DAPCU Bhadrak Response-World AIDS Day-2013

WORLD AIDS DAY-2013

ACTIVITIES :-A host of campaigns and events like Debate competition, Essay writing competition and quiz competition on HIV related topics was organized by DAPCU on 24th November 2013 among the students and volunteers of various colleges, to raise awareness among the masses. It was remarkable feature that the students and staffs like lecturers and professors showed their spontaneity to participate and ready to do the needful for the vulnerable person which is a green signal for the future activity.

MASS RALLY:-

As per the plan a mass rally was flagged off after receiving first signal from District collector & DM Sj. L.N.mishra, from the hospital campus at 9.15 am in the presence of Hon’ble CDMO, ADMO (PH) and many other dignitaries. With the support of stakeholders, TI partner NUHASS & FELLOWSHIP,

Media and positive networks, NGOs, hospital staffs, Non TI NGOs, ASHA Networks, students and staffs of Bhadrak Autonomous college, Charampa college, Bhadrak women’s  college, Royal school of nursing, FSWs, MSMs, general youths of the locality and many others. It seemed as if the whole Bhadrak District was in Motion. The participants distributed awareness kits, leaflets, brochures and other IEC materials to bystanders on the way to Balgopal Temple Campus in the heart of the district. The participants with their slogans made the city silent and thrilled for some time. There was huge public response to the Mass rally (around 500 Participants).

INAUGURATION CEREMONEY:-

The function at historic Balgopal temple campus was attended by Sj.Jugala Kishore pattnaik,hon,ble MLA Bhadrak,Sj.Laxmi Narayan Mishra,hon”ble collector  & DM, Bhadrak, Dr.Harihara das ,CDMO Bhadrak, Dr.Debasish Dey, Nadal Officer(AIDS) Bhadrak,Himansu Sekhar sahu,Sr. manager,CSR,DPCL, Sj. Manas Kumar Mohanty, Chairperson,Bhadrak Muncipality, Radhakanta Samal, Vice President,BJD, S.M.Farooque,Director Fellowship NGO,DPM DAPCU,,MR.Hemanta Kumar Dash.The observation got off to start with lighting the candle by chief guest Jugala Kishore Pattnaik & Guest of honour Sj. L N.Mishra, With a devotional hymns chanted by a lecturer Charampa college, followed by the patriotic song of Odisha “BANDE UTKAL JANANI”. 

WELCOME ADDRESS:-The warm Welcome address was given by CDMO ,Bhadrak to the honorable dignitaries  on the stage and the participants from all corners. He put a glance on the brief scenario on HIV /AIDS in Bhadrak,Odisha & INDIA and the World. He highlighted the concept, despite of being a low prevalent state how odisha has become more vulnerable to HIV/ AIDS according to the recent studies. After that the other dignitaries gave their views regarding the situation of HIV/AIDS.

Unique Programme:-

The presence of Mr. Himansu Sekhar Sahoo,senior Manager (CSR)DPCL was the buzz of the forum. He highly appreciated the efforts of DPM DAPCU in the field of awareness and prevention and control programme. He also sincerely thanks to all staffs of service delivery points. He deeply showed his benevolence to the CLHIVS. He pointed out HIV /AIDS is one among the most dreaded infections that affects men and women of all age groups, occupations and races across the world. He was puzzled over the figure and number of PLHIVs increasing day by day. It is because of his initiatives 52 no. of CLHIVS were benefited   and received the educational, Nutritional kits supplied by DPCL(School bag-1pc, pencil box-1pc,colour sketch-1 box,colour pencil-1 pkt, scale-1pc,pencil-1pc, eraser-1pc,cuter-1pc,tiffin box-1pc,Art copy-1pc,Blanket-1 pc,Horlicks-1kg, Horlicks biscuit-300g-2 pkts, Moong dal-2 kg, Chana-1 kg,moong-1kg, Chhatua-2 kg, Water bottle-1pc). 

Challenges  

As per the Micro plan /Proposal for involving almost 500 participants i.e., College students, HRGs, Member of NGOs, PLHIVs, Lawyers, Officials, etc., to observe the WAD-2013. To met the expenses the amount expected to be short surpassed the allotment of Rs. 25,000.00 from OSACS. 

Hence involvement of the TI, NGOs & Corporate sector named DPCL joint the same observance with their own contribution and made the entire procedure a grant success.

DAPCU Bhadrak Response to the Theme: Care and Support Services for PLHIVs in the Absence of CCCs

• Has DAPCU Faced any Problems after Closing CCC in the District?

