LEPRA’s Operations in Odisha

LEPRA Society completed 25 years of its operations in Odisha. The journey, so far has reached over one million beneficiaries, directly and indirectly, implementing many successful projects of public health.  All the activities were confined to leprosy control programmes until 2002 rendering comprehensive services.  In the year 2004, being an ILEP State Coordinator, LEPRA had played a vital role shouldering the responsibility of strengthening and integrating leprosy services into the General Health Care Systems, thus ensuring community participation for sustainability. From 2006 onwards, the region incorporated the partnership mode of operations such as the NGOs, CBOs and other network support groups.

LEPRA has been managing RNTCP through Tuberculosis Unit /Designated Microscopic Centres (DMCs) in Malkangiri, Junagarh and Koraput districts of Odisha.  The contribution made by the global fund projects in RNTCP were wide acknowledged by the State TB Control programmes.

A pilot project was initially launched in Odisha state under National Filarial Control Programme.  The formal filariasis interventions started in October 2006 in Puri and Ganjam districts mobilising huge number of people with minimum financial inputs and strong community participation. The women group were benefitted at large through morbidity management techniques by adopting self-care practices presenting gratifying results.  People realised the effect of care and proper management of their disability. Later in 2009, the operations were extended to adjacent blocks. LEPRA now evolved a new holistic approach to tackle lymphatic filariasis and leprosy by SANKALP project being implemented in collaboration with the Department of Health, Government of Odisha. This project is adopting an integrated approach combining many components in common. Both diseases, if diagnosed late or left untreated, can cause severe disabilities, immobility and impairment and need wound care, dressing and physiotherapy. This project is the result of learnings of LEPRA LF experiences in Odisha and Bihar.

The close interaction with communities, especially the beneficiary suffering from disfigurement and disabilities, LEPRA noticed that the eye specialist were not keep to treat the people affected by leprosy.  This made the organization to build a committed team of specialist to offer quality eye care services restoring the vision of the beneficiaries. Gradually, included the component of eye care in all its leprosy projects in late 90’s.  A speciality hospital was operation in rural regions of Kalahandi, Sonepur and Boudh districts in 2003, where LEPRA was serving eye care services for leprosy affected people and extended later to the general public. LEPRA in partnership with Sight savers International (SSI) launched ‘Comprehensive Eye Care Service Project’ in providing accessible and affordable quality eye care services in a sustainable manner in the Western Odisha”. A 30 bedded eye hospital namely ‘LEPRA Mahanadi Eye Hospital” (LMEH) near Birmaharajpur of Sonepur district became functional since 2005 onwards with a focus to treat and cure patients suffering from cataract and refractive errors. The project contribution towards reducing the backlog of cataract surgeries is well appreciated – almost contributing towards 89% to the total cataract surgeries of Sonepur district (DBCS report-2008). The health education to women groups in rural pockets has been instrumental in addressing the superstitions and gender related barriers.  Currently, a single programme umbrella for eye care operations in Odisha are being implemented through Mahanadi Netra Chikitsalaya (LMEH) and Junagarh Eye Hospital with a focus on eye-related issues faced by people affected by leprosy and the rural communities, enhancing the quality of life.

LEPRA’s malarial interventions, in Orissa and elsewhere, build on its long experience of community outreach and Behavioural Change Communication, thus initiating a unique community malaria-control project between 2006 – 2010; pioneering the concept of Malaria Samadhan Sibir in collaboration with district health institutions particularly in remote and inaccessible areas.  The MSS were so effective that communities were able to access government health facilities with no reported deaths of malaria and diarrhea due to preventive measure and awareness in the general population. The state government has acknowledged and are adopting the flip charts developed by LEPRA’s malaria programme, which is now complemented by work to support the National Vector Borne Disease Control Programme (NVBDCP) in filariasis control. LEPRA Society is selected by Caritas INDIA for implementing malaria project under the state vector borne disease control programme under Intensified Malaria Control Project (IMCP) – II guidelines, to reduce malaria-related mortality and morbidity by 50 per cent.

LEPRA Society core focus now has shifted to leprosy and lymphatic filariasis reducing the projects in HIV/AIDS programmes. Over the years, LEPRA has implemented a number of HIV/AIDS programmes in the region facilitated and coordinated CD4 Count Test of 300 positive persons at Blue Peter Public Health Centre (BPHRC) during 2007 as a part of support to OSACS. The organisation is continuing as a valued member in the state level TB‐HIV Coordination Committee from 2006. From 2009 – 2013 the region continued as a member in the Academic Committee of the State Training and Resource Centre (STRC).

