Guidelines

for

Training of Persons Affected by Leprosy to Practice Self Care at Their Homes/Villages

NLR India - Branch Office B-38, 1st floor Panchsheel Enclave New Delhi - 110017 Phone: 91-11-26498546/47 Fax: 91 11-26498547 Extn-26 E-mail : [email protected] Website : www.nlrindia.org

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Contents Contents .......................................................................................................................................... 2 Abbreviations.................................................................................................................................. 3 Abbreviations.................................................................................................................................. 3 Glossary .......................................................................................................................................... 4 Self Care Training Project .............................................................................................................. 5 1 Introduction............................................................................................................................. 5 2 Overall Objective .................................................................................................................... 6 2.1

3 4 5

Project Area ............................................................................................................................ 6 Target Population.................................................................................................................... 6 Methodology:.......................................................................................................................... 7 5.1 5.2

6

Specific Objectives ........................................................................................................6

Strategy to be adopted ..................................................................................................7 Activities, which will be carried out stepwise .................................................................7

5.2.1 Preparatory arrangements ....................................................................................... 7 5.2.2 Training workshop .................................................................................................. 8 5.2.3 Follow up of training workshop:............................................................................. 8 Monitoring, Supervision and Evaluation .............................................................................. 10

Annexure Ann 1 Job Responsibilities of Different Actors........................................................................... 11 Ann 2 NLR Supported Self Care Group Project........................................................................... 13 Ann 3 Agenda for training workshop for PAL/ASHA/family members...................................... 14 Ann 4 Individual Profile of Person Affected by Leprosy ............................................................. 15 Ann 5 Compilation of assessment result of each PHC ................................................................. 17 Ann 6 Individual Disabilities Assessment Booklet ...................................................................... 20 Ann 7 Self Care -Monitoring Format (Quarterly)......................................................................... 21 Ann 8 List of Logistics Required.................................................................................................. 22 Ann 9 Activity Plan & Budget for developing “Self Care in villages” ........................................ 23

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Abbreviations ASHA ATP DDRC DLO DN DM GHC GoI Gr 1 Gr 2 HCF IDHS LPA MO MB MDT NGO NLEP NLR NMS PAL PB PHC POD PR PT RCS SCG-CO SLO

Accredited Social Health Activist Advance Tour Program District Disability Rehabilitation Centre District Leprosy Officer District Nucleus District Magistrate General Health Care Government of India Grade 1 Grade 2 Health Care Facility Integrated District Health Society Leprosy Program Advisor Medical Officer Multi Bacillary Multi Drug Therapy Non-Governmental Organization National Leprosy Eradication Programme Netherlands Leprosy Relief Non Medical Supervisor Person Affected by Leprosy Pauci Bacillary Primary Health Centre Prevention of Disability Prevalence Rate Physio-technician Reconstructive Surgeries 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 variable which measures change. A variable which can indicate the change either positive or negative in the programme performance or its achievements

ISF:

Impairment Summary Form

Nerve function impairment: A loss of normal nerve functioning, demonstrated by loss of sensation (loss of feeling or numbness) in the area of skin supplied 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 anti-leprosy chemotherapy

Orthotics:

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

Lepra Reaction:

Acute exacerbation of disease manifested in the form of 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

Self Care

Efforts done exclusively by a disabled person himself or herself, to manage, prevent further worsening of the disability

Stakeholder:

Individuals or institutions that may be affected by or affect an activity, directly or indirectly, and/or positively or negatively. In case of Self care groups it includes persons affected by leprosy, health care providers, community leaders, voluntary organizations, social justice department, banks, and General Physicians etc.

