Training health workers
- Assessment of facility capacity of all endemic districts in Bihar
- Support the training of health workers, upgrading and monitoring of health facilities to provide Single Dose AmBisome to up to 40 district hospitals and up to 100 Public Health Centres across 3 states
- Support the establishment of appropriate "cold chain" for use of Single Dose AmBisome
The roll-out of AmBisome in India was completed in 2015 and led to an increase in the proportion of VL cases treated to 67% in the same year. Within the first 2 months of 2016, increases in cases treated with AmBisome were already observed - at 67% of VL cases treated with AmBisome in Bihar and 98% treated in West Bengal. By April 2017, 100% of all reported cases were treated with AmBisome.
There are currently 169 AmBisome treatment centres in the four VL endemic states – Bihar, Jharkand, Uttar Pradesh and West Bengal. Centres have been upgraded through the provision of ice-lined refrigerators and appropriate training and re-training, or they have been relocated according to needs.
To allow sustainable storage and distribution capacity at the state level a walk-in cooler, able to store 25,000 vials of AmBisome was installed at the state VBD office. It has been working since the end of 2015 distributing AmBisome vials onwards to the districts.
Training Health workers
KalaCORE exceeded its target number of healthcare providers trained from early onto the programme. By the end of 2018, over 41,000 health workers have been trained in total and through a series of KalaCORE-supported trainings in the four VL endemic states of India.
Training sessions have had different formats and have addressed different needs. Over the years, trainings have taken place in conjunction with upgrades or initiation of new treatment centres. They have taken the format of classroom or hands-on training for medical officers, doctors, nurses and laboratory technicians, pharmacists and district Vector Born Disease consultants or others on the detection and management methods of KA, PDKL and VL-HIV. KalaCORE has also led “Training of Trainers” workshops for key doctors from the 4 endemic states to ensure continuity of training and sustainability.
Other training activities have aimed at boosting surveillance in the health system, by training Multi-Purpose Workers (MPWs) and district officials or by sensitising frontline health workers (e.g ASHAs and Anganwari Workers) on the identification of suspected Kala-azar/PKDL.
To develop capacity of the public health system and integrate VL surveillance mechanisms and early response to outbreak, KalaCORE has been working towards integrated coordination between IDSP (Integrated Disease Surveillance Programme), the NVBDCP at the national level and the four VL endemic states of India.
KalaCORE provided Monitoring & Evaluation and skilled Human Resources support into central and state government facilities for capacity building, middle management strengthening and programme monitoring.
- By October 2016, seven M&E experts were seconded: one into the National Vector Borne Disease Control Programme nodal office in New Delhi, one M&E expert under the Jharkhand State Programme and five M&E experts under the Bihar State Programme.
Capacity and skills building of epidemiologists and surveillance officers, project management, monitoring and evaluation and data for decision making within the state level programme were also addressed via:
- The development of training modules for state level epidemiologists and district surveillance officers
- The delivery of in-state trainings to establish robust network of disease surveillance human resources within each endemic state, to ensure elimination.
Three clinical mentoring teams (CMT) were deployed from June 2016, one in Tigray, one in Amhara and one covering the Southern SNNP, Oromia and Somali regions. These teams provide on-site training and coaching to staff involved in VL case management to ensure quality of case management of VL patients. Health workers include medical staff like nurses and doctors, laboratory staff and health officers.
A range of additional training of health staff has been organised and co-facilitated by KalaCORE, CM teams and run by the WHO. By October 2017, over 1800 health workers have received training by WHO and KalaCORE.
Since 2016 KalaCORE arranged total 25 training and workshop conducted involving senior and junior clinicians. Total 45 medical colleges, 16 district hospitals and 3 missionary hospital were involved in this process besides a special workshop arranged involving dermatological society where senior dermatologist of the country were present. Total 1085 Senior and junior clinicians trained and sensitized in the period.
After this activity, the clinicians of some trained medical colleges already strated providing management of VL cases where previously no management record found. Dermatologist are now more concern on PKDL. Some of the cases confirmed diagnose as PKDL and treated by the concern dermatologist liaison with NKEP.
By April 2017 and after being trained and sensitized by KalaCORE teams, tertiary level health facilities introduced VL treatment fully.
Please visit http://kalacorebd.com/component-2/ for more information.
In 2016, training modules and materials were developed, and field level training started as well. Since then, over 28,000 health workers have been trained in VL and PKDL related issues, such as identifying and referring suspected cases to UHCs, screening for VL and PKDL and managing them clinically, and delivering IEC/BCC interventions. Training has addressed clinicians working in medical colleges and tertiary level hospitals in endemic areas, private practitioners and informal healthcare providers, as well as frontline government workers, NGO health workers, and other community leaders such as high school head teachers.
