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CENTRAL LEPROSY DIVISIONDirectorate General of Health Services| Ministry of Health & Family Welfare
OPERATIONAL GUIDELINES FOR LEPROSY CASE DETECTION CAMPAIGN IN INDIA
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Table of contents
Chapter No. Contents
1 THE EPIDEMIOLOGY OF LEPROSY
2 BACKGROUND
3 LEPROSY CASE DETECTION CAMPAIGN (LCDC) – INSTITUTIONAL FRAMEWORK
4 LEPROSY CASE DETECTION CAMPAIGN (LCDC) – PLANNING & IMPLEMENTATION
5 LEPROSY CASE DETECTION CAMPAIGN (LCDC) – MICRO PLANNING
6 OTHER KEY COMPONENTS OF PLANNING AND IMPLEMENTATIONS
7 Various planning and monitoring reporting formats and tally sheets
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1. THE EPIDEMIOLOGY OF LEPROSY_________________________________
Agent: Leprosy is caused by Mycobacterium leprae intracellular, obligatory parasite. It is a slow growing bacillus and one Leprosy bacillus takes 12–14 days to divide in to two. It is an acid-fast bacillus and is stained red by a dye called carbol fuschin.
Source of infection: Untreated Leprosy affected person (Human beings) is the only known source for M leprae.
Portal of exit: The major sites from which bacilli escape from the body of an infectious patient is respiratory tract especially nose. Only small proportion of those suffering from Leprosy can transmit infection.
Transmission of infection: Leprosy is transmitted from untreated Leprosy affected person to a susceptible person through droplets, mainly via the respiratory tract.
Portal of entry: Respiratory route appears to be the most probable route of entry for the bacilli.
Incubation period: Incubation period (Duration from time of entry of the organism in the body to appearance of first clinical sign and symptom) for Leprosy is variable from few weeks to even 20 years. The average incubation period for the disease is said to be 5–7 years.
Host factors
Age: Leprosy can occur at any age but is usually seen in people between 20–30 years of age. Increased proportion of affected children in the population indicates the presence of active transmission of the disease in the community. As the disease burden declines, it is seen more in older age groups.
Gender: Disease occurs in both the genders. However, males are affected more as compared to females
Immunity: Occurrence of the disease depends on susceptibility/immunological status of an individual.
Socio-Economic Factors: Leprosy is a disease generally associated with poverty and related factors like overcrowding. However, it may affect persons of any socioeconomic group.
Factors influencing susceptibility
Age: Children are more susceptible than adults. Individual immunity: May be determined by certain genetic
factors which influence the susceptibility of an individual Climate: Leprosy is prevalent in tropical and subtropical
climates.
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Leprosy cases can be classified as under:
S.No. Characteristic PB(Pauci bacillary)
MB(Multi bacillary)
1 Skin lesions 1-5 lesions 6 and above
2 Peripheral nerve involvement
No nerve/ only one nerve with out 1 to 5 lesions
More than one nerve irrespective of number of skin lesions
3 Skin smear Negative at all sites Positive at any site
Duration of treatment for leprosy cases and treatment regimen is as under:
Type of Leprosy Drugs used Criteria for RFT
MB Leprosy Rifampicin Completion of 12 monthly pulses in 18 consecutive months Clofazimine
Dapsone PB Leprosy Rifampicin Completion of 6
monthly pulses in 9 consecutive months Dapsone
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2. BACKGROUND____________________________________________________ National Leprosy Control Programme was started by Govt. of India
in 1955, wherein Dapsone domiciliary treatment was given through vertical units and survey education and treatment activities were implemented. It was only in 1970s that a definite cure was identified in the form of Multi Drug Therapy (MDT). MDT consisting of dapsone, clofazmine and rifampcin was recommended as a standard treatment for leprosy by the World Health Organization (WHO) in 1982. Following the recommendations of WHO Study Group, Geneva (October, 1981) and Dr. M.S. Swaminathan committee (1981) the NLEP was launched in 1983 by GoI with the objective to arrest the disease activity in all the known cases of leprosy. However coverage remained limited due to a range of organizational issues and fear of the disease and the associated stigma. Further, in view of substantial progress achieved with MDT, in 1991 the World Health Assembly resolved to eliminate leprosy at a global level by the year 2000. In order to strengthen the process of elimination in the country, the first World Bank supported project was introduced in 1993.
The 1st Phase of the World Bank supported Project initiated from 1993-94 was completed on 31.3.2000 with further 6 months extension to complete the preparation of proposal for 2nd Phase Project. Wherein, 3.8 million leprosy cases were newly detected against a target of 2 million cases and 4.4 million leprosy cases were cured with MDT. The prevalence rate reduced from 24/10,000 population in 1992 before starting 1st Phase project to 3.7/10,000 by March 2001. The 2nd Phase of World Bank Project on NLEP started for a period of 3 years from 2001-02 till 31st December 2004. This phase was implemented with the objectives which are as under:
1 Decentralization of NLEP responsibilities to States/ UTs through State/ District Leprosy Societies.
2 Accomplish integration of leprosy services with General Health Care System (GHS) and
3 Achieve elimination of leprosy at National level by the end of the Project. Herein, well planned activities were efficiently implemented in
close association of various NLEP partners viz. State & UTs Governments, World Bank, WHO, ILEP, DANLEP, NGOs and Community, Pvt. Medical Practitioners and various concerned Govt. Ministries/Departments such as Information & Broadcasting, Social Justice & Empowerment, Education, Railways, Defence/ paramilitary, Labour and Industries etc. During the last two years of the project a component of validation of case diagnosis was introduced.
In 2005, as the NRHM launched, the programme was subsumed under the aegis of NRHM and being implemented as a centrally sponsored scheme, as per the defined rules. The disease has come down to a level of elimination i.e. less than one case per 10,000 population at the national level by December 2005.
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Strategies for XII Five Year Plan (FYP)
Leprosy is a chronic disease with a long incubation period (average 5-7 years). Although the disease has been eliminated at the National Level, there are Districts & Blocks which are still having prevalence rate >1/10,000 population. Besides this the new cases would continue to occur for few more years on account of long incubation period of the disease. Therefore, creating awareness for self reporting, timely diagnosis and complete MDT treatment of leprosy cases is crucial for ultimate eradication of the disease. Another aspect of the programme is gender imbalance as seen in new cases detection. Since the programme aims for eradication i.e. zero case of leprosy as the ultimate goal, sustained control measures need to continue during the 12th plan period.
Results (Objectives) to be achieved during 12th plan period i.e. 2012-2017 are as follow:
Improved early case detection Improved case management Stigma reduced Development of leprosy expertise sustained Research supported evidence based programme practices Monitoring supervision and evaluation system improved Increased participation of persons affected by leprosy in society Programme management ensured
The programme components approved under XII FYP are as follows –
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Epidemiological Situation, as on March, 2015:
34 states/UTs have achieved leprosy elimination status. Only 2 States/UT (Chhattisgarh and Dadra & Nagar Haveli) are yet to achieve elimination. One State (Chhattisgarh) and One U.T. (Dadra & Nagar Haveli) has remained with PR between 2 and 5 per 10,000 population.
At the end of March 2015, there were 88833 leprosy cases on record (under treatment).
In 2014-15, total 125785 new leprosy cases were detected and put under treatment giving Annual New Case Detection Rate (ANCDR) of 9.73 per 1,00,000 population.
Out of 215656 global leprosy cases reported in 2013, 126913 cases were reported by India. Thus India contributed about 58.8 % of new cases detected globally.
The trend of Prevalence and Annual New Case Detection Rate per 10,000 population since 2004 is shown in the Graph below:
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In addition, as per the findings of National Sample Survey (2010 – 11) report:
The New Case Detection Rate (NCDR) of leprosy at all India level is 27.70 per 100,000 population.
The estimated leprosy cases in the country are about 334306 and range from 287653 to 381088 cases.
Twelve states have reported NCDR of higher than the elimination level. These include Andhra Pradesh, Assam, Bihar, Chhattisgarh, Jharkhand, Karnataka, Madhya Pradesh, Maharashtra, Odisha, Tamil-nadu, Uttar Pradesh and West Bengal.
The above mentioned statistics connote that though the Elimination of Leprosy at National level has been achieved by India, in the month of December, 2005, it is still home to around 60% of the worlds’ leprosy-affected persons. Out of 215656 global leprosy cases reported in 2012 – 2013, 126913 cases i.e. 58.8 % of new cases detected globally, were reported by India. Pockets of high endemicity are still prevalent in few states in India indicating ongoing disease transmission. Further, it has been observed that trend of two important indicators of National Leprosy Eradication Program, India i.e. Annual New Case Detection Rate (ANCDR) and Prevalence Rate (PR) are almost static since 2005 – 2006. In addition, the percentage of grade II disability amongst new cases detected has been increased from 3.10% (2010 - 2011) to 4.61% (2014 - 2015), which indicate that the cases are being detected late in the community and there may be several cases which are lying undetected or hidden.
The causes behind the trend of indicators are i) Slow decline in disease burden (increased new cases), ii) Dependence on voluntary reporting in remote, tribal, hard-to-reach and insurgent affected areas, iii) Non-Inclusion of cases treated by NGO hospitals/ Private Practitioners etc. in reported cases iv) Slow progress in engagement of contractual manpower at district/ block level by the States/ UTs in high endemic areas, v) Stigma still exists even in educated & well to do families resulting in delayed detection.
Hence, in order to detect the hidden leprosy cases, to increase the awareness about NLEP and to address the various reasons of these hidden cases in the community, the Central Leprosy Division proposed to conduct Leprosy Case Detection Campaign (LCDC) along with administration of single dose of rifampicin chemoprophylaxis, in India under NLEP. LCDC is a unique initiative of its kind under NLEP, will be implemented in high endemic districts of the country, on line with Pulse polio Campaign. The LCDC will help in early case detection and treatment further, detection of leprosy cases in the community will lead to depletion of source of infection in the community as undetected and untreated cases will transmit the disease agent to other people of the community. This initiative is necessary to interrupt the transmission of the disease agent in the community, and to achieve elimination status in India.
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3. LEPROSY CASE DETECTION CAMPAIGN (LCDC) – Institutional framework__________________________________________________________________________The highest level of political, administrative ownership, commitment and support needs to be sustained for successfully curbing leprosy transmission. The Central Government, the State Governments, and their international and national partners need to maintain and further enhance focus and momentum. The leprosy elimination must continue to be implemented to the fullest.
The Government of India has set up committees at various levels to ensure inter-sectoral coordination between all partners and other departments and review the progress in planning, implementation and monitoring of the programme. Before each campaign such committees which may already be existing need to be reactivated at state, district and block level.
Regular scheduled meetings must be held with clear objectives, agendas, and action points from previous meetings. This should include progress, problems encountered, proposed solutions and new action points with clearly defined responsibilities and deadlines. Minutes of the meetings and action points should be shared with all the participants. The committees should ensure that activities are completed, adhering to guidelines and timeliness.
At National level Central Operation Group will be formed. It comprises of officials from Government of India, ILEP, WHO and other partners at the national level chaired by the DGHS, Government of India. The role of the Central Operations Group is to:
Support pre-planning and to fast track decisions on extent of Leprosy Case Detection Campaign (LCDC).
Decisions on extent of districts to be covered under LCDC based on epidemiological data.
Develop and finalize LCDC plan with timeline. Coordinate activities with partner organisations like WHO, ILEP etc. Coordinate with DAVP, Song and Drama Division, Doordarshan, AIR,
Field publicity etc. Coordinate with other National and International organisations. Monitor implementation of LCDC activities at national, state and
district level.
Committees at State level:
For better organization and management it is proposed to formulate special committees at State level, which are as under:
State coordination committee State Health Secretary – Chairman State Leprosy Officer – Member Secretary
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State level representatives from Social Welfare, Education, PRI, Partners i.e. ILEP, WHO, Association of Persons Affected with Leprosy (APAL), State Program Manager – Members
State Co-ordination Committee under the chairmanship of State Health & Family Welfare Secretary with Director/State Leprosy Officer as the Member Secretary, will be formed. State level representatives of the key partners like Social Welfare, Education, PRI, Partners i.e. ILEP, WHO, Association of Persons Affected with Leprosy (APAL) and State Program Manager should be invited to attend coordination committee meetings. The role of the committee is:
To ensure inter sectoral coordination and full utilization of resources from partner government and non government departments.
Monitor preparedness in each district of the state.
State Leprosy Awareness Media Committee Director Health Services – Chairman State Leprosy Officer – Member Secretary State level representatives from Partners i.e. ILEP, WHO, State
Media Cell, local Akashwani and Doordarshan Kendras – Members
State Leprosy Awareness Media Committee under the chairmanship of State Director of Health Services with the State Leprosy officer as the Member Secretary will be formed. Partner organizations like ILEP, WHO and State Media Cell, local Akashwani and Doordarshan Kendras will be represented in the committee through their state level representatives. The role of the committee is to:
Develop a media plan with timeline. Utilize all available resources and channels for delivering simple
and clear messages to the community, which will help to ensure success of LCDC & more acceptability and cooperation to health teams during house to house visits.
