DAPCU Khordha (Orissa) Response to the Theme : DAPCUs role in strengthening referral between ICTC - ART

Linkages and referrals to the positive people are one of the major responsibility of the counselor at ICTCs. However, it is not ended with linkages only but to make proper follow up hence forth and to ensure partner notification for further test. In most of the DAPCU Districts it is being followed up and monitored to ensure 100% ART linkages. It may not be easy for the ICTCs which are far from the ART centre.

Although we have achieved good results in ART linkages, still the scenario was not so convenient in earlier days. There are some of the issues which are still could not be addressed. However, the percentage (%) of ART linkages under DAPCU Khordha was 94% during the period of 2012 and there was no such effort was made to ensure 100% ART linkages and also there is no system initiated to linkages the pending cases. And later these issues have been observed seriously and various efforts were made to ensure 100% ART linkages in the District. Now we have achieved 97% in ART linkages.

Efforts made:

It is viewed that number of testing were increased and number of positives too. So, it was challenge for us to link them with ART Centre. So, following efforts were made to reduce the linkage gaps between ICTC and ART.

1. Discussions and review in the monthly TB- HIV cum coordination meeting with data, showing number of positive detection in the ICTC in the month and ART enrollment. Along with highlighting the no of cases (from the ICTC) are not yet enrolled at ART Center.
2. Sharing of detected positive cases (source SIMS) of all ICTCs for the current month with the ART centre providing data in line listing format containing address, age, occupation, mode of transmission, ICTC where positive detected, date of detection etc to get filled Pre –ART number, Base line CD4, and ON ART Number if he/she eligible for ART.
3. Cross verification of these data with the concerned ICTCs through meetings and through telephonic discussion and feed backs.
4. All Counselors are suggested to ensure that the referred client has visited/reached to the ART center or not, through telephonic discussion / in a written format
5. ART linkages is also been discussed in the monthly ART coordination meeting where DPM is attending in a regular basis.
6. The drop out cases that are not visited to ART centre after detected positive, are the major challenge for us. Although we have no separate mechanism, but the concerned counselor is advised to visit her / his house with CSC / Link Worker/ ORW ( if it falls LWS/TI  area)  to convince them in each Saturday during the outreach activity.
7. Simultaneously the line list of the PLHA who is denying for ART registration after given consent at ICTC are to be shared with the CSC for tracking and in this effort, the concerned counselors are also going with the CSC.
8. Some long pending cases are also shared with CSC for tracking and the action taken report of those cases are submitted to DNO, DAPCU.
9. The cases who are belong to other district are ensured that they are linked with their nearest ART centre if he/she is not enrolled at our ART center. This is facilitated through telephonic discussion with the concerned DAPCU/ ART. (recently 3 cases are linked through this process)
10. Responsible also given concern TI NGO & LWS (for those cases referred by LWS/ TI and detected positive in ICTCs) to follow and ensure to ART registration.

10. DIS and other DAPCU staffs are joint visit with CSC and Concerned counselor to the PLHA who are not agreed to visit ART center.
11. CDMO & ADMO (PH) apprised concern counselors who are achieved 100% ART linkages in monthly meeting. So, that all counselors are taking initiate for achieved 100% ART linkages.

Constrains:

Difficulties to enrolled denying those cases who were agreed initially. Whereas the list of those cases could not be removed from the list.

100% enrollment is not happening due to death after detection and even for denying and absconded cases. 

Not achieving 100% in case of repeat cases.

DAPCU Khordha (Odisha) Response to the Theme : Views on DAPCU's role in Non-DAPCU Districts

I am representing DAPCU Khordha of Odisha state where there are only seven DAPCU districts out of 30 Districts. Khordha is falling in Category B. However, the service expanding to nearest District concept has also been implemented at our state as the district has been assigned the neighboring Puri District. Yes, the DAPCU district can extend service to the nearest non DAPCU district for better support and facilitation in the NACP activities.

How can the DAPCUs extend their support to non-DAPCU districts to manage/coordinate the NACP activities in the non-DAPCU district? 

