Chapter 4: IEC Structure, Composition and Activities

4.1 Organizational set up

Intensified Information Education and Communication (IEC) activities were one of the important strategies of the National Leprosy Eradication Programme (NLEP) to raise awareness about leprosy and decrease the stigma attached to the disease, by using large scale local and mass media approaches.

CentreThe Central Leprosy Division under Ministry of Health and Family Welfare provides the

leadership for leprosy control eradication programme to the states.State

At the State level the interventions are undertaken by the State Leprosy Societies/Offices. The State offices are mainly responsible for coordinating the activities within the districts. There is no uniformity in the role and responsibility assigned to the officials dealing with Leprosy at the state level. At the state level the structure is as follows:

Principal Secretary (Medical & Health)

Health Secretary

Director General Of Health Services

State Leprosy Officer & State IEC Officer

Medical Officers

Administrative staff

Staff & Responsibility

The State Leprosy Officer except for Orissa heads all the sample states where the Assistant State Leprosy Officer is the head of the Society. The State Leprosy Officer across the States looks after the planning and implementation of all the activities under NLEP in the State. The State Leprosy officers at Delhi, Tamil Nadu, Maharashtra and Bihar are handling additional charges of other departments as well. In case of Delhi the SLO also looks after the State Programme for hospital waste management as the state Programme officer and in Maharashtra and Bihar the SLO is Joint Director of Health Services and Director of Institute of health and Family Welfare and respectively. Both of them hold the administrative responsibilities for all the other programmes under health department. The SLO in Chennai is basically the Business and Finance officer (BFO-statistics) in the health department and undertakes the leprosy work as an additional responsibility.

1

Other than the SLO the SLSs across the sample states included IEC officers, budget officers, Medical officers, administrative staff members and data entry operators. Assam, Chhattisgarh, Gujarat, Delhi, Orissa, West Bengal and UP have separate officer called the Business and Finance officer.

As regards to IEC officer only few State offices i.e. Chhattisgarh, Gujarat and Orissa had IEC officer who were also in charge for IEC activities all other programmes in the health department. In case of West Bengal the IEC coordinator of the West Bengal State Health and Family Welfare Society was in charge of IEC activities in the State. In rest of the states the SLO is coordinating all the IEC activities along with other staff members.

State societies i.e. Assam, Orissa, Chhattisgarh and Gujarat have appointed epidemiologist and pharmacist, while in Chandigarh and Delhi there is a Medical Officer. However in Assam besides epidemiologist there are two medical officers.

Staff in the State leprosy offices Staff Asm Bihar Chndi* Chttsh Delhi GUJ Jhrk MH Orr TN UP WB

SLO 1 1 1 1 1 1 1 1 1 1 1 1Assistant Director

1

IEC officer 1 1 1 1Medical Officer 2 1 1Finance officer 1 1 1 1 1 1 1 1NMS 1 1 2 4 1 1 1Health workers 2Epidemiologist/Pharmacist

1 1 1 1 1

Statistical Assistant

3 1 2 1 1

Data entry operator

1 1 1 1 1 1 1

Office Superintendent

2

Section Officer 1Logistic Consultant

1 1 1

Leprosy assistant

1 1

Adm Officer 5 2 1 2 2 4 1

Driver 1 1 1 1TOTAL 16 1 8 6 7 11 6 16 8 1 8 3

*District Leprosy society** Senior Supervisors and supervisors

In Gujarat Officer on Special Duty for Leprosy was responsible for all the activities undertaken by the state office; however, the Central Ministry has not sanctioned this post. The societies also have non-medical supervisors, while in Gujarat the society also has posts of supervisors and senior supervisors.

2

Some of the states also had statistical officer to take care of the data related to patients or the prevalence rate of the state. In case of Maharashtra the state has a separate State Leprosy Office and State Leprosy Society. The Business and finance officer and data entry officer sits in the State Leprosy Society office while the rest of the staff members are placed in the other office. In case of the district Leprosy societies the staff included District Leprosy Officer, Medical officers, Non-medical supervisors, supervisors and administrative staff. In Gujarat the DLO in low endemic districts were basically TB officers under RNTCP and were holding this as an additional responsibility (part-time) while in case of high endemic districts the DLOs have been appointed full time for Leprosy division. The state of Chhatisgarh has the IEC officer as the media officer.