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Self Care Training Project 1

Introduction

Under National Leprosy Eradication Program (NLEP), integrated leprosy services, provided through GHC staff, are in place. There is a district nucleus in each district to supervise & monitor the routine NLEP activities. Newly introduced Accredited Social Health Activist (ASHA) 1 for each 1000 population, in each village, links the program with beneficiaries. Local government i.e. Panchayati raj institutions (PRI) and peripheral institutions of NRHM do exist in each district. NLR is supporting NLEP activities in 34 districts of UP, 5 districts of Bihar, 16 districts of Jharkhand, all the 9 districts of Delhi, all the 13 districts of Uttarakhand and 3 distts of West Bengal, thus supporting total 80 districts in 6 states. Even though major achievements have been made under NLEP, care after cure needs to be addressed adequately. People with Leprosy related disability, though treated with adequate MDT & cured medically, are prone to develop secondary impairments and there is a risk of worsening of their disabilities. Because of the fact that general health care staff at the state level and below is burdened with many national health programs, they do not have sufficient time to advise PAL as to how they can take care of their disabilities by observing a set of simple self care practices. It is observed that most of these PAL suffer from disabilities of Gr 1 (anesthetic hands and feet), which may be prevented from becoming Gr 2 disability (clawing, cracks, ulcers etc) by adopting self care practices. Because of the stigma associated with the disease, PAL do not reveal their disease to any person, hence, it is very difficult for health workers to contact them individually, train them in self care practices, and monitor & supervise the practice of self care done by PAL. In villages, PALs live with their families but they are scattered and distributed scantily in the general population. According to common man’s perception, success of the program is indicated by the absence of disabled leprosy cases seen in public places/roads. It is learnt from other experiences that it is more practical to practice self care in groups. Since they are scattered, group formation is very difficult. They may be encouraged to learn self care collectively at PHC and practice it at their houses to adopt it, if possible at village level too (if no. of PALs are more in one village). This group formation in the village may provide PAL the confidence and unity. It gives them opportunity to learn and share their experiences. This will also empower them to work collectively towards better lifestyle for themselves and their families. This pilot project aims at bringing these affected persons at PHC to trains them in self care, which can be followed up by GHC staff. Findings and recommendations will be used to extend self care practices to other areas in NLR supported states

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2

Overall Objective

To empower and enable, disabled persons affected by Leprosy to practice self care in their respective homes/villages with support from family, and that the monitoring & supervision of this self care is done by General Health Care Staff.

2.1 Specific Objectives 1. To enable persons affected by leprosy to adopted ‘self care practices’ and take care of their physical disabilities 2. To enable GHC staff in supervision and monitoring of Self Care Practices done by PAL. 3. To assess whether PAL are practicing self care & GHC staff is supporting PALs at their homes 4. To assess the improvement and worsening in disabilities of PAL 5. To assess the feasibility and repeatability of this intervention in other areas

3

Project Area

10 blocks, randomly selected, out of 34 NLR supported districts of Uttar Pradesh. 02 blocks, randomly selected, out of 03 NLR supported districts of West Bengal 02 blocks, randomly selected, out of 05 NLR supported districts of Bihar 06 blocks, randomly selected out of all13 districts of Uttarakhand In each selected block / PHC there will be about 20 disabled persons.

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Target Population

Uttar Pradesh -From each PHC around 15 GHC staff and 20 persons affected by Leprosy will be identified, thus in total 150 GHC staff and 200 persons affected by leprosy will be involved in this intervention West Bengal- From each PHC around 15 GHC staff and 20 persons affected by Leprosy will be identified, thus in total 30 GHC staff and 40 persons affected by leprosy will be involved in this intervention Bihar - From each PHC around 15 GHC staff and 20 persons affected by Leprosy will be identified, thus in total 30 GHC staff and 40 persons affected by leprosy will be involved in this intervention Uttarakhand- From each PHC around 10 GHC staff and 15 persons affected by Leprosy, thus in total 60 GHC staff and about 90 persons affected by leprosy will be involved in this intervention. In all NLR supported states, some PHCs may have more disabled cases and some may have less number of cases, hence number of cases per PHC may vary. In total this pilot project will cover about 270 GHC staff and 370 persons affected by leprosy

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5

Methodology:

5.1 Strategy to be adopted Selected General health care staff (GHC) will be trained in self care separately (one week or 15 days prior to actual training of PALs), for supervision and monitoring of self care practices. Identified Persons affected by leprosy, will be trained, how to take care of their disabilities themselves, in the form of a workshop. For this purpose all the Persons affected by leprosy, having disabilities, will be collected at selected PHC or community hall for self care training. During this workshop they will be explained the steps by GHC staff. Afterwards, the persons will actually practice self care which will be supervised by GHC staff at their respective homes. It is envisaged that the Persons Affected by Leprosy, Health Worker/Supervisor of the area and Family members or ASHAs will be trained in self care, at PHC level under supervision of GHC staff, ‘District Nucleus (DN)’ & NLR supervisor. In turn, it is expected that these trained ASHAs or family members and selected health staff will encourage PAL to practice self care at their homes individually. Other needs of these PALs will also be assessed and the possibilities of introduction of meaningful interventions, based on their needs, will be explored.