It is possible to manage and coordinate HIV activities in the non DAPCU district by collective efforts of DAPCU staff especially M&E, DA (Program) and DPM. The three staffs are required in different spheres. The technical group separately or jointly can provide support to the facilities in different activities. However, following are some of the activities where DAPCU can support non DAPCU district.

Components	Strategy	Remarks
Facilitating conduction of regular monthly review meetings with the NACP facilitates    (HIV-TB coordination meeting , DCC meeting)	Coordination with the district health Administration and concerned Nodal officer of NACP activities in the District and with DTO. Topics and components to be discussed in the meetings. Minutes is to be prepared and to be shared with the participants / facilities which will be again followed up.	Sharing of information and contacts can be done at the home DAPCU level through e-mail and over phone.
Hand holding support to be given through monitoring and Supervision visits	DPM and M&E will visit to the facilities for ensuring data validation, cross verification of data from source registers, ensuring correct and timely reporting. Also ensure 100% reporting through SIMS. SACS may give permission to view data in SIMS, of non DAPCU district facilities data, feedback and reset the SIMS.  There may be visit with the Program Assistant for necessary support on social protection linkages of PLHA	Viewing the facilities data in SIMS of non DAPCU District can be done by the M&E Asst at DAPCU. For this no need of separate budget. Coordinate and follow up with District Social Welfare Officer, Social security Officer over phone and through visits. Field visits travel cost can be booked at DAPCU.
Ensuring referral and linkages	Minimize gap between referral and linkages through establishing coordination between the facilities.	This can be done through field visits.
Organizing trainings and health camps	DAPCU can facilitate to conduct training programs, advocacy and letter correspondence can be done by the Program Assistant at DAPCU.	The role of DAPCU is to facilitate the process.
Replication of good practices of DAPCU	The good practices can be replicated in non DAPCU districts through discussions sharing of documents, etc.

DAPCU can play an active role to support the non DAPCU district. DAPCU was established in our district in 2008.Support has been provided to facilities in the district since then, now the facilities can function with minimal support. Poor performing centers in non-DAPCU district can be visited on periodic basis. 

Requirement of finance for the visit to the non DAPCU District which can be meet from DAPCU travel fund but certain guidelines are to be issued by SACS.

As this type of support is being conducted but no financial guidelines are being issued to DAPCU.

Liasioning and coordination can be done at DAPCU level, for that no funds are required.

DAPCU Khordha (Odisha) 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.

DAPCU Led Single Window Model has been one of the best way to link PLHA (People Living with HIV/AIDS) with various government schemes. Khordha DAPCU of Odisha has seen lot of changes in pre and post scenario of DLSWM (DAPCU Led Single Window Model). Although we had some similar activities prior to the Programme but those were very few and limited and there was not such platform for that. But after the Programme was implemented in our District we stand in such a place where the PLHA feels that, at least somebody is there who can hear us and can help us- “This is a statement of a PLHA, a divorcee came to us with her ill health condition asking for medical assistance” However, the concept of help desk has been informed through various interventions like meeting, consultation with PLHA and activities by the concerned Help desks. The   intensity for the statement is that, the PLHA who earlier had no support from others in this matter can directly access Help Desk. Now the Help Desk and especially DAPCU is acting as the link between PLHA and Social Welfare Schemes. It is only one year of establishing the Programme of DAPCU Led Single Window Model.

The Programme has been implemented in the district since 2015 as an effort we have established 24 Help Desks in different NACP facilities. The Focal persons has been trained two times on the Programme and the departments are also been tuned up with the Programme. So this became very helpful to us to place interest of the PLHA under various schemes before the concerned Dept. It is too early to say that all interests are been fulfilled through the model as there are so many constrains which are not avoidable. But DAPCU have been in the process to accelerate the movement.

The differences are like we have received 42 applications directly during pre DLSWM and after that DAPCU received 341 applications under the DAPCU Led Single Window model and 196 no of applications are already disbursed by the departments.

Planning and activities being conducted by DAPCU under DLSWM.