Available Infrastructure at the State Leprosy OfficesInfrastructure Asm Bihr Chndi Chttsh Delh

iGuj Jhrk Mah Orr TN UP WB

Rooms 4 N.A. 2 1** N.A. 11 6 N.A. 6 1Table/chairs 16 N.A. 2 2 1 N.A. 45 7 N.A. 7 18TV 1 N.A. 2 1 N.A. 1 1 N.A. 1VCD 1 N.A. 1* 1 N.A. 1 N.A.Cable connection N.A. 2 1 N.A. N.A.Digital Camera N.A. 1 1 1 N.A. N.A.Computer 1 N.A. 2 2 2 2 N.A. 17 3 N.A. 3Printer N.A. 2 2 2 N.A. N.A. 2 1Internet connection

1N.A.

1 1 2N.A.

7 2N.A.

2 1

Projector N.A. 1 1 N.A. N.A.Telephone 1 N.A. 1 1 2 2 N.A. 7 2 N.A. 2Fax 1 N.A. 1 1 1 N.A. 1 1 N.A. 1 1Public address equipment N.A.

1N.A. N.A.

Laptop N.A. 1 N.A. N.A.Photocopy machine N.A.

1 1 1N.A. N.A.

1

Tape recorder 1 N.A. N.A. 1 N.A.N.A: Data Not Available * Not functional ** A cubicle

Infrastructure

In Delhi, State Leprosy office is a small cubicle within the office of Directorate of Health Services. Similarly the Assam SLO is also located in the office of DHS. In the state of Gujarat the SLO is located in Gandhinagar within the Office of Commissionerate of health services.

On a floor, SLO, DDHS and Ophthalmologist share a big room in WB. Other officers share the common lobby.

Delhi and Chandigarh State Leprosy Offices are well equipped as regards to the infrastructure available. Most of the state offices have the basic facilities such as telephone, computer with internet connection and fax. Some of the State offices have better facilities i.e. digital camera, tape recorder, laptop and connectivity within the state and district offices through Virtual Private Network (VPN), photocopy machines and public address system i.e. loudspeakers.

3

Bihar, Jharkhand & TN have neither the basic infrastructure available nor any other equipment. None of the State offices has any separate IEC division or office.

Training: IEC as a component

Most of the states and the central authority conduct trainings with a small component of IEC while some other issues remain the main focus. During the past two-three years the Ministry has not conducted any specific training on IEC.

In Chhattisgarh and Jharkhand, the IEC components are discussed during the regular meetings only while in Maharashtra and UP the officers are not exposed to any IEC activities.

In Assam the State leprosy Society had organised a workshop with the District Leprosy Officers, Zonal Leprosy Officers and the district nucleus staff in 2007 that had a component of IEC, however the SLO had never attended any specific training for skill building in IEC activities.

Similarly the MO in Chandigarh had attended numerous workshops and had organised trainings for doctors, ANMs and other paramedic staff but did not attend any training for IEC.

In Delhi the State Leprosy Officer had attended a training programme on IEC related to health issues at University of Sydney in Australia in 2002. The SLO himself is providing training to the district officers. The district officers attend regular meetings on IEC initiatives.

The DLOs in Gujarat had attended trainings and workshops where IEC had been one of the components however none of them had attended any specific training programme for IEC activities. They organize some informal trainings on proper usage of IEC materials for their staffs, village level workers and NGO workers once in a while.

In Orissa the Lepra Society had organised training programme and also developed posters. The SLO in West Bengal had organized a training programme for the NGOs and for the district level officials. The society had also conducted several trainings on usage of IEC materials. The officials attended only one training to expand the coverage of IEC activities.

According to the SLOs, no separate training was organized in UP, TN and Maharashtra for skill building however IEC activities were s a part of training programme for medical officers and other staffs.

