Final Draft

NLR India Guidelines “Developing „Self-Care-Groups‟ in homes of Persons Affected by Leprosy (PAL-Home)”

NLR India - Branch Office B – 38, 1st Floor, Panchsheel Enclave, New Delhi - 110017 Phone: 91-11- 26497964 / 65 / 26498546 Fax: 91 11-26498547 E-mail : [email protected]

Contents Contents......................................................................................................................................... 2 Abbreviations ............................................................................................................................... 3 Glossary ......................................................................................................................................... 4 1. Introduction .............................................................................................................................. 5 2. Overall Objective...................................................................................................................... 6 2.1 Specific Objectives.............................................................................................................. 6 3. Strategy...................................................................................................................................... 7 4. Plan of Action: .......................................................................................................................... 8 4.1 Preparatory stage: .............................................................................................................. 8 4.2 Implementation .................................................................................................................. 8 4.3 Monitoring, Supervision and Evaluation ..................................................................... 10 Annexes Annex 1 Job Responsibilities of different functionaries ...................................................... 11 Annex 2 List of Stakeholders................................................................................................... 12 Annex 3 Agenda for Facilitators’ Training............................................................................ 14 Annex 4 Individual Profile of Person Affected by Leprosy.Error! Bookmark not defined. Annex 5 Individual disabilities assessment booklet ............................................................ 17 Annex 6 Compilation of assessment result ........................................................................... 18 Annex 7 SC Group Formation of PALs.................................................................................. 21 Annex 8 Compilation of SC Groups of PALs........................................................................ 22 Annex 9 Agenda of Self Care (SCG) Group leaders’ Training ........................................... 23 Annex 10 Self Care Practice Attendance Register ................................................................ 24 Annex 11 Self Care Group -Monitoring Format (Quarterly).............................................. 25 Annex 12 List of Logistics required:....................................................................................... 26 Annex 13 Activity Plan & Budget for developing “Self Care Groups” ............................ 27

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Abbreviations ANCDR DGr.II DLS DLO DPMR GHCS GoI HS HF ILEP IEC LAP M&E MO MB MDT MPR NGO NLEP NLR PB POD PR PWD SCG-CO SLO

Annual New Case Detection Rate Disability Grade II District Leprosy Society District Leprosy Officer Disability Prevention & Medical Rehabilitation General Health Care Services Government of India Health Secretary Health Facility International Federation of Anti-Leprosy Associations Information, Education & Communication Leprosy Affected Person Monitoring and Evaluation Medical Officer Multi Bacillary Multi Drug Therapy Monthly Progress Report of PHC/District/State Non-Governmental Organization National Leprosy Eradication Programme Netherlands Leprosy Relief Pauci Bacillary Prevention of Disability Prevalence Rate Persons with Disability Self Care Group Coordinator State Leprosy Officer

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Glossary

Case of leprosy:

A case of leprosy is a person with cardinal signs of leprosy, who is yet to complete his/her chemotherapy (MDT)

Disability:

A broad term covering any impairment, activity limitation or participation restriction affecting a person

EHF score:

The sum of the individual disability grades for each eye, hand and foot

Impairment:

A problem in body function or structure, such as a significant deviation or loss

Indicator:

A measurable aspect of a programme, which can indicate the level of performance and changes in performance

ISF:

Impairment Summary Form

MDT:

Multi-drug therapy

Nerve function

A loss of normal nerve functioning, demonstrated by loss of impairment or loss of sensation (loss of feeling or numbness) in the skin served function in a nerve: by the nerve and/or weakness of muscles supplied by the nerve

New case:

A case of leprosy who has never been previously treated with antileprosy chemotherapy

Orthotics:

Specially shaped inner sole of a shoe, used to correct an abnormality of the foot, including a tendency to ulceration

Reaction:

The sudden appearance of symptoms and signs of inflammation in the skin of a person with leprosy

Relapse:

The re-occurrence of the disease at any time after the completion of a full course of treatment

RFT:

Release from treatment; this occurs when treatment with MDT has been successfully completed

Stakeholder:

