DAPCU Appraising the DC on Dist. level NACP-III activities.
NACP-III (2007 – 2012) BackgroundNACP - I (1992 - 1999) : Programme was being managedcentrally. Focus was on awareness and servicedelivery units were located at rare places.NACP - II (1999 – 2006) : Programme managementdecentralized to SACS, service delivery units like TI, ICTC,ART Centre and STD Clinic were established increasingly.NACP – III (2007 – 2012) : Programme implementationwill be further decentralized to District and Sub-districtlevels.- Based on edidemiological / vulnerability criteria,610 districts divided into 4 categories.- Differential package of services planned for eachcategory.- Every A and B district will have DAPCU to implementAIDS control and prevention strategies, synchronizedwith the public health infrastructure and programmesat that level.
GOALS AND OBJECTIVESTo halt and reverse the epidemic in India over the next five yearsObjectives : Prevention of new infections. Increased proportion of PLHA receiving Care, Support and Treatment. Strengthening capacities at district, state and national levels. Building Strategic information management systems. Strategy for District PlanningComprehensive package of graded services covering the entire population of thedistrict.a) Saturating the coverage of three HRGs - FSW, IDU & MSM.b) Expanding the coverage of bridge populations – Truckers and Migrantworkers.c) Prevention among highly vulnerable population – Women, Youth & Children.d) Prevention among the general population through mainstreaming
Strategy :a) Formation of CBO and Peer led interventions for saturating coverage of all HRGs in urban areas.b) NGO led interventions in rural areas with 5000+ population.c) Mainstreaming interventions in rural areas with <5000 population. .will be done by Link Worker Scheme (LWS) by ActionAid.• Mainstreaming HIV/AIDS in all Govt. Depts. for environment building in small scattered villages.
Service delivery at district level (A category) Institutional Framework Public Health Infrastructure Services MEDICAL COLLEGE DISTRICT HEALTH MISSION ICTC PPTCT STD, OI, ART DISTRICT HOSPITAL BLOOD BANK DOCTOR, COUNSELLOR, LT CHC ICTC BLOCK HEALTH MISSION PPTCT DOCTOR, COUNSELLOR, LT STD, OI, ART REFERRAL 24 Hrs phcPRIVATE PRIVIDERS ICTC SERVICES, STD Control, OI Condom Promotion BLOCK HEALTH MISSION Doctor, Nurse cum Counsellor, LT SC, AWC Condom Promotion VILLAGE HEALTH Testing Kit COMMITTEE Care & Support IEC LW, ANM, MPW, ASHADHH - All HIV related services will be made available under one roof. This will include ICT, PPTCT, STD,OI and ARTwith necessary linkages.CHC will provide: ICT,PPTCT, STD and OI with necessary linkages to prevention and care treatment services.PHC will be responsible for ICTC services, STD control, OI and condom promotion.Mobile ICTC to service hard to reach areas.
ROLE OF DAPCU The role of DAPCU is 3 fold.1) Implementation of NACP strategies.2) Convergence with NRHM activities.3) Intersectoral Convergence
2.Convergence with NRHMa) Village level Village Health Committee – Orientation- Prevention- Treatment-Care-Support Village Health Plan – Household survey – HIV parameter LW member of VHC Untied fund at SC – AIDS Agenda Orientation to ASHA, ANM, MPW MCHN Day - PPTCT services, nutritional support to PLHA mother and newborn, condom supply, delivery kit, STI, TB other OIs, ART followup – mobile lab Promote ANC and institutional deliveries IMNCI protocol – include special care for HIV +Ve infants. Contd….
B) Block level Block Health Mission – Hospital management committee Committed to IPHS - 24 hrs. PHC/CHC be upgraded to ICTC - Provision of LT & Counsellor at ICTC - Centrifuge, Refrigerator, Infantometer – NRHM - HIV/AIDS testing kits, delivery kits – SACS - Strengthening Referral Protocol . PPCTC / TB / STD / OI ICTC - Monthly review meeting - Representative of TI, Supervisor + Counsellor (ICTC).
(c) DISTRICT LEVEL Under NRHM, the District Health Action Plan comprises the following five parts:- Reproductive and Child Heath Programme Immunization NRHM Additionalities National Disease Control Programme Inter-sectoral convergence, including AYUSH The District AIDS Action Plan will become the sixth component of the omprehensive Framework.
Dept. 3.Intersectoral Convergence Convergence activityW & CD AWW – work on PPTCT, detect discrimination. SHG - to support PLHA RRC – among girls.PR All functionaries – Orientation, Advocacy, Discrimination. Gram Sabha – discuss HIV. Budgetary supplement to prevention and control programme.RD SHG + RRC – work on PLHA (Female), Integrated IECYA & S Promote VBD, Condom, NSS Campaign for rural youth. Train NSS (P.O.) / NYK (Co.)/Students. Social marketing of condoms.TOURISM Tourist spot – Condom, IEC, surveillanceLABOUR/MINES/ IEC, Condom, Services at ESI hospital. Trade union – Orientation, discrimination Prevention, Labor – HIV in allFISHERY trainingINDUSTRYPOLICE / JAIL Support – Identifying HRG, sympathetic dealing, condom promotion in jail.EDUCATION HIV awareness in adult education, No discrimination.TRANSPORT IEC, Condom vending machine, Migration route, Orientation.BS / RSREVENUE HIV in all Dept. training.MunicipalCorporation & Awareness, Support through NGO and TIs for PLHAs. Mapping of HRG, Condom vending machinenormal local body.CIVIL SUPPLY Antyodaya Cards for PLHAs.DSW Madhubabu Pension Yojana
EPIDEMIC STATUSA : WORLD People living with HIV/AIDS 33.0 million Adults living with HIV/AIDS 30.8 million (93.33 %) Women living with HIV/AIDS 15.5 million (50.32 %) Children living with HIV/AIDS 2.0 million (12.90 %) People newly infected with HIV Per Year 2.7 million Children newly infected with HIV Per Year 0.37 million AIDS deaths Per Year 2.0 million Child AIDS deaths Per Year 0.27 millionMore than 25 million people have died of AIDS since 1981
B : India People Living with HIV/AIDS 2.5 Million Male Female H.R.G. 1.52 mln .95 mln .025 mln (61 %) (38 %) (1 %) Prevalence rate of India is 0.34%. The immerging face of the Epidemic is increasingly young, feminine & rural. 43 % of Women have not heard about HIV/AIDS.