IEC Action Plan

The Central Leprosy Division prepares a guideline for all the activities undertaken both at the national level as well as the state level. According to it, the messages through IEC should reflect:

Complete curability of the disease with MDT Availability of free treatment from all Health Facilities Availability of Reconstructive Surgery for rectifying deformities Removal of stigma surrounding leprosy and Not to discriminate leprosy patients

Mass media and outdoor & rural media should follow: Mass media activities should be carried out from the central level

thorough Prasar Bharati

4

Rural and outdoor media should be carried out at state level or at district level

IPC will remain the main means of communicationFor all these activities CLD is designated to issue specific action plan with budget norm

for each state. The target area of the action plan includes: Endemic districts Endemic urban localities Districts showing high disability rate States with high child proportion

All the State offices follow the same guideline to prepare their own action plan with specific modifications as per regional requirements. Similarly the district action plans are designed at the state level, following the same guidelines. At different levels of implementation, the action plan remains the same. But the implementation depends upon the area covered, degree of mass awareness, prevalence rate of the districts, accessibility of health services etc.

During the study most of the States and the respective districts had the readily available action plan for the years 2005-06 and 2006-07.

In most of the states, the State Leprosy officer in consultation with other staff members has designed the IEC action plan. The district leprosy societies in Assam have prepared annual action plan and the IEC action plan on the lines of the guidelines provided by the Centre. In Kamrup district the Zonal Leprosy Officer, non-medical Supervisor, medical officer and non-medical assistant were involved in preparation of the action plan and in Nalbari district the Joint Director of DHS in association with the non-medical supervisor formulated the action plan.

The district leprosy society in Chandigarh has prepared IEC action plan for the years 2005-06 & 2006-07. The plan is totally based on the guidelines issued by the central leprosy office. The staffs of the district office have designed the action plan. The area wise prevalence rate and rate of migration are some of the considerations that were considered while designing the plan.

In case of Chhattisgarh the state is following the central plan but the officers from the State office were involved in preparation of the national plan.

The Delhi State Leprosy office designs the state action plan and IEC action plan in consultation with the district level officers. The State office itself designs a uniform plan for the entire state and all the districts follow the same with some minor modifications. Considering the prevalence rate and degree of endemicity of the districts the IEC action plan is designed at the national level. The other factors that are considered are awareness level of general people and the target audience.

The DLOs of New Delhi & South Delhi districts informed that their offices have been following the plan provided by the state office. New Delhi DLO also added that during the quarterly meeting the action plan for the districts is discussed and based on the information available the plan is designed. However both the SLO and DLOs confirmed that they do not follow the plan exactly as it is on the papers. The South Delhi SLO opined that though hoardings are important component of the plan but due to ban on hoardings in Delhi more emphasis is given to IPC and meetings.

The state leprosy society, Gujarat has prepared the annual action plan as well as the IEC action plan. The state leprosy officer, State IEC office and the officer on special duty for Leprosy were involved in this process. The action plan contains the detail budget for all the activities and the list of activities to be conducted by the districts. Besides, the district leprosy societies in

5

Ahemdabad and Bharuch have also prepared their own IEC action plans. The DLOs informed that the prevalence rate and the awareness level among the population and the target groups are some of the major considerations. Both the state and the district societies follow the guidelines designed by the central leprosy division.

In Jharkhand the SLO informed that they had prepared the action plan as per the requirements of their state. Though the plan was sent to the central ministry for approval the budget was sanctioned as per the fixed guidelines (financial) for the states. While preparing the plan this society had involved the DLO in the process. Target groups and the prevalence rate were the major considerations.

In Maharashtra the state leprosy officer had prepared the IEC action plan in consultation with Assistant Director of Health Services (Leprosy) working at H.Q, the concerned technical staffs & staffs at the district leprosy office and consultants from different NGOs e.g. ILEP, International Leprosy Union, GMLF, HKNS etc. Various reports and other documents related to prevalence rate were also conferred with. The prevalence rate, the community needs, the target population and the literacy rate were the major considerations while preparing the plan.

Instead of preparing any separate IEC action plan in Orissa state officers follow the guidelines issued by the central authority. Even in case of the district societies the national guidelines meant for the districts are followed.