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1. Introduction With the introduction of Multi Drug Therapy (MDT), the National Leprosy Control Programme (NLCP) of India was re-designated as National Leprosy Eradication Programme (NLEP) in the year 1983. With the declining case load, Leprosy services have been integrated into General Health Care (GHC) System since the year 2002. Because of concerted efforts of GOI and partners, effective MDT and wider area of coverage, case load and new case detection is steadily decreasing. In spite of the major achievements made in the programme, care of the patients, after cure, is not addressed adequately. Disabled Leprosy cases treated by MDT & cured medically are prone to develop secondary impairments and there is a risk of worsening of their disabilities. Cured but disabled Leprosy cases seen in public places/roads often reflect success or failure of NLEP and the programme is often judged by visibility of these deformed persons. Social stigma is persisting mainly towards disabled persons and due to this the disabled persons have isolated themselves in Leprosy homes. Old treated persons who have developed deformity long back and settled in Persons Affected by Leprosy homes are still not willing to return to their native places due to fear of long standing stigma. Although they are treated cases, these inhabitants are unable to live a socially and economically productive life. In extremes of conditions they are visiting district hospital and availing health care services but the services are less focused on care of anesthetic hands and feet or promoting self-care. Although some support is being provided by Governments for their sustenance, quality care, for their disabilities/deformities, is not provided adequately. Some of them have developed Ulcers in their feet and often burn their hands while cooking or taking hot food /tea in a hot pot. Most of the inhabitants of these homes are suffering from Disabilities of Gr I (anesthetic hands and feet) as well as Gr II (mainly ulcers, clawing etc.). Care of these disabilities can be best done by practicing self care by the affected persons them selves. From experiences elsewhere, it is learnt that the out come of the Self Care practiced in groups, is much better as compared to the self care practiced individually. NLR India is willing to support these Persons affected by leprosy so that worsening of disabilities are checked and they are enabled to restore their normal social life. This will be done by facilitation of self care by formation of Self Care Groups (SCG). Other needs of these inhabitants will also be assessed and the possibilities of useful interventions based on their needs will be explored.

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2. Overall Objective Persons Affected by Leprosy with disability / Inhabitants of leprosy homes are empowered and enabled to take care of their disabilities, so that they are able to participate in social activities and if possible be self reliant.

2.1 Specific Objectives 1. 2. 3. 4.

To determine disability status of each person in leprosy homes. To encourage formation of ‘Self Care groups’ To promote & sustain ‘prevention of disability practices’ To ensure that inhabitants, of these homes, with disabilities learn and adopt self care 5. To ensure that the Persons affected by leprosy are enabled in taking care of their disabilities (physical as well social) collectively and independently.

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3. Strategy A Self Care Group (SCG) is a group of Persons Affected by Leprosy with Disability brought together with the purpose of learning & adopting self care practices, finding solution for their problems related to leprosy & its consequences, by mutual cooperation and group-synergy. Disability assessment, of each inhabitant of the leprosy home, should be carried out by trained health workers. These workers shall be trained NMS or Physio-technician from DLO office & shall be known as ‘Facilitators’. Facilitators will encourage and facilitate formation of groups, election of group leader and practice of self care. The formation of SCG should be by a participatory approach in which, the persons with disability staying in leprosy homes, shall form their groups themselves, to maintain congenial atmosphere in practicing self care. These group members will identify one ‘Group leader’ among themselves. Affected persons will be sensitized, motivated and persuaded by facilitator and group leaders to learn, practice and adopt ‘self-care’ in groups. Participatory approach will be followed throughout even in selecting venue for meetings, timing and agenda for the meeting and other activities. Discussion on problems and probable solutions will be facilitated at every level. Apart from developing ‘self care groups’, other needs and potential of each case will be assessed, linkages will be developed and cases will be facilitated to avail other rehabilitation services. A Non-Medical Supervisor (NMS) has been appointed by NLR to be stationed at NLR India branch office, New Delhi. He will be responsible for training, coordination , and supervision of the NLR SCG projects and will be responsible for all the activities of the projects in the country. He will be designated as Self Care Group Coordinator (SCGCO). The SCGCO will be visiting projects from time to time to ensure ownership by the government staff & sustainability of the activities. At least one NMS shall be posted by NLR at each State Capitol or at zonal level to coordinate SCG activities in different districts of the state. He will be known as Zonal SCG coordinator. This zonal coordinator will be responsible for 5-7 districts. The number of zonal coordinators will be decided by the number of homes to be supported. Role of Leprosy Programme Advisors in SCG LPAs will be over all responsible persons for the project in their districts/state. They will monitor and facilitate the NLR NMSs posted for the purpose and will coordinate with the state, for the Self Care Group activities. Job descriptions of different staffs involved in SCG projects is given in Annexure I SCG Guidelines_NLR-India_2009