It is mentioned here that there is no CCC established in the district, rather previously there is a CCC in nearby district Balasore. The PLHIVs of Bhadrak district depends upon the Balasore CCC and same centre takes all sorts of care, support and treatment to the clients. Though the CCC has the provision of Outreach Worker and the workers are very much committed to their work and follow-up the clients at the time of field work. No doubt, the DAPCU, Bhadrak has faced problem due to there is neither CCC nor a DIC for looking after the PLHIV.

• What measures have been taken by DAPCU to replace the service given by CCC?

The District has no CCC, DIC and ART centre, but there is a LAC+ in the district. The MOI/C of the LAC+ has provided time for the PLHIV for all sorts of Care, Support and treatment.  The CDMO of this district takes all sorts provisions of care to the PLHIV.

• How did DAPCU integrate the Inpatient and Outpatient services in the existing Govt. health Facility?

Most of the Outpatient are cared by the MOI/C, LAC+ and MOI/C of STD Clinic. In case of any difficulty the concerned doctor refer the clients to the concerned head/specialist of the departments for better treatment. If necessary the client may admitted in the hospital for better care and treatment or any difficulty the clients refer to the higher institution for treatment.

• What are the good Practices or approaches adopted to Provide Medical care to PLHIV within the district?

1. At the time of need the Blood bank provided blood to the PLHIV in free of cost and the RKS provide the cost for the blood sample.
2. Travel expenses  of the PLHIV met from the Red-Cross fund and it was manage by the DAPCU ( till date Rs-30,000/ has already been sanctioned from the red-cross)
3. The RKS also provided free Ambulance services to the PLHIV at the time of need.
4. All Pathological tests for the PLHIV are conducted free of cost.
5. All ANC Positive delivery was conducted in the DHH as well as the CHC level. The labour room in charge provides necessary delivery kits and Nevirapine tablet and syrup to the client which was supplied by NACO/OSACS.
6. Any types of operations need for PLHIV are conducted in the district.
7. At the time of treatments all necessary medicines are provided to the PLHIV from available fund. 

DAPCU BHADRAK Response: DAPCU -Stigma & Discrimination

              

 Roles and Responsibilities of DAPCU respect to stigma and      discrimination

·        Strategies for reduction of stigma.

·        What are the services accessible to reduce stigma.

·        In the health care setting.

·        District administration and its department.

·        In the community setting.

·        Please share any achievement in reducing stigma and discrimination.

                    Some strategies for reduction of stigma :

·        AIDS is a life threatening disease that a person carries the HIV virus throughout his/ her life till death. Now days such disease has created a morbid fear in the mind of common people as such no permanent remedy has developed in medical science. Stigma is a social attitude / thought emerges from own culture and belief. In view of the above DAPCU has taken some strategies to reduce the stigma in different situation. Stigma stands in the following situations/ levels :

a.      Community level.

b.     Family based.

c.      Health care situation.

d.     Religion & Culture.

e.      Media.

f.       Educational Institution.

g.      Work place (Corporate / industrial sector, where group of people work together).

h.     Administration (where some duty bearers have ill attitude towards the HIV infected people in discharging their services).

   DAPCU has made the following strategies to reduce the stigma in different level as follows:

 Community level campaign:

a.      Campaign for AIDS for NO AIDS.

b.     IEC/ Advocacy.

c.      Sensitization workshop on HIV/AIDS.

d.     Fixing hoardings on HIV/ TB/STD.

e.      ARSH training to adolescent girls.

 Besides that DAPCU has made the following action plan to reduce the stigma in different levels…..

1.     Need assessment.

2.     Vulnerable Mapping.

3.     Strengthening service delivery structures.

4.     Targeted intervention strategies.

5.     Condom promotion.

6.     Developing health seeking behaviour.

7.     Family strengthening programme.

8.     Farming Red Ribbon club.

   Other strategies/ services are being planned to reduce stigma, especially health, education and administration level.

                          

o   Priority on hospice care.

o   Priority on palliative care.

o   Day care, home care, hospital care and hospice care.

o   Counselling through ICTC and other service delivery points like DOTS Centre, EID Centre, Link ART/ ART Centre, STD clinic, Doctors clinic to the patients and his/ her family members.

o   Sensitization training to all the health care providers in the hospital.

o   School AIDS education programme.

o   Awareness through Red Ribbon Club.

o   Blood safety programme.

o   Health camp and STI screening programme.

o   Observing World AIDS Day by the responsibility / involvement of District administration.

o   Convergence with different line Depts. and make aware the duty bewares.

o   In the DAPCC review meeting, any topics/ issues related to HIV/AIDS are discussed to the members of the committee.

o   Work place intervention like awareness/ workshop in different factories / industries/ corporate sectors.

o   Advocacy to different stakeholders/ civil society partners/ Govt. officials through mainstreaming.

o   Media sensitization programme for writing on stigmatizing and no discriminating words.

o   Focussing on moralizing writings.

o   Motivating people for not engaging in high risk behaviour.

o   Providing administration and service providers with correct information on HIV/AIDS.

o   Campaign for togetherness in melas/ religious place/ cultural festivals.

o   Folk campaign/ Radio jingle playing.

o   Walling/ painting leaflets and its promotion in community level.

o   Involving the HIV affected people in the social benefit scheme as they think their rights rather discouragement. All the above strategies are the ongoing process of DAPCU to reduce the stigma and discrimination in different levels.