Monitor implementation of IEC/social mobilization activities in the states.
LCDC control room shall be set up in the office of the State Leprosy Officer of each state. The State NLEP consultant should be involved in planning and implementation of activities. The role of the control room will be to monitor preparedness of LCDC on a day to day basis especially mobilization of human and other resources like transport, ensure inter sectoral coordination and full utilization of resources from partner, government and non-government departments. It should also monitor implementation of the programme during the activity. The control room should provide feedback to the state steering committee and state coordination committee on progress being made and also on any obstacles being faced.
Committees at district level:
Further, for better organization and management it is proposed to formulate special committee at District level which is as under:
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District Coordination Committee District Collector/ Magistrate/ CEO – Chairman District Leprosy Officer - Member Secretary Representatives from Zila Parishad, APAL, Social Welfare deptt.,
District Publicity Department and District Health Education Officer, District ASHA Coordinator, District Programme Manager, District Epidemiologist.
District Coordination Committee under the chairmanship of the District Collector/Magistrate/ Chief Executive Officer in each district, with the Dis-trict Leprosy officer as the Member Secretary will be formed. District level representatives from Zila Parishad, APAL, Social Welfare deptt., Dis-trict Publicity Department and District Health Education Officer, District ASHA Coordinator, District Programme Manager, District Epidemiologist should be a part of the committee. The role of the committee is to:
Supervise, Support, Monitor and ensure Implementation of the highest quality LCDCs in the district.
DM and CMO should also use these meetings to clear obstacles for planning and implementation of the programme.
The Committee should meet at least three times before the round and every day during the activity.
LCDC control room at District level: A control room should be set up at the district level to monitor preparedness of blocks/ PHCs/ urban areas on a day to day basis and to monitor implementation of the programme during the campaign.Committees at Sub District level:
Similar to the District Coordination Committee, Tehsil / Block Coordination Committee must be set up under the SDMs/BDOs with similar role and objectives.
District Magistrates or ADMs should chair the Block Coordination Committee meetings in the high-priority blocks.
Role of Government Officials in organization and management of LCDC is as under:
District Magistrates/ District Collector/ Chief Executive Officer: District Magistrates are responsible for monitoring the planning
and implementation of LCDCs activities in their districts through weekly review of the progress and problem solving.
They shall ensure involvement and inter sectoral coordination of all other departments in the district for mobilization of manpower, transport and social mobilization, thereby ensuring that all departments function to their full potential as outlined below.
Depute senior officials from the administration and other sectors to supervise preparations and implementation of the LCDCs in various blocks and urban areas of the district. All senior officials are accountable for their areas.
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Organize and conduct meeting of religious and community leaders. Monitor training attendance in high risk areas.
District Leprosy Officer: Shall support the District Magistrate and the District Coordination
Committee in their roles outlined above for timely implementation of LCDCs at the district level.
Shall ensure review and finalization of microplans including IEC and social mobilization plans of all blocks and urban areas before start of activity.
Shall ensure all ASHAs and Volunteers have undergone orientation as and when required.
Make supervisory visits to sub district levels to review preparedness and monitor implementation.
Block/ PHC Medical officer/Nodal Officer for planning in urban areas:All block medical officers/urban nodal officers should be made accountable for their areas to supervise development of correct microplans, and timely implementation of case detection activities during LCDCs at the block/PHC level. This includes:
It will be mandatory for all medical officers/nodal officers to review and finalize microplans before activity and ensure their implementation during LCDCs.
Identify supervisors for field visits. Ensuring orientation of ASHAs and Volunteers before each LCDC. Conducting meetings with community leaders/religious leaders. Ensuring banners /posters are displayed in time and well ahead of
the activity. Arranging transport for delivery of logistics and miking. Developing route charts for logistics delivery and miking. Distributing various logistics to teams. Supervising house to house LCDCs activities. Collecting and compiling reports from LCDC teams and supervisors. Analysing and reviewing feedback /data from teams, supervisors,
monitors, medical officers and plan corrective actions.
Key assistants at Block/PHC level may be given by Social Welfare Officer/ Health Supervisors/Public Health Nurse. They will Assist Block/PHC Medical Officer in his role outlined above.Role of Govt. departments and other organizations in LCDCs: (Note on volunteers for awareness & motivation in community)
Education, NCC, NSS and NYK: School children/college students should take out rallies for
community awareness & motivation in support of the programme prior to the LCDCs and during the days of activity.
Schools should display banners and posters to spread the message regarding LCDC.
Schools should develop an army of school children who will identify target population in their neighborhoods and facilitate visits to the areas.
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School teachers/ college students can be part of house to house LCDC teams and/or accompany the teams during their house to house visits.
Social Welfare: Social welfare workers should take out rallies for community
awareness & motivation in support of the programme prior to the LCDCs and during the days of activity.
Offices of Social Welfare department should distribute and display IEC materials like handouts, posters and banners in their neighbourhood, spread the message regarding LCDC.
Social welfare workers should help in contacting local community leaders/various groups to raise community awareness about LCDCs.
Social welfare workers can be part of house to house LCDC teams and/or accompany the teams during their house to house visits.
Panchayati Raj Institutions: Help to identify and provide suitable days to conduct visits. Launch
the Campaigns in their areas. Help in creating community awareness & motivation in support of
the programme prior to the LCDCs and during the days of activity. Gram Panchayat Vikas Adhikari (Village development secretaries),
Lekhpals, Village Pradhans and Panchayat members should accompany LCDCs teams during house-to-house visits and mobilize community to accept the case detection drive. Their participation is crucial in covering all houses in hard to reach areas.
Give feedback on completion of activities in their areas.
Professional medical bodies: National, state and district chapters of all professional bodies
should send out a formal communication to all their members requesting them to spread the messages regarding LCDCs under NLEP.
All private and public physicians, private practitioners and other health professionals can inform their clients of the dates of LCDCs and the importance of the activity.
Display IEC materials at their clinics.
NGOs/other voluntary organizations: Create community awareness for LCDCs by contacting community
leaders, developing, distributing and displaying IEC materials. Provide logistics support. May provide volunteers for LCDC teams. These volunteers should
accompany LCDCs teams during house-to-house visits and mobilize community to accept the case detection drive. Their participation is crucial in covering all houses in hard to reach areas.
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4. LEPROSY CASE DETECTION CAMPAIGN (LCDC) – Planning & Implementation_________________________________________________________________________________________
Meetings for LCDC:To ensure that the micro-planning guidelines are followed, logistics and supplies properly arranged for, and personnel involved at all operational levels clearly understand their roles and activities to be undertaken; trainings/meetings listed below must be conducted before LCDC in each district/urban area. A meetings/training plan and timeline should be included in the microplan for each state, district and block.
State Leprosy Case Detection Campaign (LCDC) planning workshop:
The State Secretary of Health, Director Health Services and/or Director Family Welfare, State Leprosy Officer (SLO), State Leprosy Consultant (SLC) should facilitate these meetings.
The meetings have to be attended by District Magistrates, Chief Medical Officers (CMO), District Leprosy Officers (DLO), District Leprosy Consultants (DLC), Block/Municipal Medical Officers, State level representatives from Panchayati Raj Institutions, Social Welfare, Education, partner organizations i.e. ILEP, WHO, Association of Persons Affected with Leprosy (APAL), State Programme Manager (SPM) and other agencies NGOs.
The objective of the meeting should be to sensitize the district & block level planners on the strategy to be followed, need for preparing microplans for their areas, and sort out issues of coordination between the implementing partners.
District Coordination Committee Meetings: District Collector/Magistrate/ Chief Executive Officer in each
district, with the District Leprosy officer, District Leprosy Consultant should facilitate these meetings.
The meetings have to be attended by district level representatives from Zila Parishad, APAL, Social Welfare deptt., District Publicity Department and District Health Education Officer, District ASHA Coordinator, District Programme Manager, District Epidemiologist, Block/Municipal Medical Officers, representatives of medical colleges, prominent NGOs, District Information Officer.
The role of the district Coordination Committee is to supervise, support, monitor and ensure implementation of the highest quality LCDCs in the district.
DM and CMO should also use these meetings to clear obstacles for planning and implementation of the programme.
The Committee should meet at least three times before the round and every day during the activity.
District Micro planning Meeting/Urban Area Planning Meeting:
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The Chief Medical Officers (CMO) / District Leprosy Officers (DLO)/ District Leprosy Consultants and the NLEP consultants from ILEP, should facilitate these meetings.
The meetings have to be attended by all Block/Municipal Medical Officers, urban health planners, representatives from Social Welfare deptt., and other organizations involved in social mobilization, along with personnel involved in planning at the block level.
The objective of these meetings should be to sensitize the block medical officers (BMOs) and the urban area planners on how to micro plan for their areas for the upcoming LCDCs. Special attention should be paid on developing area-specific IEC strategies for problem pockets.
State /District/ Block Review Meetings:A review meeting should be organised at Block level after 2 days, at District level after 5 days & at State level after a week of completion of LCDC activities to review the performance of LCDC activity based on the feedback from monitors, state, district and block level supervisors. Data analysis from the LCDC round should also be presented at this meeting. The meeting should identify actions to be undertaken for rectification of deficiencies in the next round. Monitoring by State, District and Block Observers:State, District and Block level Officers should be nominated at each level and these officers should be allotted districts / blocks/ urban areas which should be meticulously visited before the LCDC for monitoring the preparedness and during the activity to monitor the implementation of the activity. The observers should identify any constraints that are likely to affect the implementation of the programme and find solutions to remove any bottlenecks. The list of observers along with the districts / blocks/ urban areas allotted must be shared with Central Leprosy Division.
Role of observers during preparatory phase:All state observers should attend District and Block Coordination Committee meetings and report back to the State Health Secretary on the quality and effectiveness of these meetings. They should also monitor whether vacancies of Medical Officers and ANMs have been filled up in the high-risk blocks/areas and assess the involvement of ‘non health’ government departments as volunteers. Observers should also review the micro plans to ensure that:
All components are present. All geographical areas have been included. Team composition is appropriate – all house-to-house teams have
at least one ASHA and at least one Volunteer. Sensitization trainings to detect the cases have been planned for
all ASHAs and Volunteers. Workload of teams in terms of houses to be covered/ day has been
rationalized. Areas requiring special attention have been identified and plans
developed to cover them.
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IEC/ Social Mobilization plans have been developed and documented.
Role of observers during implementation phase: All officers should again visit their allotted districts / blocks/ urban
areas during the implementation phase to assess the quality as the completeness of coverage of area through house to house visit.
It is essential to ensure a mechanism of daily feedback from the observers to the blocks and District control cell to facilitate immediate corrective action at all levels. Information on missed areas, false (L) covered houses and false X to L conversion is useful tools for assessing quality.
Qualitative and quantitative assessment on the LCDC activity from observers should be utilized for long term corrective actions like problems faced by ASHAs & Volunteers during campaign, review of microplans etc. or immediate corrective actions like repeating the activity in an area where significant number of uncovered houses are found after completion of activity.
False L house: a L marked house where search teams have claimed to have screened all inhabitants (excluding children <2 years of age) of the house, but unscreened inhabitants are found by supervisors or monitors during their visit to the house.
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5. LEPROSY CASE DETECTION CAMPAIGN (LCDC) – Micro Planning
__________________________________________________________________________
Successful implementation of Leprosy Case Detection Campaign (LCDC) requires meticulous microplanning. Important components of microplan are as under:
Campaign specific IEC House-to-house case detection activity Administration of chemoprophylaxis to 20 contacts of cases
detected during LCDC
Activities to be undertaken for campaign specific IEC:It is essential that adequate social mobilization measures and awareness at mass level are undertaken prior to the LCDCs so that community is fully informed about the i) Dates of field visits, to be undertaken by ASHAs and Volunteers in an area, ii) The need & benefits of this campaign for Leprosy patients and community which should be reminded during the campaign also. Considering before-mentioned necessities, following instructions will be pursued:
There must be publicity of LCDC for 5 days. 2 days prior to starting the activity and for 3 days after starting the
house to house case search. The cost of IEC will be at the rate of Rs. 4000 per day for each
distt. Emphasis on need based planning may be given to address the
local need for awareness e.g. leaflets/pamphlets may be suitable for literate targets while folk play will be effective for rural areas.
For effective IEC activities the spread messages on specific days and locations needs to be clearly define. The consolidated IEC plan for LCDC activity is mentioned below:-
S.No.
Mode of Communica-tion
Activities Days Remarks
1 Traditional Media
Drum beating -1st,-2nd, 6th ,9th
Publicity should cre-ate noise in the dis-tricts through drum beating & loud-speakers before be-ginning of the LCDC.
Wall painting -1st,-2nd
Loudspeaker an-nouncement
-1st,-2nd, 5th ,9th
Street Play 6th Magic shows 5th Puppet shows 6th
2 Electronic Me-dia
Local Cable TV -1st, -2nd, 5th , 6th , 9th
Message will run for all five days.
3 Other Media IPC/Advocacy meeting with vil-lage leaders/Pan-chayats
-2nd, 9th Before activity, it is important to know mindset of the lo-cals and at the end
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of the campaign; an IPC will help us to know how far they are influenced.