5.2 Activities, which will be carried out stepwise 5.2.1 Preparatory arrangements In consultation with LPA, DLO will select the Block PHC where the self care project villages will be taken up

for

1) 1st meeting will be organized by NLR in which NMS & LPA of NLR, DN staff, MO I/C of the PHC and one supervisor from HQ of selected PHC, will be invited at district level. During this meeting implementation of activities per the protocol will be discussed with DLO, project details will be explained to them. 2) A team, consisting of NMS/PT (either of two) from DN, NMS of NLR India, Medical Officer in-charge of the concerned PHC and DLO, will be constituted during above meeting. The team will be led by the DLO. 3) The team will be responsible for training, assessment, monitoring and supervision of the project. 4) All health workers/supervisors under the selected PHC, will prepare the list of ‘Disabled Persons Affected by Leprosy (PAL)’, living in the geographic area covered by them. PHC and village wise list of PAL eligible for self care will be finalized by MO I/C PHC and submitted to DLO within a month after this meeting 5) Based on the residence of the selected PALs, a list of ASHAs/the health workers/health supervisors and related PALs will be prepared. GHC staff will be responsible for their follow up and will be known as Facilitators.

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6) These Facilitators will be given one day training, as per Curriculum and agenda given in Annexure 2, for self care practices at PHC. This training will be imparted 10-15 days or at least one week prior to the organization of self care training workshop at PHC. They will be paid Rs 50 for local travel, and working lunch will be provided for the training day, which will be supported by NLR. Protocol & training material will also be provided by NLR. During this training the role of GHC staff will also be explained. 7) Responsible health workers (Facilitators) will contact all identified PAL, their family members or ASHAs of the area and invite them to attend the workshop at PHC in which they will be sensitized about the benefits of self care practices and will be taught how to practice self care. At the same PHC, GHC staff (Facilitators) will also be invited and will be re-oriented on the job, about ‘how to teach, supervise and monitor self care practices of individual or groups. 8) Proper selection of space/venue, seating arrangement will/should be made for the workshop days so that PALs can sit comfortably and should be able to soak their hands and feet simultaneously. Block community hall may be proper place for this camp, hence prior consultation should be done with block authorities. 9) Date of training workshop be decided under consultation with MOI/c of PHC.

5.2.2 Training workshop 1. The workshop will be for two days in which 20 PALs & concerned ASHA or a family member will be invited and trained as per Curriculum and agenda given in Annexure 2 2. Disability assessment of each PAL will be done on Annexure -5 (Booklet ) 3. Each disabled person will be provided with a tub and other material during the workshop 4. Photography to assess progress in future can be done along with assessment 5. Assessment of needs & individual profile of each PAL will be prepared by NLR, and GHC staff & ‘Non Medical Supervisor (NMS) of District Nucleus on the workshop day, as per Annexure-3. 6. Compilation of individual profile will be done on Annexure-4 7. All complicated cases needing referral or RCS will be referred

5.2.3 Follow up of training workshop: 1. The trained ASHAs, health staff and family members of PALs may act as motivators. During field visits, ASHAs, the Health worker/supervisor (male or female) will motivate these PALs to continue practicing self care. 2. After one month, these PALs and responsible Health staff will be invited again at PHC to review their skill in self care and monitor the progress. 3. During each review meeting PALs should come with their tub

