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

DAPCU has faced problems after closing of CCC. After closing of CCC the referral and linkages has been stopped.

No specific measures has been started to replace the services given by CCC.

ON ART PLHA linked to 4 link ART Centre of Ganjam district.  DAPCU has coordinated with the 4 link ART Centre Medical officer Incharge to provide the general medical service along with the ART.

DAPCU Angul 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?

CCC is an innovative idea implemented by NACO for providing care support treatment to PLHIV and its also provided psychological support to PLHIV clients. Presently although the PLHIV were admitted in Govt. Hospital and getting all sort of care & treatment but still  they are  in tension condition -- that their status may be disclosed to the community member.

DAPCU Angul was established in Nov-2008 and from the beginning of establishment of DAPCU Angul there is no CCC in Angul. The ART centre was established in Angul district in the year 2010. So from the beginning the PLHIV clients were getting care and treatment service from Govt. Hospital. Two HIV positive networks were working in Angul district i.e. Network of Angul positive people (NAP+) & Angul District Network of Positive People (ADNP+) and they provided  psychological support to PLHIV clients. The CCC was established in Angul in the year 2012 and before starting its work in a proper manner the centre was closed due to legal problems. So DAPCU Angul has not faced any problem after closing of CCC in the District.

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

Angul PLHIV client has not received any services from CCC Angul as it is closed before its functioning in a proper manner due to some legal problem.

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

After detection of Positive in ICTCs all clients were referred to ART Centre.  In ART centre the counselor provided proper counseling to all PLHIV clients. The PLHIV clients received all sorts of treatment in ART centre. In case of any complication  the SMO ART Centre refer the clients to concerned specialist and in outdoor timings all sorts of treatment was provided  to PLHIV and in case of any emergency the clients were admitted in the Hospital and without any hesitation all sorts of care, treatment was provided by Para medical staff / Doctors /  etc.

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

1. All pathological tests were provided to PLHIV in free of cost.
2. Blood was provided to PLHIV in free of cost.
3. In case of referral the Ambulance service was provided to PLHIV in free of cost.
4. In all CHC/SDH/DHH the positive delivery was conducted.
5. Presently it was decided in  the last HIV-TB monthly review cum co-ordination meeting held on 08.11.13 that the PLHIV can utilized the service of 108 Ambulance for coming to ART Centre in case of any financial problem.
6. Again it was also decided in the HIV-TB monthly meeting held on 08.11.13 that the fund from GKS can be utilized for needy PLHIV for referring the PLHIV to ART Centre.
7. In case of any problem to provide medical care to PLHIV within the district the matter was discussed in the DHH monthly review meeting and DAPCC meeting and decision was taken accordingly to provide proper care, support service to PLHIV.

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

Angul a centrally located District in the state of Odisha with 12.70 lakhs  population and is a most advanced district due to vast coal mines located in abode and also big industries like NALCO, NTPC, JSPL, MCL, ADANI Monnet, UCL is working in the same district.  Due to vast coal mines and big industries number of migrant population is increasing day by day.

        HIV/AIDS and migration are two of the crucial social issues increasing today’s changing world.  In Angul two TI NGO namely U.S.S. and SARC is working for migrant population since 2008 to till date. SARC working area is Talcher, NTPC, South Balanda, Bhusan site, CPP, Nalco and working  for 12000 target population and presently it covers 16216 migrant population & with the referral of  SARC to ICTC 23  numbers of migrant labourer were detected as HIV positive and their details status are given below:

Pre ART	On ART	Death	Out of State / Migrant
16	09	02	05

           USS working areas is inside the JSPL Plant and working for 10000 target population and presently covered 15176 migrant populations & with the referral of U.S.S. to ICTC 25 numbers of migrant laborer were detected as HIV Positive and their details status are given below:

Pre ART	On ART	Death	Out of State / Migrant
14	08	01	10

            Every month, DAPCU Angul staff closely supervise the work of TI, verified their record, visited the Hotspot, DIC and collected various information from the clients regarding the TI work, attended the meeting/ awareness meeting / Health check up camp organised by TI and both ICTC supervisor and DPM attended the PMC meeting and discuss their problem and their problem was also highlighted in the DAPCC meeting and action was taken accordingly.

           

           It was observed by. DAPCU Angul that generally the HIV/AIDs intervention strategy in Angul district is focussed on following stages of migration.

