disability management
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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 - PowerPoint PPT PresentationTRANSCRIPT
Disability Management
SEAROProgramme Managers Meeting
JakartaSeptember 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• 29 countries have reported morbidity
management activities
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
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
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
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.
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
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
Mapping MDAPost-MDA
Surveillance1. MDA
2. MMDP
VC/IVM
Situationanalysis
Plan Minimum package of MMDP care
Situationanalysis
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MMDP and rehabilitation
integrated into health services
M&ETAS
Management of morbidity and disability prevention (MMDP)
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
An Aide Memoire forNational ProgrammeManagers
How to build Programmes
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
MMDP Tool Kit
• Hydrocele management– Techniques, community health worker
• Implementation– Guidelines-clinical and operational
• Monitoring– Indicators for minimum package
• Evaluation– Assess impact of MMDP
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.
Challenges
• Lymphedema– Choice of model– Sustainability
• Hydrocele surgery– Cost range varies– Techniques vary– Can it be monitored?
• Role of Incentives• Social and psychological barriers
Challenges
• M & E– Indicators• Input, Process, Impact• Quality of life
• Access vs. availability, Usage• Reporting– Formats
• Validation issues
An Integrated Approach
Resources