In the above table, (-) indicates days before LCDC. Hence traditional media & electronic media will run two days prior LCDC and on 5th, 6th and 9th day during the LCDC days. Similarly other media will run 2 days prior to LCDC and 9th day during the LCDC days.
Activities to be undertaken during House –to – house case detection: It is to be understood that the prevalence rate i.e. cases being registered or being represented to the Health System through programme is just tip of the iceberg, major portion of which is still submerged under water or in other words several leprosy cases are still hidden in the community. Hence, strategy proposed to do house to house search through involvement of ASHAs and trained volunteer to enable examination of both male and female suspects in the community. Considering before-mentioned innovations, following instructions will be pursued:
Team of one ASHA and one volunteer will be formed for population of 1000 person.
On an average 200 households will be covered by each ASHA and Volunteer.
The activity will be undertaken in 14 days. Honorarium of Rs. 20 per day will be paid to Volunteer along with a
certificate of recognition.
Microplanning for House to House Leprosy Case Detection Campaign:
The aim of the LCDCs is to detect leprosy cases as early as possible. To ensure the same the search teams must visit each household in the LCDC area. The duration of the house-to-house (h-t-h) search and case detection operation should be decided by the number of available search teams in the area because teams have to be allotted rational/feasible work load.Area allocation and workload of teams:Each team should be allocated clear-cut, well-demarcated areas clearly mentioning the starting and ending points, identifiable with landmarks; for each day of h-t-h activity.Each team should be given optimal number of houses to be covered in consultation with the concerned ASHAs/ Volunteers working in the area taking into account the local geographical conditions and the time taken in travel and to revisit X houses. The number of houses to be covered each day should not be fixed by the district officials. However as a general guideline:
In rural areas 15-20 houses per team per day may be planned. This number may be changed in view of local situation to allow optimal time for travel and revisits to X houses.
In urban areas 20-25 houses per team per day may be planned.
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The number of houses per day may be less in sparse/scattered population. This number may vary from day to day depending upon the geographical situation of area planned to be covered by the team on a particular day.
The no. of houses to be covered each day should be mentioned in the microplan.
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Composition of teams: Teams of two persons each should go house-to-house case search Out of the two members in each team, one should be a local male
volunteer and one ASHA. In high risk areas one additional person from the local community,
where team will be working, should accompany the team. This person should preferably be a male or someone with recognition and influence in the community. In areas where misinformation is an issue, the person should be a local religious leader/local doctor.
While planning for rural areas, ensure the following in the micro plan:
All hamlets (tolas/ purwas) adjoining the village are documented and covered during the activity.
Brick kilns are covered by h-t-h team or special mobile teams. Names of prominent local influencers like pradhans, panchayat
members, local doctors, teachers, religious leaders, anganwadi workers etc. are incorporated.
For urban areas ensure that: All peri-urban areas, slums, pavement dwellers, construction sites
and new settlements are covered in the micro plans. Households on upper floors are accounted for while estimating no.
of houses to be covered by teams. The names of local resident welfare organizations, community
leaders etc. are included in the microplans.
Activities of teams:(a) Search and detection/diagnosis of cases affected with Leprosy
during house to house visits : During h-t-h activity, maps should be used to visit all houses
systematically as per the micro plan. No house should be left unvisited.
House to house visits and revisits to ‘X’ marked houses should be undertaken at the time when inhabitants of the area are most likely to be available at their homes.
During house-to-house visits, teams should knock at the door and then enter each house.
Team should then greet the respondent politely, introduce themselves, and explain the purpose of their visit.
The next task is determining the correct number of inhabitants of the house. To determine correct information, the team members have to go systematically and ask all the following questions in each house:
1. How many families (households) are staying in the house? Number of families is to be determined by the number of ‘chullahs’ (kitchens).
2. What is the number of persons residing in each house hold?3. Are all persons in the house? Determine information
household wise.
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4. Are any person (who normally live with the family) away from home for reasons like: Gone to fields or market place or school. Visiting friends /relatives within the village or in other villages / cities. Gone out to their place of work. Outside the house for any other reason.
All persons irrespective of age present at home should be examined for the presence of light color patch, redness, swelling or nodule on skin, only children less than 2 years of age may be exempted from physical examination.One member of the team should examine the person and mark every examined person on left little finger with indelible ink marker pen, allowing the mark to dry for a few seconds.The second member of the team should mark the tally sheet after every member of the family is examined and mark every visited house as L/date or X/date with chalk or geru.Team members should advise family regarding need & benefits of this campaign for Leprosy patients and community. They should try to address the queries and myths regarding disease and programme. Before moving to the next house, team should thank the mukhiya/ head of the family and family members as well for their cooperation and be doubly sure that all inhabitants of house have been examined in the house. Details of unexamined inhabitants of the visited house should be entered in the X Tally sheet.
(b) Examining people outside houses:During h-t-h visits, teams as well as the supervisors should be on the lookout for unexamined people on the street, in the play grounds, fields etc. by examining them for finger markings and examine all unexamined persons.(c) Marking of houses by search teams:
All visited houses should be marked with white/coloured chalks or geru as:L/date: All persons staying in the house have been examined in this
round. This includes perons visiting the house when the campaign is on.
X/date: All or some eligible inhabitants of the house were not examined
for reasons like: Persons not at home for the following reasons away to
farms/ fields, place of work, school or market places Visiting friends or relatives Locked house - even if the family is not expected to return
for a period of one to two years.A list of X /Date houses should be made on the X tally sheet and submitted to supervisor at the end of each day by each team. Teams should also indicate the number of the house visited and put an arrow in the direction where they are moving.
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EXAMPLES OF HOUSE MARKINGL-1 L-2 X - 3
______ _______ ________ Date Date Date
For revisit - make record of left out houses and revisit on the next day only. If not available revisit after 2, 7 days again.
Revisit to X houses:All X marked houses generated by search teams during the day, irrespective of cause should be revisited by teams during afternoon/evening to examine the inhabitants of these houses. Teams should make these revisits at a time when all the inhabitants are expected to be available in the house. The biphasic nature of the activity should be essentially planned to ensure examination of such persons who were out of the house at the time of first visit.
In areas where people are reluctant to go for physical examination and leprosy case search is an issue, revisits to X houses should be made along with the local influencers/community leaders who would be able to motivate the family for better cooperation.
Flexible timings and flexible days of activity will increase the acceptability and cooperation by the community.
Micro Planning for High Risk Areas and Underserved Population:
It has been observed that the same population groups are often missed by the routine programme activities. All these groups must be identified and such areas must be enlisted in the micro plans. These areas should be considered as high risk and the population as underserved.Indicators for High-risk areas and underserved population include the following:
A confirmed leprosy case has occurred in the recent past. Problems in terms of non-cooperation from community during case
search/ campaign. Low routine case detection coverage. Urban slums or peri urban areas not recognized by district
authorities. Remote, sparse and difficult to reach population groups like
nomadic tribes, boat people, and isolated families living along riverbanks for farming, river islands etc.
Mobile population and tribes People with working hours that do not coincide with the visit of
teams (for example persons going to the fields during harvesting and sowing seasons are simply missed because teams do not reach either before they leave or after they come back from the fields).
People living at construction sites, brick kilns23
DRAFT
Travellers, who may be on the road or in the train when the campaign takes place.
People living in houses outside recognized settlements (the “no man’s land”).
People that have lost their faith in the health programme, because of low quality of services provided, lack of explanation, and/or rude behaviour of health functionaries in the past.
People of specific socio economic status, which require ‘special’ efforts to reach. Persons with high socio economic status may disagree with case detection campaign, because they assume that leprosy cannot occur to them. Whereas, People of low socio economic status may distrust anything offered for free and request other services.
Misinformed groups, who may refuse examination because of wrong beliefs or stigma attached to the Leprosy. They do not oppose examination because of religious reasons, but because of lack of proper information through the proper channels.
Special efforts for high risk areas and underserved populations:The States and districts will need to take special measures to ensure that all people are examined in these high-risk pockets. The special measures for high-risk areas include the following (these are in addition to what is already being done for other areas):
Intensive efforts for social mobilization and IEC need to be undertaken in these areas, such as:
Intensive miking, house-to-house visits by health workers to involve community leaders, panchayat members particularly the women members, religious leaders and other local influencers like medical practitioners, local moneylenders, grocery shop owners, popular teachers, prominent youth etc to provide proactive support.
Local community members/influencers must accompany search teams during house-to-house visits in such areas, especially during revisit to X houses.
Female community member and a male volunteer residing in the area should be a part of search teams. This will improve access to all persons in the area.
Team composition, workload and timings of team visits. Deployment of reliable trained and motivated manpower in such
areas – best workers for worst areas. Workload of house-to-house search teams should be rationalized to
give a feasible workload to each team. The search teams should undertake house-to-house visits when all
persons are most likely to be available at their homes. This may require changing hours of operational activities to early mornings or late evenings.
More intense supervision in the area with supervisors being allotted less number of house-to-house search teams.
Increased supervision in these areas by state and district officials who should make frequent visits both during planning and implementation phase.
Designate a person in each district to be responsible for these underserved population groups/areas.
Intensive monitoring of such areas by best independent monitors/ SMOs to get accurate feedback.
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LCDC in misinformed groups: Search teams working in these areas should be specifically
selected and specially trained to search for all hidden cases, in each household, convince them and then carry out examination activities.
Each house-to-house search team in such areas must have at least one male member/volunteer and ASHA from the community where they are working.
Teams in such areas should be assigned no more than 10-15 houses per day. This would allow the teams to spend more time in each house.
Local community members/influencers must accompany search teams in such areas to convince reluctant community.
Teams should also carry appeals from community/religious leaders to convince reluctant people/ community.
During house-to-house campaign in these areas the male volunteer in the team should take the lead in seeking permission from head of the family before entering the house.
After introducing themselves and explaining the purpose of their visit members of search team should determine the number of households in each house (as defined by the number of kitchens in the house) and then determine the number of inhabitants in each household by asking all relevant questions.
Additionally members should also cross verify the number of people living in the house from neighbours, local influencers accompanying the teams, people in the street etc. Teams must check finger marking of each person and examine all those persons who are unmarked.
If any family member raises queries regarding leprosy, team member must respond in a respectful and courteous manner to clarify their doubts or misgivings. The portion on FAQs may be referred by the search teams.
LCDC at Brick kilns, construction sites: Brick kilns, construction sites must be covered by house-to-house
search teams. Search teams must be specially trained to carry out search in these specific situations.
Owners of brick kilns/construction sites must be informed well in advance about the date and purpose of visit by search team by the district/ block officials.
The local clerk/contractor should be contacted in advance and a list of the families working at the kiln/sites should be prepared.
The search team must carry this list during their visits. Search teams must visit the homes of the workers at these sites
and also surrounding brick fields (Pather/Pasar) where the families are making bricks. These may be situated at a distance of about 1-2 kilometres from the brick kiln.
The teams should examine all persons excluding children < 2 years of age, at these sites and should counter check from the list to ensure that all families are covered and all persons are examined.
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Since families frequently migrate to these sites, brick kilns and construction sites should be visited twice during each LCDC round to ensure that all new arrivals have also been examined.
Micro planning for urban areas:Planning for urban areas is crucial for successful implementation of LCDCs. Some of the commonly observed deficiencies in urban areas are:
Lack of adequate health infrastructure and manpower Large slums (unauthorized) Periurban areas with new settlements and some areas/colonies not
recognized by municipal health authorities Multiple construction sites
For planning and implementation purposes, urban areas should be divided into smaller planning units based on municipal wards or assemblies and if this is not possible then by roads or prominent landmarks. Each such unit should be put under the charge of a medical officer or nodal officer. The officer should be responsible for:
Development of microplans for house to house LCDCs. Manpower deployment in the area by arranging additional
manpower from non health departments like social welfare, education and NGOs or volunteers.
Developing a plan for IEC activities like: Miking from fixed sites and slow moving vehicles like cycle
rickshaws Delivery of messages on the programme through the cable TV,
cinema slides and telephone Display of banners, posters, vertical boards, hoardings in the
area. A list of prominent sites for display of these should be developed.
Meeting with community and religious leaders of the area Training of search team Inter-sectoral coordination with other agencies
Supervision of LCDC activities Daily feedback from supervisors and monitors and Immediate
corrective actions during the round Compilation of daily reports and onward transmission to identified
officer/ official. Involvement of local municipal bodies and their staff is essential in
urban areas. Municipal staff is familiar with the layout of the urban areas and their inputs are vital for planning and supervision of house-to-house activities.
Coordination with education department, social welfare, civil defence, other local NGOs, resident welfare associations and community leaders is vital for meeting shortage of community volunteers, social mobilization and also for community acceptance.
Maps must be used while planning for urban areas. If maps are not available with municipal bodies search team members and
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supervisors should be sent to the area before the round in order to become familiar with the area and develop maps.
Marking after examination: All persons (except the children of less than 2 years of age) after
examination by ASHAs/ Volunteers, during house to house visit in LCDCs should be marked with indelible ink marker pen on the left little finger.
