DAPCU Balangir response on the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

1. Has DAPCU faced any problems after closing CCC in the District?

• Yes. The PLHIVs were deprived of getting medical treatment like OI, drug reaction etc. through CCC.
• When CCC was there in this district, the PLHIVs were coming with a confidence and without any hesitation of getting care, support and treatment.

2. What measures have been taken by DAPCU to replace the services given by CCC?

• DAPCU has coordinated with DLN for providing support to PLHIVs, those are coming from remote places to ARTC, Balangir for their shelter and treatment at DSRC.
• LFU tracking is being made through DLN and other networks like USS. ICTC counselors are suggested for follow up even the client is not detected at their ICTCs.

3. How did DAPCUs integrate the In Patient & Out Patient services in the existing Govt. Health facilities?

• Any medical treatment / test is required which is not available at ARTC, through district health administration, the PLHIVs are included to get the benefits from the Govt. health facilities.
• Most of the times the health care providers like doctors, Staff nurses are sensitized on HIV/AIDS which in turn the PLHIVs are get benefited from the health facilities.

4. What are the good practices or approaches adopted to provide medical care to PLHIV within the district?

• DAPCU has coordinated / organized various sensitization programmes on HIV/AIDS to make aware the Health Care Providers on the same.
• Free clinical tests are being done at SDH levels.
• Now it become a general that HIV positive deliveries are being conducted at DHH and SDH level through constant sensitization to the Health Care Providers (from top to bottom) through various sensitization programme, during field visits etc.

Balangir DAPCU Response to the Theme- Comprehensive HIV/AIDS Services to the HIV Positive Migrants

Prevention & Early Detection

Though there is no TI working for migrants, the transit migrant’s intervention is done by TI-NGO at Titilagarh railway station which is major transit point. During intervention counseling (group and one to one) on HIV/AIDS, distribution of free condoms and take home IEC materials are given.

In Balangir district the migrants return during September to October. In that period health camps are conducted in migration prone blocks for free health checkup and HIV / TB / STI etc screening are also done. Suspected clients including their partners are referred to nearest ICTC for HIV testing.

The detected HIV positive client is immediately linked to ART centre for ART registration and in regular interval they are followed up by concerned counselor. During counseling session their destination / duration of stay / cause of migration etc are observed for future tracking and follow up.

Linking to ART, Treatment Adherence, Follow-up of MIS & LFU

By making inter district coordination (Ganjam, VSS, Burla-Sambalpur, Angul) the clients are followed up for LFU/Mis cases and ART registration. Out of 108 nos. of detected migrants, out of them 28 nos. of client have registered out of Balangir. Positive clients from other districts have also registered at Balangir ARTC. We have ensured inter ARTC / LAC coordination during our ART coordination meeting.

PPTCT services

If any ANC found positive and his spouse is migrant, it is always followed up by concerned counselor for institutional delivery and the same information is shared with other DAPCUs where they migrate.

Pictures Related to Health Camp for Migrants

Balangir response- Coordination Among DAPCU's

Need for DAPCU coordination:
1.    There is definite need for inter DAPCU coordination both inside and outside the state to have a generalized approach towards all the aspects of NACP.
2.    We need to know what steps are being taken to solve a specific problem / issue related to NACP in other districts for replication or modified implementation according to our district’s situation.
3.    It propels productive competitiveness between different DAPCUs increasing the hunger for better programmatic achievements.
Coordination with other DAPCU.
1.    For conduction of training outside the district like FSSWS, STI/RTI etc.
2.    During preparation of AAP in sharing knowledge and experiences.
3.    To mutually impress upon SACS for specific support and necessary changes / developments / arrangements to solve district / state level problems related to programme implementation.
4.    We also need the cooperation of other dist DAPCU, TI Partner, ARTC & LAC for following up of migrated PLHIVs and their CST status.
5.    We also coordinate with other DAPCUs to better our Socio economical Benefit Schemes (SBS) provision system.
6.    Sometimes we also need to relocate ART & STI drugs in between districts during stock out and expiry related situations.
Role of SACS in DAPCU-Coordination.
1.    SACS conducts the joint review meeting of all DAPCUs & NRHM (DAPCU district).
2.    During field visit of SACS officials they also share their experiences, which helps developing programmatic results from other districts with us and ask us to coordinate and implement the same.
3.    When the MD-NRHM was jointly in charge of PD-OSACS, he issued a letter to include DPM-DAPCUs as a member in RKS & ZSS Governing Body.
Inter-DAPCU coordination in Odhisha:
1.    With the coordination of all 7 DAPCUs of Odisha, DPM DAPCU is now a member of both RKS (DHH) and ZSS which is helping us to bring issues related to NACP on the table for discussion and subsequent solution.
2.    We usually follow up with other DAPCUs during IEC programmes like RRE, WAD, NYD, Health camps for returnee migrants etc to implement innovation, if any from other districts to increase participation and quality of service
e.g.
1.    As some PLHIVs are taking ART from other districts, by establishing coordination with other DAPCUs (Ganjam, Angul) the line list regarding ART registration, CD-4 count, life / death status is updated.
2.    With unified approach of all DAPCUs of Odisha, OSACS is impressed upon to release the TA/DA claims of ICTCs counselor & LT on quarterly basis.
3.    One innovative idea implemented by our district has now spread to other DAPCU districts of Odisha, i.e. payment of Rs.1000/- from local RKS to non-SACS LTs for carrying out blood test for HIV in ICTCs.
 