In TN the SLO prepares the annual IEC action plan in consultation with field officers and the Deputy Director of Medical Services (Leprosy). Like other states, UP officials also follow the guidelines issued by the central ministry. However the final implementation is carried out on the basis of the prevalence rate in the districts.

In WB the IEC coordinator under NRHM had individually designed the IEC action plan for the state office. The plan was for the years 2005-06 and 206-07. The consultant informed that he referred to the earlier reports, reviewed documents and the activity-wise monthly performance reports. The plan contained the details of various IEC activities to be undertaken within the state. In the North 24 Pargana district, the district office had prepared annual IEC action plan separately for the district. The DLO informed that the district non-medical supervisor, doctors from NLEP i.e. CMOs had assisted them in preparing the action plan. He informed that the coverage areas, prevalence rate, knowledge of the target groups and accessibility to health services are the major considerations while designing the plan.

Monitoring and evaluation of IEC activities

There is no direct monitoring or evaluation mechanism for the activities as well as the funds utilized. For the funds the ministry receives a monthly report from the societies and a utilization certificate and audited statement annually. As regards to activities and especially IEC activities, review meeting are held annually and bi-annually. The impact of the IEC activities is discussed during these meetings and any further recommendations or changes are also discussed.

Most of the states did not have any IEC monitoring and evaluation component built into the IEC action plan. However in the States like Gujarat, Tamil Nadu and West Bengal the district leprosy offices had done some kind of impact assessment on their own. In Gujarat and Tamil Nadu the SSAU, the sample survey assessment unit had conducted the impact assessment in the districts. While in West Bengal the officer in North 24 Pargana district informed that they had done the assessment on the basis the awareness level of the mass.

6

Assam IEC activities carried out in Assam were Spots aired by Prasar Bharati targeted for the general masses. Advertisements in newspapers on World Leprosy Day (30th Jan) Hoardings displayed at the adjacent cities of Guwahati (Dibrugarh, Silchar) Wall writing, IPC, IPC workshop with Medical Officer & Health Officer, influencers and

opinion leaders in the districts Folk show conducted in the urban areas and districts. SLO informed that they have made posters, leaflets and folders for the school children, who are also among the targeted groups. He mentioned some incidences like patients with skin patches coming to health centers for check up after reading the messages in the IEC material, which proves that the IEC initiatives have been creating awareness on leprosy issues.

Chhattisgarh: There is a mass media plan to cater to the major target audience: general public. There are TV spots, Radio Jingles, Slides, Wall writings, Pamphlets, Booklets, Mobile Vans to spread awareness about the disease. According to the official, pamphlets and booklets can be more useful as compared to visual slides. Radio is another popular medium that reaches out even to the illiterate people.

Chandigarh: The major IEC activities include inter personal communication (IPC) and meetings with community members. The Society had organised quiz competition in schools and displayed messages through posters. A rally was also organised within the last two years. In 2003-04 messages were broadcasted through local cable TV and on radio. Articles in health magazines and national newspapers have been published.

Delhi: As per the SLO the focus at present is on the IPC and public meetings. Messages have also been disseminated through poster and wall paintings. Posters were also put up in DTC busses and metro trains (2004-05). Besides the society has organised activities such as half marathon on 2nd October 2005 inaugurated by Delhi CM, rally for school children, quiz competition for school students and their parents, street plays. He also informed that during the annual Health Mela the State Leprosy office put up a stall for free counseling, information and check up. The telephone help line is also used for message dissemination.

In the districts also the main focus is on IPC, community meetings and street plays. The district societies have also conducted quiz competition for school students. In the South Delhi district the DLO informed that since the staff members are also responsible for all the activities of NRHM, Leprosy programmes are not getting much priority.

Jharkhand: Though the State leprosy society extensively used print media for information dissemination but the SLO informed that there is no specific media plan. Prevalence rate of the particular district or area is the only consideration for deciding the IEC activities. The messages have been disseminated through posters, banners, display boards, hoardings, and wall writings. Messages have also been printed on other print materials such as writing pads and notebooks.