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4. Plan of Action: Activities, which will be carried out stepwise, are as follows: 4.1 Preparatory stage: 4.1.1.

The DLO will identify the Facilitator (PTT/NMS) from DN team

4.1.2.

Identification of Persons affected by leprosy homes should be done by the facilitators in consultation with DLO/SLO.

4.1.3.

Stakeholders’ meeting will be held involving DLO & DN staff and facilitating team from NLR, to finalize the SCG plan and initiate its implementation. Representatives from department of social welfare will also be invited to participate. Key persons (stakeholders) for participation in the meeting will be identified by SLO & DN staff. List of possible stakeholders is attached (Annexure II)

4.1.4.

A meeting will be held with the inhabitants of selected Persons affected by leprosy home by facilitator with the objective of sensitization, exploration and commitment of Persons affected by leprosy with Disabilities for their self care.

4.1.5.

Training of selected health staff (Facilitators), from DLO office, will be conducted, so that the staff learns counseling techniques, physical assessment & self care practices. (Curriculum and agenda for training is given in Annexure III)

4.2 Implementation 4.2.1.

4.2.2.

4.2.3.

A profile of Persons Affected by leprosy in relation to their disabilities, available skills, literacy etc. and need assessment of individual person of the home will be undertaken by the facilitator and other trained staff. 10-15 Persons affected by leprosy will be interviewed and assessed by one staff in one day. (Individual assessment form is given in Annexure IV). During this visit, individual Disability assessment of Persons affected by leprosy in detail should also be performed on individual disability assessment booklet.(a prototype of booklet is enclosed at Annexure V) Compilation of assessment result of each home will be done by Facilitator on the format given in Annexure VI

4.2.4.

The groups will be formed by participatory approach involving Persons affected by leprosy. Each Group will be comprised of 5-10 persons with similar kind of disabilities.

4.2.5.

One person, from each group, will be identified by the members as their ‘group leader’ to supervise each member of group performing self care practice. These group leaders will be supervised by the facilitator from DLO office. Information about the group will be recorded on Annexure-VII. Compilation of group details in home will be done on format as on Annexure VIII

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4.2.6.

Training of group leaders will be done by facilitator as per agenda (Annexure IX)

4.2.7.

The Persons affected by leprosy will be trained in groups and will be motivated to learn & adopt “self care” practices by the trained facilitators/Group Leaders.

4.2.8.

First self care practice of each group will be performed in the presence of facilitator. The facilitator will plan his movement accordingly and train the group leaders and members by demonstration. Subsequent practices will be done by members under the guidance of group leader. The facilitator will supervise and guide the group from time to time. Main Supervisors of the activities will be ‘Facilitators’ from DLO office and representatives of Persons affected by leprosy homes.

4.2.9.

Group leader will maintain an attendance register of their members as per Annexure X

4.2.10.

SCGCO and Zonal SCG coordinators from NLR will support and advice facilitators and group leaders to maintain quality.

4.2.11.

Initially, SCGCO and Zonal SCG coordinators will visit the district and homes frequently, and then periodically to ensure adoption of self care practices of good quality

4.2.12.

The facilitator will visit the homes on monthly basis to interact with group members, group leaders to review adoption of self care practices, to assess the progress made and identify the needs. Observations of the monthly visit will be sent by facilitators with attendance of Persons affected by leprosy to DLOs and Zonal SCG Coordinator.

4.2.13.

