HMG, MOH,
Eastern Regional Health Directorate

Dhankuta, Nepal.

Field Supervision Report

Special Leprosy Campaign  (Skin camps) in Morang district

 

From: Nawaraj Subba (Senior Public Health Officer)

To: Dr. Mahananda Mishra (Regional Director)

Date and Period of Supervision: 21 -23 Baishak 2060

Place: District Public Health Office Morang

Program: Skin and Leprosy Camp

Objective of Supervision: Supervision and assess the program.

 

Brief Summary:

Three skin camps were conducted in Morang districts where 30 cases were identified and 930 patients were examined.

 

Findings:

 

§         Skin camps were conducted as per schedule in the Morang district and its summary is as follows.

 

Skin Camp: Dainiya, Morang	Skin Camp: Mangalbare, Morang	Skin Camp: Haraicha, Morang
OPD = 382 Case detected = 21 (MB=11, PB=10) Smear Taken = 22 Free drug dispenses = 382	OPD = 282 Case detected = 6 (MB=1, PB=5) Smear Taken = 13 Free drug dispenses =282	OPD = 266 Case detected = 3 (MB=2, PB=1) Smear Taken = 10 Free drug dispenses =266

 

§         SPHO, DTLA, HET, In charges of HIs were mobilized for conducting the skin camps. FCHV were also active for taking suspected patients in camps.

 

Problems encountered and reported from the district.

Information dissemination for skin camps was not uniform in three Centres. In Dainiya people were informed as camp for all type of skin diseases including leprosy. So the number of patients in this camp was high. Whereas in Mangalbare and Haraicha people were informed for checking all leprosy suspected people so the number of visiting OPD was comparatively low in these two camps.

 

Recommendations:

1. Uniformly IEC should be developed and disseminate during skin camps in the district.

 

 

 

 

 

 

 

 

HMG, MOH,

Eastern Regional Health Directorate

Dhankuta, Nepal.

 

Field Supervision Report

Special Leprosy Campaign (School survey) in Saptari and Siraha district and Rapid Inquiry Survey in Udayapur district

 

From: Nawaraj Subba (Senior Public Health Officer)

To: Dr. Mahananda Mishra (Regional Director)

Date and Period of Supervision: 4 -8 Jestha 2060

Place: District Public Health Office Saptari and District Health Office Siraha and its catchment schools

Program: Skin and Leprosy Camp

Objective of Supervision: Supervision and assess the special leprosy campaign.

 

Brief Summary:

Special Leprosy Campaign organized by MoH/DoHS/ LCD and sponsored by NLR in EDR was successful in Saptari, Siraha and Udaypur districts. School Survey programme was conducted in Saptari and Siraha districts. Three schools in Saptari and Six schools in Siraha districts were supervised by a Regional Level Coordinated team. Two VDCs, one SHP, one PHC and DHO have been supervised in Udaypur.

 

Findings:  Coordinated supervision team comprising of Nawaraj Subba (SPHO from ERHD), Dhruba Urao (RTLA from ERHD), Kedar Shah (FO from NLR), Puskar Kafle (AO from NLR) had visited and supervised the school survey program in Saptari and Siraha districts. A brief finding is as follows:

 

§         Saptari (2060.2.5)

1. Public Secondary School, Rajbiraj -8

School Survey has been started in a classroom. DPHO, DEO, DTLA were present there on their supervision. Survey was just started when our team reaches there.

 

2. Janta Secondary School, Itahari Bishnupur Hati

Bindeshor Prasad Shah, SHPI of Bishnupur SHP, Sailendra Kumar Mandal (Health Teacher), Mishri lal Shah, VHW and Gita Bogati, MCHW were found involving in the school survey program. AHW, VHW and MCHW have already examined total 35 students when we reach there. MCHW was examining girls' students in separate rooms. Health teacher and Headmaster were coordinating the overall school survey program in the school.

 

3. Chhinnamasta Bhupendra Sanskrit Madhyamik Vidhyalaya, Sakhada (Raj Kumar Yadav AHW, Gauri Shankar Thakur VHW, Vidhya Das ANM and Kameshore Yadav health teacher were involved in the school survey. Total 300 students were examined and no cases identified in the school.

 

§         Siraha (2060.2.6)

1. Sarswornath Madyamic Vidhyalaya, Sarswor (Shiv Narayan Shah AHW, Parshuram Upadhyaya VHW, Durga Kumari Shah MCHW and Laxmeshore Mishra School teacher were involved in the school survey program. Total students number of school is 700 as noted.

2. Laxyan Mandal Janata Madhyamic Vidhyalaya, Baniniya Arnama-3

Shivaji Kamati AHW of Baniniya Arnama SHP was not present in the program when we reach there by 8.00 am. Shanti Kumari Shah MCHW had arrived at school at 8.00. Shivnath Shah Health teacher did coordination of the school survey program. Our coordinated regional supervisory team, district supervisor Mrs. Sharma PHN and School teacher had made a consensus and decided to appoint Mr. Ramesh Shah AHW of Chikana SHP on the place of AHW Shivaji Kamati who was absent. School survey was started at 8.00 am after being appointed new AHW Ramesh Shah in team who was in his personnel business at that time. PHN Mrs. Sharma will report to DHO immediately about problem of this school survey at Arnama.