7

Gujarat: In Gujarat there is a splurge of activities on World Leprosy Day (30 th

January) and Gandhi Jayanti (2nd October). The society has been publishing advertisements related to leprosy issues in the regional (Gujarat Samachar, Sandesh) and national newspapers (Times of India, Indian Express) since quite a long time.

Apart from event based IEC activities, state leprosy society conducts reconstructive surgery camp where they distribute IEC material and counsel LAPs and their families and relatives. Various formats of IEC material (posters, hoardings, leaflets, pamphlets, scrolling board etc) have been used in exhibition in Health Melas, camps and IEC workshops with DLOs and NGOs organized by SLS. District level societies generally use mid media and IPC than mass media as mass media is a one-way communication. The SLO also added that these societies have concentration in high endemic areas including urban slums and industrial areas. The population of these areas is considered as mass media poverty area.

In Ahmedabad the DLO informed that they use wall writings, hoardings, rallies, folk shows; announcements through loud speakers, exhibitions of IEC (print) material, counseling slide shows depicting pictures of LAPs. In addition, IPC meetings with opinion leaders, IEC orientation camp for Mahila Mandal, Yuva Mandal, AWW, NGO and link workers are also conducted on regular basis. DLS of Ahmedabad had also organized a quiz competition on leprosy related issues in schools and training programme for government and private doctors in 2006. Ahmedabad DLO mentioned that they are planning to give scroll bar advertisement but Bharuch DLS had already started advertising on the local cable television channel. The latter had organized Block Leprosy Awareness Campaign. BLAC is a 1-2 months activity in which intensive IEC activities have been implemented and new leprosy cases are detected and LAPs, deformed patients and their relatives/families are being counseled.

In Tamil Nadu the messages across the state have been disseminated through wall paintings, posters, pamphlets folk dance, street plays, school quiz, and rallies.

Maharashtra: A special media plan had been designed for the IEC activities in this State. The State leprosy officer informed about dissemination of messages through electronic and print media. Scrolling messages appeared on ‘Zee Marathi’, spots on local cable channel, articles published in the Monthly Magazines published by Health, danglers, flipbook, calendar –time table, cloth banners, sun board sheet, comic book, puppet show, street play were all organised for general public or community. Besides IPC and community meetings were conducted on regular basis.

West Bengal: WB took initiative to disseminate knowledge through the satellite television channel TARA News, live-phone-in programmes (both in rural and urban areas), posters and leaflets, quiz competitions in schools, health Mela, Puja pandal stalls, wall paintings, short plays and dramas (both in district and block level) etc. The wall paintings are prototype as they follow the IEC material distributed from the central authority.

Bihar, UP and Orissa do not undertake any IEC activities but they have their own action plans and sanctioned budget for IEC.

IEC implementation partners in the process

8

The ministry has produced all the radio and TV spots through DAVP only. Earlier in 201-2002, Lintas had been involved carrying out varied activities wherein they had produced both radio and TV spots. Through that campaign the agency had carried out pre-test of all the creative. Besides this no research has been conducted for evaluation of IEC activities. Across the State Leprosy societies the SLO along with the team had been undertaking all the activities along with NGOs.

The Medical Officer at Chandigarh informed that their society had been undertaking most of the IEC initiatives on their own. However they had undertaken few IEC activities such as school rallies in collaboration with GLRA.

In the case of West Bengal the NGOS such as ILEP (international Leprosy Eradication Programme), GLRA (German Leprosy Relief Association) and other grassroots NGOs i.e. Balm India and Gracultis have been supporting the IEC initiatives.

According to the State leprosy officer in Chhattisgarh besides ILEP, there are no formal partners as such. Lately, the state has been involving agencies such as Jivodaya Kushth Seva Sansthaan, Vivekanand Kushth Seva Sangh Sansthan, Gayatri Parivaar and Samyak Jan Seva Shikshan Sansthaan to spread awareness among the mass. ILEP has been assisting in making interpersonal communication materials, diagnostic cards, training etc. MITANIN, ANM (Anganwadi Nurse Midwife), Gayatri Parivar Mahila Mandal and Volunteers are appointed to work specially towards spreading awareness about the disease. Target audience constitute of slum dwellers and people living in poverty stricken, unhygienic areas.

