Bangladesh

Activities

Support National Kala-azar Elimination Programme (NKEP) in better staffing and capacity building
  • Case management
  • Improving surveillance
Outputs

To increase treatment compliance, KalaCORE first seconded clinical and laboratory staff to the Surya Kanta Kala-azar Research Centre (SKKRC) hospital.  Soon after a Logistics and Supply Chain Management Officer was seconded to the NKEP to maintain a central database of drugs, diagnostic kits and associated logistics at UHCs. By April 2017, five Kala-azar Coordinators were seconded at the upazila health centre level to help improve the Kala-azar surveillance system via the improvement of patient reporting and outbreak investigation. A Data Management Officer also started functioning at the CDC, assisting the elimination programme by strengthening the existing surveillance system for reporting and patient follow up. In addition, an M&E manager was also appointed to support monitoring and evaluation who developed a complete M&E system of NKEP including a comprehensive M&E guideline for NKEP

 

At end of the 2018, central level KalaCORE seconded staff (including a medical officer, a M&E manager and one supply chain manager were taken over by the national programme, while all KalaCORE supported staff at the SKKRC including nurse and laboratory technician by icddrb’d.

Please visit http://kalacorebd.com/component-1/ for more information.

 

Supporting training of tertiary level health facilities
  • Training health workers
Outputs

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.

Development of VL outbreak management strategy
  • Case management
  • Improving surveillance
Outputs

Following a collaborative process of workshops and formation of a sub-committee, a guideline for Kala-azar outbreak management in Bangladesh was developed in 2016.

 

As per the guideline, an Outbreak Management Team (OMT) was formed at two levels: i) Central level team and ii) upazila level team. Training of the OMT quickly followed. Since 2016, the programme in Bangladesh has conducted a total of 34 training events involving central level CDC team for 121 upazilas/UHC level. 

 

Since the formation of the OMT, a total of 11 outbreak investigations were conducted.

Please visit http://kalacorebd.com/component-3/ for more information.

Training local health workers and sensitizing the community
  • Health education
  • Training health workers
Outputs

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.

Strengthening surveillance of visceral leishmaniasis
  • Improving surveillance
Outputs

Strengthening of VL surveillance in Bangladesh started with input of national level experts closely reviewing the existent national HMIS surveillance system. The VL web-based system (linked to the national HMIS system) was updated integrating new VL surveillance forms. By April 2017, 91.3% of cases were reported from 84.2% of treatment centres via the VL web-based surveillance system. During this time, zero case reporting was also introduced in the VL web-based surveillance system, which is particularly important during the elimination phase of disease surveillance and for monitoring VL post-elimination. In collaboration and consultation with the communicable disease control (CDC), DGHS and the WHO, VL surveillance was migrated to the DHIS2 system and in 2018 all data were captured electronically (via DHIS2) on a real time basis. Before the end of the programme, tertiary care centres were also included within the DHIS2 system for Kala-azar reporting.

 

A training plan and specific guidelines for use of web-based VL surveillance were also developed. Training covered central level NKEP team members surveillance staff from upazila health complex (UHC) and also included "Training of Trainers" sessions with district level statistical assistants/statisticians.

 

By January 2016, five upazila Kala-azar Coordinators (UKC) supported by KalaCORE, were also recruited and seconded to endemic sub-districts. Each UKC started providing support on early detection of VL/PKDL cases and appropriate treatment but also prompt case reporting. UKCs continuously worked with upazila level surveillance teams (comprised of a Medical Officer, Nurse and a Statistician) to ensure timely reporting into the web-based surveillance system. The government has been working towards the creation of permanent posts to sustain high quality patient management beyond the timeframe of KalaCORE’s support. Key clinical positions have been agreed during this reporting period for handover to national bodies to ensure that they are continued in the long term.

 

Please visit http://kalacorebd.com/component-5/ for more information.