-          Pre departure

-          Migration

-          Adaptation

-          Settle period

-          Remigration

           
         For providing comprehensive HIV/AIDS service to the HIV positive migrants and for prevention and control of HIV/ AIDS within the district the two TI NGO working for migrants are given emphasis on following points    

-          Group meeting

-          One to one contact

-          Mid media activity / IEC campaign

-          Health Camp

-          Hot spot level  meeting

-          DIC level meeting

-          Condom promotion

-          STI/RTI  Treatment

-          Referral / linkage  to ART centre/ DIC/CCC/DSRC’/ RNTCP

-          Advocating meeting

-          Legal support

-          Linkage with various social benefit scheme  etc

After detection of HIV positive the migrant workers / clients were refer to ART centre for pre ART regd. /CD₄ test / on PRT registration/DMC etc. During follow up of the client,  the TI partner /  DAPCU staff  /ICTC counsellor gave stress on  inadequate adherence to ART treatment is associated with detectable viral land, decreasing CD₄ count , disease progression, episode of OIS and poorer health out come.

           

           Again MIS case and LFU case of Angul ART Centre was divided into ICTC wise and in the monthly HIV-TB.  Meeting the same MIS case / LFU case was distributed to concerned ICTC counsellor for follow up of the same client.

For providing comprehensive PPTCT Services to HIV positive migrant women emphasis was given by TI/ DAPCU/ ICTC counsellor on following point: 

·  Institutionalisation of delivery  of positive women

·  Prevention of unintended pregnancies among the HIV   infected migrant women.

·  Prevention of HIV transmission from HIV infected migrant women to their infants

·  Care and support to HIV infected migrant women, their children, 

     Again in Angul district during Dasahara, Laxmipuja and Kalipuja festival time, most of the outside migrants clients were return back to their native place of Angul District.  So to provide HIV/AIDS services  to their doorstep, health check up- camp/ STI/RII treatment/ HIV / AIDS  counselling  and testing/condom distribution / Exhibition  was  organised by DAPCU Angul  with the  support of NRHM MHU van & with team of doctors/ paramedical staff/ counsellor/ LT of ICTC  in different villages during the same time.

Out of District:

           Out of Angul district migrant clients also tested their blood in Angul CTC and regd. their name in ART centre. In case of LFU and MIS case   of out of district migrant client   their details name / address was given to the concerned counsellor of other District and the concerned counsellor of the same district flow up of the same client.

Outside State:

All sorts of support / linkage / referral services are also provided to migrant clients of outside state. If the client leave the district then their name and address was given to OSAS/ BBSR for further   follow up. 

Over all sort of social / medical / psychological / moral / legal support was provided to HIV positive migrant workers/ clients. 

Angul Response to theme - Coordination between DAPCUs

Co-ordination among staff of a DAPCU and among DAPCUs is essential to achieve the desired goals i.e.  Getting to zero (Zero HIV transmission, Zero Stigma –discrimination & Zero AIDS related death).

There are 7  DAPCU functioning in Odisha. Coordination among DAPCUs of different district is carried out from the beginning of the establishment of DAPCU i.e. from- November 2008 onward. In the  beginning each staff of one  DAPCU  District  co-ordinates with counterparts of other  District DAPCU Staff for the establishment DAPCU, Specially regarding number of files, maintenance/ organizing DAPCC meeting/ DCC meeting/ Data compilation etc.

What are the issues on which DAPCUs support each other and how is the co-ordination achieved?

• In case of one DAPCU district misses any letter/ or communication from OSACS/NACO etc., the other DAPCU districts forwards/ informs the same letter/ communication through Email/Phone etc.
• In case of any form provided by OSACS BBSR to DAPCU district is missed the other DAPCU district forwards the scan copy of the same to the concerned DAPCU district.

What role do the SACS play in enhancing this coordination?

In time intervals the OSACS, organizes DAPCU review meetings/ trainings etc in which all DAPCUs staffs share their feeling/ achievements problems etc by which we get a lesson and accordingly we prepare/ modify our plans/ activities etc.

Recently OSACS, had organized one exposure visit to Bangalore and DPM Ganjam and Angul visited Bangalore on 28th to 29th January 2013. In _ Mysore they met the DAPCU Staff of Mysore and collected various information about their activities.

