Friday, 21 November 2014

Evaluation Summary Session

Back in Delhi, hearing other states reports , discussing the recommendations.

It was interesting to be back in Delhi and to hear about other people’s experiences. Everyone gave their presentations from the states and common themes of undetected cases and no attention to the neurological aspects of leprosy, the medical colleges sadly provide a poor service from which patients default. The ASAHAS are also key people to the efforts in detecting cases and giving MDT. There is a huge urban/rural divide because there are no urban ASHAS. to fill in the health gaps in the urban areas. There has been a huge loss of leprosy clinical skills post integration. The people who are supposed to be running the leprosy service don't know about leprosy and have frequently been transferred from another service. Setting targets for elimination compounds this but this is a smaller part of the picture.

The hotel is uber luxurious, for lunch we had multi cuisine and one could nibble on Japanese sushi. Whilst I enjoyed it I felt uncomfortable and it did not seem a good use of WHO especially when they are short of epidemiologists in the country office.

We did small group work on aspects of the leprosy programme and Suarabh had an innovative analysis suggesting that we should just look at numbers of leprosy cases rather than prevalence bassed estimates people responded to this but I suspect that nothing will change. The quality of the group feedback was excellent and people had done good presentations, and a notable one on IEC was from a chap with a management background. We also discussed leprosy colonies, The health department doctors are offended by the colonies and talk of no more people going into them and closing them, actually the colonies are organic and all different. The national sample survey which would be very relevant to our evaluation is still not yet available and stuck on someone’s desk in the Department of Health, but it needs to be approved by parliament before it can be discussed with the contributors. It is now years since the sample survey was done and the suppression of results reflects badly on the programme.

The feedback meeting was huge with a full ballroom and the dias crowded with dignitaries. Krishnamurthy gave a long but not critical feedback and did not mention the absence of neurological examination. It also did not reflect the range of data presented on Tues from the states or the group work. Concern about the colonies was again expressed. It is possible that there will be new targets for leprosy, one is to detect all patients before disability. Saurabh and I had discussed this earlier in the week. It would be excellent of this could be the new target because it will circumvent the problem of having to detect fewer cases to be successful. I spoke to Sunil Anand afterwards who was disappointed at the lack of mention for a role for NGOs.

It was an interesting experience, I enjoyed being part of the team, It has been very sobering seeing the situation in Rajasthan and then getting the bigger picture for India. I feel that the loss of skills is associated with integration and that the skills from the vertical programme need to be revamped. I am hopeful that we might be able to have a new slogan and that would energise the programme.

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