behavioral healthcare centers.

Creating Positive Mental health and prevention of suicide is a complex issue which reflects socio Cultural dimensions which needs to be dealt seriously by all the sections of the society including media.

Therefore, we call upon all citizens of Sikkim to work together to build positive mental health and prevent suicide.

As per the direction of the Hon’ble Chief minister of Sikkim at the inauguration of the CATCH Sikkim Programme on 26th August 2010, positive mental health and suicide prevention under Inter Sectoral coordination to address all issues will be done. To address issues related to other social and environmental Factors through inter and intra-sectoral coordination and balanced development to cope up with rapid social economic and developmental changes in the state are proposed to be addressed through coordinations under CATCH Sikkim Programme. There is an attempt to address all the risk factors through series of other measures at all levels in collaboration with Coalition group and inter-sectoral coordination. PROPOSED PROGRAMME UNDER DISTRICT MENTAL HEALTH PROGRAMME UNDER NATIONAL MENTAL HEALTH PROGRAMME. The activities undertaken under CATCH Sikkim programme, general health services and primary health care will be able to only screen people with risk factor of people suffering from Mental Health Problem and referred those who have Mental Health problem. There is need for intensive provision of dedicated mental health care which can be provided only through DMHP. At present, only East district is covered under District Mental Health Programme. FUTURE ACTION PLAN FOR SUICIDE PREVENTION UNDER DMHP IN ALL FOUR DISTRICTS OF SIKKIM 1. Placement and Training of all categories of Manpower

STAFF REQUIREMENT FOR EACH DISTRICT WHO WILL BE PLACED UNDER DMHP IN ALL DISTRICTS

SL NO Name of the post 1 Psychiatrist (Specialist) / MO trained in Mental Health.

2 Clinical Psychologist 3 Psychiatric social worker

4 Psychiatrist Nurse 5 Record keeper/Clerk 6 Nursing orderly

7 Total

The achievement of IPHS standards WILL BE ENSURED UNDER NRHM, BY providing resources, flexibility and powers, as follows SL no

Health Facility

Existing in IPHS Additional activities proposed to meet the requirements under NMHP

1 Sub centre Health worker male Health worker female

Training of male and female health worker w.r.t NMHP

2 PHC One medical officer and 14 staff

Training of PHC medical officers and staff w.r.t. NMHP

3 CHC 64 staff including MBBS doctors

Training of general duty officers and health staff w.r.t NMHP

4 Sub divisional hospital

All the officials and staffs.

Training of general duty medical officers and health staff w.r.t. NMHP

5 District hospital

1 psychiatrist MBBS doctor Staff nurse and pharmacist, Social worker/counselor 1-2

1 psychiatrist/ Programme Officer 1 clinical psychologist/ trained psychologist 1 psychiatric social worker/social worker 1 psychiatric /community nurse 1 record keeper Training of programme officer, psychologist ,social worker and community nurse w.r.t NMHP Training of MBBS doctors and general health staff including pharmacist.

1. Media sensitization. 2. Advocacy workshop, Coalition formation of all Government

Departments and Civil Society, religious leader, CBO etc to address positive mental health and healthy society in order to prevent suicide under Mental Health Programme.

3. Provision of Medicines and equipments as per the guidelines of DMHP.

4. One of the important issues to be addressed in CATCH Sikkim Programme.

5. Cover all secondary and senior secondary school, trains all the school personnel, programme people, nodal teachers.

6. 24X7 phone lines, Set help lines. State Crisis Helpline, online counseling.

7. Suicide prevention website. 8. Reduce access to common items used for hanging. 9. Massive awareness campaign through CATCH Sikkim Programme and

massive community mobilization to address Mental Health and suicide prevention.

PROPOSED BUDGET FOR STATE MENTAL HEALTH CELL Sl . No.

Items Calculation Total

1. Manpower Programme Assistant 12,000X12=1,44,000 1,44,000 Data Entry Operator 8,000X12=96,000 96,000

2. Training 5,00,000 5,00,000 3. IEC 4,00,000 4,00,000

4. Office Expenditure 3,00,000 3,00,000 Total 14,40,000

BUDGET PROPOSED IN 2010-11 IN SOUTH, WEST AND NORTH DISTRICTS SL NO ITEMS

1ST YEAR (2010-11) IN

ONE DISTRICT

1ST YEAR (2010-11) IN THREE

DISTRICTS 1 Staff 8.7 26.0 2 Medicine/Stationery/

Contingencies 4.5 14.0

3 Equipment 6.0 18.0 4 Training 5.0 15.0 5 IEC 2.0 6.0 6 Total 26.0 78.0

BUDGET FOR DMHP INITIATED ACCORDING TO X FIVE YEAR PLAN (FOR EAST DISTRICT) 2010-2011,

SL NO

ITEMS 3rd year 2010-11

1 Staff 10.2 2 Medicine/ Stationery/Contingencies 6.5 3 Equipment - 4 Training 2.0 5 IEC 2.0 6 Total 20.7

TRAINING LOAD AND DETAILS OF TRAINING FOR NATIONAL MENTAL

HEALTH PROGRAMME

Details No Per Unit DA TA 500 300 1 150000 Food 500 200 1 100000 Resource Materials 500 250 1 125000 Hall 1500 20 30000 Honorarium 500 20 5 50000

