DAPCU Central Delhi Response to the Theme : DAPCUs role in strengthening referral between ICTC - ART

Following are the strategies currently being adopted to ensure linkages between ICTCs and ARTC in our district:

1. Proper documentation of address & contact details of all clients visited at ICTC.
2. Gapless Line Listing of all HIV Positive Clients.
3. Outreach by ICTC Counselors to motivate the HIV Positive clients who are reluctant to register themselves at ART.
4. Also, outreach by DSRC & TI-NGO staff of their respective clients (detected HIV Positive at ICTC) to ensure their ART Registration.
5. Strengthening linkages between ICTC & ARTC through regular meetings.
6. Support ICTC staff for ART Registration of HIV Positive Clients if they face any difficulty at ARTC.
7. An intensified LFU Tracking Exercise was coordinated, monitored & facilitated by DAPCU-Central Delhi in Central, West & New Delhi Districts (in 2013-14) through following activities:
   1. Facility & Area wise scrutiny of all LFU data provided by Delhi SACS & 9 ARTCs of Delhi.
   2. Scrutinized details of LFUs were disseminated to the concern ICTC, PPTCTC, DSRC & TI-NGO staff for tracking of the same.
   3. LFU tracking were done by the concern facility staff and reported the same to the DAPCU.
   4. 1355 LFU cases were tracked out of total 1612 LFU cases provided during the Intensified LFU Tracking Exercise.

Following steps can be taken by DAPCU to link all the patients with ART who were detected HIV at the ICTCs:

1. DAPCU can emphasis ICTC/ PPTCTC staff to note the proper addresses & details of ID Cards (particularly Aadhar Card details) of all the clients visited at the Center.
2. More stress can be given on Out Reach activities by ICTC/ PPTCTC staff.
3. Intensified LFU Tracking Exercise as cited above can be undertaken annually to minimize the gaps at ICTC-ARTC Level.
4. DAPCU can coordinate with, and take support from other DAPCUs of the State for effective follow-up of clients missed/ LFU for ART.
5. The help of CSC/ Help Desks can be taken, in case of the clients who do not have any Id-Card. Address of the client can be verified by the CSC/ Help Desk after proper visit at and client can be registered at ART on the behalf of the reported address verification of the Client by CSC/ Help Desk.
6. The HIV Positive Clients can be motivated to register themselves at ART by aware them the benefits (including benefits of Financial Assistance Scheme of Delhi Govt.) which they can avail after ART Registration.

DAPCU Central Delhi (Delhi) Response to the Theme : DAPCU Led Single Window Model

Describe efforts taken or Planned by DAPCU to increase the number of people availing Social  Benefit Schemes in your district in FY 2016-17.

Efforts taken by DAPCU-Central Delhi:

• Help Desks have been set up at NACP facilities to create awareness among clients about Social Benefit Schemes and the procedures for availing benefits.
• One staff at each Help Desk has been designated as a nodal person and oriented about DAPCU Led Single Window Model and various Social Benefit Schemes.
• Scheme related details and application forms were collected from respective government departments and placed at Help Desks.
• During the DAPCC meeting, the District Magistrate was briefed about the Single Window Model. Assurance was given by the District Magistrate to extend support and facilitate the process of availing benefits.
• DAPCU-Central Delhi staff coordinated a special drive for making Aadhar cards at ART Centers located in Dr. Ram Manohar Lohia Hospital, Lok Nayak Hospital and Safdarjung Hospital. More than 390 Aadhar cards were issued to People Living with HIV and their care givers.
  
  

Efforts planned for 2016-17:

• Periodic orientation of Help Desk Nodal Officers.
• Assess the needs and eligibility of People Living with HIV and their kin for Social Benefit Schemes.
• Invite representatives from government departments to monthly review meetings of NACP facilities to brief about existing Social Benefit Schemes and the procedures for availing benefits.
  

Sensitize staff of government departments about People Living with HIV and the barriers (such as, stigma and discrimination) they face in availing Social Benefit Schemes.

DAPCU Central Delhi Response to the Theme: World AIDS Day-2013

OBSERVANCE OF WORLD AIDS DAY 2013

The World AIDS Day 2013 is observed in Central Delhi District by DAPCU-Central Delhi under the guidance and with collaboration of Delhi SACS and HIV Unit WHO, SEARO.