Quarterly assessment of progress in disabilities of Persons affected by leprosy will be done by facilitator on the prescribed booklet. Report of the progress should be sent to DLO, SLO, Zonal and National SCGCO (Annexure XI)

4.2.14.

Half yearly meetings should be conducted to involve all stakeholders and to ask for help wherever needed.

4.2.15.

Indoor sports, songs & other cultural activities should be encouraged

4.2.16.

Protective aids and learning materials required to control disabilities should be provided by the district health society. In case the funds are not available with the district health society, NLR may be requested. List of required logistics is attached at Annexure XII

4.2.17.

Achievements, problems identified will be documented

4.2.18.

Proposal for financial estimate based on needs, will be prepared by NLR staff under consultation with DLO. After agreement with the NLR Leprosy Programme Advisors, it will be submitted to B.O. (Annexure XIII)

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4.3 Monitoring, Supervision and Evaluation Monitoring of the project will be carried out by analysis of quarterly and annual reports. Monitoring will be done through quarterly review meetings. Monitoring will also be done by six monthly stakeholders’ meeting Monitoring and supervisory visits will be carried out by LPAs concerned, Zonal SCG coordinators and mainly by the facilitators and District nucleus staff. Evaluation of the project will be planned after completion of one year of self care practices to evaluate the outcome of the interventions provided in the project. Following indicators can be used quarterly to assess the progress of the planned activities. Indicators Proportion of Persons affected by leprosy practicing self care regularly Proportion of Persons affected by leprosy with improved disability status (physical impairments only), assessed after every 3 months. Proportion of Persons affected by leprosy with worsened disability status (physical impairments only), assessed after every 3 months.

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Source of Verification Attendance Register maintained by group leader Disability assessment records (Cohort) Disability assessment records (Cohort)

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Annex 1 Job Responsibilities of different functionaries Facilitator – (Identified NMS/PTT from District nucleus) 1. To carry out assessment of disability in PAL home. 2. To train the group members about self care practices. 3. Train the group leaders in supervising self care and motivating members. 4. To pay supervisory visits to these homes 5. To conduct review meetings monthly & quarterly 6. To document the events & changes measured. 7. To facilitate developing linkages with departments and 8. Appraise DLO, Zonal and SCG coordinator and seek advice / help required. Group leader – (Selected by group members) 1. Encourage group members to perform self care practices, share the problems, ideas, experiences and act to overcome difficulties. 2. Supervise self care practices by members and promote independency in performing self care. 3. Participate in monthly meeting of group members and facilitate discussions 4. Brief the facilitator about the progress, problems and details of activities undertaken. Zonal SCG Coordinator – (Based at zonal levels in the state) 1. To plan, implement, monitor and supervise the projects of NLR. 2. To liaise with DLOs and SLO for the launch and provision of support from NLR 3. Participate in monthly meetings and half yearly meetings of stake holders 4. To train facilitators & supervise their performance 5. To give feedback to facilitators on their reports and performance 6. To send report to national SCG quarterly and half yearly National SCG Coordinator – (Based at NLR Branch Office, New Delhi) 1. To plan, implement, monitor and supervise the projects of NLR. 2. To supervise and facilitate Zonal SCGs to carry their tasks efficiently 3. Participate if possible in meetings of stake holders 4. To train facilitators & supervise their performance 5. To receive reports and provide feedback 6. To scrutinize project proposals and discuss with Coordinator projects and CR

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Annex 2 List of Stakeholders

NLR Supported Self Care Group Project

1

Govt. (Central, State ,District Level) Health Department (SLO,DLO,DNT)

2

Deptt. of Social Welfare.

3

MO I/C & GHC staff of local health facility.

4

ILEP representatives.

5

WHO representatives.

6

Local Leprosy & non Leprosy NGOs.

7

Community development NGOs

8

Pradhan/president of PAL home

9

Social worker/donor clubs, industrial houses, banks

10 etc.

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Anexure III

NLR Supported Self Care Group Project Agenda for Facilitators’ Training Day I Time 09.30 – 11:00 am

Welcome,

Topic Introduction, What

Resource person is

SCG?,

Objective of SCG for LAPs 10:00 –10:30 am

How the disability develops? Neuritis & Reaction, Why care is important?