The mark should be large and cover the entire nail and adjoining skin.
The mark should be allowed to dry for a few seconds to prevent it from being rubbed off by the child.
Marker pen should be capped immediately and kept in horizontal position to prevent it from drying.
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Essential steps for increasing community participation:The LCDC, to be successful in detecting maximum number of cases, needs to be supported by:Excellent Information, Education and Communication (IEC) over the mass media.Well planned local miking/drum beating on slow moving vehicles and from fixed sites starting 2 days prior to the campaign and continued during campaign.Interpersonal messages from the ASHAs/Health workers prior to the LCDC round.Community participation in the selection of the dates to organize the house to house search.Increased acceptance by the local level by involving all sectors (Health, ICDS, Education, Panchayati raj institutions, local NGOs).Launching of LCDC by local influencers or community leaders.
DRAFT
Activities to be undertaken for Administration of chemoprophylaxis:For administration of single dose Rifampicin chemoprophylaxis, at least 20 contacts of each leprosy case detected under LCDC will be interviewed for acceptability and be given single dose of Rifamipicin under supervision.
Inclusion criteria for contacts are as follows:Residents who are contacts of cases and who have been living in that particular location for more than 3 months. Three categories of contacts are distinguished:
Household contacts are people living in the same house as the in-dex case.
Neighbor contacts are all people living next door to the index case. Social contacts are people who spend >20 hours per week with the
index case (example: school mates, office colleagues, fellow be-lievers) Age of contact person 2 years or more
Exclusion criteriaI. Pregnant womenII. Migrants III. Persons who have received/have been receiving rifampicin therapy
for any reason in the last 2 years Hospital inpatients Contraindication to rifampicin therapy i.e. liver failure/disor-
ders, and renal failure, H/o adverse effects of Rifampicin e.g. flu syndrome (based on interview)
A TB suspect (having cough for more than 2 weeks). After ruling out TB, Rifampicin will be given
IV. Persons who answer any of the 5 screening questions positively will be sent to RNTCP to confirm or rule out TB:
Cough for two or more weeks, Coughing up blood stained sputum (haemoptysis)? Fever for two or more weeks? Noticeable weight loss for new patients or a 3 kg weight loss
in a month (subsequent visit)? Excessive sweating at night for two or more weeks
Management of complications if any: Any of contact person under implementation research develops adverse effects / complication, s/he will be referred and treated in government hospital and will be ensured to get treatment. Report of adverse effect management will consist of (a) type of adverse effect (b) management of adverse effect and outcome of the adverse effect.
Management of any other ailment identified among the study participants during the study: Appropriate referral arrangements will be made at nearest district hospital and Community Health centers in district for the freshly diagnosed patients and persons with complication if any and also for patients with other ailments. (Final instructions for administration of chemoprophylaxis will be circulated later).
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6. OTHER KEY COMPONENTS OF PLANNING AND IMPLEMENTATION
Besides planning and implementation of activity at booths, house-to-house, transit site etc. other key components which require planning and implementation are as under:
Supervision Mapping of areas Orientation training of search team IEC/Social Mobilization Recording and reporting Review of micro plans and data analysis for planning interventions Use of data for planning actions
Supervision:
High quality supervision is vital to the success of the programme. Supervision should not merely be inspection for fault-finding. Supervisors should be supportive and should be able to:
Identify problems and help to solve them. Support, encourage and motivate search team members in
carrying out high quality LCDC activities completely.Supervisors must carry out the following activities: -
Assist the BMO/SMO in reviewing and revising micro plans for booth and house-to-house activities before the LCDC round. This includes:
Assignment of the areas to house-to-house search teams in terms of well defined boundaries
Clearly identified start and end points with landmarks Allocation of rational workload
Developing a reasonable daily itinerary for house to house visits by the teams.
Developing maps for teams and supervisors The names of the local influencers should also be incorporated in
the micro plan.
Visit search teams working under him/her during house to house search activities to, identify issues like last minute absenteeism of team members
Ensure that search teams are working as per their microplan and that: All areas and houses are visited, including isolated communities,
mountainous areas, and apartment dwellers on top floors All cases identified during the LCDC must be validated after
detection. Tally sheets are marked immediately after each home visit. Correct marking of houses and children being done. Revisit by search teams to X marked houses is being done. Ensure that all logistics needed forms etc. are distributed to search
teams as per plan.
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Randomly visit a sample of the ‘L’ marked houses to detect unexamined persons.
Visit ‘X’ marked houses of reluctant persons to convince them about the need of the LCDC.
For teams not performing well, conduct on the spot orientation training of ASHAs and volunteers to suspect the cases of leprosy.
Assist medical officer in Collection, compilation and analysis of data from search teams.
Attend evening meeting and provide feedback to Medical Officer. Logistics and supplies are prepared for the next days work.
The supervisors should be familiar with the area, prepare a supervisors’ maps with assignment of teams on map, and develop a plan for supervising teams in a systematic and planned manner. Each supervisor should be independently mobile. No matter how well supervisors are trained, if they are not independently mobile, they cannot supervise properly. They should use the supervisors’ formats to supervise teams in the field.Each supervisor should visit each team at least twice during the campaign days. Supervisors must be trained on their role with the help of the training instruction given in the annexure.If a monitor or supervisor, during random crosschecking of areas, already visited by search team, detects 3 or more than 3 false ‘Ls’, then the search team must revisit all houses in that area.
Supervisors must pay attention to high-risk areas and go where teams do not like to goEach Supervisor must be independently mobile
Mapping: Maps are useful for planning and ensuring completeness of activities.
Planning unit Maps:Maps should be developed at each block/ PHC/ Urban area and should indicate:
Supervisors’ areas with demarcation High risk and difficult to reach areas Areas from where more cases and grade II disabled cases have
been detected Population likely to be missed Ice factories Major landmarks and roads
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Sample Map of planning unit-PHC/urban area
Supervisor Maps: Every supervisor should also have a map that indicates: Team areas with demarcation and day wise work plan Villages /urban wards / mohallas/ urban slums / hamlets High risk areas Areas from where more cases and grade II disabled cases have
been detected Population likely to be missed Major landmarks and roads
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A team that is not equipped with a map of the area and an itinerary for covering the area will certainly miss cases
Team Maps:Each team must have a map and itinerary for the area it will cover. It may be noted that even teams will miss cases if they do not have a map and itinerary to guide them. In addition, maps are helpful for teams to mark and revisit X houses.
For each team, find or draw a map that indicates: Each settlement’s location Streets and landmarks within each settlement Houses and hamlets lying outside of the main roads Major landmarks (e.g., rivers, bridges, health centres, schools,
markets, nurseries, train/bus station, police check points, etc.) Roads and tracks The precise limits of the catchment area of the team (the border of
their working area), showing without ambiguity where another team takes over. Indicating a street, as boundary between teams is insufficient with out clarifying which team covers which side of the street. Lines separating territories of villages often overlook houses in between the main settlements.
Sample Mapof a Team
Anganwadi
River
Island Team 2
HamletDay 3
Mukhiya Field
Day 2Mosque
MarketPond
SchoolTeam 3
Team 1
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Orientation Training of Supervisors and ASHAs/ Male Volunteers:Orientation of ASHAs/ Volunteers:The District training team /Block Medical Officers/Urban Health Officials/ PHC Medical officer must brief the Volunteers/ ASHAs a week or two before the LCDC. Block Medical Officers, shall orient supervisors (MO, PHC) also. The briefing will be organised in batches of 40 – 50 Volunteers/ ASHAs per session and will last for about half a day. The trainers should refer to the training instructions for details on how to conduct orientation (Handouts for ASHAs excerpts at annexure I).The orientation will cover the operational as well as the interpersonal communication aspects of the LCDCs. The instruction sheet for search team, tally sheets, infokit on frequently asked questions should be distributed and discussed during this orientation. The training session has to be interactive and participatory with particular focus on newly inducted search team members. Demonstration of finger marking, tally sheet and house markings followed by exercises for ensuring all operational skills as also Role Plays on IPC and FAQs should form an essential component of the all Volunteers/ ASHAs training sessions.
Orientation of Supervisors:The District training team /Block Medical Officers/Urban Health Officials/ should undertake a half-day orientation of the supervisors. During orientation, crucial role of the supervisors in making LCDCs successful should be essentially discussed and emphasized. The instruction sheet for supervisors should be distributed to the supervisors and discussed during orientation. The tally sheets, ‘L’ sweep tally sheet, supervisors’ daily reporting format should also be distributed and exercises conducted on these during the orientation. The trainers should also refer to the training instructions on how to conduct orientation (Annexure I).
Recording and Reporting:Templates for tally sheets are given as forms T1 to T3. A tally sheet (Form T2) should be used for recording number of persons examined and houses visited during each day. No other system of recording should be used. On h-t-h case search days record the number of houses visited and the number of persons examined in each house. Details of X houses should be recorded on the X tally sheets by each team every day (Form T3).At the end of each day, each supervisor should go through the tally sheets of all his/her teams, compile the information and submit a consolidated report using the reporting form for supervisors (Form MR1).At the end of each day, each block/urban area should send to the District Leprosy Officer (DLO) a report of persons examined and houses visited using form MR2. The district should compile the report on form MR3 and send a consolidated district summary report to the state on form MR4.
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The SLO shall consolidate the state report on form MR5 and FAX it to Deputy Director General (Leprosy), Govt. of India within 3 days of completion of activity. (FAX No. 011- 23061801).
Information Education Communication (IEC) and Social Mobilization:Effective communication is critical to ensuring that all cases are detected during LCDC. This requires a planned, intensive approach to interpersonal communication, community mobilization, advocacy, and visibility for the programme through IEC activities. Each state and district should design an IEC strategy to meet three broad objectives:
Create community and family awareness & acceptance of the LCDC during house-to-house activities so that no cases are missed.
Actively engage community groups, volunteers, civil society organization, Panchayati Raj Institutions and front-line workers from as many government institutions as possible to actively support the programme, especially in areas where coverage has not reached 100%. It must be assured that the Volunteers/ ASHAs are well trained in inter-personal communication in order to be able to convince the reluctant, while maintaining the enthusiasm and support of the programme’s traditional supporters.
Activities on IEC and social mobilization will be carried out in coordination with GOI, State governments, district administrations, ILEP/ WHO, NGOs, Panchayati Raj Institutions, Education department, Information and Broadcasting department, ICDS, key religious institutions and others to expand the reach and impact of the programme.Key Strategies:
Advocacy with policy makers for creating a sense of urgency for National Leprosy Eradication Program in India.
Mobilization of district/ tehsil/ political leaders to support National Leprosy Eradication Program.
Focus on interpersonal communication (IPC) for raising awareness in urban slums and rural areas supplemented by mass media & print material.
Mobilization of the Panchayati Raj Institutions system to support leprosy elimination, including calling of Gram Sabha to plan and ensure population screening for case detection.
High-risk area approach for programme planning, monitoring, training and social mobilization in selected areas/ districts.
Special messages & use of different channels of communication for hard to reach groups and urban areas.
Involvement of private sector health practitioners and community-influencers for reporting of any suspected cases of Leprosy.
Integration of LCDC messages for different levels of communication.
Consistency in the message. Messages that change repeatedly during the preparation will lead to confusion and decreased participation in LCDCs.
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Messages:The following key messages must be delivered through pamphlets, big hoardings and paintings and through interpersonal communication also in the language understood locally:
If you have a light color patch, redness, swelling or nodule over the skin, it may be leprosy.
Leprosy, like any other disease, can happen to anyone however it is completely curable.
Disability caused by leprosy can be prevented if reported and treated early.
If you or anybody known to you is suspected to be suffering from leprosy, immediately contact nearest Govt. Dispensaries, Health Centres and hospitals.
Treatment of leprosy i.e. Multi Drug Therapy is available free of cost.
Persons affected by leprosy, needs compassion and empathy. Discrimination to patients is inhuman.
Other messages which must be delivered are as under: Why repeated rounds of LCDC (directly answers the most pressing
question - why again and again, filling the knowledge gap on eradication).
Date and timings of LCDC house to house search round. Importance of LCDC in curbing transmission of leprosy and
achieving elimination under NLEP.
Branding of the campaign: The materials should be developed using a uniform colour (Beige -
100%) & NLEP logo for improved recognition of campaign material even by illiterates. Tag line of the campaign is likely to be “Haath Badhao Kushth Mitao”.
At the Central, State, District and Block levels, it is expected that the Program managers/ CMOs will ensure that communication activities are based on the above themes and use their discretion to fine-tune the plans and activities based on local/emerging needs and priorities.
Central level activities:The IEC Bureau, MOH & FW will be responsible for media planning on national channels of DD and AIR, as well as media planning through cable and satellite, and FM channels. The Bureau will use software, featuring celebrity endorsements, provided by UNICEF as follows:(a) Television :
← Develop or re-date existing video spots (New spots to be developed as per the communication need).
← Develop a media plan for national channels, including Doordarshan and satellite channels.
← Book paid airtime for telecast of TV spots on DD1, DD2 and satellite channels.
(b) Radio :35
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← Develop or re-date audio spots (New spots to be developed as per the communication need).
