original plan -rdpp
TRANSCRIPT
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 1/24
RENAL DISEASE PREVENTIONPROGRAMME
(RDPP)
DEPARTMENT OF HEALTH SERVICESNORTH CENTRAL PROVINCE
SRI LANKA
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 2/24
& DemographyThe North Central Province consists of two districts namely Anuradhapura
and Polonnaruwa and it is located 200 km away from the capital Colombo,
towards the North. It has a land area of 10,258 sq.km and is the largest
province in the country, with a population of 1.1 million as estimated in 2002.
The land area of Anuradhapura district is about 6861 sq.km and is thelargest district in Sri Lanka, consisting population of 800,000. The Land
area of
Polonnaruwa district is 3332 sq.km and consists a population of 310,000.
The North Central Province lies between altitude 8´ and 9´ in North and
longitude 80´ and 81´ in East. The minimum temperature in the province isgenerally 20 C0 in January and February and maximum temperature is
around 30 C0 during the months of May and August. The mean annual
rainfall ranges from 1500 mm in the East and 2000 mm in the West. Much
of it depends on the North East monsoon rains between November and
January.
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 3/24
About 90% of the people of the community live on cultivation and
another 5 ± 6% of the community is engaged in permanent jobs in
the province. Out of the community engaged in farming, nearly40% of them work as casual laborers to assist agricultural activities.
As a result they were exposed to heavy usage of artificial fertilizer
and pesticides. Most of the people in this province are exposed to
severe evaporative conditions in their open lands due to the nature
of work they get involved in dry climatic condition.
Even though the province has more than 3000 tanks, only a few
tanks are used as sources of safe drinking water. And the coverage
of the provision of the pipe born water is about 35% in the
province. The average intake of safe drinking water is also a
serious factor under dry climatic conditions. Malaria was the
leading disease of this province, in the past few decades andsubsequently very potent insecticides such as DDT & Malathion
were used in the control measures.
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 4/24
SITUATION ANALYSIS
The cases of Chronic Renal Failure are progressively increased over last 10 years in Sri
Lanka. Out of the cases of Chronic Renal Failure reported in Sri Lanka, more than 60% of
the patients were from the North Central Province. The burden of managing those patients
were reflected mainly to the Nephrology Unit, General Hospital Kandy and the National
Hospital, Colombo Sri Lanka.
Over last 3 ± 4 years the cases reported, due to Renal diseases NCP were ranked second
only to the cases of poisoning. Even though the number one cause of hospital death in NCP
was due to poisoning, the leading disease causing death was, Chronic Renal Failure
(CRF). The Renal Disease being the number one killing disease in NCP. This disease
condition is more crippling the lives of the community than any other Medical condition.
Usually the patients of Renal Disease are detected late in the disease spectrum. As a resultthe medical management involved in the Renal Disease has become complicated. At the
terminal stages of the illness the treatment is extremely costly and it is almost unbearable to
the patients.
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 5/24
Diagnosed patients of CRF attending clinic / Hospital in Anuradhapura district
No Division Name Hospital
Date of
Registration
to the Clinic Address
Diagnosed at
(Name of the
hospital)
1 NPC P. Santha 24.03.2005 Puwarsankulama GH - Anuradhapu
2 NPC C.R. Karunawathi 16.07.1998 Railway Town , Medawachchiya GH - Anuradhapu3 NPC Thegis 18.12.2004 Paniyankadawala GH - Anuradhapu
4 NPC P. Seelawathi RH Parasangasw 26.05.2005 Siyabalagaswewa , Parasangaswewa GH - Anuradhapu
5 NPC A. Senarathna 09.06.2005 Peragoda , Parasangaswewa GH - Anuradhapu
6 NPC E. Siripala 29.01.2004 Paniyankadawala GH - Anuradhapu
7 NPC S. Premawathi 21.04.2005 Siyabalagaswewa , GH - Anuradhapu
8 NPC S.P.Ariyarathne RH Willachchiya 20.05.1999 No.27,Ulukkulama,Pemaduwa GH - Anuradhapu9 NPC B. Menikhamy 07.09.2000 No.282,Left Bank,Mahawillachchiya GH - Anuradhapu
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 6/24
Cases of CRF in Sri Lanka 1996 ± 2003 (Cases/ Deaths)
Year Anuradhapura Polonnaruwa Sri Lanka
1996 745/136 176/31 5475/870
1997 746/119 283/28 4827/992
1998 1102/138 288/51 5526/1042
1999 1267/167 341/47 6194/1095
2000 1354/202 345/39 5841/1035
2001 1405/184 395/41 6113/1075
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 7/24
j l =. vqf r da. Sk ai y ur Kj d¾; d dol l r . k susk a&
Colo bo Matale Kurunegala Puttala a Anuradhapura Polonnaruwa
Cases C/D C/D C/D C/D C/D C/D
2002 1069/30 70/4 461/120 112/8 1880/136 780/82
2003 882/274 141/11 305/57 118/12 2212/143 808/98
2004 1203/302 150/12 380/62 124/17 2980/157 860/96
2005 1470/402 153/11 391/64 135/22 3021/183 890/94
2006 1520/507 156/14 412/76 148/31 4820/220 970/110
2007 ot
available
ot
available
ot available 151/30 5430/234 988/112
2008 ot
available
ot
available
ot available 156/34 5836/253 1117/108
2009 otavailable otavailable ot available ot available 6432/281 1207/112
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 8/24
Occupational DistributionOccupational Distribution
CategoryCategory NumberNumber %%
FarmersFarmers 174174 56.3[71%]56.3[71%]
House wifeHouse wife 2929 9.49.4
LaborsLabors 1515 4.94.9
Business PeopleBusiness People 0505 1.61.6
CarpentersCarpenters 0505 1.61.6
Post manPost man 0303 1.01.0
GramasewakaGramasewaka 0202 0.60.6OthersOthers 1313 3.93.9
Missing data'sMissing data's 6363 20.420.4
