Nepal

Activities

Support for pharmacovigilance in VL endemic districts
  • Case management
Outputs

The revised National Strategic Guideline on VL Elimination Program has recommended various new regimens of anti-VL drugs: Liposomal Amphotericin B, Amphotericin B, Paromomycin and Miltefosine. KalaCORE is supporting the Nepal government with the continuation of VL focused pharmacovigilance (PV) activities in VL endemic districts by collecting data through specially developed forms, conducting routine monitoring and supervisory visits to sites, conducting 6-month follow up and review meetings, and undertaking PV signal analysis and sharing results with the national committee.

Developing a national level IEC/BCC strategy in support of VL elimination
  • Health education
Outputs

A national IEC/BCC strategy has been developed with national stakeholders. The IEC/BCC messages for VL control have been endorsed by government stakeholders, including Epidemiology & Disease Control Division, and the National Health Education, Information & Communication Centre and WHO country office for Nepal.

IEC/BCC materials, including posters, leaflets and flip books, have been produced for training communities in early identification of VL. These materials were developed following a review of the strengths and weaknesses of existing communications materials.

Developing strategic capacity for surveillance, monitoring and evaluation appropriate response to emerging outbreaks
  • Improving surveillance
Outputs

KalaCORE has developed vector control guidelines and drafted VL outbreak response strategies which are relatively advanced and well defined. The programme will be supporting the sustainability and evaluation of the national vector control strategy, and is pushing to finalise broader outbreak response strategies so that the vector control components can be evaluated and enhanced.

VL Surveillance and M&E Officers are currently in place within the national programmes, and plans for capacity building for an outbreak investigation team within the national programme have been finalised.   

Study areas are being selected for intensive monitoring & evaluation of vector control effects at district level as part of entomological capacity strengthening.

Improving case detection of VL and PKDL through the training of healthcare providers
  • Case management
  • Improving surveillance
Outputs

500 health workers in endemic areas will be trained in diagnosis and treatment of VL and PKDL. A full review of current training materials has now been completed, and the programme is working to fill gaps in standard resources. Task-specific training is being provided to female community health volunteers, and clinicians working in public as well as in private health facilities in VL endemic districts 

The programme is in the process of further training to vector control officers and public health officers in active case detection and case-based surveillance strategies of VL & PKLD at district level. 

 

Improve access to diagnosis, treatment and cross-border sharing of information
  • Case management
  • Improving surveillance
Summary

Objectives

  • Improve the existing VL case management regarding diagnosis, treatment and follow up along the Indian-Nepalese border.
  • Establish baseline data on VL patients' cross border movements.
  • Understand health-seeking behaviour of migratory VL patients
  • Develop mechanisms for further and sustained active cross-border collaboration of health authorities in the affected areas.
Outputs

KalaCORE coordinates with WHO and Epidemiology & Disease Control Division (EDCD) to assist with the training of health workers in the use of AmBisome, which arrived in Nepal in October 2015. These trainings were delivered successfully, and as a result, treatment with AmBisome in Nepal is now well underway.

The AmBisome roll-out has resulted in an expansion in access to treatment by marginalised communities residing in difficult-to-reach VL endemic areas.  Results of a recent analysis indicate that, within 90 highly endemic blocks in Bihar, all but 3 blocks were situated within 30km of the nearest upgraded treatment centre.