 Share a few examples on which you have taken the support of other DAPCU and how it has helped you?

• DAPCU Bhadrak mobilized one ILR (Ice Line Refrigerator) from FAKKOR Company. DPM DAPCU Bhadrak was able to mobilize the same ILR, as he discussed the “HIV  Kits”  preservation problems in DAPCC meeting and Collector and District Magistrate  of Bhadrak instructed  FAKKER Company to provide the same to DAPCU Bhadrak.  Accordingly DPM DAPCU Angul also discussed the same kits preservation problem in DAPCC meeting and Collector and District Magistrate instructed to  Executive Director of JSPL to provide the same to DAPCU, Angul and it is under process. 

Show a few examples of the results achieved by inter DAPCU Co-ordination?

• Recently OSACS BBSR organized one inter DAPCU District co ordination   visit and experience sharing among   DAPCU District staff in Angul District.  DPM and M&E Assistant of Khurda and Bhadrak visited the DAPCU, Angul on 3rd July, 2013.  In the same day one meeting was held under the Chairmanship of Joint Director Basic services OSACS BBSR.   In the same meeting DNRT member  was also present & in their presence   each District briefly presented their two major achievements report The DAPCU staff of Khurda and Bhadrak also verified the various files / records of DAPCU Angul and also gave a feedback to Angul DAPCU for better management of work.

Example:
In letter received register the staff of DAPCU Angul are not writing any comments in remark column.  But DAPCU Khurda emphasize to mention “what are the action taken against each letter” received by OSACS /  NACO / various line Deptt and after that , DAPCU Angul is also writing the action taken  issues against  each   received   letter in remark column.

The DAPCU staff of Khurda and Bhadrak also visited the ICTC  II of Angul district and verified their  record. DAPCU, Angul staff also learned many lesson from their supervision style and were able to know that- what are the various issues on which one can minutely observe the activities of the counselor and LT of different ICTC.

In the afternoon session of the same day DNRT member  gave direction to three  DAPCU district staff i.e. Bhadrak, Angul, Khurda for preparation of District Annual  work plan and accordingly the three DAPCU district prepare the AWP and submitted the same to OSACS, BBSR.  Again on 5th July these three DAPCU district staffs guide the other four DAPCU district staff for preparation of District AWP.

Lastly for the first time in Odisha DAPCU history the inter DAPCU coordination visit was organized under the leadership of Joint Director, Basic services OSACS, and DNRT member .  The same programme was highly appreciated by the Collector and District Magistrate of Angul / CDMO Angul/ ADMO (PH)/ DPM, NRHM, Angul and by the DAPCC, Members.  

Ganjam Response to Co-ordination among DAPCU

There is 100% need   for DAPCUs to work in coordination with each other.

Areas where DAPCUs Support each other:-
1- Sharing of  Innovative idea  related to leveraging resources from line department/UN Agencies/Corporate/District red cross fund/any  other assisting agencies
2- Sharing and exchange of  new idea/strategies to track MIS cases/LFU of the district as well as outside district.
3- Providing IEC material  during stock out time.
4- Sharing/forwarding communication of OSACS or some time some urgent letter or guidelines of Govt or NACO
Role SACS in enhancing this coordination:-
1- Conducting  periodic Review meeting with all staff of  DAPCUs of all district.
2- Organising  capacity building/training programme of all DAPCUs staff.

Support from other district:-

1- Sharing of   telgu leaflet  help us to distribute in  one telgu dominated  ICTC.
2- Some time any urgent communication from OSACS missed but the same communication forwarded by other DAPCU.
3- DAPCU  Bhadrak  provided the Input to ganjam DAPCU for prepearing the Distritc Annual Work Plan.
4- DAPCU  khorda  shared the PPT of  update of Odisha HIV scenario and it helped for  full site sensitization workshop .

Balasore Response to coordination among 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, as the role & responsibilities of DAPCUs are same, Coordination among the DAPCUs is required for sharing information & strategies to achieve the goal of the DAPCU as well as goal of the NACP. 
• DAPCUs are coordinating with each other through telephone, e-mail & during the review meeting at OSACS level/ State level.