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4. The review meetings will be held every month for the first 6 months, to assess the progress. During these meetings PALs should demonstrate how they practice self care and if some deviation, may be trained on the spot. After a period of 6 months, the monitoring meetings will be held every 3 months. For each such meeting, they (PAL & ASHA or one family member) will be paid TA and lunch for one day as per Annexure -8. DLO will chair the meeting, MO i/cPHC will participate 5. Recording of progress of the cases will be done every 3 months. Quarterly assessment of progress achieved by each PAL will be done & recorded by the team on the prescribed booklet. (Annexure 5) This booklet will be under the charge of GHC staff identified as facilitator. Report of the progress shall be sent to DLO, SLO, Zonal and National SCGCO on monitoring format (Annexure 6). 6. Achievements, problems identified will be documented on the monitoring format. 7. Minutes of the meeting will be prepared and circulated to all concerned including SLO and NLR India (B.O.). 8. Protective aids and learning materials required by each PAL, to prevent / control disabilities will be provided by the district health society. In case the funds are not available with the DHS, NLR may be requested for the same. 9. List of logistics that are usually required for self care practices is attached at (Annexure 7). 10. For facilitation of Disability Certificates, Bus Passes, other concessions/ facilities, and also for protective aids & appliances, ‘District Disability Rehabilitation Centre (DDRC)’, may also be contacted if it is functioning/ existing in the district. 11. In addition, all local NGOs working for the disabled PAL are to be contacted and invited in quarterly review meetings 12. Evaluation of the project will be under taken by NLR and the team jointly after completion of one year of the project 13. Expenditure in the project will be done as per the budget calculations at Annexure 8

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6

Monitoring, Supervision and Evaluation

Monitoring and supervisory visits will be carried out by team constituted for the purpose. Monitoring will also be done through monthly review meetings during initial 6 months and later through quarterly review meetings, at the center identified for the purpose. 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 will be used to assess the progress of the planned activities. Indicators Number of Self care training workshops & review meetings organized Number of PAL attended self care training workshop Proportion of PAL attending review meetings regularly Proportion of PAL using Aids/Appliances given Proportion of PAL with improved disability status/ulcers), assessed after every 3 months. Proportion of PAL with worsened disability status/ulcers, assessed after every 3 months. Proportion of the PAL referred for complications Proportion of the PAL under gone RCS of the total PAL eligible for RCS No. of health staff Trained No. & proportion of trained health staff visiting the field

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Source of Verification Self care register Workshop/Self care register Review meeting records Review meeting records Individual disabilities assessment booklet Individual disabilities assessment booklet Individual disabilities assessment booklet Individual disabilities assessment booklet Training List Supervisory report

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Ann 1 Job Responsibilities of Different Actors District Nucleus Team 1. Facilitate organization of training workshop 2. Facilitation of selection of PAL from each PHC 3. Training of GHC staff, PAL and their Family members in self care at PHC 4. Supervisory visit to PHC every month and ensuring availability of aids/appliances to PAL. 5. Support and guide the GHC staff in maintenance of records at PHC level 6. Monitoring of the SC project Medical Officer PHC:1. Identify, Support, Guide and Supervise the health staff involved in the project at PHC Level 2. Attend all meetings related to Self Care Project 3. Arrange required logistics every month and ensure its supply through facilitators to PAL who are practicing self care at home 4. To facilitate the development of linkages with various stakeholders such as NGOs working for disabled and PAL 5. Ensure the participation of all stakeholders in quarterly review meetings 6. Ensure follow up of cases and its recording by GHC staff during routine visits. Facilitator – (Identified Health staff from PHC-Health Supervisor/ Worker) (May be more than one in each PHC depending upon area & number of PAL) 1. To facilitate learning of self care by PALs 2. To pay supervisory visits to assess and improve the performance of the PAL in self care during their routine field visits 3. Distribute logistics during training / supervisory visits 4. To help team in conducting monthly/quarterly review meetings 5. To document the progress and maintain records at PHC 6. To facilitate the development of linkages with various stakeholders such as NGOs working for disabled / DDRC / and PAL 7. Ensure the communication for participation of all stakeholders in quarterly review meetings 8. Consult MO I/C PHC, DLO to seek their advice/help, if required. 9. One of the facilitator from each block PHC will be responsible for maintaining records and reports at PHC and sending them to DN & NLR. National SCG Coordinator, NLR 1. Should have close liaison with NLR-NMS & LPA responsible for this activity 2. Participate if possible in quarterly monitoring meetings. 3. To receive reports and give feedback 4. To scrutinize reports and discuss it with Coordinator Rehabilitation and CR. 5. Transfer of relevant information to the Zonal SCG Coordinator, for better functioning of self care project,