In Uttar Pradesh three international NGOs i.e. The Leprosy Mission (TLM), American International Federation (AIFO) and Netherlands Leprosy Relief (NLR) have been supporting the societies interventions. TLM mainly supports in providing capacity building of the staff members, technical support and printing of IEC materials such as posters and other print materials. At the district level few NGOs such as Pragya Mahila Mandal, Ekta Shikshan Sansthan, Raman Foundation and Rotary Club support to conduct awareness campaigns.

The Delhi State leprosy society has undertaken the IEC interventions in collaboration with few NGOs such as TLM. They had broadcasted messages on TV that have been produced by BBC WST and provided by the central authority.

In Jharkhand, except for ILEP (International Leprosy Eradication Programme) there is no other agency supporting the society for its IEC interventions. The District Task Support Team (DTST) at the districts coordinates with the district societies for various activities. However, the NGOs across the state work without any collaboration with the state agency. The SLO perceived that the NGOs hardly work but claim to have done a lot.

In Orissa the Lepra society under one of its programme had provided training and designed posters for awareness generation. There is no other agency to support the state leprosy society for its IEC initiatives.

Budget Allocation: IEC

9

The state leprosy societies receive the Grant-in-Aid from the central ministry. Besides there is no external funding as of now. WHO only provides for monthly expenditure on the maintenance of all equipments and the salary of a data entry operator across the societies. The funding to the societies is more than sufficient rather many of the societies have not been able to spend the allocated money. None of the societies has been receiving the money directly from any other agency.

Budget allocations in the State Leprosy Societies

State2005-06 2006-07

Budget Sanctioned % Spend on IEC Budget Sanctioned % Spend on IECAssam 87,18000 32% 16274784.00 31.6%Bihar 40686432.00 10.12% 4520596.27 0.9%Chandigarh 10,14,000.00 9, 54,000.00Chhattisgarh 14700000.00 49.21% 14700000.00 28.54%Delhi 200000.00 16.5 6161000.00 14.28%GujaratJharkhand 6132222.00 13.8%Maharashtra 25457000.00 50% 27636000.00 22.87%Orissa 42807000.00 27.9% 55956000.00 10.06%Tamil Nadu 14231000.00 29.9% 1957000.00 22.4%Uttar Pradesh 42807000.00 28% 55956000.00 19.7%West Bengal 234,11,000 16.9% 158,66,000 31.3%

States2005-06 2006-07

Total Budget IEC % Total Budget IEC %Assam 93.73 27.95 29.82 98.72 31.63 32.04Bihar 216.59 96.16 44.40 227.56 72.54 31.88Chandigarh 10.14 3.59 35.40 9.54 3.10 32.49Chhattisgarh 129.63 53.21 41.05 131.33 38.43 29.26Delhi 73.58 35.31 47.99 61.61 16.32 26.49Gujarat 117.52 41.39 35.22 155.33 46.70 30.07Jharkhand 167.41 70.77 42.27 177.32 46.82 26.40Maharashtra 201.42 78.00 38.73 268.87 53.11 19.75Orissa 152.18 79.65 52.34 189.37 59.27 31.30Tamil Nadu 142.31 42.55 29.90 195.70 49.90 25.50Uttar Pradesh 428.07 184.77 43.16 559.56 138.54 24.76West Bengal 158.66 49.75 31.36 234.11 39.77 16.99Total 1891.24 763.1 40.35 2309.02 596.13 25.82

But in almost all the states, the Leprosy Societies received their funds for interventions from government of India. But few states such as Jharkhand received additional funding from World Health Organization (WHO) directly whereas the central authority does not mention.

The percentage of budget spent on IEC activities varies from 29.82 to 52.38 in 2005-06 across the states while it was far less in 2006-07 as the percentage ranges from 16.99 to 32.49.

10

The amount spent on IEC at aggregate level had a sharp decline. Interestingly, Assam with lowest percentage in 2005-06 and Chandigarh with highest percentage spent on IEC in 2006-07 have values quite similar.