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

The issues on which DAPCUs support each other:

1. EID testing of HIV exposed infant of HIV positive mother: there is no EID centre in Balasore district. It is at district Headquarters Hospital, Bhadrak under Bhadrak District. Bhadrak DAPCU is also sharing number of EID testing conducted in EID Centre of HIV exposed infant of HIV positive mother under Balasore District. DAPCU, Balasore can trace out the gap between referral & EID testing of HIV exposed infant of HIV positive mother of Balasore district.
2. Follow up PLHA for Pre ART, CD4 test, LFU & MIS Cases, HIV person detected in ICTC who are in other district: DAPCU Balasore is also sharing information to follow up PLHA for Pre ART, CD4 test, LFU & MIS Cases of Bhadrak district detected in Balasore district.
3. Inclusion of social benefit scheme of PLHA of other district: PLHAs those who are coming to ARTC or detected in Balasore district are being informed on Inclusion of social benefit scheme and it is communicated to DAPCU, Bhadrak for follow up. And DAPCU, Balasore is communicating the name & address of PLHAs of other district detected in Balasore to OSACS for their willingness for Madhu Babu Pension Yojana.
4. Sharing information on strategy of implementation of programme: DAPCU is also an implementing agency of NACP activity in the district level. It is also sharing information on strategy adopted by DAPCU for smooth implementation of programme.

How is this coordination achieved?

1. Data sharing through email & telephonic contact.
2. Organising coordination meeting under ARTC
3. Sometimes visit to other DAPCU

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

1. During the review meeting coordination among the DAPCUs is being established.
2. Information of other district sent by DAPCU, OSACS is sharing of Data & innovative among DAPCUs.
3. Arrangement of exposure visit.

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

1. Implementation of innovative activities in the district and sharing with other DAPCUs
2. EID/DBS test of HIV exposed infant is being done with the Co-ordination of DAPCU, Bhadrak
3. Preparation of District Annual action Plan
4. Issues against action taken in DAPCC Meeting
5. To include the PLHA in different Social Benefit Scheme sharing with other DAPCUs
6. Training of Preferred Provider of TI project on STI/RTI Syndromes Management with the Coordination of DAPCU Bhadrak
7. During the preparation of Spatial Map DAPCUs helped each other

Share a few examples of the results achieved by inter DAPCU coordination. 

1. Implemented the innovative activities
2. EID/DBS test of HIV exposed infant are being done smoothly
3. DAPCU helped each other for preparation of District Annual action Plan
4. Discussion in DAPCC meeting sharing the issues with other DAPCUs
5. PLHA include in different social benefit scheme
6. Training has been given to P.P Doctors of TI project on STI/RTI Syndromes Management under DAPCU Bhadrak
7. DAPCUs share their views and ideas during spatial maps preparation 

Koraput Response to coordination among DAPCUs

YES ! Its very important to establish and develop the co-ordination and co-operation among DAPCUS in the state.

There are 7 nos.of DAPCUs in Orissa who are highly responsible for overall activities related to HIV/AIDS in the district. There is a strong inter-coordination among these DAPCU’s. The major coordination areas are as follows like:-

A. Data sharing.
Relating to data sharing, if there is a good co-ordination among DAPCUs then we can  easily share our achievements and work  strategies with other DAPCUs which make others to do better and follow the right direction to achieve our  goal i.e Prevention and control the HIV epidemic in the District.Datas like, 

• Target Vs Achievement of all SDPS in the District.:-Sharing the district achievements to other DAPCUs.
• LFU/MIS case. :- If the PLHIVs are  from other district, it will help to trace the case by the help of other district staffs  and reentering them on ART .
• Social Benefit schemes & providing TA to PLHIVs:-In case of providing SBPs to PLHIVs, it is very essential to take the help of others ,b’ coz the district work plans  are different from  one to another. if one district workout one kind of SBP ,then it will be a example to other district’s  authority to follow the same for approving the scheme for PLHIVs
• Sharing District Action Plans:-If there is a good co-ordination ,it will  help to make success of design and work out own district plans.
• This co-ordination helps to solve the stock out condition in the districts.
• It helps to create innovative Intervention ideas to develop the district mission.
• It helps in case of identifying the HRGs  in the district by the NGO.

B. Sharing the knowledge and experience of successful works.

C. Provide  guidance to the newcomer.And help him/her to make every work/programme under NACP ,successful.

The  role of the SACS in enhancing this co-ordination:-

SACS has a great role in enhancing this coordination. Because some time it is not possible to communicate  messages to all and some times there is  mis-communication. So SACS has to build the co-ordination between DAPCUs to share the detail programme with one another and work as a group to achieve the state goal.