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Zonal SCG Coordinator, NLR – 1. To train facilitators & guide them as and when required 2. Will have a close liaison with LPA so as to coordinate and facilitate the self care project 3. Participate in quarterly monitoring meetings at PHC level 4. Ensure the participation of all stakeholders in quarterly review meetings 5. To give feedback to facilitators on their reports and performance 6. To facilitate the development of linkages with various stakeholders such as NGOs working for disabled and PAL 7. Zonal NMS from NLR will collect report from DN and compile and send it to branch office. Role of ‘Leprosy Programme Advisors (LPA)’ LPA will be over all responsible for the project in his districts/state. They will motivate DN and initiate the project. They will plan their own ATP in such a way that their presence in each monthly monitoring meeting is ensured. They will coordinate different functionaries engaged in the program.

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Ann 2 NLR Supported Self Care Group Project Agenda for GHC staff (one day training, one to two weeks prior to training of PALs)

Time 09.30 – 09.45 am 09.45 – 10.15 am

Topic

Methodology Facilitator

Registration Welcome, Introduction & learning objectives.

Lecture/discussion DN & NLR team

What is Self Care?, Objective of the project? 10:15 – 10:45 am

10:30 –11:30 am

11.30-12.00 pm

12.00 – 01.00 pm 1.00 – 2:00 pm 02:00 – 3.30 pm

Job responsibilities, of different actors & that of the Facilitators, during the workshop and afterwards How the disability develops? Neuritis & Reaction, specially the secondary impairments. Why care is important? Disability Assessment (ST, VMT, EHF score) differentiation between simple and complicated ulcers, recording of disability status. Practice on selected patients/PALs Lunch Management of disability,

DN & NLR team

DN & NLR team

DN & NLR team

DN & NLR team DN & NLR team

How to perform ‘Self Care Practices’ (prevention of injury, HOPE, physiotherapy, blink exercises etc) 3:30 – 4:30 pm

How to use aids & appliances given Counseling & motivation of PAL (role play).

DN & NLR team

4:30 – 5:00 pm

How to monitor & supervise

DN & NLR Team

5.00 p.m

Summary & Feed back

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Ann 3 Agenda for training workshop for PAL/ASHA/family members Day I Time 09.30 – 10:00 am

Topic Welcome, Introduction & learning objectives.

Resource person DN & NLR Team

What is Self Care?, Why to do it? 10:00 – 10:30

Job responsibilities of the PAL & ASHAs/family DN & NLR Team members during the camp and afterwards

10:30 –11:30 am

Simple description of Neuritis & Reaction,

DN & NLR Team

How the primary disability develop? How

the

secondary

disability

develops

and

progresses? 11.30-01.00pm

Management of disability,

Facilitator

(A) How to perform ‘Self Care Practices’ (prevention of injury, HOPE, physiotherapy, blink exercises etc) (B) How to use aids & appliances given 1.00 – 2:00 pm

Lunch

Practice session on H.O.P.E. (PALs sitting in groups & during soaking) 2.00-3.30

Disability Assessment (ST, VMT, EHF score) & its Facilitator recording by GHC staff Taking of foot prints for footwear

3:30 – 4:30 pm

Counseling & motivation of PAL by GHC staff

DN & NLR Team

4:30 – 5:00 pm

Day Summary &Feed back

DN & NLR Team

Day II Time 10.00 – 10.30 10.30 – 12.30

12.30 – 01.00 01.00 – 01.30 01.30 onwards

Topic Welcome to PALs and their family members Recapitulation of the previous day Soaking, scrubbing, oiling/dressing by PALs Individual counseling, explanation about use of special appliances Instructions/discussions for follow up Feedback Lunch & disbursement of TA/per diem

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Resource person GHC staff Supervision by GHC staff GHC staff

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Ann 4 Individual Profile of Person Affected by Leprosy NLR Supported Self Care Project 1. Name of PAL : ____________________________ Age ____________ Sex____________ 2. Mailing Address___________________________________________________________ __________________________________________________________________________ 3. Contact phone number:_____________________________________________________ 4. Total dependant family members: - (In case of husband and wife both having deformity, details of children should be given on father’s form, only) Male (Ad)