11.00-12.00pm

ST/VMT, Disability assessment, Identification between simple and complicated ulcers, EHF scoring, recording, exercise

12:00 – 01.00 pm

Management

of

disability,

Self

Care

demonstration (Care of eyes, hands, feet, ulcer & other Secondary infections), role play. 01.00 – 02:00 pm

Lunch

02:00 – 03:00 pm

Mgmt. continued

03:00 – 04:00 pm

Project

description

of

Self Care Group

Formation (protocol) 04:00 – 04:30 pm

Job responsibilities of Facilitators & Group leaders

04:30 – 05:00 pm

Discussion & Feed back

Day II Time 09:30 – 11:00 am

Topic Supervision, Monitoring, Evaluation

11:00 – 12:00 pm

Counseling, techniques, role play

12:00 – 01:00 pm

Referral System (SC to Tertiary hospitals)

01.00 – 02:00 pm

Lunch

02:00 – 03:00 pm

Record /Report

03:00 – 04:30 pm

Recapitulation, open discussion

04:30 – 05:00 pm

Feedback

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Resource person

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Annex 3 Agenda for health staff & PALs’ Training NLR Supported Self Care Group Project Day I Time

Topic

10.00 – 11:30 am

Welcome, Introduction, What is SC practice? Objective of SC practices. Guidelines & Annexures How the disability develops?

11:30 –12:30 am

12.30.-1.30pm

Care of disabilities eyes, hands, feet & ulcers

1.30 – 02:00 pm

Lunch

02:00 pm

Management of disability, Care of eyes, hands, feet, ulcer & other Secondary infections HOPE execises & fill up format Ann -3 & 5.

–

04.00

04.00-4.30pm

Contents

Resource person

-Low awareness -Late detection -Inadequate treatment -Reaction -Ignorance eyes, hands, feet & ulcers

Care of eyes, hands, feet, ulcer & other Secondary infections HOPE execises & fill up format Ann -3 & 5.

Open discussion

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Annex 4 Individual Profile of Person Affected by Leprosy NLR Supported Self Care Group Project 1. Name of PAL : _________________________________ Age ________________ Sex__________

2. Mailing Address:__________________________________________________________________ 3. Total dependant family members: - (In case of husband and wife both having deformity, details of children should be given with only father’s form) Male (Ad)

Male (Ch)

Female (Ad)

Female (Ch)

Literacy status: Illiterate Primary (upto 5 Secondary (up Sr. Secondary class) to10th class) (up to 12thClass)

4. Disability Assessment ( Grading ) :Left Right Left Right Left Right Foot Eye Eye Hand Hand Foot 0 2 0 2 0 1 2 0 1 2 0 1 2 0 1 2

5. Skills & Source of Income Special Source of Income (Begging, skills / Business, Service) potential

Total

Graduation

Specialization (specify)

Ulcer Yes

Earning by donor (Persons, NGO, CG, State Govt.)

Total EHF

No

Total income (INR) Optional

6. Need Assessment for physical rehabilitation Self care MCR RCS Aids & Appliances required Materials /Foot wear Crutches, Grips Wheel Chairs Goggles artificial Aids limbs

others

7. Need assessment for socio-economic Rehabilitation (SER) / Vocational training Vocational Micro credit Needing relations with Others Employment Training* finance healthy population (business) *Carpentry, weaving, tailoring, shoe making /repairing etc.

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8. Need assessment for Socio-Economic Rehabilitation (SER) and vocational training of their children / Family members S. No

Name of the child or Spouse

Age

Gender M F

School going Any special Yes/No skill they posses

*Need

1 2 3 4 *Immunization, Educational Material, Training, employment etc.

9. Special information (if, any)

Date

Signature

Place Name……………Designation………………..