Sensitization of the community through KalaCORE supported IEC/BCC interventions is estimated to have directly covered over 2.2 million and indirectly reached over 10 million people from 2016 to 2018.
Community members have been reached at monthly grassroots government led meetings, via school activities (e.g wall painting) or during school awareness programmes. Other BCC activities at endemic areas included screening of a purposely developed docudrama, participatory Gazigaan (local folk song) sessions, and the distribution of materials with information on VL – e.g. handouts, penholders, posters installed in strategic places like pharmacies or local health providers’ chambers.
Please visit http://kalacorebd.com/component-4/ for more information.
In January 2015 KalaCORE together with IMA launched an emergency response for VL in South Sudan. Two mobile teams were formed and have since been conducting health facility visits to prove ad-hoc support to health facilities all over the country. Teams have travelled to inaccessible areas, often completing their journeys on foot.
KalaCORE has been supporting health facilities by procuring drugs and diagnostics, providing basic equipment and light refurbishment, and conducting clinical mentoring visits for health providers. Drugs capable for the treatment of VL patients have also been procured and distributed, with a buffer stock kept for rapid response.
As of October 2018, 46 facilities in VL endemic states have been actively supported by KalaCORE, including facilities re-activated and upgraded. In most facilities at least one person has been trained in the last year, rapid tests and first line drugs have been available with no stock ruptures in last 3 months and VL guidelines, SOP's have been present in treatment wards and laboratories operating at basic GLP standards in place.
An estimated total 1,392 health workers have been trained from January 2015 to October 2018 - either on an ad hoc basis by the clinical mentoring teams during visits to remote health centres or at formal, central trainings in Juba. KalaCORE supported IMA emergency health teams conduct training in the health facilities in the remote areas for frontline health workers. Training workshops in Juba have been organised by KalaCORE in collaboration with Ministry of Health, WHO and MSF. Training has also been given to senior health workers as ‘Training of Trainers’. Senior health workers do cascade mentorship of the other staff in their respective health facilities. Training has also been monitored and evaluated. Pre-and post-training tests in Juba have been showing a good improvement in test scores.
Three clinical mentoring (CM) teams were formed in June 2017 for the provision of on-the-job training and mentoring on VL case management at health facilities, stock management and support for surveillance. CM teams have been instrumental to VL care delivery via supervisory visits. In addition to the training of health staff of multiple health cadres (e.g. medical, laboratory staff, pharmacists), reporting and checking drug stocks and supplies, CM teams have also actively encouraged community engagement through the training of health promoters and participation in activities like radio programmes on VL.
VL care provision has often suffered in Sudan due to high staff turnover in facilities. In response KalaCORE has been providing ongoing training of health providers - health workers at refugee and IDP camps, medical staff (medical doctors, medical assistants, nurses and lab techs) at health facilities, senior medical doctors, and separate laboratory training. Training materials and delivery have been developed through inter-agency cooperation, coordinated by KalaCORE and WHO and including Federal Ministry of Health, the University of Gedarif, Institute of Endemic Diseases, DNDi and MSF. By October 2018 over 2,000 health workers have been formally trained.
Comprehensive health facility assessments of 36 facilities in Sudan were conducted at the start of the programme in 2015 and results from these assessments were used to guide facility strengthening, provision of basic equipment, drugs and diagnostics and training plans.
By 2016, each of these facilities had received equipment and a key trained contact person was nominated. Meanwhile, 23 clinics began to provide decentralized VL services in camps for South Sudanese refugees and internally displaced persons (IDPs) in the White Nile, South Kurdufan, North Darfur and South Darfur states. Seven new treatment centres (4 in Red Sea state and 3 in Kassala state) were established by March 2018 and rehabilitation of 2 VL wards in Gedarif teaching hospital and in Gedarif paediatric hospital was also initiated.
By October 2018, each of the VL treatment centres supported by KalaCORE and WHO, had at least one person trained in the last year, rapid tests and first and second line drugs available with no stock ruptures in last 3 months, VL guidelines and SOP's present, wards and a laboratory with basic standards in place.
Health facility strengthening has been largely facilitated by the clinical mentoring (CM) teams and the creation of a “Kala-azar hotline”. The CM teams have been visiting facilities to give on-site training, bedside monitoring and help address drug and diagnostic kit supply gaps, while the “Kala-azar hotline”, accessible 24/7, provides advice via mobile phones and immediate support for health personnel managing patients under treatment to.
Also, of note was the establishment of the Kala-azar Research Centre (KRC) in 2016. It is the first such centre on VL research allowing for the formation of collaborations between the University of Gedarif (UoG)(Sudan) and the University of Gondar (Ethiopia). KalaCORE M&E activities and studies on understanding access to VL care have been conducted there.