Male (Ch)

Female (Ad)

Female (Ch)

Total

5. Literacy status: Illiterate

Primary (upto 5 Secondary (up Sr. Secondary Graduation class) to10th class) (up to 12thClass)

Specialization (specify)

5. Disability Assessment: Particulars

Yes

Anesthesia in hands Claw hands Hand ulcer Anesthesia in feet Deformed feet Foot Ulcers Persistent Red eye Lag-ophthalmos Multiple disabilities 6. Skills & Source of Income: Special skills / potential

Source of Income (Pension, Begging, Donation, Business, Service)

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Total income per month (INR) Optional

15

7. Need for physical rehabilitation Self care Materials (HOPEkit)

Protective foot wear

RCS

Aids & Appliances required

Crutches, Grips artificial Aids limbs, splints

Wheel Chairs

Goggles

Others

8. Need for Socio-economic Rehabilitation (SER) / Vocational training Vocational Training*

Micro Others Prohibitions/reservations/participation credit Employment (business/housing restriction needs to be addressed finance etc.)

*Carpentry, weaving, tailoring, shoe making /repairing etc. 9. Need for Socio-Economic Rehabilitation (SER) and vocational training of their children / Family members. S. No

Name of the child or Spouse

Age

Gender School going Any special skill M F Yes/No they posses

*Need

1 2 3 4 *Immunization, Educational Material, Training, employment etc. 10. Other important information (if any)

Date Place

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Signature Name…………… Designation………………..

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Ann 5 Compilation of assessment result of each PHC NLR Supported Self Care Project Name of PHC __________________________________________________________________ Address (postal): _______________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Name of Medical Officer i/c____________________________ Contact no. ________________ 1. Total no. of PAL ____________________________________________________________ 2. Total no. of PAL families_____________________________________________________ 3. Age/Sex wise Analysis (PAL and their Family members) < 15 yrs.

16 – 45 yrs.

46 – 60 yrs.

>61 yrs.

Total

Female child

Total

Male Female

4 Literacy Status: (PAL and their Family members) Education Male adult Male child Female adult Level Illiterate Primary 10th Grade 12th Grade Graduation Specialization 5

No. of school Going Children

Male ____

6

Total no of PAL:

7

No. of PAL who possess special skills : Male ________ Female _______

Male Adult

Male Child

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Female____ Female Adult

Total____ Female Child

Total

Total_______

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8

Status Disability Wise: Particulars

Male Adult

Male Child

Female Adult

Female Child

Total

Anesthesia in hands Claw hands Hand ulcer Anesthesia in feet Deformed feet Foot Ulcers Persistent Red eye Lag-ophthalmos Multiple disabilities 9

Need assessment for Physical Rehabilitation:

a) No. of PAL requiring MCR chappal c) No. of PAL requiring artificial Limbs e) No. of PAL requiring grip aids g) No. of PAL requiring RCS

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

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

Details No. of PAL earning by service. No. of PAL earning by business. No. of PAL earning by begging. No. of PAL earning from donations. No. of PAL getting pension Other Sources (specify)

Male

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

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Female

Total

b) NGOs _________ d) State Govt. _____

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12 Need assessment for Socio-Economic Rehabilitation (SER) and Vocational Training (VT). S. No. 1. 1.1 1.2 1.3 2. 3. 4. 5

Particulars

No. of Male

No. of Female

Total

Vocational Training

Micro-credit finance Prohibitions/reservations/participation restriction needs to be addressed for Service/Employment Any other (grant/pension/small business/self employment/housing etc.)

13 Need assessment for socio-economic Rehabilitation (SER) and vocational Training of children & family members of PAL. S. No.