On the occasion of the World AIDS Day 2013, a Three Days HIV Counseling & Testing Camp was coordinated & facilitated by DAPCU-Central Delhi for the World Health Organization (WHO) staff and their families in the premises of WHO Regional Office for South East Asia (SEARO), Indraprastha Estate, Mahatma Gandhi Marg, New Delh-110002 from 2^nd December 2013 to 4^th December 2013.

Welcome and Introduction of the activity and Delhi SACS	Dr Rohit Sobti, RSP, SEARO
The work of Delhi SACS	Dr Anil K. Gupta, APD – DSACS
HIV Testing & Counseling – What, Why and How it can benefit you and your love ones	Dr B.B. Rewari, WHO India
High Tea & Offer of voluntary HTC services	HIV unit jointly with Delhi SACS
Free HTC services will be provided (2 to 4 Dec-13	WHO premises

Following Activities were undertaken during the camp:

• Profile of and efforts made by Delhi SACS in the global fight against HIV-AIDS epidemic were briefed.
• Benefits of HIV Testing & Counseling were explained.
• HIV Counseling & Testing were provided to the staff of WHO-SEARO and their Families.
• IEC material was displayed and distributed in the camp.
• Condoms were distributed in the camp.

More than hundred visitors of different countries including India were benefited through the activities performed in the camp as follows:

1. 106 were counseled. (100 Males and 6 Females)
2. 102 were tested for HIV. (97 Males and 5 Females)
3. No client was found HIV Positive.
4. IEC Material was disseminated to 106 visitors.
5. 1200 condoms were also distributed.

All aforesaid activities was coordinated by DPM, DAPCU-Central under the guidance of Delhi SACS. Overall efforts made by DSACS & DAPCU-Central Delhi were appreciated by the visitors & organizers from WHO-SEARO.

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

Problems faced after closing of CCCs

• No exclusive In-patient care is now available for PLHIVs.
• Difficulties in verification of addresses of clients to be registered in ARTCs and addresses of those couldn’t be verified by the ARTCs.
• Scarcity in Couple Counseling, Nutritional Counseling etc. those were provided by CCCs.
• Lack in Psychological, Social & Legal support necessary after community rejection.
• Non-availability of Home Based Care for PLHIVs.

Measures have been taken to replace the services given by CCCs

• Necessary in-patient care is being provided through Government Health Facilities those having staff sensitized on HIV-AIDS.
• Staff of ARTCs is supported by TI-NGOs, ICTCs and DAPCU in the verification of addresses of PLHIVs.
• All type of necessary counseling is provided by the staff of ARTCs and ICTCs to PLHIVs.
•  Psychological, Social & Legal supports are provided DLN of PLHIVs, TI-NGOs and coordinated by DAPCU.

Integration of In-Patient and Out-Patient Services in the existing Government Health Facilities

• Authorities and Medical Officers of the Existing Government Health Facilities are requested with the support of IDHS-Central & District Administration to provide all necessary In-Patient and Out-Patient Services to PLHIVs with extra care.

Practices & Approaches adopted to provide medical care to PHIV within the district

• Medical, Para-Medical & Non-Medical Staff of the Government Health Facilities are being regularly sensitized on HIV-AIDS and PLHIV’s related issues.
• Stigma & Discrimination towards PLHIVs are being diminished in the Society through Advocacy Meetings, Mainstreaming Workshops, IEC activities in Mega Camps, Health Camps & School Health Melas.
• PLHIVs are being educated about Social & Financial Benefit Schemes available for them. Details of the schemes are collected & compiled by DAPCU from different departments & institutions and shared with ARTCs and TI-NGOs for further sharing with PLHIVs.

Central Delhi DAPCU Response to the Theme- DAPCUs & Stigma and Discrimination

Roles & responsibilities of DAPCUs with respect to Stigma & Discrimination relating to HIV:

Issues of Infringements or disturbances with respect to stigma & discrimination in accessing and utilizing the rights, services, provisions and benefits available for PLHIVs have been tackled by DAPCUs.

Measures those have been initiated to facilitate reduction of stigma and discrimination in:

               ·   Access to services:

o   It has been ensured that all necessary services are being provided to PLHIVs without any discrimination and stigma at all HIV-AIDS related services.

o   PLHIVs are educated with the help from Staff of ICTCs/ ART Centers and TI-NGOs about their rights, services, provisions and benefits granted by Government & Societies.