←← Develop a media plan and book paid airtime for broadcast of
radio spots on FM and AIR stations.(c) Print :
← The central IEC division will prepare and release press advertisements prior to LCDC.
←← The content of the press-advertisement will be in
synchronization with the theme of the television and radio materials.
Preparation and Distribution of IEC materials:
State-Level Activities: The State IEC Bureau, in coordination with ILEP/WHO should take primary responsibility for creating public awareness for the LCDC through the mass media, and facilitate greater public participation and acceptance for the program.
Radio (AIR): Book paid airtime for broadcast of Radio spots on FM and AIR primary and local radio stations/channels.
STATE IEC Bureau will coordinate with AIR officials to ensure that the broadcast plans cover all the high-risk districts. To maximize reach and impact, all the relevant AIR primary/local stations/channels should be used.Separately, MOHFW/GOI will send a written request to AIR to mount special programs/announcements in the slots, which are free/prepaid by MOHFW/GOI.
Press: State IEC Bureau will prepare and release press advertisement on the upcoming round. The press-ad should be released in selected newspapers at national and regional languages with high readership in the high-risk districts.The content of the press-advertisement will focus on the theme of the mass media campaign.IEC Materials:Audio cassettes for miking in districts/blocks: Audio cassettes for the miking activities will be produced and distributed to the CMOs. State IEC Bureau will coordinate with partners to ensure timely production and distribution of the tapes to the block-level.Poster and banner: The State IEC Bureau will coordinate with partners to ensure timely production and distribution of all the IEC materials i.e. banners/posters etc. to all the districts using the approved prototypes provided in advance.In coordination with partners, state IEC bureau will issue a letter with detailed IEC matrix to the entire district stating distribution plan of all the materials produced by other partner agencies with quantity and date of delivery to final destinations.
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Distribution of materials: State IEC Bureaus should procure IEC materials at the state level for distribution to districts. This will ensure consistency in production and messaging, and timely delivery of the materials. Materials should be placed with district Chief Medical Officers 15 days in advance of the LCDCs.IEC Funds Distribution: State IEC Bureau to ensure that the funds for the district and block-level IEC for LCDC round.
Building partnerships: Considerable effort is required at the state level to forge a wide partnership for leprosy eradication. This includes all government sectors, the Panchayat system, private sector, NGOs, media, religious organizations and others as appropriate. The State IEC bureau should convene regular partners’ meeting two months prior to each LCDC to map partner resources and to assign key social mobilization activities.Ensuring visibility: The State IEC bureau should convene a small working group of partners to plan and carry out activities involving high-level political, social and cultural support for the programme. This would include involving the Chief Minister and ministers for pre round and round activities, mobilizing celebrities/ local influencers as leprosy ambassadors who will make public appeals for the LCDC. Activating social/ religious leaders to mobilize larger networks to work for leprosy eradication in underserved communities should also be undertaken.
District-Level Activities:In coordination with the district administration, the district health department, the block MOs other partner agencies and the CMOs will plan and conduct intensive local-level IEC and social mobilization activities, especially in designated high-risk blocks, to facilitate greater public participation and acceptance for the LCDCs. District Task Force shall establish a media sub-committee to plan coordinate and oversee implementation of IEC and social mobilization activities in the district. Local mobilization activities should include special efforts to increase the acceptability of LCDC search team during campaign. Towards this, the following activities will be undertaken:
District IEC/Social Mobilization Plan: In coordination with local partner agencies, develop a detailed district IEC/Social Mobilization micro plan. Plan to be finalized in consultation with the District Task Force on Leprosy eradication. The plan needs to be integrated into the programme micro-plan so that both activities are clearly identified together. This will allow for gaps to be identified, and for the best utilization of resources. The District Magistrate and Chief Medical Officer need to make every effort to consult with religious leaders, particularly from minority communities, to ensure their participation in the programme. Religious leaders need to be requested to review the microplans, ensure that volunteers from the minority community join the search team during house to house activities, and make their own appeals through local channels.
Disbursement of Block Funds: Based on the funding norms, and after making basic provision for conducting the district-level
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activities enumerated below, funds will be disbursed to all blocks well in advance of the start of the round. A briefing, on the block-level activity and funding guidelines, will be conducted for the BMO by the CMO.
IEC Materials: The following activities will be coordinated at the district level:
District HQ will take responsibility for distribution and actual usage of banners/poster/flyer/leaflet. All the materials should be distributed to the blocks well in advance of the LCDC round. District HQ will ensure that the posters and banners are put up at least 3 days prior to the round at all prominent places in villages and mohallas.
District HQ will distribute the audio cassettes provided to all the Block MOs for use in the miking activities. Number of miking units will be as per budget norms mentioned in budget guidelines.
Local Press-Advertisement: CMO Office will prepare and release one local Press-advertisement announcing the upcoming round in the local newspapers. The local press-advertisement should not be released in prominent state-level newspapers as press-ads in these will be released directly by the State IEC Bureau. From DMs office district Information Officer will provide update and press releases to local journalists prior and during the LCDC rounds.Press Briefings: Under the Chairmanship of DM/CMO, a press briefing/ sensitization meeting will be organized for all district-level journalists, a day or two in advance of the round. The briefing will focus on status of the NLEP, and the need for the upcoming house-to-house LCDC rounds. The SLOs will provide all necessary supportive/technical data.
Local AIR Radio Station and Cable-TV Mobilization: DM/CMO Office should mobilize local AIR stations and cable-TV operators to place leprosy announcements/messages in local programs and cable channels.
Mobilize local cable-operators and cinema theatres in urban/peri-urban areas to screen leprosy messages in the local cable-TV network and cinema theatres.
Distribution of materials: DM/CMO will ensure that all the materials are dispatched well in advance (10 days prior to the round) to blocks with a copy of usage guideline.
Block Level Activities:Block MOs, will plan and conduct intensive local-level IEC and community mobilization activities, especially in identified high-risk and resistant pockets, to facilitate greater community participation and acceptance of LCDCs. High grade II disability indicates that a large no. of cases are being detected late and high no. of child cases indicates that active transmission in community is persisting therefore local mobilization activities should include special efforts to ensure that all hidden cases of leprosy must detected during the LCDC rounds. Towards this, under the leadership of the Block MO, the following will be undertaken:
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IEC/Social Mobilization Microplans: At least one month in advance of the rounds, a block level microplan will be finalized. The microplan will especially include the following:
Listing of high-risk pockets and outreach areas requiring special efforts.
Detailed route-charts/schedules for miking activities, prioritizing high-risk pockets.
Deployment-chart of all local community mobilizers and volunteers, ensuring that all high-risk pockets are covered for community mobilization activities.
Listing of influencers such as community/religious leaders, gram pradhans, and medical practitioners.
Listing of all prominent fixed-site PA systems such as mosques and temples.
Miking to be carried out by slow-moving vehicles such as cycle-rickshaws/cycles and not from fast moving vehicles. Miking must be conducted in villages prior to the arrival of a LCDC search team. Miking vehicles/drum-beaters must follow the route-charts. Fixed-post miking in mosques/temples to be mobilized for making live announcements at least thrice a day, on all 5 days. Announcements might also be arranged using regular PA systems at railway stations, bus stands and other public transport systems.
Facilitate and coordinate the efforts of all local mobilizers and NGO volunteers to maximize impact in high-risk and resistant areas.
Conduct mobilization meetings with local influencers such as community/ religious leaders, gram pradhans and panchayat members (especially women panchayat members), and local medical practitioners. School children should also be mobilized to encourage families and neighbours for acceptability of LCDCs.
Microplans need to include the names of local influencers, community mobilizers and religious leaders who will be working during house to house activities for LCDC.
Mobilize local cable-operators in urban/peri-urban areas to screen leprosy messages in the local cable-TV network and cinema theatres. Similar messages can also be given through the telephone system.
Distribution of IEC materials: Ensure that IEC materials are distributed well in advance as per the IEC guidelines. Ensure pasting of POSTERS in entire districts. Emphasize more in high-risk villages/mohallas, schools, mosques/ temples, prominent places like local markets/haats etc.
Mobilize local cable-operators and cinema theatres in urban/peri-urban areas to screen leprosy messages in the local cable-TV network and cinema theatres
Review of Micro plans:
Review and updation of micro plans is critical for implementation of good quality LCDCs rounds. The review is essential before each round to
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identify deficiencies/ shortfalls based on the observations of previous rounds, incorporate appropriate changes and interventions for improved implementation of subsequent rounds.
General Principles:
A micro plan would exist at most places. As far as possible review and make improvements in the existing microplans rather than start to make new plans.
The existing microplans used in the LCDCs should be reviewed along with the data generated in the recent rounds and feedback from monitors, central and state observers, medical officers, district and block level supervisors, to make suitable amendments in the microplans.
Delegation of planning responsibility to the appropriate administrative level e.g., block or PHC or urban area where the activities will take place. Each block/PHC/urban area should be taken as the basic unit for microplanning. It should be further sub divided into supervisor’s areas and these into LCDC team areas.
Microplans should be developed and reviewed with the volunteers, ASHAs, supervisors, block medical officer, community mobilizers, other field volunteers/ local influencer (if available) and block medical officer (BMO) sitting together.
Block medical officers and supervisors should be responsible for planning of LCDC activities for their areas.
All habitations and all houses in block/urban area jurisdictions should be included in the microplans. Microplans must target whole population.
The national guidelines regarding number of houses/ team/day, logistics and IEC etc as per financial guidelines, should be considered and adapted to local needs. The adapted plans should be communicated to the higher levels.
Plans should be based on local conditions, accessibility, geography, population movements, working hours (when are people available at home?) culture, etc. in the catchment area.
Meetings should be held with village pradhans (councilors in urban areas), sarpanches and other local influencers to get their inputs on the local conditions while developing or reviewing the microplans.
Micro plans should be prepared in local language so that volunteers, ASHAs, supervisors, local influencers and other team members of LCDCs can follow them easily.
LCDCs activities can only be of high quality if microplans are based on local capabilities and constraints
Use of Data for Planning Actions:
It is essential to use the existing data for identifying actions required to plan and implement LCDC in the area.Existing micro plan of the area can provide data on: -
Total houses along with population residing in the area.
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Name of villages and their hamlets/ Name of all urban mohallas/ localities. If these lists are not available they should be developed with inputs from census data, revenue records, local municipal bodies, elected representatives etc.
List of high risk and underserved areas. List of areas missed in the previous rounds. Feedback on the past LCDCs or SAP rounds (from all sources such
as: monitors, central or state observers, medical officers, supervisors and vaccinators).
Data derived from analysis of tally sheets, supervisors’ L sweep formats and reporting formats.
List of available volunteers/ ASHAs team members and supervisors with department wise break up.
List of Anganwadi (ICDS) centres in the area with available manpower.
Map of the block.
Major sources of LCDC data:
(a) Microplans(b) Search team’s Tally sheets(c) Supervisors and monitors feedback
(a) Microplans: The h-t-h activity microplans provide useful information on: Number of h-t-h teams deployed Workload of each h-t-h teams for each day Composition of teams Whether all villages/hamlets/urban areas are planned to be
covered including the areas found missed in the previous rounds. Teams deployed to cover areas at special risk
(b)Volunteers/ Team members’ tally sheets: The various basic data that can be derived from the search team’s tally sheets are as follows:
Number of houses visited by each team during the entire LCDC activity and also during each day of activity.
Number of persons examined in houses and outside houses by each search team during the entire LCDC activity and also during each day of activity.
Number and percentage of ‘X’ houses generated by each team Number and percentage of ‘X’ houses revisited by teams to
examine persons. Number and percentage of ‘X’ houses left at the end of activity.
All the above information should be collated for each supervisor area and for the block. The information derived should be used to identify areas for interventions as follows:
Very low generation of ‘X’ houses in a block or supervisory area or team area denotes that the house-to-house activity has probably not been of good quality. If the teams work correctly there would be some generation of Xs. Very low generation of Xs should, therefore, lead to actions like intensive monitoring in the area and retraining of search teams.
High X houses left at the end of activity could be due to absence of inhabitants at home or a weak mechanism for revisits to X houses
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or failure to examine people for various other reasons like refusal to examination. Appropriate actions in the form of strengthening mechanism to revisit X houses or improving social mobilization efforts need to be undertaken.
(c) Supervisors and monitors feedback: The information derived from supervisors and monitors feedback is:
Percent false L houses detected by supervisors Percent false L houses detected by monitors The data on % false L houses detected is one of the most important
indicator of performance of search teams. High false L houses in an area could be due to one or all of the following reasons: Problems of microplanning such as irrational workload of teams
or improper composition of teams. Problems of training resulting in lack of understanding of how to
enumerate the total number of inhabitants of house, before marking houses as ‘L’ or lack of motivation to do a complete job of enumerating and examining all persons in the area.
Lack of proper supervision of search teams.
Actions to be taken following detection of high false “Ls” should be based on the underlying reason. It should call for:
Analyzing the workload of each team for each day to rationalize the workload by increasing teams or redistributing workload amongst existing teams considering the geographical difficulties.