Promising Practices

Community Based Monitoring System (CBMS)

In the beginning of the project in 2006, this sample CBMS tool was initially developed and introduced with a few relevant malaria related indicators. This tool was developed with the participation of community people. In subsequent years the Gaon Kalayan Samittee (GKS) were formed and strengthened under the aegis of National Rural Health Mission (NRHM). The project also facilitated formation of Panchayat level Health Resource Centres (PHRCs) to support and hasten the grassroots developmental initiatives. When the GKS members got empowered and graduated to higher levels, and the PHRCs developed into vibrant institutions, the existing CBMS tool on malaria was revised/ modified jointly by incorporating relevant indicators which members thought were useful to them. The affected communities got involved in advocating for change as participants in the process, and not as objects.

The Mayurbhanj Integrated Community Health Project, LEPRA Society, Odisha, facilitated the use of this tool in 118 villages through GKS and PHRCs. Over a period of four years, the attendance and regularity of Anganwadi Workers (AWW), Accredited Social Health Activities (ASHAs) and health workers in the area has increased in 50% villages, dichlorodiphenyltrichloroethane (DDT) spray and use of mosquito nets have been regular, blood slide collection has also increased by 12%, and district authorities have opened 51 new Fever Treatment Depots for malaria. As an outcome of this community mobilisation process as many as 431 issues were brought to the notice of health as well as other district level authorities out of which 285 issues were addressed. These outcomes could be directly attributed to the effective use of information emanated from the CBMS tools.

Malaria SamadhanSibir (MSS)

Malaria Samadhan Sibir (Malaria Consultation Camp) is one of the unique initiatives of Mayurbanj Integrated Community Health Project (MICHP) which was meant to reduce high prevalence of malaria in the district. MSS is generally a camp organised in remote and highly inaccessible areas highly endemic in malaria. Sibirs (camps) are organised in pre- decided venues and dates with the active involvement of all concerned in the district working in malaria control. This combines three elements:  health education using IEC vans; provision of diagnostic and treatment services to those with fever; and joint meetings of health functionaries and key community members to organise communities for vector control and programme-related problem solving. Hence, all kinds of services/ benefits are made available at doorsteps of the people. Apart from receiving services people also share their health related grievances which are either settled on spot or settled in later dates.

During the project period (2006-2010), project has organised 244 numbers of MSS in different remote pockets of 26 blocks of the district, where 38,268 villagers (18205 male and 20013 female) directly benefitted through the diagnosis and treatment services during the programmes. Nine thousand four hundred and fifty four (9454) persons were suspected for malaria and their blood slides were examined; out of which 1945 cases (21%) were found positive and received treatment. Nine thousand five hundred and two members (3562 male & 5940 female) from GPHRCs and GKSs participated in the interface workshop organised during the MSS to discuss issues and problems related to malaria.  Six hundred and seven issues were raised and discussed during MSS out of which 494 issues were addressed by Health Authorities during MSS and 113 issues were addressed in due process.

The MSS has been adopted by the Mayurbhanj district Health Department under the same name and strategy and organised 51 MSSs during 2009-10 in inaccessible pockets of the district in collaboration with LEPRA Society and other Non-Government Organisation (NGOs). The most visible contribution towards the disease control has been the reduction of Annual Parasite Index (API) to 4.35 in 2009 from 8.5 at the beginning of the project in January 2006, and reduction of positive case load from 22,913 (January 2006) to 10,619 by December 2009.

Sputum Collection Centres (SCC)

A Tuberculosis (TB) suspect, is required to give sputum twice; once on spot and the second time on the next day for required testing to ascertain positivity. In remote and inaccessible tribal dominated areas people are required to travel even more than 40 to 50  kilometres to provide sputum at the Designated Microscopic centres (DMCs). Because of distance factor people are not usually encouraged to travel that far, to provide sputum twice. In order to bridge the gap between the TB suspect and the sputum testing Centre, this innovative model was introduced in the Koralep area. The project identified places close to villages (places not more than 5 to 6 kilometres away) where the sputum is collected by the volunteer. It is the responsibility of the volunteer to take the sputum samples to the DMCs for testing, ensure the test is done, collect the test report, and if any person is found TB positive then the volunteer ensures that the person is linked to Directly Observed Treatment Shortcourse (DOTS) treatment. This model was scaled up in the Sahyog project and subsequently in the Axshya India TB project between 2008 and 2012.   As many as 300 SCCs were functional in the region. This helped TB detection to a great extent. The picture above depicts the model and explains the linkages.