Problems Faced

Assam: The SLO in Assam informed that the budget allocated for vehicle is too less especially for the hilly areas. In order to address this financial crunch the workers generally visit those places on bicycle. The District Leprosy society in Chandigarh informed that since the leprosy interventions have come under the umbrella of NRHM so the fund allocation has been a problem. She informed that even for designing the IEC materials such as hoardings the society has to receive final approval from the central ministry that leads to lot of delay in final implementation of activities. In addition, the officials generally choose to relax after achieving a small part of the target.

Bihar: As per the information by Bihar State leprosy society, the society has not received any funds for the past two years. He added that since the society has not been able to spend all the money in the earlier years hence has not received any further funds. As a result the society has not been able to do much for IEC.

Jharkhand: The state society faces a major problem with budget allocations. The officer informed that they have never received funds as per their requirement hence they are unable to implement activities according to the plan and are forced to cut down the quantity of IEC materials produced which leads to coverage of limited area. Even the inconsistent receipt of funds creates problems for the society to implement not only IEC but other activities as well.

West Bengal: The society is facing major problem with shortage of staff. Lack of sufficient grant for transportation also put a constraint on the activities. Most restricting problem appears as the curtailed fund from central ministry or other agencies. Other problems are due to lack of skilled professionals, supervisionary lapse due to less amount of money granted for visits. Mobility support from the Centre is 40,000 per year only for one vehicle to visit the entire state. This small amount cannot suffice expenses for driver, petrol and maintenance round the year and thus calls for the supervisionary lapse.

Gujarat: According to Officer on Special Duty (leprosy) the society had been facing problem in developing IEC materials because of lack of expertise in IEC implementation. He added that leprosy supervisors are trained in detecting cases, treatment however they cannot carry and assess IEC activities efficiently. For example, they should know which IEC material has to be used for target population. OSD- Leprosy mentioned that SLS is being given support in providing funds to all the districts but adequate planning at the district level is required. Therefore, capacity building workshop for preparing Annual Action Plan is required for district leprosy officials.

Chhattisgarh: The society in Chhattisgarh informed that most of the times the IEC action plan gets delayed that further leads to delay in implementation of IEC activities. The proposed budget

11

for IEC also gets curtailed and so the society is unable to implement the IEC activities as per the designed plan. The State leprosy officer added that there is no IEC cell in the society. Naxalite problem also restrains them to reach a certain segment of the population.

Orissa: Similar to Chhattisgarh the Orissa State Leprosy Society also complained about delay in receipt of funds which ultimately hampers the implementation of IEC activities. The officer informed that there are no IEC personnels who can specifically design the activities as per the target group. He added that there is need of specific guideline for tribal communities and the prototype they have received from the centre is very old.

Maharashtra: As per the information the budgetary allocation for IEC activities is very less hence the society not able to conduct the activities as per the plans. Illiteracy amongst the tribal population and numerous local dialects also hinder the awareness generation process. Miss conceptions & stigma related to Leprosy is still existence in Rural and tribal areas, but due to lack of funds the society is unable to do much in this front.

Uttar Pradesh: Local dialect/language barrier - the diverse languages and dialect often act as a barrier

because more local dialects mean designing effective and good quality IEC material to make an impact on the general public in large numbers, it is essential that the IEC materials are developed in different dialects which requires efforts and sound technical knowledge.

More priority should be given to sensitizing the district nucleus staff and CMOs so that they can efficiently carry out the project activities especially the IEC activities.

The political barrier as there is much of political drama that goes on in the city hence the IEC posters and banners related to leprosy did not make a significant effect. The State IEC officer explained by saying, “ when one day u put a poster on leprosy on any wall or board and the very next day you will see the poster being replaced by another poster or hoarding of any of the political party or MLA or its agenda and the like. Hence one may not be able to see any significant posters anywhere in the city”.

Suggestions

The policy till date has been to carry out IEC campaigns in the High endemic areas or clusters only. According to the Central Authority, this policy needs to be revamped.