Age groups of family Members Age M F Total groups

Need (No.) Immunizatio Educational Training Employ other Need n Material ment participati on in society

1 0 -5yr 2 6yr-18yr 3 19yr-45yr 5 46yr-60yr 6 >60 yrs Total Other important information (e.g. referral etc.) If any other, give details on separate sheet)

Date:

Signature: Name: Designation:

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Ann 6 Individual Disabilities Assessment Booklet

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Ann 7 Self Care -Monitoring Format (Quarterly)

Name of PHC: ______________ ___________________________________________________ Postal Address: _________________________________________________________________ District: __________________________________ State: ______________________________ Starting month: ___________________________________ Year: ________________________ Monitoring month: ________________________________ Year: ________________________ Total no. PAL trained in Self Care: _________________________________________________ No. of PAL with ulcers at the training workshop: ______________________________________ No of PAL with ulcers healed: _________________________________________(________ %) No. of PALs showing improvement in ulcers:___________________ __________(________ %) No. of PALs showing worsening in ulcers:______________________________ _(________ %) No. PAL developed new disability (excluding ulcer):___________________________________ No. developed new ulcers: ________________________________________________________ No. of PALs using aids & appliances given___________________________________________ Total no of PAL requiring RCS at the time of training__________________________________ Total number of PAL undergone RCS_______________________________________________

Date:

Signature: Name: Designation:

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

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Ann 8 List of Logistics Required As far as possible, locally made, easily available, affordable materials should be used by the Persons Affected by Leprosy. However, following is the list of articles, which are required for the care of anesthetic hands, feet and eyes 1. 2. 3. 4. 5. 6. 7. 8.

Tub, water, seating arrangements (cot, stool, platform etc.) Pumice stone or piece of brick, hard scrubber, coconut cover/jute etc. Antiseptic lotion (e.g. savlon) for ulcers (may be required in some) Antibiotic ointment (e.g. soframycin) etc. for ulcers (may be required in some) Cotton, bandage (may be required in some) locally available oil Learning material (illustrations) about self care Photocopies of Government schemes available to Persons with disabilities (to be supplied by Br. Office) 9. Protective aids / appliances like – Goggles/ eye shield 10. Footwear with soft insole and hard sole 11. Insulated utensils (if available) 12. Grip aid, splints etc.

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Ann 9 Activity Plan & Budget for developing “Self Care in villages” S. No.

Activity

1

Meeting of DLO/NMS /PT from DN/Medical officer PHC

DLO /SLO

2

Submission of List of PALs by MO I/C within 0ne month after activity -1 Selection & listing of Persons with disability village wise

DLO/MOI /C

3

Responsi ble staff

Constitution of Team for training DLO etc

5

Training of PHC supervisors oin POD at PHC 10 days prior to POD camp for PALs

6

Training of Health Staff & DLO/MO selected Persons Affected by I/C Leprosy with disabilities at PHC in a care camp

Review meeting ,every month for 2nd quarter and once in a querter for 3rd & 4th querter==8 monitoring meetings

Particulars

Calculation details (INR)

10 Persons

@INR 150 for 10 persons (Tea & Snakes/Lunch)=1500.00

--

DLO

-DN Team & NLR LPA/NMS

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Total (INR)

1500.00

Nil

Nil

Nil

Nil

NMSDN & Supervisors (M/F) from PHC Supervisors responsible for follow up should be trained Facilitators from DN team and NLR team 40PALs ,about15 Staff members

Nil

Nil

40 persons

Wage loss &TA for PALs only@ INR 50x40persons=2000.00 x8=16000.00 Snaks@20x55=1100x8=8800.00 Total for one PHC=24800.00

DLO /MOI/C

4

7

Propo sed month

Tea, snacks @ 50.00 for 15 persons = 750.00 and per diem @ Rs. 50 for supervisors only = Rs. 750

1500.00

(Tea & Snakes) for all @INR50x55x2days=5500

9500.00

Wage loss & TA for PALs only @ INR50x40x2=4000.00 Total for one PHC=9500 24800.00

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S. No. 8

Activity

Procurement of logistics

Responsi ble staff NLR

9

Distribution of MCR footwear & other appliances

DLS/NLR

10

Printing of formats, banner etc

NLR

Propo sed month

Particulars

Plastic tubs dressing material etc

Calculation details (INR)

Total (INR)

Tubs @ INR60x20=1200.00

5200.00

Dressing material @ 200x20=4000.00 Total for one PHC=5200.00 @INR 300x20=6000.00

6000.00

MCR/footwear, Grip aids, Utensils etc for 20 Assessment forms 1500.00 etc

1500.00 50000.00

Grand Total

Arif,SCP100528nlrguidelines_SelfcareatHomeFinal

24