Social Audit (SA)

During 2011, the blacklisting of a number of NGOs by CAPART (Council for People’s Action and Rural Technology) in the country, created a general suspicion towards the manner and functioning of NGO community as a whole. There was adverse reporting in different media across the country highlighting deficit of credibility of certain NGOs and demanding reinforcement of stringent control mechanisms. In this backdrop, LEPRA Society decided to initiate Social Audits in the organisation as a proactive step towards transparency and accountability.  As the first step, a concept note on Social Audit was developed in order to bring uniform understanding across the organisation and to follow common processes while implementing the same in projects. The organisation carved out following objectives for undertaking the Social Audits. They are; a) disclose the project performances to the stakeholders, b)  enrich organisational learning through reflection and feedback, c) enhance public participation, strengthen relationships and partnerships among stakeholders, d) create a platform for wider public to raise issues about misappropriation of funds, unethical practices by the project (if any), e) reaffirm organisations accountability to its beneficiaries, f) share models for other development organisations to replicate, and f)  demystify the general perception that NGOs, in general, are deficit in credibility. The first ever Social Audit started in the LF project Puri on August 5, 2011. Subsequently other projects of the organisation initiated this practice.

The Sreyassu-Community Based Organisation (CBO), AP, the Technical Resource Unit (TRU)/Strengthening Referral System (SRS) project Odisha, the Munger Referral Centre, Bihar, the Targeted Intervention (IDU project) Bhagalpur, Bihar have conducted Social Audits in the year 2012. It was a unique experienceand a source of inspiration for those who value openness and accountability.

Conducting Social Audit was an evolving process as well as a great learning exercise for the organisation. The feedback from the observers, remarks of auditors and the suggestions from the participants reported were used for reference and corrective actions. There was wide coverage of all events by media, both print and electronic which was a step towards organisational visibility.    Before organizing the event, there was a bit of skepticism about the successful organisation of the event, fear about handling a large number of unknown audience, and a bit of uncertainty about attendance (too large or too low). The good work done in the area as well as organisational transparency stood behind us as strengths and encouraged us to go ahead with the event. Social Audit events brought lots of good will to the project as well as to the organisation. All sections of people acknowledged and appreciated the organisational disclosure process and encouraged to keep continuing the same.

Referral System and integration of Reconstructive Surgery (RCS) into General Health Care System

After successful completion of District Technical Support Team project (2004-2007), it was strongly felt to establish a good referral system in the general health care system, so that the leprosy patients can be diagnosed and managed at Primary Health Centres (PHCs) and referred to district hospitals, referral centres and RCS centres for difficult, complicated and RCS cases. The TRU & SRS project (2007) continue to build the capacity of Primary Health Centre (PHC)/Community Health Centre (CHC) and district staff for management of normal cases and organised special trainings for RCS surgeons, physio-technicians, shoe-technicians, District Leprosy Officers (DLOs), District Leprosy Centres (DLCs) for management of referral and RCS cases. Thus, LEPRA established 10 Referral Centres and supported 10 RCS centres at government institutions by strengthening the operation theatres, hands-on-training to government surgeons, extending its in-patient wards for hospitalisation of RCS cases and rigorous counselling of staff and monitoring the programme.  Through the project, LEPRA reached 71,236 leprosy affected persons for care and services, provided 22,935 customised foot-wear, trained 4103 government staff and facilitated 2058 reconstructive surgeries. The model is very well appreciated and integrated in the National Leprosy Eradication Programme (NLEP) revised Disability Prevention and Medical Rehabilitation (DPMR) Guidelines.

Regions involvement in Disaster Response work

LEPRA Society always believes in inclusive growth and has adopted holistic development as an important approach. Hence, extending support to its own beneficiaries during disasters has been the practice. There are genuine manifestations, in the past, of its humanitarian support to people during need. Being an organisation with expertise on health it always chose to cater to the immediate health needs of people as one of its immediate disaster response activities. The organisation provided support during the Super Cyclone in Odisha (October 1999), the Fire Incident at Malisahi Slum of Bhubaneswar (November 2007), another fire incident in Malisahi Slum (January 2012), fire incident at the Govindpur village,Birmaharajpur Block of Subarnapur District (June, 2012), and the Phailin Cyclone Response work  in Puri District (2013) which are the major organisational disaster responses. As per the long-term Phailin restoration plan 25 needy LF patients were provided revolving loan support apart from medical care to 2352 persons for different ailments.