Assam: The suggestions provided by the officials are: IPC meetings should be conducted frequently to cover the total population Importance should be given on local media and local languages or dialects in IEC

materials Different pension schemes etc should be started to stop the leprosy patients to be beggars Cured leprosy patients should be employed in IEC wings Medical colleges/Govt. hospitals should provide operation facilities for deformed leprosy

patients Social Welfare Department should reach out for rehabilitation of the leprosy patients

12

Political leaders, opinion leaders, NGOs, PRIs etc with the help of Health & Family welfare Department should create awareness regarding leprosy in the community

IEC activities should be emphasized to sustain the activities A separate IEC officer is needed to carry out and monitor these activities Amount of fund should be more

Chhattisgarh: There has been no specific IEC training or workshop, but activities are discussed in a more general context. According to the officials, having illuminated posters can be an eye-catching way to scale-up leprosy communication in the area. Advertisement through mass media especially for the remote areas, showing short films on closeness of leprosy patients with common people would be beneficial to remove societal stigma and discrimination.

The problem in allocation of funds is that it is received late. Secondly, a break up of the funds is already provided with the sanctioned amount. Hence, it often becomes difficult to spend the amount according to the needs. The officials felt that more authority should be given to them in terms of deciding the spending pattern, as they are more familiar with the situation and needs of the general public. They also said that a strict and already decided spending pattern hampers the activity restricting their work to the already mentioned criteria.

Orissa: CNA should be conducted in tribal and difficult areas Impact Evaluation of IEC Activities Guidelines should be flexible to accommodate the area specific need. In some areas Active search is required like SAPEL or MLEC (DLO Khurda) IEC activities should be intensified in areas where there is less number of detection of

cases (DLO Khurda). Inclusion of IPC component of NLEP in ASHA Training Program (ASLO Orissa)

Maharashtra: Additional funds are needed for mobile van in tribal area and IEC from school children &

teachers IPC should be emphasized for which experts should be put to block level Active search could reveal the hidden cases IEC activities should be carried out by the local people Release of funds in sufficient amount and in proper time is the most crucial part

Uttar Pradesh Motivation: according to the reports of IEC officer, the most important thing in campaign

against leprosy is the energy, the motivation with which the DLOs and the field staff should carry the message to the community. Since there is still a stigma that persists and especially people at first go will not be willing to listen and to open up with their queries etc. Hence, inter personal communication being the foundation of this campaign, its necessary that the staffs have excellent communication skills and enthusiasm to carry the message forward in a positive node/energy.

Putting the right IEC material at right place- it was reported that as there is much of political drama that goes on in the city, its important that care is taken that the IEC material once

13

placed does not get replaced or overshadowed by the political posters or banners etc. These should be designed in a manner that fosters positivity in thoughts. Earlier posters used to carry similar messages that in turn reinforced the stigma and discrimination and people even hesitated to look at those posters. Along with proper training and good vigilance it’s essential that we make sure the correct placement of correct/right kind of IEC material at right public places.

Sustainability – its essential that the efforts or IEC activities are reinforced at regular repeated intervals. She stressed by saying that “ doing one rally or one school quiz a year in one or two school won’t make much difference. The activities need to be repeated again and again for making a successful sustained effect”. Thus, the campaign should be carried with a missionary zeal.

As reported by the IEC officer, Central Leprosy Division should provide Prototype for IEC materials etc as it used to provide earlier.

Gujarat: They came out with only two suggestions: There should be more advertisement on the local news channels, Academic calendar should be provided with leprosy symbol, slogan and symptoms.

Tamil Nadu: The officials in Tamil Nadu suggested that: IEC activities should get more priorities IPC activities should be more intensified Supervision of IPC and other activities is very important

West Bengal: The suggestions provided by the officials are: Suitable jingles should be made for different target groups and areas Rehabilitation factor should be emphasized through IEC materials to bring the cured

leprosy patients back into the mainstream of life Grant should be sufficient to carry out different IEC activities.

Amount of grant should be fixed after considering few factors like geographical area to be covered, required mobility support, potential to carry out all activities, prevalence rate of the districts etc.

_____________________________________x_______________________________________

14