Khorda Response to Theme- DAPCUs and F-ICTCs

DAPCUs have been playing a great role in linkages between facilities in the grass root level.  They also have a vital role in establishing FICTCs in the district. Some of the important aspects are as follows 

• Gather information about the area, demographic profile; analyze the risk and hazards, type of community, vulnerability, as well as mapping of facilities available in the area.
• Analyze the spatial map and data based on the health aspects like available of health facilities, number  of deliveries conducted in a month ,manpower available and reasons of vulnerability etc. 
• Apprise to concerned authorities of concerned area i.e. district health authorities and SACS regarding the need for FICTC.
• Facilitate procurement of equipment from RKS / other sources.  DAPCUs also need to ensure that technical guidelines for quality assurance of the equipments and supply consumables to the facility are followed.
• Facilitate the process of establishing FICTC and provide hand holding support for establishment and functioning 

How do you help in Locating a suitable health facility to establish  F-ICTCs
CHC/ PHCs are the major health units in the area where primary and secondary treatment is provided so the CHC are the suitable units to establish FICTCs. Apart from this the following aspects are considered

• Number of deliveries conducted  at the CHCs  in the month 
• Availability of Human resource at the CHC
• Other support facilities must exist like DMC, TI or LWS programme at the area.
• Close to a designated ICTC for referrals  

Capacity building of the F-ICTC (i. e. training of staff, providing registers/ formats, providing guidance, supervision etc)

DAPCU need to facilitate capacity building training for the staff ( Staff nurse for HIV counseling and LT for HIV testing )   in consultation with SACS . While selecting the staff for training the MO I/C must provide consent and ensure the regularity of the staff. 

To enhance the quality and interest of the staff  of  FICTC ,DAPCU can arrange exposure through visits to other facilities or to depute the trained staff of ICTC to the FICTC to provide hand holding support and for trouble shouting.  However during the field visits the DAPCU staff provides hand holding support for the counselor to ensure proper counseling and helps to maintain registers, CMIS etc. During t he visits of the DAPCU staff the records , documents like consent papers , lab registers etc are seen and provided supports relating to any shortcomings. During all the visits the progress have been briefed to the medical officer in charge of the Facility and apprises for improvement. The FICTCs are visited more than one time in a month to provide maximum support and facilitate the process. While visiting,  programme based indicators are also discussed to enhance their capacity on the other hand the staff are also invited for monthly coordination meetings in the DAPCU.     

Strengthening of linkages between F-ICTC and Designated ICTCs Monitoring and evaluation of F-ICTCs

There should be a proper coordination in between Facility and Designated ICTC to reduce loss cases There should be regular intervention in between two facilities. The counselor of SA ICTC need to visit or to attained meeting of the referred facility to establish and strengthen the referrals. The counselor of FICTC must have proper counseling (post test counseling  especially) to ensure that the referred client has reached at the Designated ICTC and he or she has to inform the counselor regarding the referral. On the other hand the TI and Non TI NGOS can play a vital role to facilitate and ensures that the referred clients are tested at the Designated ICTC. The counselor of FICTC need to maintain referral records so that she/ he can track the case

DAPCU plays a major role for trouble shouting in between two facilities and to ensure linkages during the field visits .Good relation and coordination need  established in between two. DAPCU  team while field visits need to look after the system and the evaluate the process and facilitate to short out issues . During the field visits  the records and reports need to be validate and ensure them  for proper maintenance.  

Share a few achievements from KHORDA districts

Three FICTCs had been planned in the Khordha District( CHC Tangi, CHC Mendhasal and CHC Banapur) and out of three two are functional now. During the last one year we have an experience to setup 2 FICTCs (at CHC Mendhasal and CHC Banapur). Earlier only one FICTC ( CHC Tangi) was only functional.  

To set up of the FICTCs DAPCU has discussed with the CDMO, Nodal officer at the district regarding functionalization of FICTC. The matter has also been discussed in the Medical Officers’ monthly meetings by the DPM. The matter has repeatedly  discussed and follow up with the concerned Block Programme Managers   during the field visits and during their Monthly meetings at the District.

Problem faced 

While facilitate for the process for establishment of FICTCs  DAPCU faced lot  of problem. After repeated discussions in the monthly meetings no actions was taken in the concerned CHCs. Issues like the there is no room available , no funds at RKS , it is not been passed in RKS meeting  and members are not paying attention etc were cited. So when ever DAPCU visit the CHC for follow up found no action has been taken. 
The LTs who are given HIV testing training were not interested for HIV testing saying that they have been over burdened with other works etc.

Strategies 

Frequent field visits ensured the concerned CHCs to apprise MO I/C  to facilitate the process and to provide designated space for FICTC .Along with this DAPCU has also facilitate to provide specifications of the equipments  for quality assurance and the name of the supplying agency.
Supplying of consumables and records to the facilitate and ensure the staff to is well aware of the use and maintenance of algorithm of test and facilitate to understand records and CMIS  during the Field Visits by the DAPCU staff.  

Administrative orders passed to the concerned persons to facilitate the process. In our district CDMO played a vital role to activate these facilities.

The DPM, NRHM has also been approached to facilitate to procurement of equipments from RKS and to facilitate for functionalisation of FICTC. 
Output

At present all the FICTCs are equipped with the required equipments.  Out of three FICTCs two Facilities (CHC Banapur , CHC Mendhasal)are reporting regularly in a single reporting format supplied by SACS.  One Facility is not reporting due to transfer of the trained staff nurse and LT at CHC Tangi.  

 Future plan
The list of \staff nurse/ ANM and LT   from CHC Tangi for HIV counseling and testing training in coordination with SACS 
The names of the staff (counselor/ LTs) of CHC Tangi and also CHC Mendhasal has been informed  to SACS for imparting HIV counseling and testing training.