Balangir's Response to Theme- DAPCUs and F-ICTCs

DAPCUs and F-ICTCs

What is the role of DAPCUs in establishing F-ICTCs? How do you help in

Locating a suitable health facility to establish F-ICTCs

1. Clint load per day at the facility.
2. Availability of human resources such as Staff Nurse & Lab. Tech.
3. Communication facility to the health centre.
4. Registered TB cases per month.
5. In & out migration factors.

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

1. Propose the name of the staffs to OSACS for training.
2. OSACS provides the registers and reporting formats.
3. DAPCU to supervise and provide hand holding support.

Strengthening of linkages between F-ICTC and Designated ICTCs

1. Both the counselors of F-ICTC & designated ICTC shall be    jointly reviewed in each month.
2. They will coordinate with each other regarding referral and reach of the client.
3. Motivation to ASHA by in time payment of incentives for accompanying ANCs for HIV test & subsequently institutional delivery.

Monitoring and evaluation of F-ICTCs

1. The difference between total ANC + TB positive cases of the facility and the number of HIV testing should not be lower on the part of the later.
2. A considerable number of HRG and general clients getting tested or not is also a fact of consideration.
3. Gap analysis should be done between referral and reach of the client.

Share a few achievements from your districts in this regard

In our district Balangir which comes under KBK + categorization by Central Govt. for being backward economically and socially, essential health care related human resources like Staff Nurse & Lab. Techs. are not adequately available and for this the only three F-ICTCs attributed to the district are in the process of fictionalization with HIV testing being started on 28-06-2013 in 2 F-ICTCs out of 3. This is also being possible only due to deputation of some ICTC’s counselors and LTs to the F-ICTCs thrice / twice a week.

 

DAPCU Balangir Response for Supervision

What according to you is Supervision

“The person listens well, He Governs well.”

The supervision means to look someone’s work for giving supportive suggestion, encourage and improve his/her work efficiency / performance. Supervision is to be an interpersonal interaction that has a general goal whereby one person (the supervisor) meets with another (the supervisee) in an effort to make the work of latter more effective. Develop the worker’s effectiveness.

How do you plan and implement your visits for supportive supervision.

• Prioritize the facility which is week in a specific field.
• Ask him/her what type of help he/she does want.
• Distribute the problems categorically – Verbal and written.
• Try to resolve over telephone or someone else available nearby the supervisee.
• Plan and inform him regarding your arrival for hand holding support.
• Gather required information for resolution of any problem.

What should DAPCU keep in mind while undertaking supervision?

• Analyse the gap between requirement of knowledge and the work assigned to.
• Propose for requirement of training if any.
• Improve capability and quality of his/her work.
• Resolution of problems at that point.
• Maximum support to the supervisee / worker.
• Develop the worker as a professional person.
• Induce the working environment.
• Provide a suitable and appropriate forum for the worker to assure those to whom he or she is accountable that he or she is acting responsibly.
• Promote best practice for worker by using existing resources.

List of Do’s

1.  Listen carefully the worker problem / difficulties

2. Prioritize the problem / difficulties

3. Be time specific, because time is valuable for both the supervisor and supervisee

4. Resolve, as if you are facing the problems

5.Try to get the worker / supervisee, understand in an indirect approach

6. Always build a friendly atmosphere, not an admonishing approach

7. Place a timeline for the work carried out

8. Always try to apply “Feel – Felt & Found method”

List of Don’ts

1.       Shifting of responsibility

2.       Use of discouraging words or remarks

3.       Direct dissuading approach

4.       Interference in personal matters

DAPCU Balangir Response to the Theme of Women & HIV

WOMEN and HIV:  

•  In present situation women play a vital role in spreading HIV infection to others. In the case of a returnee migrant, when he returns to his home after a long gap, his spouse can not deny immediately for physical relation or after having HIV test whether he is infected or not.
•   Suppression of illegal sexual relation of an unmarried boy also invites harassment to that woman when she gets married to that boy.
•  As most of the women are not earning member of the family, they are many a times are deprived of their livelihood from their mother-in-law’s house. It some times yields commercial female sex worker to earn some bread and butter. 