               ·    Health Care settings:

o   Suggestion/ complaint boxes have been installed at HIV-AIDS related facilities of the districts.

o   Revision of suggestions and complaints and addressing of the same with the support from Officers In-charge of the Health Facilities.

o   Regular sensitization of the Medical & Non-Medical Staff of the Health Facilities with respect to Stigma & Discrimination relating to HIV.

               ·     District Administration and it’s departments:

o   Issues related to stigma and discrimination is discussed in the meetings with District Administration and is resolved with the support from them.

o   PLHIVs are facilitated & supported in obtaining the benefits of Welfare Schemes with the help of District Administration.

               ·      Community Settings:

o   Creating awareness of community towards PLHIVs IEC (Information, Education & communication) through participation and activities in Health Camps, Mega Camps, and School Health Melas etc.

Achievements of our district in fighting stigma and discrimination:

• Advocacy cum awareness meeting with the Staff of Kamla Market, Police Station. Over 50 police personnel were sensitized about HIV-AIDS and Stigma & Discrimination present in Society about the epidemic and PLHIVs.
• Mainstreaming of Police Officers/ Officials at Police Bhawan, Daryaganj.

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

DAPCUs ensure comprehensive HIV/ AIDS services that are provided to the HIV Positive Migrants by following means:

1. Within district:

Comprehensive HIV/AIDS services are being provided to the HIV Positive Migrants within the district by DAPCU with the assistance of TI-NGOs, especially those are being working on the Migrants. IEC & HIV/AIDS Service Demand Generation camps are regularly organized by TI-NGOs on the Migrant’s hot spots within the district. HIV-AIDS services like counseling, HIV Testing, providing condoms, referrals and linkages to the other linked facilities are being provided to the migrants through activities performed by TI-NGOs with the co-operation and co-ordination from DAPCU side. Regular follow-up of clients residing in the district are being done by Counselors of ICTCs and ART Centers to minimize the numbers of LFUs and MIS’. If any HIV Positive client is faced problem in the registration at the HIV-AIDS health facilities due to non-availability of Id-Proof then DAPCU with the help of TI-NGOs and District Administration takes efforts to make sure that concern HIV Positive migrant client can availed the Id-Proof.

2. Out of district:

Since, some of biggest and renowned hospitals are situated in the Central District of Delhi, therefore, huge number of clients, not only from other district of Delhi but also from other state of India are came over here and obtained the facilities concerning to the HIV-AIDS from the HIV-AIDS related facilities in the District. Also HIV Positive Clients are given options to choose ART facility as per their convenience either situated in the district or other districts of Delhi for treatment. According to their choice, they are linked with ART Center chosen by them.  Line lists of HIV Positive clients found at the ICTCs/ PPTCTCs in the district are maintained and shared with SACS and other concern DAPCUs for proper follow-up of LFUs and MIS and ensuring comprehensive services coverage of Migrant Clients of other districts of Delhi. All DAPCUs in Delhi co-ordinate and help one another for the same.

3. Out of State:

Central Delhi is a gateway of migrants from & to Union Territory of Delhi due to presence of two busiest railway stations of the Country i. e. Delhi and New Delhi Railway Stations and also biggest wholesale markets of India i.e. Sadar Bazar, Paharganj, Chandni Chowk, Karol Bagh etc. There is huge number of migrants come in and gone out every day from Central Delhi to another parts of the country. In addition of the above presence of National Level Big Hospital, the numbers of clients are very huge which are obtaining facilities from HIV-AIDS facilities present in the District. As per cited above Line lists of HIV Positive clients found at the ICTCs/ PPTCTCs in the district are maintained and shared with SACS for proper follow-up and ensuring comprehensive services coverage of Migrant Clients of other states of India. Follow-up of LFUs and MIS of other states are done with the help of DSACS and concern SACS. Also permanent address of the clients’ native place is obtained & recorded during his/her visit at the ICTCs so that follow-up of the same can become trouble-free.

DAPCU Central Delhi Response to the Theme Co-ordination among DAPCU's

Co-ordination among DAPCUs

• Need of co-ordination among DAPCUs:

DAPCUs can enhance their performances through co-ordination among them. They can learn from experiences of other DAPCUs. They can decide that what sort of approach they should adopt in their work, by learning from the successes of other DAPCUs. Similarly, bad experiences of any DAPCU can intimate other DAPCUs to what & how they should not do their work. Consequently, speed and efficiency of DAPCU’s work are improved.