Contingencies 45000 500000 PARTICIPANTS: PROGRAMME OFFICERS OF STATE & DISTRICT 30

MO OF STNM, DISTRICTS, PHC 100

SUPERVISION PARA MEDICAL PERSONNEL 50


.

D.9. NPPCD Introduction :- Hearing loss is the most common sensory deficit in humans today. As per the NSSO survey, there are 291 persons per one lakh population who are suffering from severe profound hearing loss. Of these, a large percentage is children between the age group of 0-14 years which results in a severe loss of productivity, both physical and economical. An even larger percentage of our population suffers from mild degree of hearing loss and unilateral (one sided) hearing loss. Objective of the Programme :-

1) To prevent avoidable hearing loss due to disease or injury. 2) Early identification, diagnosis and treatment of ear problem responsible

for hearing loss and deafness. 3) To medically rehabilitate persons of all age group suffering from

deafness. 4) To strengthen the existing inter-sectoral linkages for continuity of the

rehabilitation programme for persons suffering from deafness. 5) To develop institutional capacity for ear care services by providing

support for equipments, materials and training personnel’s. Component of the Programme :-

1) Man Power Training and Development :- For prevention, early identification and management of hearing impaired and deafness cases, training would be provided from medical college’s level specialists (ENT and Audiology) to grass root level workers.

2) Capacity Building :-

Capacity building in respect of ENT / Audiology infrastructure will be provided to all District Hospitals, CHC’s and PHC’s.

3) Service Provision including Rehabilitation :- Screening camps for early detection of hearing impaired and deafness will be set up at different levels of health care delivery system.

4) Awareness Generation through extensive IEC Activities :-

Early identification of hearing impaired, especially in children so that timely management of such cases is possible and to remove the stigma attached to deafness.

5) Monitoring and Evaluation :- Monitoring and evaluation is done at regular intervals for exact and accurate figures.

Strategies / Interventions / Activities

1) To develop human resource for ear care & strengthen the service delivery including rehabilitation through manpower training & development.

2) To promote outreach activities and public awareness through IEC strategies with special emphasis on prevention of deafness.

3) To develop institutional capacity of the district hospitals, CHC’s, PHC’s selected under the project through ENT / Audiology infrastructure.

4) To conduct Screening Camps for early detection of hearing impairment & deafness, management of hearing & speech impaired cases & rehabilitation (including provision for hearing aid) at different levels of health care delivery system.

Activities :-

1) Manpower Training and Development :- Training of all Medical Officers, Health Workers including

ASHA has been proposed and is to be conducted to make these personnel aware of the existing facility available for deafness in order to facilitate appropriate referral.

2) Service Provision including Rehabilitation :-

This is being routinely carried out at all PHC’s and CHC’s and cases are being referred to STNM Hospital for expert management. Screening Camps are being organized throughout the State.

The detail of Screening Camp for 2010-11 is as under :-

No. of Camps Patients Examined Hearing Aid Funds Utilized

12 673 Nil 1,20,000

3) Capacity Building :- Audiometric Assistant under the programme has been

appointed & is working, appointment of Instructor for Hearing Impaired Children is under process & Office Assistant under NPPCD is required

Financial calculation for the NPPCD TRAINING Slno

No of

days for the training

No of Train

ees

No of Trainer

s

DA for the

participants

Honorarium

for the Trainer

s

Working

lunch

Incidental

Expenditure

Venue Hiring

Total

1 1 30 MO’S (State Level)

ENT Specialist(1)

110x30x1

=

3300.00

1000x1= 1000.00

200x30x1=6000.00

250x30x1= 7500.00

10000.00

2 1 30 Health Workers (District Level) 4 Districts

1 ENT Specialist/1MO

90x30x1x4= 10800.00

600x1x4= 2400.00

200x30x1x4=24000.00

250x30x1x4= 30000.00

10000.00 X 4 batches = 40000

Total

14100.00 3400.00 30000.00

37500.00 50000.00 135000.00

Documents

D. Disease Control Programs - RRC-NE