What are the ways in which your district ensures that women have access to HIV services?

• All ASHAs / AWWs/MPHW (M/F) were sensitized on HIV/AIDS through out the district which enables them to know regarding HIV/AIDS and its vulnerability / prevention of transmission etc.
• In each monthly meeting, it is observed / reviewed the target of pregnant women in the district and how much they are tested by ICTC?
• In monthly doctors review meeting in presence of Dist. Collector & CDMO it is presented that how much ANCs were tested according to target / estimate? In turn it is impressed by CDMO to all doctors regarding HIV service provision to all estimated ANCs.
• Counselors are instructed to attend the ASHA sector meeting regularly for more no. of referrals of ANCs to access HIV services
• ASHAs are given incentives to promote the ANC referrals to ICTC for uptake of HIV services.
• In coordination with ICDS, HIV / AIDS related posters are prepared and distributed through them for more accessibility of HIV services.
• In each Mela / Utsav, IEC stalls on HIV involving counselor of concerned area, are installed with counseling aids and free condom distribution / demonstration.
• Doctors are also sensitized to refer more no. of suspected cases to ICTC for HIV service provision.

Have you made any Special efforts to address their needs and Vulnerability?

•    There are some NGOs working for HIV infected persons, those who are debarred from either from their father-in-laws house or from their mother-in-laws home.
•    They are given some interest free financial loans to make by themselves stand alone and self dependent.
•   In connection to vulnerability factor, it is observed from the line list of HIV positive persons, strategy of intervention is made time to time at district level in coordination with district health administration and SACS.

You can also share with us how women's day was observed in your district?

The INTERNATIONAL WOMEN’S DAY, 2013 observed at Town Hall, Bolangir on 8^th March 2013 in our District.

The occasion was chaired by Mrs. R. Prakash, wife of the Superintendent of police Bolangir as Chief Guest, Mr. Bikrant Kumar Kindo, CDMO, Bolangir as chief speaker, Dr. Jyotirmayee Sahu, DMO, DHH Bolangir, Dr. Manjulata Panda, ADMO, Bolangir & Dr. Jyotsna Mahapatra, Social activist as Hon’ble Guests. The participants were from public representatives of the district, SHG members from District & Block Federation, inmates of SWADHAR Home, Bolangir & Eminent women of the District.

CDMO emphasized and focused on the vulnerability of HIV/AIDS in our district in connection with women as they are the creator of new generation. In brief he presented the roles and responsibility of women in this context in our district.

DAPCU Balangir Response to Role of DAPCUs to Support TI

     
 1.      Coverage of HRGs registration:

HRG registration master registers are cross checked during field visit to Hot spot areas of TI operational areas. Their age group is also verified in case of FSW. Some times it is advised not to take old cases.

     
 2.      Strategies to improve ICTC service to the HRG’s (twice a year):

In each and every month the gap between referral to ICTC and reach of HRG at ICTC is observed / analysed and during monthly coordination cum review meeting to reduce the gaps. It is also advised to PEs that to keep contact with their concerned counsellors (if required) for the availability of the counsellor if the HRGs want to come ICTC beyond the working hour.

      
3.      Pre ART Registration and Testing for CD4 Count of HRGs found HIV Positive:

PM-TI and PEs are encouraged to accompany the detected clients to ART centre for ART registration. During field visit to TIs it is verified the gaps between detection vs ART registration and the same also discussed before the CDMO in monthly review cum coordination meeting at district level. ART staffs are also keeping contact with TIs to refer their HRG positive clients for ART registration.

      4.      Measures to improve the STI service to the HRG’s and ensure RMCs:

During staff review meeting of TIs client wise STI / RMC / PT etc. service provided are checked and some times cross checked at PPPs to ensure the STI service provision to HRGs. Cross verification is also done through STD clinic if any client has received the STI related treatment.

      5.      Distribution of condoms, needle & syringes to all HRGs:

Though there is no TI on IDU in Balangir, condom distribution is monitored according to their calculation for demand of condoms according to HRG (High, Medium, and Low). PEs are encouraged for promotion of social marketing condoms for proper utilization of condoms and in turn it will prevent infection transmission. Condom stock / availability at TIs are regularly monitored.