Re-look at the composition of teams to have teams suited to the locale; which may mean having at least one male volunteer (preferably from the area) in teams and/ or having a team member of the same religion as the area in which team is working and /or having a member of the local community working as a team member.
High false Ls due to improper training and lack of motivation should be addressed by retraining of search team by good quality trainers, ensuring attendance during trainings of all search team members who did not perform well during the recent rounds and also all volunteers/ search team members who are participating in the programme for the first time.
Address supervision issues by retraining and motivation of the supervisors to explain the criticality of their role.
Other actions like reducing the number of teams for supervision and having all teams of a supervisor working in a close geographical area (sector approach) need to be considered for improving supervision.
Areas with operational problems in terms of: Missed areas % teams with search team members not as indicated in
microplans. % teams with inappropriate composition of teams i.e. team of only
female or male members. % teams with inadequately trained members. % teams not examining persons outside visiting of houses.
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% supervisors not cross checking the work done by the teams.
% areas with clusters of houses missed by teams. % teams not conducting bi-phasic activity.
Percentage Persons/ children above age of 2 years found unexamined during street survey:Data on unexamined person found during street survey conducted at the end of house to house LCDC activity should be analysed by age break-up and by various sites. This analysis helps in identifying where person are being missed. High percent of persons found unexamined during street survey indicates suboptimal quality of activity. Immediate actions should be taken by improving implementation of house to house case search.
Percent houses with potentially missed cases (commonly called percent missed houses) : This indicator is derived by adding the % X houses left at the end of the activity (data from tally sheets) and % false L houses detected by monitor (data from monitors formats).
%Missed houses = % X houses left at the end of activity
+ % false L houses detected by monitors
Data on percentage of missed houses should be looked at for recent rounds. High percentage of missed houses indicates the probability of number of cases having been missed. This data, therefore, helps to identify areas where there are problems of microplanning, training and social mobilization. It is more important to look at the data on missed houses at the block and supervisor level to pin point the geographical areas that require specific interventions to reduce the missed cases during LCDCs.
.
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Annxeure I
ACTIVITY SCHEDULE FOR LCDCs AT DISTRICTDays Activities to be planned for LCDC60 - 45 days before the round District Task Force meets to review preparedness
and set timeline for completion of planning activitiesReview microplans for house to house case searchIdentify manpower for search teamsIdentify requirement of other resources like trans-portReview plan for social mobilizationAssign blocks to district officers
45 – 30 days before the round Review and refinement of existing microplans at blocks/PHCs/urban areasPlan and conduct district micro planning meeting, urban area planning meetingsPlace orders for procurement of logistics and print-ing of supervisory instructions, checklists and tally sheets etc.
30 – 23 days before the round Finalize microplans including man power identific-ationBlocks/ PHCs /urban areas to submit microplans to the district CMO, DLO, SMO to check completeness of microplansDTF meets to review progress in Micro planning, IEC/ social mobilization.
23 - 16 days before the round Orientation of district trainers/medical officersOrganize meeting of community /religious leaders at district headquarters Panch sammelans / community meetings in rural areas etc. to decide the dates of LCDC in the area
16 – 9 days before the round Finalize and release funds to blocks/urban areasStart orientation of supervisors and search team members Make supervisory visits to identified high risk pock-ets both in rural and urban areas to review pre-paredness
9 – 5 days before the round DTF meets to review preparedness and solve last minute problemsDistribute logisticsDistribute IEC materials like banners, posters etc.Continue orientation of supervisors and search team membersContinue supervisory visits to PHCs
5 – 3 days before the round Start intensive social mobilization and media an-nouncementsDisplay IEC materialsContinue supervisory visits to PHCs
3 -1 days before the round Start miking and public announcements from fixed sites like temples, markets etc.Organize rallies, prabahat pheris
Leprosy Case Detection Cam-paign (LCDC) all days of activ-ity
Implement house to house case search activityDistrict task force to meet daily to review activity and take corrective actionsDaily evening meetings at block/PHC to get feed-back from supervisors and plan for corrective ac-tions during the round
1 - 2 days after completion of round
Consolidate reports for the district and report to SLO
3-5 days after round Organize district task force meeting to review imple-mentation of last round and plan corrective actions
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for subsequent round
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INSTRUCTIONS FOR SUPERVISORS’ AND SEARCH TEAMs’ TRAINING
Before conducting the training, make sure: The training sessions have been scheduled in consultation with the
Block Medical Officer. The date and time for the training and the venue has been clearly
conveyed to the search team members.
Following materials will be required for the training sessions: Microplan of the block/urban area to be covered with the names of
the search team members, supervisors and local influencers. Marker pen to demonstrate finger marking Chalk or geru to demonstrate house marking. Tally sheets to demonstrate how they should be filled in.
The following should be covered in training session: Registration and introduction of all the search team members and
supervisors. Appreciation of the role of each member and supervisors in
achievements under the NLEP. Review of the current status of NLEP situation. The preactivity preparations including identification and interaction
with local influencers. Explanation of House to house activities including How to enter the home and initiate a dialogue with the family
members ensuring cordiality Key questions to be asked in each house House marking Revisits to X houses IPC including responding to queries from people (with help of
frequently asked questions). Procedure for examining a person Finger marking the person Tally sheet marking
Registration: Before starting the session registration must be done to ensure all volunteers/ ASHAs/ search team members and supervisors are present.
Introduction: All participants must introduce themselves to trainer who should also give his own introduction.Microplan and area allocation must be reviewed by the trainer:
Check the names of supervisors and volunteers/ ASHAs/ search team members attending the programme to ensure that there are no replacements.
If the absent volunteers/ ASHAs/ search team members/or supervisors are more than 5 (five), this should be explicitly recorded so that special training sessions may be held for the left out search team members and supervisors.
Trainer should assess if the search teams are aware of the area to be covered by them in the forthcoming round.
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If search team members are not aware of the area assigned to them, trainer should note the names of such team members/teams. The area assignment should then be discussed with these search teams after the main training session is over along with the BMO and supervisor.
Trainer should also discuss with the teams whether: They are comfortable with workload in the area to be covered by
them. They have any constraints/problems/concerns in covering their
areas.
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INSTRUCTIONS FOR Search team members
Leprosy Case Detection Campaign (LCDC) means detection of hidden cases of leprosy in community. This campaign helps to eliminate leprosy by stopping spread of the microorganism. Detection of all leprosy cases during LCDCs are essential for elimination of leprosy. No person is safe till leprosy is eradicated. All persons (excluding children upto 2 years of age) must be examined during all LCDC rounds.
←Pre Activity preparations:
The preparations of the activity should start at least one to two week before the scheduled dates of LCDC.
Local influencers must be identified in advance to provide assistance during house-to-house case search activity.
Community leaders/local influencers must be identified to inaugurate the campaign in the community/ area.←
Before starting the LCDC activities: Check all other logistics like indelible ink marker pens to mark
children, chalk/geru to mark houses, pen/pencil along with tally sheets
You should prepare and carry a map with day wise description of the area to be covered before starting LCDC activities.
House to House LCDC activities: During h-t-h activity, maps should be used to visit all houses
systematically. No house should be left unvisited. Do not sit at a convenient place but visit all houses in your
designated area and actively search cases by physical examination for cardinal signs of leprosy, of all people residing in an area.
Enter each house. Greet the respondent politely, introduce yourself, and explain the purpose of your visit.
Enquire about the number of families staying in the house and the members in each family.
Enquire about any person who may be away from home for reasons like: Gone to farm/fields/workplace/ school/ market/ relative’s home
etc. Visiting friends, relatives or market places and Accompanying
parents to their place of work. If any unexamined person/ persons is not at home during the
time of your visit, record this on the ‘X’ tally sheet and plan to revisit the house in the evening or on the following days when the person would be most likely to be available in the house.
Before moving to next house ensure that every person in each household has been examined during this round.
Enquire about all members inside the house, whether they are examined or not.
Enquire about any person visiting the house. They should also be examined.
Mark every examined person on left little finger with indelible ink marker pen. Allow the mark to dry for a few seconds.
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Exercise utmost care in exhibiting polite and courteous behaviour while interacting with family members. Answer all queries correctly and confidently. Do not lose patience or be impolite under any circumstances.
Before moving to the next house thank the head of the family and family members for their cooperation and ask them if they are sure that all persons even children more than two years of age have been examined. Since leprosy can affects children of more than two years of age also.
A new tally sheet should be used every day. Record information on the tally sheet for every visited house and every immunized child.
All visited houses should be marked L/date or X/date. All houses marked X/date should be revisited during the round till
all persons in the house have been examined. House to house activity should stop only when it become sure that
all houses have been visited and all persons including children more than 2 years of age have been examined.
House marking:L/date: -
All persons including children more than 2 years of age have been examined.
This also includes persons visiting the house when the LCDC activity is on.
X/date: - All or some persons, are not examined for reasons like: Persons not at home for the following reasons
Away to farm, fields, workplace, school, market places etc.or accompanying parents to their place of work
Visiting friends or relatives Refusal Locked house - even if the family is not expected to return for
a period of one to two years.
What to do if…?Tally sheets are finished Use plain paper to record.Chalks/ Geru not supplied Procure chalks/ geru locally.Family members refused for their examination
Find out reasons for their refusal, try to convince them or seek help of lo-cal community influencers. If not successful inform supervisor.
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INSTRUCTIONS FOR SUPERVISORS
Your role is critical to the success of the programme and effective supervision carried out by you will help reaching the goal of leprosy elimination. You have to identify problems and solve them on the spot.
General Instructions: You should be familiar with your area of supervision before the day
of LCDC. You should have a plan for supervising all team areas working in
your area. You should have maps of the area with team areas assigned on the
maps. You must meet all teams in the morning before they start work. You must meet the medical officer of your area every evening to
give a feedback of the work done in your area along with the checklist and map.
You should be constantly moving in your area on the LCDC days.
Before the LCDC:Visit the areas to be covered by teams in the areas allotted to you and familiarize yourself with (At least 3 days prior to activity)
Houses in the areas. Search teams. Boundaries of your area and boundaries of your teams.
Check: Area allocation with day wise activity plan for the teams. Team maps and prepare supervisor’s maps. Areas where problems were encountered in last round. Analyse tally sheets and feedback of supervisors and
monitors from previous rounds to determine problems and problem areas.
Plan for supply of vaccine and logistics to all your teams.Meet:
Community leaders (formal as well as informal) from the area and arrange volunteers to assist teams during house to house visits.
Team members to discuss the area allocation and special plans to cover problem areas.
Supervision of house-to-house immunization activity:In the morning:
Check that all h-t-h teams: Have reported to their area Have received logistics. If not, report to Block MO to arrange
for same Are clear about the area/houses that they have to visit each
day Have begun work on time
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Check at least 5 houses along with each h-t-h team to see whether they are:
Making an attempt to enter all houses. Determining the correct number of residents of the house. Examining all persons and children above 2 years of age in
each house. Marking all persons after examination. Marking the house L/Date or X/date and filling the tally sheet
as per the guidelines before moving to next household. Be on the lookout for unexamined persons on the street by
checking them for finger markings. Check the areas already covered by each team.
Every 10th house (if you are supervising 2- 3 h-t-h teams) or every 15th house (if you are supervising 5 h-t-h teams)
Also cross check few X to L converted houses for correctness. Border areas between the teams are covered.
Border areas with the neighbouring supervisors are covered Fill supervisors’ tally sheet (form 7B) and submit to Block MO
In the afternoon and evening: Visit X houses/X clusters with the teams to examine the community
people. Meet all your teams. Collect the tally sheets and review them for X houses/X clusters. Discuss any problems faced by the teams in the field and suggest
solutions. Give feedback to teams based on random checks of ‘L’ houses. Compile information and meet Block Medical Officer in the evening. Plan activity for the next day with all the teams.
Reaching all hidden cases of leprosy in your area is your responsibility
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FREQUENTLY ASKED QUESTIONS AND ANSWERS
Does leprosy still exist?Yes – leprosy is not a disease consigned to Biblical times. Around a quarter of a million new cases are recorded each year globally and three million people are living with irreversible disabilities, including blindness, because of leprosy.
In Which countries is leprosy found in the world today?The countries with the highest number of new diagnoses are India, Brazil and Indonesia followed by some of the African nations. More than half of all new cases of leprosy are diagnosed in India which remains home to a third of the world’s poor.In 2014 there were 13 countries reporting more than 1,000 new cases of leprosy. These were Bangladesh, Brazil, DR Congo, Ethiopia, India, Indonesia, Madagascar, Myanmar, Nepal, Nigeria, the Philippines, Sri Lanka and Tanzania.
What are the signs of leprosy?Early signs include spots on the skin that may be slightly red, darker or lighter than normal skin. The spots may also become numb and have lost hair. Often they appear on the arms, legs or back. Sometimes the only sign may be numbness in a finger or toe. If left untreated, hands can be-come numb and small muscles are paralyzed, leading to curling of the fingers and thumb. When leprosy attacks nerves in the legs, it interrupts communication of sensation in the feet. The feet can then be damaged by untended wounds and infection. If the facial nerve is affected, a per-son loses the blinking reflex of the eye, which can eventually lead to dry-ness, ulceration and blindness. Bacteria entering the mucous lining of the nose can lead to internal damage and scarring which in time causes the nose to collapse. Untreated, leprosy can cause deformity, crippling and blindness.