• Meeting with all Block level officials in the PR (Panchayati Raj) Department in the DRDA in next month
• Discussion on the SPS (Social Protection Schemes) issues in the all DAPCC meetings (ongoing)
• Planned for PLHA meet at two blocks of Khordha District.
• One PLHA meet has already been conducted at Banapur Block in the meeting the 11 applications received and responded.
• Demand generation camp at Two Blocks (Banapur and Balugaon) for availing of SPS (Planned)
• Intervention at ART centre ensuring that updating of SPS profile of all PLHA that whether they are availing any   schemes or not if not than ensuring that they are informed about various SPS under Help Desk, ART centre (on going)
• Review of SPS in all Monthly coordination meetings and sharing the process undertaken by DAPCU and present status. 
• Every month visits are being conducted to the concerned departments to ensure release / process of pending cases and applications submitted. (on going)
• Efforts to reduce the gap between sanction and availing of MBPY (Madhu Babu Pension Yojana) - (321 cases sanctioned out of 1122) on going

Important out comes (qualitative)

• The Collector and DM are very much convinced and always show his deep interest and kind attention to sanction / disburse any request of PLHA as soon as possible.
• None of the request of PLHA is laying pending with the Collector & DM office.
• DSWO (District Social Welfare Officer), W& CD (Women and Child Development) department and Block level officers are recognizing the request and demand of the PLHA which is submitted through Help desk, DAPCU.

From left: Officials from Child Protection officer, W & CD, DNO, CDMO, PO main streaming Unit and JD (IEC) from OSACS during Inter department training on SPS.Add caption

Response from DAPCU Khordha on WAD 2013 celebration.

DAPCU khordha has observed the occasion involving the multi stake holders in the District. Youths, members of RRC, NCC, Scouts etc along with the community members participated in the event. The programme was organized in coordination with the Zilla Swastya Samitee (ZSS) of the district. A preparatory meeting has been conducted under the chairmanship of Chief district Medical officer (CDMO) of Khordha District on dated 23rd Nov.13 where all wing officers of District health Administration and members of ZSS were attended. Apart from them the line departments like District Sports Officer, District Labour Officer, delegate on behalf of Superintendent of Police (SP) District Information and Publication Relation Officer (DIPRO) along with programme officers of RRC of different colleges and institutions were attended. The plan was discussed and responsibilities were shared.
Programmes

As per the decision various programmes were conducted like Essay competitions among Colleges and Nursing schools students and Inter High school painting competitions of Khordha. The topic for the competition was “stigma and discrimination against PLHA is a social taboo”- what is your role to reduce the evil.  The concept of painting competition was “ Let us Live ” DAPCU staff has facilitated the process to complete the events.
On World AIDS Day(1st  Dec-13)
As per the plan a multi stake holders rally has been flag off by the Local MLA sj. R. Sahoo and CDMO Dr. D. Sahoo from the CDMO office. Near about 200 participants attended the rally with pla cards and slogans. All slogans and deliberations of the Guests are based on the stigma and discrimination. However a public meeting was conducted where the Collector and DM of Khordha, CDMO, Project Director DRDA, Addl. District Magistrate Khordha graced the occasion. We have organized quiz competition on the meeting venue. Various questions on HIV/AIDS, Stigma Discrimination, and other related topics were prepared and asked and prizes were given along with the winners of the competitions organized previously by the guest.
On the occasion we had approached one positive person (positive speaker) for the meeting requested to address the public. Who joined in the meeting and started her deliberation saying I am HIV Positive living since five years with your love affection and care you have shown me and my fellow beings (PLHA)….    With this few words the house became stunt and a different environment created. The Chief Guest and other guests also remain silent and became sentimental. They were not even expected some body can disclose her/ his status in the open field. She spoke her journey after being detected positive how she faced discriminations and all hated comments and other issues. She requested not to discriminate any of the PLHA and support them to keep them live to live rest of the live. However the positive speaker had painted different quote on the minds of the participants. After her speech the house offered her standing obsession with clapping. She has been felicitated by the Collector and DM, Khordha.   Followed by the speech a cultural program was conducted by the participants based on the issue of stigma and discrimination.
In one sentence we can say that addressing stigma and discrimination in various components was the unique thing while observing WAD in the year 2013. 

DAPCU Khordha 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?

