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Disability Management

Disability Management. SEARO Programme Managers Meeting Jakarta September 23-24 2014. GPELF Progress. 60 countries are implementing MDA 4.9 billion doses delivered to 1 billion people since 2000 15 countries are under post-MDA surveillance

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Disability Management

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  1. Disability Management SEARO Programme Managers Meeting Jakarta September 23-24 2014

  2. GPELF Progress • 60 countries are implementing MDA • 4.9 billion doses delivered to 1 billion people since 2000 • 15 countries are under post-MDA surveillance • 29 countries have reported morbidity management activities

  3. Why manage morbidity and prevent disability? • Integral to elimination programmes • Main reason is to relieve suffering • Patients with clinical and social consequences have a right to health care • May increase community cooperation in MDA

  4. Morbidity management and prevention • Evidence base for interventions • Role of hygiene, secondary bacterial infections • Hydrocele surgery • Foot care programme is • Sustainable • Economically feasible • Acceptable to patients • Effective in reducing • Frequency & severity of ADLA • Improves quality of life

  5. Morbidity Management and PreventionApproaches Lymphoedema • Kiribati: House-to-house education to patients and their relatives by health workers • India: Provision of kits and training of patients • Indonesia and Bangladesh: Self care groups for leprosy and lymphedema patients • Africa: Self-care groups provide opportunities for monitoring & follow-up, building capacity, and empowering participants • Haiti: Hope Clubs • Hydrocele Surgery • Camp approach

  6. Home-based Management • Family home-based care, • family member in training, follow-up and monitoring of the lymphoedema patient • Community home-based care • integrated with services that include care of patients with other chronic diseases • Primary health care system, • integral part of the primary health care system.

  7. What is MMDP? • ADLA, lymphoedema and hydrocoele • Lymphoedema and elephantiasis • hygiene and skin care to prevent ADLA, • proper wound care, • exercise, • elevation of the affected limb • proper footwear • Hydrocoele - surgery • Psychological and social support

  8. MMDP development • WHO 2010 Consultation • WHO Strategic Plan 2010-2020 • WHO Position Statement • WHO April 2013 Consultation • Aide Memoire for Programme managers • Tool Kit • August 2014 Consultation

  9. Management of morbidity and disability prevention (MMDP) VC/IVM Post-MDA Surveillance 1. MDA Mapping MDA TAS Verification Dossier development M&E MMDP and rehabilitation integrated into health services Situation analysis Situation analysis Minimum package of MMDP care 2. MMDP Plan

  10. Goals and aim of MMDP • Minimum package of care • Treating episodes of ADLA • Preventing episodes of ADLA and progression of lymphoedema • Providing access to hydrocoele surgery • Providing antifilarial medicines

  11. An Aide Memoire for National Programme Managers How to build Programmes

  12. MMDP Tool Kit • Situation Analysis • Collect indicators • Strategic Plan • Development and costing • Burden assessment • Options , standardized protocol • Clinical management • Wound care, ADLA referrals, pain management

  13. MMDP Tool Kit • Hydrocele management • Techniques, community health worker • Implementation • Guidelines-clinical and operational • Monitoring • Indicators for minimum package • Evaluation • Assess impact of MMDP

  14. What will success look like?(2020) • Full geographical coverage with MMDP in national programmes in all endemic areas; • Access to basic recommended care for all people with hydrocoele, lymphoedema or elephantiasis • Reduction in the frequency and intensity of episodes of ADLA for people with lymphoedema; • No new cases due to lymphatic filariasis.

  15. Challenges • Lymphedema • Choice of model • Sustainability • Hydrocele surgery • Cost range varies • Techniques vary • Can it be monitored? • Role of Incentives • Social and psychological barriers

  16. Challenges • M & E • Indicators • Input, Process, Impact • Quality of life • Access vs. availability, Usage • Reporting • Formats • Validation issues

  17. An Integrated Approach

  18. Resources

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