- Case management
- Improving surveillance
- Validate and upscale index case detection and camp approaches for Active Case Detection (ACD) of VL and post-kala azar dermal leishmaniasis (PKDL).
- Increase awareness of established monetary incentives for community health workers and patients, upon diagnosis of VL.
- Training of Indoor Residual Spraying technicians to conduct active case detection for post-kala azar dermal leishmaniasis and VL.
The ACD programme during KalaCORE was rolled out in three phases running over three years, respectively. Before field work began for the first phase roll-out in Bihar, necessary preparations were undertaken, such as village mapping, approvals from the government, liaison with district and block officials and training of front-line workers. During the first phase of ACD in 2016, and over the span of 3 days of field operations, 10 field teams (one person from IPE Global: India and one government staff member) covered 2760 households, equivalent to approximately 14,000 people. Most of the households were situated in very poor communities. 122 suspect cases of VL and PKDL were identified.
ACD activities have provided useful interim data on the duration of illness, PKDL, gender access to services and access of marginalised population. Lessons learnt from the first phase were used to shape the second phase of ACD which took place in 2017 (started in April 2017), and in turn lessons from the second phase were applied to the third ACD phase in 2018.
In conjunction to ACD, KalaCORE has tested and implemented other methods to increase VL case-detection in the communities affected and ensure sustainability of VL awareness in the communities:
- Case searching has also been conducted through the Behaviour Change Communication (BCC) teams of New Concept Information Systemsvia “lay surveillance”. Under this component BCC teams searched for suspected VL or PKDL cases, after health education group session in communities. This was done mainly via asking questions to the communities they interacted with, or by asking community health workers or other key people in the community. The teams were able to identify suspected cases of VL or PKDL and referred them to a Public Health clinic (PHC) for confirmatory diagnosis.
- KalaCORE piloted the “Kala Azar Mitra” (KAM) scheme, where former VL patients or individuals whose family members have been affected by VL, become dedicated champions known as Kala Azar Mitras. They engage in house to house searches for suspected cases of VL or PKDL and encourage diagnostic/treatment seeking. In the beginning of 2017, KAMs were active in 150 highly endemic villages in Bihar and Jharkhand.
- In 2018, KalaCORE initiated a new pilot programme with Community Based Resource Persons (CBRPs). CBRPs are women from villages in marginalized communities, also known as ‘Sahelis’ (friends) of the community, who are trained to be able to identify suspected cases (VL/PKDL) and facilitate access to diagnostic and treatment services.