Yes DAPCU facing problems after closing CCC from the Program. CCC has been intensive care unit for the PLHA.CCC has also been treated as FRU for the PLHA for OI management and drug adherence.

DAPCU has been facing following challenges after closing of CCC:

• There is no monitoring of Drug adherence and follow up of clients who start ART.
• No address verification of the clients there is no home visits happening to know and follow up clients after initiation of ART.
• No address verification challenged to trace out cases if found LFU and MIS cases.
• New life skill and positive living of the PLHA( after initiation of ART) is not been provided to the clients.
• Increased rate of LFU and MIS case has been a major challenge for DAPCU to re enrollment of LFU and MIS cases  in case the clients address is not been verified.
• No follow up of cases through home visits after closing of CCC.
• Intensive health care is not been provided where as earlier client could reach CCC at any point of time with their problems. Whenever any OI occurs they hesitate to come to the medical as they get harassed, and feel likes stop taking ART in future.

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

Tracing of LFU and MIS case- ORW and PCs of TI / LWS are assigned to tracking of LFU and MIS cases they have been assigned areas where they will follow up the cases:

Address Verification – During the positive detection in the ICTC the counselors are instructed to obtain valid address. After detection of positive one to one cases are being followed up for ART registration. The concerned Counselors are instructed to follow up the case with ART counselor to ensure 100% ART registration.

Psychosocial support -  Instructed to all the counselor of ICTC and Counselor of ART Center to counsel about the life style, intake of life long drug to the PLHA including the positive life style CD4 Count and Pre ART registration. Apart from this the clients are referred to DLN for psychosocial support and counseling. The ORWs are present at the ART centre to counsel the client who came for ART registration.

Home Visit- All the counselors are asked to have home visit to the clients who are LFU and MIS. Along with the ORWs of TI, Non TI NGOS and LWS are also asked to have home visits. Various areas has been assigned with the TI, Non TI and LWS to tracking of cases. DAPCU is directly involved in the process to coordination with NGOs, ART center, LWS and SACS.

Management of Co infection cases- The list of co infection cases obtained from ART center in every month and shared with the RNTCP to follow up of cases and track of each is being obtained by ART center and RNTCP.

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

Followings are some of the areas integrated for in and outpatient services in the Govt. Health facilities:

• The Head of the institution of the Hospital near to ARTC is directly involved in the ART coordination meeting who also facilitated to provide services to the PLHA in the existing health facility.
• All pathological tests, Blood transfusion are performed free of cost for the PLHA in the Hospital
• For intensive medical requirement like surgery etc of any PLHA DLN used to coordinate with the department in coordination with ARTC and DAPCU. The SMO ARTC also have greater role to facilitate health services for the PLHA in the government health facility.
• Sensitization programmes are conducted in the Hospitals in support of non TI NGOs to reduce stigma and discrimination against the PLHA.
• For institutional delivery of Positive ANC a coordination mechanism has been developed with one of the Non TI NGO. The positive (ANC) is being shared to the NGO and their ORWs are asked to monitor and follow up the ANC by home visit. Their work is also been reviewed in the DAPCU level. The ORWs are facilitates for delivery of positive mother in coordination with ICTC under PPTCT programme.    

DAPCU KHORDA Response : DAPCU-Stigma & Discrimination

Role and responsibilities of DAPCU

DAPCU being the decentralized unit needs to address any discrimination against the PLHA and simultaneously to enhance education against stigma and discrimination against PLHA. Basing on the theme-“zero discrimination “ DAPCU has represented one IEC stall at the local festival and also in World AIDS Day observation. DAPCU has responded some of the issues in the district to reduce the discrimination against the PLHA through conversations and facilitation in various aspects. The Role of the DAPCU in this aspect is as follows

· Sensitizing youths in school and collages , organizing events where they can participate in the discussion and can share their views like in competitions , mass Rally in the events like National youth day, world AIDS day etc.

·  Facilitate to reduce stigma and discrimination on health services  

Access to services

DAPCU has been facilitating to avail Pension scheme (MBPY) to the PLHIVs of all 10  Blocks and one  Munsipality and  one NAC. Initially the concerned officials in the block were not supporting for disburse the fund to their accounts stating that they have not received any letter from the District  authority although the District Social Welfare Officer has already communicated to the respective blocks. Based on the problems DAPCU has visited all the Blocks and discussed with the Block Development Officers and concerned section to disburse the pension now we are seeing a good result on it.