EXPERIENCE –I.

  Two school going orphan CLHIV were victimised with stigma during their school. DAPCU and TI partner and District Administration made the awareness programme in the concerned school, on HIV/AIDS, after that the school and the students accepted the children as normal.

  This was happened in Barabhagia sasan under Bhadrak Block.

EXPERIENCE – II.

  One family and the patient were discriminated by the villagers due to stigma in the Guamal village under Tihidi Block. After the massive awareness programme in that particular village, on HIV/ AIDS with the help of PRI members, the villagers accepted that family and treated them as normal.

                                     

Stigma always facilitates discrimination. Due to stigma, people suffer from discrimination. Once stigma is reduced, the discrimination cannot be happen. Everyone behaves to HIV/AIDS affected people differently and does not accept them as normal only due to stigma. Stigma is harmful but Discrimination is more painful. Stigma is the cause but Discrimination is its effect.

Bhadrak, response on Coordination among DAPCUs

Is there a need for DAPCUs to work in coordination with each other?  

There is an utmost need for DAPCUs to work in co-ordination with each other.

If so share how are DAPCUs in your state are doing this.

For the first time in Odisha, the DAPCUs of Khurda, Angul and Bhadrak are sharing their achievements in Angul and DAPCU Angul is sharing their record keeping and filing in presence of Mr. Praveen, DNRT, NACO and Dr. B.K. Behera, Joint Director (Basic Services), OSACS, Odisha. This has resulted in encouraging a development of a professional work culture amongst other DAPCUs.

What are the issues on which DAPCUs support each other and how is this coordination achieved?

Data Validation- Given the movement of populations between various districts for work and other personal reasons, a large number of people get tested in districts other than that of their residence because of privacy and other issues. For this reason, it is important for the DAPCUs to share their information so that accurate data is compiled.

LFU/MIS cases identification- Because of the above mentioned reasons, a lot of cases that are labelled as LFU and are MIS cases can be tracked with the co-ordination of several concerned DAPCUs.

Regarding Buffer Stock- As it has already been documented, timely delivery of medicines and other consumables is very important for the benefit of the patient, co-ordination and support can help each DAPCU deliver goods in time.

What role do the SACS play in enhancing this co-ordination?

The role of OSACS is vital in this co-ordination because through them the head of OSACS may send uniform formats, copies, guidelines, orders etc. which will make data comprehension easy and co-ordination easier.  For example, if OSACS issued a circular to ART centre, for better co-ordination OSACS may copy to DAPCU for follow-up action. DAPCUs should request OSACS for conducting periodical review meeting with DAPCU staff and also conduct training periodically to update the staff about new guideline etc. The OSACS may also reply or take action against the various request sent from DAPCUs.

Examples in which you have taken the support of other DAPCUs

• The DAPCU, Balasore helped us in a follow-up tracking of the PLHA about Pre-ART registration, On-ART status, and LFU and MIS cases.
• The DAPCU, Balasore referring the exposed infants to the EID centre, Bhadrak.

 Examples of the results achieved by inter DAPCU coordination. 

• There has been an increase in the testing of EID cases.
•  There has been an increase in the follow-up tracking of ANC.

At last, the DAPCU team Bhadrak can say that we are regularly with touch with all other DAPCUs of Odhisha regarding various issues. But I would also like to request OSACS to play the role in co-coordinating DAPCUs to handle the particular cases that might come up. 

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

What is the role of DAPCUs in establishing F-ICTCs? 

1. To identify the 24 hours PHC or area hospital having 20 bedded services for the patients.
2. To ensure the staffing position like Doctors/Pharmacists/Staff nurses/ANM/LHV/Attendant/lab technician.
3. To ensure the lab-facilities, where DMC will be functioning along with normal routine testing.
4. To ensure at least 50 deliveries in a month. 
5. To ensure the ANC flow to the hospitals.
6. To ensure about the community accessibility towards the health service.
7. To ensure about the minimum infrastructure.