Share a few examples in which you have taken the support of other DAPCUs and how it has helped you. 
1-Incase of preparing District Action Plans.
2-Conducting DAPCC with DCC meeting
3-Conducting different innovative programme with line departments.
4- To involving the PLHIV in different Social Beneficiary plans.
5-In case of stock out of Kits and other consumables

Few examples of the results achieved by inter DAPCU coordination. :-

The above things are carried out after due sharing the knowledge and experience relating the programmes  with each other. 

Finally, Its very important to have a good relation and co-ordination with each other among DAPCUs.

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

District AIDs Prevention and Control Units (DAPCU) have a major role in identifying and establishing the F-ICTCs in districts. In basing upon   some of the important   data, the F-ICTCs will be established. They are as follows:

1. Identifying the area basing upon HRG population/ANC load/TB cases/Positivity/In & out migrated population.
2. After identifying the area, co-ordinate with CDMO/ADMO (PH) in district level and apprise them for establishing the F-ICTC. And also to the SACS level for providing of further training of Staffs (One Staff-Nurse or head quarter ANM for In-charge Counselor and LT from pathology/Malaria/RNTCP).
3. Consult & Co-ordinate with the concerned M.O I/C to take the list of staffs for training and discuss the strategy of opening and running a new F-ICTC at their end.
4. Discuss with the M.O. I/c about the procurement the ICTC items for  Laboratory  use from RKS fund (NRHM) and Testing Kits/Registers/Formats /IEC materials  from SACS though DAPCU level.
5. After procurement of items and training of staffs F-ICTC will be fictionalized.

These above things are carried out by DAPCU. So DAPCU has a major role in establishing the F-ICTC.

After establishing the F-ICTCs in district, DAPCU has to monitor once or twice in case of need to the F-ICTCs and provide hand hold support to the both (Counseller/LT) for maintaining the registers and preparing CMIS reports for month wise. In each stage, they must be followed up by the DAPCU staff.

In Koraput district, 7 F-ICTCs had been proposed to establish. Out of them, 4 F-ICTCs are already functioning and reporting to DAPCU/SACS in the district. One F-ICTC is going to be functionalized from 10th July, 2013 onward (at Bandhugaon) and rest two F-ICTCs (at Kunduli & Narayanpatna) will be functionalized during next month (i. e. August 2013) after completion of training of Counselors/LTs at SACS, all other necessary arrangements have been done. DAPCU, Koraput is also showing interest to establish the F-ICTCs in other near districts like Malkangiri & Nabarangpur. 

Angul Response to Theme- 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
Angul is centrally located district in the state of Odisha.  In Angul district there are only 9. of ICTCs to provide HIV/AIDS counseling & testing facility. 5. FICTC   was    established at following places:

• CHC, Kosala– July’2011
• Banarpal – Feb.’2012
• Bantala – Feb.’2012
• Godibandah – Aug.’2012
• Boinda - - Aug.’2012

 DAPCU played a vital role in establishment of FICTC in Angul district.  Before  the establishment of  FICTC the DAPCU staff visited the different PHC/private Hospital, where ICTC  was   not  established and collected information.-like daily average patient load, monthly average patient load, No. of ANC client load and No. of delivery   conducted in the concerned /PHC ,  infrastructure facility available, human resource facilities   available   etc. DAPCU discussed this with ADMO (PH) & CDMO and with their approval DAPCU submitted a proposal to OSACS for opening of FICTC at concerned PHC.

After establishment of FICTC the Medical Officer of selected the Counselor & LT from the existing staff such as usually ANM/Staff Nurse for Counselor and for LT from RNTCP/General Pathology.
In FICTC the staff provides counseling and testing along with other services and OSACS through DAPCU provides rapid HIV testing kit, quality assurance, PEP drugs & supply IEC Material, Flip Chart & Posters etc.

Capacity building of the F-ICTC (i. e. training of staff, providing registers/ formats, providing guidance, supervision etc.)
DAPCU recommended the   name of FICTC staff for training to OSACS in consultation with 
Medical Officer of concerned CHC/PHC and occasionally DAPCU provided handholding    training/support to the FICTC staff for quality of service. Besides training DAPCU also provided register format, consent form, reporting form    IEC material; Condom   demonstration model etc. to FICTC.