• Co-ordination among DAPCUs in Delhi:

Four DAPCUs are working in Delhi. All of them are working with good co-ordination among them. Experiences are shared through 

Regular formal and informal communications at all levels in DAPCUs. DAPCU review meeting is one example of the formal communication among DAPCUs. Exposure visits to another DAPCUs as & when needed are being done.

• Issues on which DAPCUs are supporting each other:

Maintenance of records & data, format for presentation of performance at DSACS & NACO, monitoring & supervision of HIV-AIDS related facilities, relocation of staff, test kits, equipment s etc. (as & when required), preparation of different line lists, tracking & follow-up of LFUs and any other issue that need help from other DAPCUs.

• Role that is being played by DSACS for enhancement of co-ordination among DAPCUs:

Co-ordination among DAPCUs are fully supported and enhanced by Delhi State AIDS Control Society (DSACS) in Delhi. Any exceptional work done by any DAPCU is appreciated and shared with other DAPCUs by DAPCU Nodal Officer, DSACS. Co-ordination among all four DAPCUs in Delhi is also strengthened by Regular Review Meetings at DSACS. 

• Examples of taking support from other DAPCUs:

Support from other DAPCUs has been taken in making presentation to show performance of the DAPCU in the review meetings. Gaps in different line list are being filled with the help of other DAPCUs. 

• Examples of achievements by inter DAPCU co-ordination: 

Various line lists of HIV Positive Clients have been prepared and are being updated without any gap. Standard formats are followed by all four DAPCUs for presentations of performances in the meetings at DSACS and NACO. 

  
  

Central Delhi's Response to Theme- DAPCUs and F-ICTCs

Role of DAPCU in locating a suitable health facility to establish F-ICTCs:

An analysis of client load at the health facilities such that PHCs, CHCs, FRUs, Charitable Hospitals, Private Hospitals, Sub District Hospitals etc. in the districts can be performed by DAPCUs to list out the suitable facilities where ICTCs can be established. Data regarding client load may be gathered by DAPCU with the help of NRHM establishment in the district. Not only the client load but categories of clients should also be considered in the process of finding a suitable health facility. Facilities having comparatively more ANCs, HRGs, Migrants should be given preference.   If it will find feasible economically to open an ICTC in the health facility than a stand- alone ICTC may be established otherwise an F-ICTC may be established in the health facility. 

   

Role of DAPCU in the capacity building of the F-ICTCs:

Needs for capacity building of F-ICTCs can be assessed by DAPCU staff during supportive supervisory visits of the F-ICTCs and assessments may be shared with the SACS and NACO. DAPCUs can assist the SACS and NACO in arrangement and providing Induction and Refresher trainings to F-ICTC staff. It can also helps in the delivery of logistics to the F-ICTCs. Queries (if, any) of the F-ICTC staff can be answered by DAPCU Staff (if possible), at the time of supervisory visits itself. Necessary corrective actions (if required) may also be taken during the supervisory visits. On Job Training may be facilitated by DAPCU, for the staff of newly established F-ICTC at the designated ICTC with co-ordination of the Nodal/ Medical Officers of the designated ICTC. Programmatic Updates and other necessary information received at DAPCU from different sources may be conveyed to the F-ICTCs.

Role of DAPCU in the strengthening and linkages between F-ICTCs and designated ICTCs:

Linkages between F-ICTC and designated ICTCs in the district can be defined and established by DAPCUs. It can be further strengthened by the process of rapport building between the Officers/ officials of F-ICTC and designated ICTC by including them in regular meetings at district and state level organized by SACS and DAPCUs. 

Role of DAPCU in the Monitoring & Evaluation of F-ICTCs:

Monitoring and Evaluation of F-ICTCs can be done by DAPCU through regular supervisory visits, analysis of monthly reports of F-ICTCs and review of their performances during regular meetings at the state and district levels. Feedbacks should be provided by the DAPCU to the F-ICTCs regularly on their respective performances. Corrective actions (if required) should be taken on time by DAPCUs concern to functioning of the F-ICTCs.