 

3. Sriram Dulari Madhyamik Vidhyalaya, Kalyanpur

Pawan Kumar Panjiyar AHW, Ram Briksha Shah AHW and Girija Devi Karna VHW were involved in the school survey program. They have made 21 volunteers for their support in screening. 2 PB cases and 6 suspected cases were identified in this school. Headmaster Rajendra shah and Lal dev Shah health teacher were also active in the program.

 

4.  Janasewa Madhyamik Vidhyalaya, Karjanaha

Gurudayal Mahato AHW had just arrived at 9.30 at school. But Renu Shah MCHW, Sanukaji Shrestha VHW and one more FCHV was present at 6.00 am at school as per reported. Survey began only at 9.30 when we asked the AHW to start. He had only 1 and half an hour to complete the survey of total 1300 students and he had not even prepared any volunteer for help. Our supervisory team helped to make some volunteers and than started survey.

 

5. Nepal Rastriya Phul Kumari Mahato Madhyamik Vidhyalaya Bandipur

Survey program had been completed when we arrived at 11 am. We saw only Headmaster of the school and noted report. There was 1100 students and 3 cases were suspected as per report.

 

6. Mohan Higher Secondary School Mirchaiya 

Shiv Mahato AHW, Sangita Lama ANM, Prem dev Yadav VHW and Dev Narayan Yadav Health teacher as well as other teachers were involved in the school survey program. There are 2000 students in school and program had just started since it was a day school.

 

Problems encountered and reported from the district.

§         It was experienced that the orientation was not effective in Siraha district since most of its school survey programmes that we supervised were not properly managed in terms of IEC, time and human resource management.

§         Lacking of local supervision was felt during our supervision since Health Post In charges has not been mobilized for supervision.

 

Recommendations:

1.      Supervision by local level (HP level) is necessary.

2.      Orientation at different level with specific written guidelines would have ensured proper and uniformed proceedings of school survey program in a district.

 

 

Udaypur (2056.2.11-15)

Coordinated supervisory team: Mr. Nawaraj Subba (SPHO, ERHD), Mr. Dhruba Urao (RTLA, ERHD), Mr. Kedar Shah (TO, NLR)

 

Triveni Sub Health: SHP was closed when we arrived at 11.00 am. VDC Secretary said that special leprosy campaign has been running so SHPI might have gone for the campaign. In the mean time SHP In charge Mr. Rajendra Prasad Deo came at SHP when we were talking about health services in the SHP. Mr. Deo said that he came to SHP late due to his involvement in delivery case when he was on the way to office. We asked where has gone peon. Peon has gone to DHO Udaypur as Mr. Deo answered. (Later when we asked at DHO whether peon from Triveni has come or not; DHO staff answered that no people has come from Triveni). When we asked Mr. Deo whether any suspected leprosy patients are coming or not. He answered no patients are being referred so far. General outlook of SHP was not good. Disposable syringes (15-20 in number) were collected in a paper cartoon along with other disposal such as paper, swabs etc. Community based ward level notice board was kept in a store. It was also reported that sometime vaccine supply is inadequate. We asked Mr. Deo why did so occurred? He replied as some time clients from nearby Sindhuli district come, that time vaccine will be inadequate. We discussed with him for necessary solution. Graphs were displayed on wall. It is a positive side of SHP.

 

Katari PHC: EPI session and Inj. Depo-Provera session was running by Mrs. Gurung (ANM) when we reached at PHC. PHC in charge Mr. Krishna Kumar Shah (Sr.AHW Officer) was busy in examination of OPD patients. We had held a meeting after OPD session. Mr. Shah reported that two VHWs Mr. Lal Bahadur Tamang, Mr. Ram Bahadur Thapa and Mrs. Parbati Katuwal MCHW are in a rapid inquiry team and they will continue till 15th of Jestha. One of the leprosy suspected case so far has been referred to PHC by the survey team till than. PHCI reported that it is almost impossible to cover all nine wards of a VDC in 5 days. Health workers are working under stressful security condition in their field as reported. One of the supervisors Mr. Tank Chaudhary HA had come for supervision at PHC yesterday but he did not answered queries regarding leprosy campaign. PHC in charges reported that district supervisor did not made him and his PHC staff fully oriented for special leprosy campaign due to poor cooperation with DTLA during orientation programme. Anyway PHC was doing well for special leprosy campaign.

District Health Office Udaypur: We hold a meeting with DHO, DPHO and statistical assistant in office. DHO is unhappy with what DTLA doing that time. He said that DTLA might not be found in field though he has been sent for supervision. Regional level supervisory team too did not see DTLA on their way. It was learned that there is more problem in those hilly VDCs where movements have been difficult due to security problem.

Problems and constraints

1.      FCHV are not being mobilized in this special leprosy campaign for rapid inquiry survey. Five days is not enough to complete the survey by VHW and MCHW in a VDC.

2.      We interviewed so many people on the way bot nobody reported that someone came to their house asking leprosy patches in Triveni VDC.

3.      Orientation for district supervisors was not effective since HA who was supervising to Triveni, Katari was unknown about special leprosy campaign.

Recommendations

1.      Micro planning for such Special leprosy campaign needs more in depth homework to ensure involvement of all partners and mobilization of resources.

2.        A single programme was conducted in a district in the special campaign 2060. I recommend that double or multiple program approach could be effective and fruitful.