In the DAPCC meeting DAPCU has raised issue regarding non providing travel concession for the PLHIVs by the Govt. Bus conductor while going for ART treatment. The DSP has assured that he will communicate the massage to all the Block level Police station to file cases if any PLHA complain against the bus conductor for non giving concessions

Health care setting

·  Various sensitization programmes were organized at the DHH, CHCs in coordination with NGO s and DLN

·  Full site sensitization programmes has been organized in the CHCs  

· Counselors and DIS of DAPCU district has been instructed to attained ASHA sector meetings and mass gatherings for sensitization regarding HIV AIDS , stigma and discrimination.

·  Availing free health services in the hospitals for the PLHIVs ( all tests are free for the PLHIVs) in the medical

·   One PLHA( ANC +Ve) was denying to give TT at one of the CHC of Khordha district. Through the intervention of DAPCU and Concerned ICTC in support of Network the matter has been addressed.

· One Positive pregnant women after diagnose was denied to delivery at DHH Khordha. In response of this DAPCU and Concerned counselor had advocated with ADMO (Ph) and CDMO to conduct delivery at DHH and finally the delivery has been conducted at DHH.

Dist. Adm and its departments.

·  Two sensitization programmes has been organized at the Jail in consequence of discrimination occurred in the sub  jail, Khordha by the inmates and the jail officials.

·  No issues  of  discrimination has been reported from the jail since that.

·  DAPCU has sensitized about HIV AIDS , myths on HIV AIDS and against discrimination to the concerned officials of Khordha Block and BMC Bhubaneswar, Banapur and Jatni has been along with this  advocated to issue various schemes like MBPY and MKY, AAY for PLHIVs.  

·   District Social Welfare Officer (DSWO)  has been agreed to include CLHIVs(having single parents , orphans) in to sponsorship  programme

Community settings

A discrimination case has been reported at DAPCU and DLN by positive couple who were denied for health service (Immunization) at one of the CHC of Khordha District. Her husband was also denied to access any social services like use of Saloon, Shop etc.  The couple were about to segregate from their village. In the mean time DAPCU, Concerned Counselor in support of DLN intervenes in the matter and visited the village with representative of the CHC along with the concerned personnel of OSACS and shorted out the issue.

Village meeting organized and sensitized the community the details of the report is attached.

SENSITISATION  PPROGRAMME

            The sensitization programme was organized in the Haja Vilage by DAPCU , OSACs and Link Worker Scheme Project of Kalinga Network For People Living With HIV(KNP+).In this Sensitization programme The GIPA coordinator,  OSACS,  DPM DAPCU, Khordha,  and President KNP+, Sarapanch of the village, SEO were  also presented in this programme apart from this more than 60 participants  from the community were presented along with ICTC Counsellle Botoloma, Lab Tecnician  Botoloma,  ASHA, AWW,SHG Members, Ward Members, and general  people.

The DPM DAPCU warm welcome to all the Guest persons and  participants  and discussed the importance of the meeting where he apprised the community not to create any discrimination against the PLHIV. Addressing the myths related to transmission he suggested there is no other way except 4 cause of transmission so there should not be any discrimination against the PLHA. He also asked the  Sarapanch and Naib Sarapanch  to address the community about the role and responsible for PLHA as they are also the fellow being of the society and  their own village..

The GIPA Coordinator to give his valuable information regarding the discrimination. He focus on,

§  Why the people discriminate PLHIV?

§  What is the impact on the PLHIV?

§  What’s impact on the Community?

§  Rights of the PLHIV.

In the meeting the President, KNP+  as pa positive speaker described the life story from identification to discrimination and segregation  by her laws house and from the community. She has been discriminated but sustained till today she has build up positive thinking and positive living with her and now working against the discrimination.

Her presentation has contributed much to the participants to understand the feelings of the person who have been discriminated by the community. After that  she has requested to the villagers to cooperate with the PLHIV and not to discriminate. However the myths and  misconception has been addressed and in some extend the present community has been aware about HIV and AIDS. 