Achievements of our district:

• Five F-ICTCs have been established since December 2012 in the Districts looked after by our DAPCU. 
• Required logistics such that Registers, Referral slips etc., are provided to the F-ICTCs by DAPCU-Central.
• All established F-ICTCs are continuously being monitored and supervised by DAPCU Team Members through supervisory visits. Staffs of F-ICTCs are oriented regarding maintenance and updation of registers and other documentations during the supervisory visits. 
• Monthly reports of all established F-ICTCs in the district are being submitted in DAPCU-Central Delhi regularly.
• Staffs from F-ICTCs are being invited in the regular review meetings at State and District Levels. They also regularly participating in the aforesaid meetings.
• Programmatic updates are being conveyed to the F-ICTCs regularly by DAPCU-Central.
• Data of Client Loads in the different health facilities has been gathered, compiled and submitted to the DSACS by DAPCU-Central regarding find out the possibility for establishment of new F-ICTCs in the district.

Central Delhi's Response to Theme- Supportive Supervision

Supervision

Supportive supervision is a process that promotes quality at all levels of the  system by strengthening relationships within the system, focusing on the identification and resolution of problems and helping to optimize the allocation of resources, promoting high standards, teamwork, and better two-way communication.

Supportive supervision in context of DAPCU is working with health staff at the district level to establish goals, monitor performance, identify and correct problems, and proactively improve the quality of service.

Together, the supervisor and health workers identify and address weaknesses on the spot, thus preventing poor practices from becoming routine. Supervisory visits are also an opportunity to recognize good practices and help health workers to maintain their high-level of performance. 

Planning & Implementation of visits for supportive supervision:

• Supervisory visits are planned and shared with SACS and IDHS well in advance.
• Visits of facilities are planed with keep in the mind that all facilities are covered at-least once in a quarter.
• Plan to spend sufficient time (from several hours, to a full day or more) to conduct the supervisory visit. The amount of time of a supervisory visit varies depending on the needs of the health facility. For example, in some cases a full-day visit would be more effective than just couple of hours. It allows the supervisor enough time for meeting with the health worker to discuss performance goals, meeting with the community, assessing the facility and traveling.
• Visits are planned as supervisors can observe a counseling session, interview clients, and arrange for staff meetings without adding extra burden on the staff.

 Points keep in mind while undertaking supervision

• Following up on recommendations made during previous visits.
• Stick to the schedule and respect the health worker’s time. Always schedule a return visit before leaving the site.
• Monitor and assess performance of the health facility
• Observe counseling sessions and note strengths and weaknesses.
• Talk to the clients about the quality of services.
• Involve the community members in the evaluation process to get their feedback. (In case of TI-NGOs).
• Check the availability of stock and the condition of equipment.
• Review health facility records, including coverage and dropout rate monitoring charts.
• Use information gathered during the visit to discuss progress with the health facility team.
• Review indicators, milestones, and performance with staff.
• Identify gaps and solve problems in positive ways.
• Provide staff with informational updates on policies or new recommended practices.
• Provide on-site updates and training.
• Ask the staff to identify areas of strength and weakness. A supervisor can serve as a facilitator and help the staff develop strategies for solving problems.
• Identify information/training needs together with staff.
• Work with health facility and district- or central-level authorities to set priorities.

Do’s

• Provide a climate for motivation
• Create a supportive working relationship
• Respect the employee as a person.
• Give honest feedback to the employee. Everyone makes mistakes, and everyone wants feedback to improve his or her performance.
• DO be responsive (return phone calls, emails).
• Assume the person can't perform a certain task. Ask how he or she will do the task. Help the person figure it out.
• Praise health workers in public for good performance and for practices that meet quality standards. Correct performance only in private.
• Both the supervisor and supervisee should keep a written log/record of items discussed, including strengths and weaknesses, and actions to be taken (by whom and by when).

Don’ts

• DON'T get angry. "Getting angry is easy. Anyone can do that. But getting angry in the right way in the right amount at the right time, now that is hard." (Mark Twain)
• DON'T be cold, distant, rude or unfriendly. Especially in difficult times, employees take cues from their immediate supervisors and need to hear from them.
• DON'T send mixed messages to your employees so that they never know where you stand. Keep your message simple, focused and prioritized. Too many messages and initiatives just confuse and alienate people.
•  DON'T avoid taking responsibility for your actions. You are trying to develop accountability throughout your staff. So, lead by example.