C : Orissa People living with HIV / AIDS in Orissa 13351 (OSACS) Male Female Child Male Child Female 4544 505 375 7927 (59.37 %) (34.03 %) (3.78 %) (2.80 %)Vulnerability factors :• Large scale migration to other states in regular intervals.• Large scale developmental projects such as, Mining industries, Hydro Electric and Irrigation Projects.• Low literacy level especially among women.• Rapid urbanisation and industrialisation.• Merely parroted knowledge. Transmission through : Sexual 82.82 % Blood / Blood Products 0.86 % Infected syringes & Needles 2.72 % ANC / PPTCT 8.80 % Not specified 4.81 %
D : BolangirPeople living with HIV / AIDS in Bolangir 217 Death due to AIDS Male Female Total 35 177 40 217 (81.56 %) (18.43 %)Year wise +Ve Cases 250 217 200 2003 2004 150 102 2005 100 2006 37 38 2007 50 22 13 2008 2 3 0 Till June 2009 2003 2004 2005 2006 2007 2008 Till Total Total June 2009
Delivery of Services so far : ICTC WISE COUNSELLING & TESTING COUNSELLING TESTING Name of centre Male Female Total Male Female TotalICTC - I 8887 6342 15229 5028 3196 8224ICTC - II 2214 5486 7700 1560 4719 6279TITILAGARH SDH 3939 3574 7513 2241 2077 4318KANTABANJI CHC 2221 2825 5046 2152 2817 4969PATNAGARH SDH 8679 4883 13562 180 156 336TOTAL 25940 23110 49050 11161 12965 24126 ICTC wise +Ve Cases 250 217 200 177 150 M 95 F 100 77 81 73 40 Total 50 22 4 9 1019 15 4 19 3 0 3 0 H H L H C H TA DH DH SD H SD IC TO - II -I H H NJ TC AR TC AR BA IC IC G AG LA TA TN TI N KA TI PA
Link Worker Scheme ObjectiveMainstreaming Interventions in rural areas with <5000 population:• In these villages, focus will be on creating general awareness about HIV/ AIDS and STIs, and also providing referral services for STI treatment, VCT/PPTCT, care and support. Such interventions will be done through the link worker model• To prevent transmission from HRG to vulnerable population i.e. women and children.• In Bolangir 2 lacks population will be covered under this scheme. Implementation • Selection of Link Worker is on process in 6 blocks. Bolangir, Deogaon, Belpara, Loisingha, Titilagarh, Gudvela. • Village mapping has started in Loisingha & Gudvela.
New Centre established NEW ICTC Counselling BELPARA 365 CHUDAPALI 272 GHASIAN 238 AGALPUR 68 SAINTALA 98 SINDHEKELA 470 MURIBAHAL 186 GUDVELA 127 TOTAL (8) 1824Testing not started.LoisinghaKhaprakholDeogaonAbove three centres are newly opened but staff not joined and centre may be shifted.
CONDOMNAME OF AREA OF TARGET STD SOCIAL NO. REFL TESTED +VE HOT SPOT AREA DISTRIB TI OPERATION GROUP TREATMENT MARKETING UTED RYS BOLANGIR FSW, 250, 552 398 61 342 RAJMAHAL AREA, GANDHI 8837 25355 MUNICIPALITY AREA, MSM 200 NAGAR, HATISAL PARA LOISINGHA, AGALPUR, CHUDAPALI SAI TITILAGARH MSM 250 170 134 17 298 DURLA 11950 700 PATNAGARH TENDAPADAR KANTABANJI GUDIGHAT BANKEL TANIA BALIPATASAHARA TITILAGARH FSW 250 159 108 6 253 ULBA 19250 5560 PATNAGARH BERHAMPURA KANTABANJI RAMPUR RYS : Rajendra Yuva Sangha, Bolangir SAI : Social Awareness Institution. SAHARA : Social Association for Humanitarian Activities in Rural Areas.
ART Registration at Burla. Male Female Total Pre ART 34 19 53 On ART 25 5 30
Position of MBPYNo of cases No. of cases Not Deathsanctioned received traceable140 36 19 19
Challenges Ahead & support needed from dist. administration1- To increase footfalls in ICTC2- To ensure more no. of ART registration.3- Convergence with NRHM and all line departments in activity &training.4- Coverage of all HRGs in the district5- To address out migration6- Strengthening the referral system7- Liquidation of advances pending with district