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Annex 5 Individual disabilities assessment booklet

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Annex 6 Compilation of assessment result of Each PAL Home (leprosy Colony) NLR Supported Self Care Group Project Name of Colony: ________________________________ Regd. No._____________________ Address (postal): ______________________________________________________________ ______________________________________________________________________________ Name of Pradhan: ________________________________

Contact no. _____________

1. Total no PALs. _______________Houses ____________

Rooms: _____________

2. Total no PAL families: ______________________________________________________ 3. Age/Sex wise Analysis (All i nmates Pals only)

< 15 16 – 46 – >61 yrs. 45 60 yrs. yrs. yrs.

Total

Male Female 4

Literacy Status: Education Male Male Female Female Total Level adult child adult child Illiterate Primary 10th Grade 12th Grade Graduation Specialization

5

No. of school Going Children

6

Total no PALs:

7

No. of PALs already with special skills :

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Male ____ Male Adult

Male Child

Female____ Female Adult

Male ___

Female Child

Total____ Total

Female _____Total______

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Grading 8

Disabilities (grade wise):

Male Adult

Male child

Female Female Adult child

Total

Gr – 0 Gr – I Gr – II 9

Status Disability Wise: Particulars S.No. a) PALs with foot Ulcers b) PALs with anaesthesia in hands c) PALs with anaesthesia in feet d) PALs with lagophthalmos e) PALs with corneal anaesthesia f) PALs with deformed hands g) PALs with deformed feet h) No. of PALs with multiple disabilities

Male Adult

Male Child

Female Adult

Female Child

Total

10 Need assessment for (Physical Rehabilitation): a) No. PALs requiring MCR chappal c) No. PALs requiring artificial Limbs e) No. PALs requiring grip aids g) No. PALs requiring RCS

b) No. PALs requiring SPL wheel chair d) Goggles f) No. of PALs requiring Self care material h) Others

11 Main source of income: SN a) b) c) d) e) f)

Details No. PALs earning by service. No. PALs earning by business. No. PALs earning by begging. No. PALs earning from donors. No, of PALs getting pension Other Sources

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Male

Female

Total

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12 Earning by donations/Pensions :- a) Individual ______ c) Central Govt. ____

b) NGOs ______ d) State Govt. _____

13 Need assessment for Socio-Economic Rehabilitation (SER): (Vocational Training) S. No.

1. 1.1 1.2 1.3 2. 3. 4. 5

Particulars

No. of Male

No. of Female

Total

Vocational Training

Agreed for Micro-credit finance Needing relations with healthy populations Employment Any other (small business)

14 Need assessment for socio-economic Rehabilitation (SER) and vocational Training of children & family members of PAL. S. N o.

Age groups of family Need (No.) members Age M F Total Immunizatio Educational Trainin Em other Needing plo groups n Material g relation ym with ent Healthy populatio n 1 0 -5yr 2 6yr-18yr 3 19yr-45yr 5 ≥46yr 6 Total Special Information; (If, any give details on separate sheet) Date

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Signature Designation

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Annex 7 SC Group Formation of PALs NLR Supported Self Care Group Project Name of PAL Home: _________________________________________________________ Address: ___________________________________________________________________

Group No.

Name of Group leader

Age

Sex

Disability Gr 1 Gr 2

S. No. 1.

Name of Group members

Age

Sex

Disability Gr 1 Gr 2

2. 3. 4. 5. 6. 7. 8. 9. 10.

Date: _______________

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Signature of Group leader/Facilitator

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Annex 8 Compilation of SC Groups of PALs NLR Supported Self Care Group Project

Name of PAL Home: _________________________________________________________ Address: ___________________________________________________________________

Group no.

Name of Group leader

Total no of Group Members

Group Members Male Female Gr I GrII Gr I Gr II

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Date: _______________

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Signature of the Pradhan of PAL Home

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Annex 9 Agenda of Self Care (SCG) Group leaders’ Training (One day only) NLR Supported Self Care Group Project Venue: Persons Affected by Leprosy (PAL’s Home) Name of Trainer: ___________________________________________________________

Time

Topic

09:00 – 09:15 am

Welcome & Introduction

09.15 – 09.30 am

Objective of self care Group.

09.30 – 11.00 am

How to care Eyes, Hands & Feet. Self care exercises.

11.00 – 12.00 pm

Care of simple & complicated ulcer.