DAPCU supervise the activity of FICTC and provide supportive supervision for quality counseling.  DAPCU staff also guided the FICTC staff    during     preparation of CMIS report in the   initial stages

Strengthening of linkages between F-ICTC and Designated ICTCs

Only 1st system testing kit was provided to FICTC. After detection of HIV +ve in 1st system the FICTC counselor are expected to refer the client to the nearest standalone ICTC for confirmatory test. After confirmatory test the ICTC counselor provides the report to the concerned client and shares the status of concerned client with FICTC counselor and refers the client to ART Centre & DMC. Again during outreach work the ICTC Counselor follows the client for Pre-ART/`On-Art & institutional delivery.

Monitoring and evaluation of F-ICTCs
During field visit the DAPCU Staff verify the counseling register/ Lab Register, Stock register/ Kit expiry date,  kit stock, condom stock , Refrigerator temperature,. consent form Maintain or not, IEC Material properly displayed or not, Flip chart /leaflet etc in the counselor table or not,, Condom & condom demonstration model , PEP chart is with counselor or not. Cross check the    DMC referral with the referral of FICTC and vice versa. consumables provided by the concerned CHC/PHC or not. HIV-TB 10 point     scale   is     with counselor or not. Etc.The problem of FICTC was discussed in DHS review meeting. 

Share a few achievements from your districts in this regard
In Angul district all clients referred from FICTC have reached the nearest ICTC for confirmatory test. During recent visit of NACO & OSACS official on 03.07.2013 it was observed that they verify the record of FICTC, Bantala and cross check with the record of ICTC, DHH, Angul. and found  that all the 5 clients referred by Counselor of Bantala after detection of +v e  in screening test., tested in ICTC-I and all the 5 Nos of  clients   registered their name in ART Centre, DHH, Angul   Again  one +ve delivery was conducted on 08.05.13 at DHH Angul and both  the Mother & baby pair received Nevirapine. Again     all   the FICTC staff submitting    CMIS   report in time.

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.   

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

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

• Identify the location for the establishment of F-ICTC
• Coordinate with health facility, district health administration & OSACS
• Facilitate documentary evidence with health facility, district health administration & OSACS

Locating a suitable health facility to establish F-ICTCs

• Identify the suitable heath facility for the establishments of F-ICTC through verify & analyze the data of ANC registration & institutional delivery conducted, TB case load & availability of Human resources.
• Submit all physical data to OSCS through recommendation of District Health Authorit

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

• Facilitate to recommend the name of Lab. Technician & Staff Nurse to OSACS for training and in reverse DAPCU facilitate & coordinate with health facility & OSACS for training of Lab. Technician & Staff Nurse 
• DAPCU provides all registers & formats to F-ICTC received from OSACS
• Provides guidance to health facility / F-ICTC through regular supportive supervision, meeting with institutional head & staff for smooth function of F-ICTC

Strengthening of linkages between F-ICTC and Designated ICTCs

• Review the function & linkages in the review meeting of Counselors & LTs of F-ICTC & ICTC
• During field visits verify the records of F-ICTCs regarding referral and linkages to designated ICTCs and discussed with F-ICTCs staff and Medical Officer. 
• Cross verification of  F-I CTC referral with designated ICTC record and analyze the gap and feedback to concerned F-ICTC

Monitoring and evaluation of F-ICTCs

• Regular field visit for supportive supervision and monitoring 
• Review the activities of F-ICTCS on monthly basis 
• Verify the records, validate the Data and on time reporting to OSACS 
• Accompanies and coordinate for monitoring and evaluation by higher authority like OSACS etc
• Regular discussion with CDMO, ADMO (PH) and OSACS on F-ICTC status and if gap identified

Few achievements:

• Established 5F-ICTCs in Balasore district 
• On time reporting of F-ICTCs 
• All F-ICTCs staffs are participating in district level Monthly Meeting 
• Facilitated supply of equipment and consumables from RKS Fund to F-ICTCs
• Three locations were identified and proposal has been sent to OSACS for opening of new F-ICTC in Balasore District
• Sensitize all hospital staffs of F-ICTC on HIV/AIDS