Khordha Response to Theme- Coordination between DAPCUs

Is there a need for DAPCUs to work in coordination with each other? If so share how are DAPCUs in your state are doing this.

Yes there is requirement of Coordination in between DAPCUs to share experience and strategies in between them. It is known that since establishment of DAPCUs in the Districts many changes has been occurred and various activities has been initiated it is due to various exposures, sharing and discussions among each other during the district and state review meetings. Sharing of best practices of DAPCUs by NACO and DNRT also contributing to learn from each other. In conclusion there is need and requirement of DAPCUs to work in coordination.

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

Followings are some of the important issues where DAPCU can support each other.

Availing Social benefit schemes: In this context DAPCU required coordination to know about various social benefit schemes of Government and non government agencies availed by other DAPCUs .Through sharing of the process other DAPCUs can adopt the strategy and can avail the same scheme. In this aspect the implemented DAPCU can also share documents like sanction letters, necessary orders of Government for example Order to include PLHIVs in BPL category, Nutrition / ration for CLHIVs from ICDS and sanction of household land for PLHA etc.

District specific programmes/campaigning : DAPCU needs coordination to know about the process and strategy adopted for designing and implementation of District specific programme like DAPCU Bolangir of ODISA has implemented Migrant programme so that can be implemented in other DAPCU districts through coordination and sharing.  

Component wise achievements: Through DAPCU coordination component wise achievements can be shared for example DAPCU Khordha of Odisha shared with DAPCU Angul and DAPCU Bhadrak regarding improvement of Cross referrals from RNTCP to ICTC which has been increased more than 90% so the strategies has been shared in the DAPCU coordination which was held at Angul (with 3 DAPCUs) and like vice versa DAPCU Angul and DAPCU Bhadrak has shared their remarkable achievements which DAPCU Khordha learned. DAPCU Khordha replicating some of the major activities carried by those DAPCU learned from them.

Issues redress by the DAPCU: Through coordination some of the issues like enhance client load to DSRC , enhance in and out referrals regular checkups of HRGs to DSRC and ICTC etc The strategies can be replicated as it is adopted by DAPCUs

Tracking of LFU and MIS cases: DAPCU required coordination for tracking of MIS and LFU cases in two ways one is to track those cases that are falling in the jurisdiction of the neighboring DAPCU District and second the procedure / strategy adopted by the same or other DAPCUs can be replicated through Coordination. However for instant  the strategy adopted by DAPCU Khordha to ensure 100% ART linkages has been shared with DAPCU Bhadrak and DAPCU Angul ( in DAPCU Khordha the A RT linkage was less than 85% which has been increased 95 to 100% since last 6 months.

Sharing of IEC material of different language: IEC materials of different language can be shared through DAPCU Coordination. For instant DAPCU Koraput has received IEC materials in Telugu language from DAPCU Vizianagaram, AP. Not only Telugu language but IEC from other languages can be generated through DAPCU coordination and in this aspect DAPCU coordination required. 

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

• Followings are some of the aspects where SACS need to play role
• Facilitate relation between DAPCUs sharing of best practices of DAPCUs
• Initiate inter DAPCU coordination like two to three DAPCU can visit one nearest DAPCU ( which has already started through OSACS and  DNRT)
• Organizing meetings in regular intervals.
• Hand holding support to DAPCUs and facilitate to identify issues and strategy planning.

Share a few examples in which you have taken the support of other DAPCUs and how it has helped you. 

During last month Odisha SACS and NDRT has arranged DAPCU coordination meeting at ANGUL DAPCU where DAPCU Khordha and DAPCU Bhadrak have participated. This visit pioneered the scope to work in different areas. We came to know many things from DAPCU wise presentations.

During the visit to DAPCU Angul, we came to know that both the DAPCUs have generated resources from different corporate and companies. The strategies and process has been shared in the meeting and DAPCU Khordha after the visit has initiated to tap resources from o ne of the corporate which is at Khordha. The event is under process. Justification of presenting the event is that this action has been implemented after DAPCU Coordination.  

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.