12.00 – 01.00 pm

Self care practices (demonstration)

01.00 – 01.30 pm

Protective aids & Appliances & how to use them

01.30 – 02.00 pm

Lunch break

02.00 – 03.00 pm

Job responsibilities of Group leader and group members.

03.00 – 04.00 pm

Communication skills including counseling techniques

03.00 – 04.00 pm

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Open discussion.

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Annex 10 Self Care Practice Attendance Register NLR Supported Self Care Group Project

Name of PAL Home ____________________________

S. Name No. 1

Age Sex

Group No._________

Date of Starting Practice:______________

Dates 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2 3 4 5 6 7 8 9 10 11 12 13 14

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Annex 11 Self Care Group -Monitoring Format (Quarterly) Self Care Group -Monitoring Format (Quarterly) Name of PALs Home: _______________ Name of Facilitator: _______________________ Mailing Address: ______________________________________________________________ District: _____________________________ State: ___________________________________ Starting month: ___________ Year: ______Reporting Month: ___________ Year:________ Total No. SCG Members: _______________________________________________________ No. practicing Self Care regularly (80% of days in a month): _______________ (______%) Total No. with Ulcers: ________________No of ulcers healed: ______________ (______%) No. of ulcers showing improvement: ___________________________________ (______%) No. of ulcers showing worsening: _______________________________________________ Total No. Developed new disability: _____________________________________________ Total No. Developed new ulcers: ________________________________________________ Problems Identified

Action taken

1

1

2

2

3

3

Date

Signature

NOTE: Reasons for new disability and new ulcer should be given with details

Annex 12 List of Logistics required As far as possible locally made, easily available, affordable materials should be used by the PALs Following is the list of articles which are required for the care of anesthetic hands, feet and eyes 1. Tub, water (mixed with salt), seating arrangements (cot, stool, platform etc.) 2. Person can dip his hand or feet in a dug pool 3. Cotton, bandage, locally available oil, small but smooth stone piece or a small piece of rough towel or coconut cover/jute etc. 4. Antiseptic lotion (e.g. savlon) and/or Potassium permaganate powder for ulcers only 5. Antibiotic ointment (e.g. soframycin) etc. for ulcers only 6. Protective aids / appliances like - Goggles, Footwear with soft insole and hard sole, insulated utensils, grip aid, splints etc. 7. Learning material (illustrations) about – self care 8. Government schemes made available to PALs

Annex 13 Activity Plan & Budget for developing “Self Care Groups” NLR Self Care Group Project S. Activity No. 1 Identification & prioritization of leprosy colony(name of PALs home) 2 First meeting with stake holders 3

4

Training of facilitators (D.N) in physical assessment & counseling technique

Responsible staff DLO

Proposed month

Particulars

Calculation details (INR) Nil

DLO

Snacks

INR 20 x no. of persons

DLO

Lunch Per Diem INR150each For local participant INR 300.00 each for other distt facilitators Actual TA to facilitator by bus or sleeper class Wage loss to 3 PALs

INR 80 per person INR 150 x no. of facilitators x 2 days

Disability assessment of PALs Facilitator (10-15 PALs per day)

Incentive to facilitator

INR 300 x no. of facilitators x 2 days

INR 300 per person

INR 100 x 3PALs x 2days INR 50.00/visit

Total (INR) -

Activity S. No. 5 Training of Group leaders

6

7

8

10

Responsible staff Facilitator

Proposed month

Particulars Lunch +Tea

Monitoring meeting one every Facilitators from month x12 months DN team (monitoring) Provision of self care booklets -NLR -

Refreshment

Support to DLO in Providing - do logistics to each case as per requirement for self care practice if fund is not available

Logistics for Self Care Practices

Half yearly review meetings

All main stake holders

Quarterly

Grand Total

Stationery (Learning material, IDAB etc

Calculation details (INR) INR 50. no. of participants including resource person & facilitator INR 10 x no. of persons x 12 months INR 20 x no. of persons

Plastic tub

INR 100 x no. of persons

Steel box for record keeping Tea & Snacks

INR 300/- x each PAL Home INR 30 x no. of persons

Total (INR)