1. Dr. S.R.S. RANA Dr. V.S. PAL Dr. D.S. BIST (S.L.O.) (STATE COORDINATOR) (EPIDEMIOLOGIST) Prepared By

2. CONTENTS Slide number 1 – Introduction 3 - 4 2 – Health Facilities5 3 – Staff position 6 4 – Staff training status7 5 – Epidemiological development 8 - 10 6 – Indicators 11 - 16 7 – District wise case load17 8 – Major achievement and constrains18 9 – Conclusion 19 10 – Recommendation 20

3. INTRODUCTION - UTTARANCHAL AT A GLANCE Existence on9 th November 2000 Area53484 Sq Km Forest cover34434 Sq Km CapitalDehradun Population9092366 Sex ratio964 fem. : 1000 m. Population density170 / Sq Km (159/Sq Km 2001) Boundaries International--China, NepalNational -- U.P., Himanchal Per capita income> Rs – 14808 /- Source of IncomeHydro power,Forestry,Herbal Tourism, Pilgrim tourism Ores: Lime, Magnesite, Gypsum

4. HEALTH FACILITIES UTTARANCHAL STATE S.N.NAME OF HEALTH FACILITIESNUMBER 1District Hospitals10 2Dist. Female Hospitals6 3Base Hospitals3 4Combined Hospitals14 5Community Health Centers36 6Primary Heath Centers53 7Additional PHCs176 8State allopathic Hospitals325 9Rural Female Hospitals33 10Sub Centers1525

5. CATAGORYSANCTIONEDWORKINGVACANT Medical Officers-M / F 1296 and171999468 Pharmacist70168615 Chief pharmacist17816414 A.N.M.19331719214 N.M.S. (form. NLEP)603228 N.M.A. (form. NLEP)289132157 H.V.34534302 Health educator100802 Health supervisors552417135 Health workers (male)855511344 H.E.O.851471 Computer1257253 D.H.E.I.O.080206 Ophthalmic assistant1179423 A.W.W.66586222436 A.W. Supervisor311197114 STAFF POSITION UTTARANCHAL December - 2004

6. TRAINING STATUS GHS in LEPROSY 3 Days / 1 Day JULY - 2004 82.8% 95% 87.7% 100% 79.3%

7. STATE WISE LEPROSY CASE LOAD - INDIA Source of information -- lea Jul. – Dec. 2004

8. UTTARANCHAL LEPROSY PREVALENCE RATES (/10,000 pop.) DECEMBER 2004

9. TRENDS IN PREVALENCE RATES - UTTARANCHAL

10. 1 - PR--------1.2 2 - NCDR --------1.1 3 - MB Proportion--------45 % 4 - Nr. Of Registered cases--------1,062 5 - Deformity Gr 2--------1.2 % 6 - Child rate--------8.6 % 7 - Nr. of female cases --------323 (31 %) 8 - Treatment completion rate--------90.7 % On Mar.2004 9 - Nr. of patients treated with steroids--------31 ESSENTIAL INDICATORS FOR LEPROSY - UTTARANCHAL (December 2004)

11. 6 YEARS PR AND NCDR TREND

12. 6 YEARS TRENDS CHILD & DEFORMITY PROP.

13. MB PROPORTION YEAR WISE

14. CHILDREN AMONG NEW CASES

15. DISTRICT Dehradun13715351461.061721.25-158.24928.48 Tehri Grl,648309130.2180.2702 11.110527.77 Pauri Grl.747220460.61510.68-047.841019.60 Chamoli395884120.30100.25---0220 Rudra Prg243900130.53090.36-0111.110233.33 Uttarkashi315341120.38100.3101--0330 Haridwar15486014502.904332.79024510.3915636.02 Almora676015090.13080.11---0337.5 Nainital8180561011.23650.7906023.072132.30 Pithoragarh495554250.50230.46---0626.08 Champawat240686140.58210.87---0523.80 Bageshwar267483070.26100.14---0125 U S Nagar13237822141.612091.6502219.585926.94 G.TOTAL909236610621.1610431.1413908.6232330.96 Balance Case Population (estimated) PR Child Rate Child Cases Deformity Cases Gd-2 NCDR New Cases Female Rate Female Cases DISTRICT WISE INDICATORS DECEMBER - 2004

16. CASE LOAD BY DISTRICTS IN UTTARANCHAL AS ON December - 2004 BAGESHWAR 1 % CHAMPAWAT 1% PITHORAGARH 2% NAINITAL 10% ALMORA 1% HARIDWAR 43% CHAMOLI 1% R.PRAYAG 1% TEHRI 1% DEHRADUN 14% PAURI 4% U.S.NAGAR 20% UTTARKASHI 1%

17. MAJOR ACHIEVEMENTS 2004 1.Integration: all Hospitals & Health Centres provide leprosy services 2.High cure rates: 88% MB, 96% PB 3.Uttaranchal likely to reach the target of 1/10,000 (elimination goal) by March 2005 (Note: sustainable services will be needed for new cases for years to come) 4.Counseling given to 40 cases during BLAC, 26 new cases confirmed at Laksar and Narsan blocks in Haridwar District 5.During SAPEL in four blocks of Haridwar District, 87 cases detected 6.IEC in 10 out of 13 Districts of Uttaranchal 7.POD camps: Planned 190, Executed 172 8.SAPEL done in ZERO-case Blocks: only ONE new case detected (Kot block - Pauri)

18. MAJOR CONSTRAINTS 1.Vacancies of GHS staff (MO, NMA,NMS,HEO, Health supervisors) 2.Newly appointed MOs and other staff untrained 3.Printed SIS booklets are still lacking in some HF, they are only using photo copies of sample. 4.Drug management is not up to mark: large proportion of MDT expired February 2005 5.Poor VMT and MOD

19. CONCLUSION  Tehri, Uttarkashi and has more D.G. 2 deformity (but only 02 & 01 cases)  Female rate <25 in Chamoli, Bageshwar, Champawat and Pauri  High PR in Haridwar, US Nagar, Nainital and Dehradun due to increased activity  PD ratio > 1 in Chamoli, Rudraprayag, Uttarkashi, Haridwar, Almora, Nainital, Pithoragarh and Bageshwar  Proportion of MB 44.7  Bit high number of defaulters in US Nagar  Block wise PR 1-2 (14), 2-5 (07) >5 (02)  Expiry of MDT 17.2 % it has to be looked after. MB(A) is going to expire on Feb 05  Guide in health facilities 8.% only  Three indicators calculation at least only in 9.1 % HF

20. RECOMMENDATION – ( MAJOR INITIATIVE TO BE TAKEN DURING -2005 )  Innovative action plan to be made at all level to identify cases in high PR blocks  Action plan to increase the awareness in community by mass media and other IEC  Thorough integration of vertical leprosy staff to GHS  Effective implementation of SAPELs and POD  Very active and effective support by NLR  Strong supervisory tiers to be prepared and trained for monitoring  Training of untrained staff with Reorientation training to all  Urban leprosy plan to be initiated