Is leprosy very contagious?Most people will never develop the disease even if they are exposed to the bacteria. Approximately 95% of the world population has a natural immunity to leprosy.
How is leprosy spread?There is much stigma surrounding leprosy and many people believe it is a punishment or a curse. The truth is it is simply a mildly infectious disease. It is not hereditary and cannot be caught by touch. Scientists believe it is caught through droplets of moisture passed through the air from someone who has leprosy but has not yet started treatment. It takes years, however, of living in close proximity with an untreated leprosy patient to catch the disease. Around 95 per cent of people are thought to be naturally immune to leprosy.
Does leprosy cause body parts to fall off?In short: no. Leprosy attacks the nerves in the cooler parts of the body, particularly those that relate to the hands, feet and face. The result is a loss of sensation in these areas meaning a person is at much greater risk of injury as they cannot feel pain. A stone in a shoe may go unnoticed or
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a burn while cooking with the resulting injury and infection sometimes severe enough to cause the bone to ‘shorten’. The feet of a leprosy-affected person are prone to ulcers and, if not treated properly, can lead to amputation.
Why is the incubation period for leprosy so long?Leprosy bacteria are the slowest growing bacteria known to man – doubling only every 12 to 14 days. It may be years before there are sufficient symptoms to cause someone to seek medical attention.
Is there a cure?Leprosy is curable with multidrug therapy (MDT) – a combination of three drugs taken daily for six to 12 months. MDT is available free of charge. The sooner a person with leprosy is treated the better as they are less likely to suffer from irreversible disabilities as a result. While reconstructive surgery can correct a clawed hand, a ‘dropped’ foot or restore the blinking mechanism to the eyes, it cannot bring feeling back to areas where there has been nerve damage.
What side effects do the medications have?Dapsone: Some people may have a mild anemia. Very rarely, other blood problems have been reported. Rifampin: Sometimes it will cause abnor-mal liver tests, but the problem clears when the medication is stopped. It may cause a harmless orange color in the urine, sweat or tears. Clofaz-imine: It has virtually no side effects except some darkening of the skin which slowly fades when the medication is stopped.
What is a leprosy reaction?Reaction is the body’s response to the dead bacteria in the body. When patients begin taking Multi-Drug Therapy (MDT) the bacteria are killed quite rapidly. Sometimes it takes years for the dead bacteria to be com-pletely cleared from the body. During this time the body may react against these dead bacteria. This can cause pain and swelling in the skin and nerves and other parts of the body. Fever and muscle aches may also occur. The eyes could be red and painful. During reactions there is increased risk of damage to nerves in the eyes, hands and feet. Treating reaction quickly can prevent nerve damage.Up to half of all people with leprosy have reactions. A reaction does not mean the disease is getting worse or that the medication has stopped working. It is not an allergic reaction to the medication. It means that the body is reacting or fighting against the dead bacteria. These bacteria may have been killed by the body’s resistance to the bacteria or by the medication. This is why some persons develop reactions before they even start MDT.
Why the medications should continue if reactions occur?If medications that kill bacteria were not given, the bacteria would begin growing again.
How are reactions treated?Some reactions can be treated with medicine such as aspirin or Tylenol. In some cases, medications such as prednisone or thalidomide may be
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required to prevent nerve damage during reaction. Episodes of reaction may occur off and on for a period of time.
What percentage of treated patients go on to relapse and need to be treated a second or subsequent time?Approximately one per cent of patients relapse or need treatment a sec-ond time. There are some contributing factors to this - time being a ma-jor one. Most relapses we see are detected more than ten years after the first treatment. If a patient relapses in a rural system, tracking that can be complicated. Also, relapse is a specifically defined word for leprosy. It does not include people who did not complete their initial treatment or lack documented evidence thereof. Medical record keeping in the devel-oping world can be very different to what we are used to at home.What happens to pregnant women who have leprosy?Most women with leprosy have normal pregnancies and deliver healthy babies. Patients on treatment do not transmit leprosy to their babies.
What proportion of new cases are children (and at what age are they commonly diagnosed)?Children account for around 7.5% percent of new cases (WHO: Global Leprosy Situation). Many developing countries classify children to be those 15 and under. Because the incubation period of leprosy is long, cases in very young children (under the age of six) are less commonly detected though not unheard of.
What is claw hand and can it be corrected?Clawing of the hands or toes is a common disability caused by leprosy. Leprosy starts damaging the small nerves in the skin's surface, but if left untreated it begins affecting the large nerves in the elbow, wrist, knee and ankle. The resulting damage can lead to loss of sensation in the hands and feet and muscle paralysis, which causes clawed fingers and toes.In the late 1940s, Dr Paul Brand became the first surgeon in the world to use reconstructive surgery to correct the deformities of leprosy in the hands and feet. Movement can be restored by using a muscle transfer technique where, with the help of a physiotherapist, a muscle is identified for transfer and strengthened. After surgery and several weeks in plaster, the patient is taught how to use their old muscle to do a new job and then apply the technique subconsciously. The results can see a leprosy-affected person walk again without dragging their foot on the ground or use their hand to grip items.
When will leprosy be totally eliminated worldwide?The WHO definition of elimination is “less than one in 10,000 of the total population actively taking leprosy antibiotics in the month of November of a given year”.Less than a handful of nations report figures above this definition of elim-ination each year. However, leprosy in India has been technically elimi-nated according to the WHO definition for several years now, despite
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150,000 new cases annually. The WHO numbers also do not include all the leprosy patients experiencing ongoing disease complications who may have already completed antibiotics.Historically, as a population becomes more developed with people re-ceiving adequate nutrition, housing, sanitation and access to health ser-vices, leprosy can mostly disappear within two to three generations (e.g. Europe in the last 150 years, and post-war Japan and South Korea). Mul-tidrug therapy has made tremendous achievements against leprosy. However, antibiotics alone have never been enough for total eradication of any disease.Why does leprosy still destroy lives?Age-old stigma surrounding leprosy, that dates back to ancient times, sees entire families having their job opportunities, education, marriage prospects and dreams shattered. Fear and misunderstandings surround-ing leprosy fuel a vicious circle that begins with people hiding the first suspect skin patches in order to avoid being shunned by their families and becoming a social outcast.
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LCDC Manpower Planning form Form P1Name of District/ Block/Urban area: ___________________________ Round:Name of the Area
Urban/ Rural
House to house case search Underserved population case searchEstimated houses in the area
Teams re-quired
Team mem-bers re-quired
Supervisors re-quired
Number of sites with floating popu-lation and sparse popula-tion to be covered by search team
Teams re-quired
Team mem-bers re-quired
Supervisors re-quired
Total
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LCDC Logistics and Transport Planning form Form P2
Name of District/ Block/Urban area: ___________________________ Round:Name of the Area
Urban/ Rural
Logistics for Supervisors Other logistics Transport for supervisionCheck-lists
L sweep tally sheet
Report-ing formats
Teams' tally sheets
Chalk/ geru
Indelible ink marker pen
Arm-bands/ Identity cards
No. of Su-pervisors
No. of Su-pervisors using own transport
Additional vehicles required for super-visors
Specify type
Total
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DRAFT
LCDC Template for House to House case search Planning form Form P3Name of District/ Block/Urban area: ________________________________ Round:Name of Supervisor: ____________________________________________Team number
Name of team members
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Day 11
Day 12
Day 13
Day 14
Description of area to be covered
Name & Ad-dress of first house owner with land-mark Name & Ad-dress of last house owner with land-mark No. of houses in the area Name of local influen-cer/s Meeting point before afternoon activity
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DRAFT
LCDC Template for special area planning (brick kilns, construction sites, river islands, nomadic popu-lation groups etc.)
Form P4
Name of District/ Block/Urban area: __________________________________ Round:Team members:_______________________________Name of Supervisor:_________________________________________Day Site 1 Site 2 Site 3 Site 4 Timing of visit
Type and address of area
Timing of visit
Type and address of area
Timing of visit
Type and address of area
Timing of visit
Type and address of area
Timing of visit
Type and address of area
Note: Each site should be visited at least twice during the activity. Starting time and ending time should be indicated in the row of Timing of visit.
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LCDC Daily Miking Format Form P5Block/Urban area: _______________________________________ Round:S.No. Type of Vehicle Description of the area to be covered
Time Name of person monitoring mik-ing
Time Name of person monitoring mik-ing
Time Name of person monitoring mik-ing
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DRAFT
←Leprosy Case Detection Programme Form P6Checklist for Preparing / Reviewing Microplans District / Block / Urban Area: ___________________________ Date: __ /__ /__ Round :MICRO PLANNING CHECKLIST YES NOHas data and feedback from past rounds been analyzed for corrective actions this round? Brick kilns, construction sites, periurban areas, slums, recently developed townships included in microplans High risk and hard to reach areas identified and special plans developed to cover these Have reliable and motivated volunteers been identified and assigned areas/ search teams? Well defined day-wise area allocation to house to house search teams with boundaries At least one male volunteer from the local community part of each house to house team Are ASHA workers part of search teams in their areas? Is the daily workload distribution of house to house teams reasonable (in terms of houses and geography) Are young and energetic volunteers deployed as a part of these search teams? Supervisors identified and assigned for house to house search teams? Is there an orientation plan for volunteers/ search team members and supervisors? MAPS Map of Planning unit /block/urban area with essential information marked prepared Supervisor’s map with day-wise demarcation of area to be covered by each team Team wise maps with demarcation of area to be covered daily by each search team TRANSPORT Inventory of available and required vehicles Firm arrangements made for the procurement/hiring of vehicles Independent mobility / transport arranged for each supervisor Daily vehicle movement / route chart prepared for each vehicle for supervision SOCIAL MOBILIZATION IEC plan through mike announcements, inter-personal communication etc. Plans for briefing media (District and State level) SCHEDULE Plan for DTF / TTF / BLTF meetings Schedule forr District level officials to visit blocks to oversee preparations and monitor implementation Work plan with time-line, activities/task, time to be completed and person responsible
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DRAFT
LCDC Supervisor’s Checklist for Supervising search team’s Activity Form P7Name of Supervisor : ___________________________________________________Name of District /Block / Urban Area : ______________________________________ Round :Note: Write Y (Yes) or N (No) in answer each question Y/N RemarkDoes the area have an IEC material (like banner) displayed prominently? Have all team members reported to work? If no, arrange for replacement Is the team clear on the work they are supposed to do today? Does the team clear on the work they are supposed to do today? Does the team have sufficient tally sheets? If no, arrange to supply Is the team examining all the family members (even children more than 2 years) for the cardinal signs of leprosy? Is the team marking the left little finger of the person examined correctly? Is the team marking the tally sheet correctly after each person examined? Is the team marking each house correctly after each household's examination? Corrective actions taken
Comments
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DRAFT
LCDC Supervisor’s tally sheet Form T1
Name of Supervisor : ___________________________________________________ Round:
Supervisor shall check and examine any person found un-examined outside of houses in their team areas. Put a tally for each person each day during LCDC TotalNo. of persons/ children checked outside of houses in team areas
No. of persons/ children found un-examined outside of houses in team areas
No. of persons/ children ex-amined by supervisor today out-side of houses in team areas
Supervisor shall visit every 10th ‘P’ marked house and examine any person missed by the search teamsName of village/urban area:___________________________________________________ Team number: TotalNo. of house visited / day No. of persons/ children found examined by supervisor
2-15 years of age >15 years of age No. of persons/ children detec-ted un-examined by supervisor
2-15 years of age >15 years of age No. of persons/ children ex-amined by supervisor
2-15 years of age >15 years of age No. of persons/ children ex-amined by supervisor and found to be a suspect case of leprosy
2-15 years of age
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>15 years of age
Total no. of houses checked by supervisor Total no. of L houses with unexamined persons/children detected by supervisor Total no. of persons/children examined by supervisor today in houses
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LCDC Form T2Tally sheet for house to house case search activity Sheet Number: _____ Name of District / Block / Urban Area: _______________________________________ ________________________________________
Date: ___ / ___ / ___
Name of Supervisor: ________________________________ Team No:__________ Name of Team Members: _________________________________________ _________________________________________ _________________________________________ _________________________________________ __________________________________________
Team Location: ______________________ Round :
Note:1. Use fresh tally sheet each day.2. Continue in the next sheet, from next day3. Mark a √ in the appropriate square for each child immunized and each house visited
Name and address of first house owner with landmarks Total
No. of Houses visited 1 2 3 4 5 6 7 8 9 10 Total no. of persons/ children > 2 years residing in the house
No. of persons/ children > 2 years examined in the house
No. of Houses visited 11 12 13 14 15 16 17 18 19 20
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Total no. of persons/ children > 2 years residing in the house
No. of persons/ children > 2 years examined in the house
No. of Houses visited 21 22 23 24 25 Total no. of persons/ children > 2 years residing in the house
No. of persons/ children > 2 years examined in the house
Name and address of last house owner with landmarks
Teams should make an active effort to examine persons/children outside of houses while doing house-to-house activity. Put a tally mark for each examination done outside of houses. Total
No. of persons/children examiend in streets/ fields/ farms/ market place/ work place etc. Total number of houses visited Total number of persons/children > 2 years examined Total number of persons/children examined outside of houses Signature of team members: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature of team supervisor: _____________________________________________
Signature of Medical Officer I/C: _____________________________________________
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68
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LCDC Form T3X Marked Houses Information SheetTeam No:__________
Name of Team Members: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
House Number Name of Family Head
Address of X Marked House Reason for X Mark Date House Con-verted from X to L
No. of persons/ chil-dren examined to convert X to L
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DRAFT
LCDC Daily Supervisor’s reporting format (to be filled by the Supervisor at the end of each day) Form MR1Name of Supervisor : ___________________________________________________ Round:S.No. Team
no.Total houses vis-ited by teams
no. of persons/ children examined in house by teams
no. of persons/ children examined outside of house by teams
no. of 'X' houses gener-ated by teams
no. of 'X' houses conver-ted to 'L' by teams
no. of persons ex-amined in 'X' houses
no. of 'X' houses left at the end of the day
no. of 'L' houses checked by su-pervisor
no. of 'L' houses with unex-amined persons/ children detected by super-visor
no. of persons/children ex-amined in 'L' houses by su-pervisor
no. of persons/children ex-amined outside of houses by super-visor
Total per-son/children examined(1+2+3+4+5)
1 2 3 4 5 Total
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LCDC
Daily Block reporting format (to be filled by the Block Medical Officer at the end of each day) Form MR2
Name of Block: ___________________________________________________ Round:Date: ___ / ___ / ___
S.No.