      6.      How do DAPCUs and TSUs coordinate to support TIs? Please give examples:

In monthly review cum coordination meeting held under DAPCU under the Chairmanship of CDMO, PO-TSU is invited to attend the meeting and give feedback to the programme. TI performance is also presented before him and triangular suggestions are taken for better implementation of TI programme.

      7.      Does DAPCU support TIs in accessing the district administration? Are there any good practices related to getting social benefit schemes for PLHIV:

In quarterly DAPCC/DCC meeting which is held under the Chairmanship of Collector & Dist. Magistrate all technical and critical decisions are taken immediately into consideration as Dist Collector is the apex body of the committee. It helps a lot to solve the problems related to access the social benefit schemes by PLHIVs (not only to HRGs but to General PLHIVs also) at the very moment.

For an example: opening of zero (0) balance account in bank to get monthly Madhu Babu Pension Yojana (MBPY) & delay in sanction of MBPY and Mo Kudia Yojana (MKY-Concrete House) to PLHIVs. Now in Balangir district 10 nos. of applications are in process of disbursement of MKY through Block Development Officers at Block level.

DAPCU Balangir Response to DCC for HIV-TB

1.            What are the advantages of DCC in HIV-TB collaboration activity?

      a)      As the District Collector is the Chairman of DCC it is easier to convincing regarding the urgency of HIV-TB collaboration throughout the district to effect the required mainstreaming and convergence both inside the health and other line departments.

  b)      The DCC meeting comprises not only HIV testing service provider unit but all the facilities providing services related to HIV are involved for their performance / achievement review such as ICTC, F-ICTC, TU, DMC, ART, TI, CCC, DIC, DSRC, BB & NGO/CBO under one umbrella i.e. District Collector.

c)      Helps to take in time decision and in other hand helps to save the time.

d)     Builds a close coordination between all platforms.

e)    All the stakeholders from different wings perceive their roles and responsibilities in the HIV-TB collaboration activity.

f)    Appropriate and strategic plans are taken into decision at the time of gap analysis of target vrs achievement.

2.      Share examples from your districts - How can DCC for TB – HIV strengthen the cross referrals between the ICTC and RNTCP (diagnostic and treatment services, and ART and DOTS services, and overall implementation of the National framework for TB – HIV Collaborative activities).

a)   Counseled clients where HIV testing facility is not available. Clients are followed up by concerned counselors for their HIV test at nearest ICTC.

b)   Even clients are accompanied by ASHA / LW or counselor for the betterment of the client.

c)  Where the DMCs are not co located with ICTC clients are being referred to nearest ICTC and they are looked after by concerned STS.

d)  However through the convening of DCC in every quarter, our performance in the field of cross referral, co-infection detection and CPT administration has remarkably increased.

Year	From RNTCP to ICTC	From ICTC to RNTCP	Co-Infection
2009	65	189	0
2010	243	697	6
2011	567	1057	11
2012	898	1269	10

3.      Share examples from your districts - Appropriate measures are taken to prevent the spread of TB infection in facilities caring for HIV – AIDS and spread of HIV infection through safe injection practices in the facilities providing RNTCP treatment services.

a)      ASHAs are sensitized by ICTC counselor in their ASHA sector meeting regularly.

b)     All ASHAs are referring and accompanying the suspected TB cases to DMC.

c)   At regular intervals ANM, staff nurses are sensitized regarding HIV-AIDS specifically on safe injection practices.

d)    Universal precaution guidelines are always being adhered to for ensuring non transmission through the processes of health care provision at any of the service delivery units of HIV, TB and its CST.

4.      Share examples from your districts - Role of ICTCs, ART, and Care and Support Centres in intensified TB case findings.

a)    All co-infected cases are being followed by STS, Counselor and ART Centre regularly.

b)    They are also given medicines at their door steps.

c)     STS and counselors are making joint visit to the co-infected clients.

d)    Gradual improvement in HIV-TB collaborative activity is shown in the above table.

5.      Share examples from your districts - What are the strategies DAPCU should opt for 100%   treatment, care and support for TB – HIV co- infection cases?

a) Client specific / personified co-infected cases are reviewed (Date of detection, CPT administration, ART adherence etc.) in monthly HIV-TB co-ordination cum review meeting.

e)    Counselors of ICTC are attending the ASHA sector meeting for more no. of referrals to ICTC for service uptake.

b)     Responsibility is given to ICTC-Counselor and STS/STLS of respective areas.

c)      Feed back is taken jointly by DPM and DTO for each client.