In the above circumstances, DAPCU should monitor properly other things like

• Service delivery system of NRHM and RCH
• STI prevalence in the areas.
• Distance  from the standalone  ICTC 

Finally, DAPCU will give proposal in the DAPCC meeting to ensure its observations to the members of the committee and it will be unanimously taken decision by the members to propose OSACS for establishing FICTCs.

How do you help in locating a suitable health facility to establish F-ICTCs?

By proper monitoring its infrastructure sanitation, hygiene, care and treatment and other services.

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

In case of capacity building of the existing staffs like ANM, Nurse, Lab-technician, the name will be intimated to OSACS for Induction training, prior to providing services, DAPCU can arrange  the orientation  training in the District level for the above staffs for early functioning.

In case of ensuring supply management system, DAPCU will provided the registers all types of reporting formats and testing  kits from its existing storage facilities by direct delivery system, and DAPCU will co-ordinate with NRHM regarding supply of other  equipment for laboratory.

Strengthening of linkages between F-ICTC and Designated ICTCs

In the crisis management, DAPCU will strengthen the co-ordination by supplying the materials, deputation of Counsellor and LT etc.

Monitoring and evaluation of F-ICTCs

As a result, FICTC is a service delivery structure in the HIV programme, for its proper functioning, DAPCU should take the greater role to strengthen its service.

Share a few achievements from your districts in this regard

Inauguration and Sensitization Workshop at Bonth PHC

Bhadrak's Response to Theme- Supportive Supervision

What according to you is Supervision?

The word ‘supervision’ can be read as over-seeing, looking over someone’s shoulder to check on them; and also ‘it means outstanding or special, helping someone to extend their professional skills and understanding. This will be relevant to varying degrees in supervision, depending on the context. It can be helpful to think about supervision both in terms of development and performance.

How do you plan and implement your visits for supportive supervision

• Be clear about why there is a need for supervision and who has asked for it.
• Set a time frame for the supervision session; even a few minutes of focused time can be worthwhile.
• Protect the time and space where possible and appropriate; try to ensure there will be no interruptions and that there is privacy.
• Ensure that there is confidentiality; this means working in a place where the supervision cannot be overheard, and sharing identifiable personal details of patients only with those people who really need to know.
• Be transparent about the extent to which the supervision is about development or performance; this may need to be renegotiated or stated during the session.

What should DAPCU keep in mind while undertaking supervision?

Through field visits, DAPCU verify all the registers of service delivery points and cross check the reports and the registers. DAPCU also identify the staff position, vacancies training needs, consumables status (HIV testing kits/condoms/formats and registers/IEC materials etc.)  Co-ordinate with the NRHM unit to ensure HIV testing is a part of ANC. Identify gaps in the ANC HIV testing and address them with support of NRHM personnel in the      district.

Monitor referral linkages among various facilities ICTC to STI Clinic and vice versa, ICTC to RNTCP and vice versa, ICTC to ART Centre, ART centre to STI Clinic, TI to ICTC, RNTCP, ART, Linkages with the govt. Facility for getting social benefit scheme etc.
Follow-up with various facility centers for submission of statement of expenditure and utilization certificates and reports to OSACS. Follow-up with various facility centers for submission of Audits statement  and compliance report to SACSs.
Co-ordinate with the Medical Officer I/c, District Health Officials about facilitating positive deliveries co-ordinate and liaise with NRHM and other line departments for including HIV related messages/issues in their campaign.
Join various meeting at field level like ASHA sector meeting, monthly staff meeting at block level for demand generation as well as awareness purposes.

Cross Baitarani river for supervision of ICTC-Chandbali (JD-STD& DPM)

While supervising, the DAPCU should verify the previous visit gaps and compliances made by the staff till date and update all the information to the Medical officer I/c for better improvement and co-ordination purpose.

Lastly, the supervision is purely a supportive supervision and there is requirement of such an environment that the staff of a service delivery point encourages to do all the necessary works for the facility.
                                                                                                                                                                                       List of Do’s 

1. Share the documents to the staff.
2. Write the gaps at the time of supervision in visiting register.
3. Provide hand holding training to the staffs.
4. Ensure to update all the necessary reports and registers and submit the correct report to OSACS in time.
5. Ensure the job responsibility.
6. Do check documents carefully; do follow the rules and process. Do raise concerns with the contracting authority.

List of Don’ts

1. Never write baseless allegation about staffs.
2. Do not collect the staff’s personal information.
3. Never disclose any PLHA status without his/her consent.
4. Never deny to provide the service to a client.
5. Do not submit false or misleading information.

Supervision of LAC, Bhadrak by M & E Asst.

Supervision of ICTC- Dhamnagar by DPM