Name of su-per-visor
Total teams super-vised and no. of each team
Total houses vis-ited by teams
no. of per-sons/ chil-dren ex-amined in house by teams
no. of per-sons/ chil-dren ex-amined out-side of house by teams
no. of 'X' houses gener-ated by teams
no. of 'X' houses con-verted to 'L' by teams
no. of per-sons ex-amined in 'X' houses
no. of 'X' houses left at the end of the day
no. of 'L' houses checked by su-per-visor
no. of 'L' houses with un-ex-amined persons/ children detected by su-pervisor
no. of per-sons/chil-dren ex-amined in 'L' houses by supervisor
no. of per-sons/chil-dren ex-amined out-side of houses by supervisor
Total per-son/chil-dren ex-amined(1+2+3+4+5)
1 2 3 4 5 Tota
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DRAFT
l
LCDC Daily District reporting format (to be filled by the District Leprosy Officer at the end of each day) Form MR3Name of District: ___________________________________________________ Round:
Date: ___ / ___ / ___
S.No. Name of Block
Total houses vis-ited by teams
no. of per-sons/ children ex-amined in house by teams
no. of per-sons/ children ex-amined outside of house by teams
no. of 'X' houses gener-ated by teams
no. of 'X' houses conver-ted to 'L' by teams
no. of persons ex-amined in 'X' houses
no. of 'X' houses left at the end of the day
no. of 'L' houses checked by su-pervisor
no. of 'L' houses with unex-amined persons/ children detected by super-visor
no. of per-sons/children examined in 'L' houses by supervisor
no. of per-sons/children examined outside of houses by su-pervisor
Total person/chil-dren ex-amined(1+2+3+4+5)
1 2 3 4 5
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Total
LCDC Consolidated District reporting format (to be filled by the District Leprosy Officer at the end of the activity and sent to SLO) Form MR4Name of District: ___________________________________________________ Round:
Date: ___ / ___ / ___
S.No. Day num-ber
Total houses vis-ited by teams
no. of per-sons/ children ex-amined in house by teams
no. of per-sons/ children ex-amined outside of house by teams
no. of 'X' houses gener-ated by teams
no. of 'X' houses conver-ted to 'L' by teams
no. of persons ex-amined in 'X' houses
no. of 'X' houses left at the end of the day
no. of 'L' houses checked by su-pervisor
no. of 'L' houses with un-examined persons/ children detected by super-visor
no. of per-sons/children examined in 'L' houses by supervisor
no. of per-sons/children examined outside of houses by su-pervisor
Total person/chil-dren ex-amined(1+2+3+4+5)
1 2 3 4 5
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Total
74
DRAFT
LCDC
Consolidated State reporting format (to be filled by the State Leprosy Officer and sent to DDG (L) immedi-ately at the end of the activity, fax 011 - 23061801
Form MR5
Name of State: ___________________________________________________ Round:Date: ___ / ___ / ___
S.No.
Name of dis-trict
Total houses vis-ited by teams
no. of per-sons/ chil-dren ex-amined in house by teams
no. of per-sons/ chil-dren ex-amined out-side of house by teams
no. of 'X' houses gen-erated by teams
no. of 'X' houses con-verted to 'L' by teams
no. of per-sons ex-amined in 'X' houses
no. of 'X' houses left at the end of the day
no. of 'L' houses checked by super-visor
no. of 'L' houses with un-ex-amined persons/ children detec-ted by super-visor
no. of per-sons/chil-dren ex-amined in 'L' houses by super-visor
no. of per-sons/chil-dren ex-amined outside of houses by supervisor
Total per-son/chil-dren ex-amined(1+2+3+4+5)
1 2 3 4 5 Total
Name of SLO: _____________________________________________________________Signature: __________________________________________
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DRAFT
LCDC Form MR 6Template for Identifying Supervisors & Teams areas within blocks requiring interventions
Name of Block/Urban area: ___________________________ Round:
Name of Supervisor Number of houses visited by teams
Number of per-son examined by teams
% X houses generated by teams
% Remain-ing X houses at end of ac-tivity
% False L houses
Any operational problems
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DRAFT
LCDC Form MR 7Template for tally sheet analysisName of Block/Urban area : Round :Team no.: Number of Houses visited/ day 1 2 3 4 5 6 7 8 9 10 11 12 13 14
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DRAFT
LCDC Form MR 8Template for planning interventions Round:Name of Block/Urban area: Block/ Urban area Issues/ Prob-
lemsInterventions planned
Microplan actions Training ac-tions
IEC/SM ac-tions
Administrative actions Other ac-tions
LCDC Form PR1
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DRAFT
DISTRICT TASK FORCE MEETING – FEEDBACK FORMState: ________________________ District:____________________________Date of DTF: _____/____/________ Report prepared by:Number of DTF: _____Please tick (√ ) as appropriateDuration of DTF:<1 hour >1
hour
Discussion time on leprosy:<1 hour >1
hour No dis-
cussion
Time for which DM present during leprosy discussion:<1/2 hour >1/2 hour Presence of following persons in DTF:1 CMO 7 Education officer 2 DLO 8 District transport officer 3 Deputy CMO 9 ILEP/ APAL/ WHO repres-
entative
4 SMO 10 NGO representatives if any 5 Community/ re-
ligious leader 11 Any other
6 Urban area planner
Conduct of DTF:1 Action taken report of last DTF discussed Yes No NA2 Feedback of earlier rounds discussed Yes No NA3 Appropriate decisions taken on relevant issues: Yes No NAa. Micro plan status including manpower and transport Yes No NAb. Training issues Yes No NAd. Social mobilization/ IEC issues Yes No NAe. Funds Yes No NA4 Implementation of decisions Yes No NA
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LCDC Form PR2BLOCK TASK FORCE MEETING – FEEDBACK FORMState: ________________________District:____________________________Report prepared by:Block / Urban area Block Task Force Meetings
No. of meetings planned
No. of meeting actu-ally conducted
No.of meeting chaired by DM/ ADM
District Total
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DRAFT
LCDC Form PR3Feedback on Microplan review/ revision for LCDCState: ________________________District:____________________________Report prepared by:Block/ Urban area
High-risk/ hard to rich terrain (Y/N)
Team composition Team workload Areas for special atten-tion*
No. of search teams
No. of search teams with at least one male volunteer
No. of search teams with at least one mem-ber of the same community which is being served
No. of teams al-lotted less than 20 houses/ day
No. of teams al-lotted 20-25 houses/ day
No. of teams al-lotted more than 25 houses/ day
No. of areas identi-fied
No. of teams designated for these areas
Total * Areas needing special attention may include brick kilns, construction sites, flooded areas, mines etc.
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DRAFT
LCDC Form PR4Feedback on Training plan in LCDCState: ________________________District:____________________________Reported by:District level informationDate of the training of trainers planned Date : _____/____/________Number of Participants Who trains the trainers? (Write names and designation) Where is the venue of the training of trainers? Block level informationDate of the search team members training? Date : _____/____/________Number of search team members? Where is the training planned? (See if the place identified is accessible to all members)
Name of search team members available (Y/N) Same as in micro plan (Y/N) Have all members been informed of the date and venue of the training appropriately? Dates of the supervisors training Date : _____/____/________Number of supervisors Who trains supervisors? Where is the training planned? (see if the place identified is accessible to supervisors) Name of supervisors available (Y/N) Same as in micro plan (Y/N) Have all supervisors been informed of the date and venue of the training appropriately?
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LCDC Form PR5
Feedback on Training of supervisors and search team members for LCDCsState: ________________________District:____________________________Reported by:BLOCK /URBAN AREA High
Prior-ity (Y/N)
TRAINING OF SUPERVISORS TRAINING OF SEARCH TEAM MEMBERS TRAINING SESSIONS
Total Super-visors
No. trained be-fore round
% trained
Total search team members
No. trained be-fore round
% trained
Total training session held
No. ses-sions conduc-ted by District Trainers
District Total
83
DRAFT
LCDC Form MR 9Assessment of team performance during house-to-house case search (Fill one form for a team for a day)State: ________________________District:____________________________Block:__________________________________________________________________Name and exact address of the village / urban locality: ________________________________________________________ Reported by: Date : _____/____/
________1) Assessment of completeness of house-to-house case search activity: Visit 10 “L” or unmarked houses of one team’s work of one day. If any un-examined person/children is found in a L-marked house visit an additional10 houses in the same team area (total 20 houses)
S. No. 1 2 3 4 5 6 7 8 9 10House number put by team on the house Number of persons/ children > more than 2 years ex-amined during this round
Number of persons/ children > more than 2 years not ex-amined during this round
2) Operational Components: SMOs should try to meet the team working in the area and observe their activities at approximately 5 houses.Workload of the team: Number of houses being covered by this team Less than 20 /
20 to 25 / Above 25
Team Composition: Are the two team members the same as mentioned in the micro plan? Both / One / None
Is one of the first two team members is a male volunteer? Yes / NoTraining: Number of search team members of this team trained before this round Both / One /
NoneTeam performance: Is this team working according to the micro plan? Yes / No
Is the team checking and examining persons/children found outside of houses? Yes / NoSupervision: Was the supervisor crosschecking work done of this team in the field? Yes / No
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DRAFT
LCDC Form MR 10 Assessment of block performance during house-to-house case search (Fill one form for a block for a day)State: ________________________District:____________________________Block:__________________________________________________________________Name and exact address of the village / urban locality: ________________________________________________________ Reported by: Date : _____/____/________1) Are there any missed areas (clusters of houses missed by the teams in areas supposed to have been already covered)? Yes / No If yes, number of such areas ____________________2) Monitor areas requiring special attention in the block. Visit at least 1 to 10 special areas like brick kilns, construction sites, river islands etc. Special areasS. No. 1 2 3 4 5 6 7 8 9 10Name of site Is this site a part of micro plan? Are adequate number of teams de-ployed at this site?
Are teams proactively seeking/ ap-proaching people?
Is supervisor cross-checking work of this team?
The information for any site should be recorded only once during each round in the above table. If the monitor visits the site again, he/she should not record the informa -tion again.3) Are teams revisiting X- houses generated earlier in the day in an effort to immunize children? Yes / No / Partial4) Verify X-to-L conversions done by teams in areas monitored. During monitoring activities visit X houses that have been converted to L by the team. As this may include more than one team’s area the team number must be included below.S. No. 1 2 3 4 5 6 7 8 9 10Team Number House number / date put by A team on the house during first visit
X- X- X- X- X- X- X- X- X- X-
Number of cases detected in persons/ children in the household after re- visit by the team
85
DRAFT
LCDC Form MR 11LCDC monitoring - Survey of area to assess LCDC completeness (to be done the day following completion of house to house activities)Instructions:• This form is to be completed after the last official day of house-to-house activity.• Each monitor should survey at least 20 persons/ children more than 2 years of age outside of houses at each site/area.• At least 8 of the 20 people examined through the survey should be children i.e. 40%.• Each monitor should survey at least 6 sites during the day.• Suggested sites are: markets, construction sites, slums, brick kilns, Jaggery factories, embankments, river islands etc.State: ________________________District:____________________________Block:__________________________________________________________________
Name and exact address of the village / urban locality: ________________________________________________________
Reported by: Date : _____/____/________Record the details as below. Examine any unexamined person found. (Put a tally mark for each person examine)Area Name Total Number of persons/ children > than 2 years checked in streets, fields areas.
Number of unexamined persons/ children > than 2 years found.
Number of cases suspected in persons/ children in the examined during this exercise
86