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 9/24
Geographical DistributionGeographical Distribution
DSDDSD NONO %% DSDDSD NONO %%Mada,yaMada,ya 5353 1717 KabitigoKabitigo 99 33
NPCNPC 4848 1616 RajangaRajanga 99 33
NPENPE 2020 77 RambeRambe 99 33
Kahat,yKahat,y 1919 66 TabutteTabutte 99 33PadaviyPadaviy 1616 55 HorowpHorowp 66 22
Gal,wewGal,wew 1414 55 PalagalPalagal 55 22
GalnevGalnev 1212 44 KekirawKekiraw 44 11
Noch,mNoch,m 1212 44 IpalogaIpaloga 22 0.50.5
TirappaTirappa 1212 44 MahawilMahawil 00 00
MihintalMihintal 1111 44 Out sideOut side 1515 55
TalawaTalawa 1111 44 MissingMissing 1313 44
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 10/24
CRFCRF Hospital Death and live dischargesHospital Death and live discharges
2001 General Hospital2001 General Hospital -- AnuradhapuraAnuradhapura
0
100
200
300
400
500
600
700
800
900
1993
1994
1995
1996
1997
1998
1999
2000
2001
Live Discharges Deaths
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 11/24
Number of Cases & Death of CRF in Sri Lanka 2000
0
1000
2000
3000
4000
5000
6000
7000
Colom
bo
Matale
Kuruneg a
la
Puttalam
Anuradha
pura
Polon
naruwa
Sri Lanka
No of Cases
& Deat
Cases
Death
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 12/24
Cases of CRF by Age
Age
No %
0-10 00 00.0
11-20 04 1.3
21-30 29 9.4
31-40 57 17.4
41-50 73 23
51-60 73 23.6
61-70 51 16.5
71-80 10 3.2
Data not available 12 3.9
Total 309 100
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 13/24
2. Survey and Studies conducted
At the National level out of the cases of CRF reported at National
hospital Colombo and the General hospital Kandy about 34% of the
patient sought treatment were from the North Central Province. This
alarming sign was reflected over the authorities in the NCP and
motivated to intervene this health problem.The health authorities of the NCP along with the National Water
Supply & Drainage Board (NWSDB) Anuradhapura were
conducted an initial consultative meeting in order to draw the
attention and make proper interventions in 2003. In the scenario the
Nephrology unit of General hospital Kandy and the university of Peradeniya joined hand in hands with the health authority of NCP
and conducted a survey in the divisional secretariat division of
Madawachchiya in 2003.
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 14/24
The survey was carried out from house to house by checking the
urine for protein using salicylic method and 300 people were
screened and 200 became positive for urine protein. Out of these
positive cases, 5% of the people showed the early signs of Renal
Failure in Ultra Sound Scanning, which was carried out, in the same
DS Division as a part of the survey. As a conclusion about 4% of the
people were positive to show early signs of Renal Failure.
Subsequently selected population was screened in the divisionalSecretary division of Padaviya and Madirigiriya and showed the
positive figures as 6.7% & 8% respectively. These two revealed
figures alarmed the Health Authorities further to motivate activities
to combat this disastrous condition, which is hidden in the
community at present. As the study reveals in year 2006 the disease,community will be increased by 15% in the Province.
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 15/24
The majority of the community in North Central Province consumes water either from
surface water collections (tanks) or from shallow wells. Another minority uses tube wells
as the sources of drinking water .Agriculture being the main occupation in this province
invariably the community get exposed to high concentrations of Agrochemicals and
various artificial fertilizer. In addition to the direct expose to these chemicals, the water
sources get contaminated with these chemicals and accounts for human ingestion.
Due to the scarcity of the sources of safe drinking water in the province, the community
has to collect water from distance in the process of collection and storage of the water.
The majority of utensils used in these purposes are made out of Aluminum, which are at
substandard quality as far as the health standards are concerned. Some of the utensils aremade out of Aluminum discarded from the automobile trade too. The possibility of
contamination of Lead cannot be excluded.
Subsequently the Medical care needed for these people was felt and a new Renal Care
Unit was established at the District Hospital Madawachchiya. Currently there are nearly
500 patients attend to this clinic following the early identification of signs of Renal
disease.
When identified early, it is possible to manage these patients to avoid the secondary
manifestation of this disease. Also it enhances well-being of the patients. The limitations
in the curative care facilities at the General Hospital Anuradhapura is most felt as this
the only Hospital available with tertiary care facilities in the entire province.
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 16/24
Patients with early
signs of CRF
Chronic Kidney Disease
(CRF)
Patients not
detected yet
Healthy community
Renal Research & Survey
Clinical studies
(Facility improvement)
PaPatho/Histo logical post
Mortem
Community
BasedSurve s
Improvement of the
Secondary Care
Drugs/Human Resource
Investigation facilities BuildingsDivisional / General Hosp.
Social
welfare
Improvement of the
Tertiary care
Dialysis facility
expansion
(Buildings/HR/Equip.)
(Drugs/Reagents/Recu
rrent cost)
Early Identification &
Follow up (Screening)
(Secondary care)
Prevention / Avoidance of risk factors diseasesmagnitude
(Health Education/Media/Sign Board)
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 17/24
No Activity Cost Responsibility
7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12
1
Requisition of revised drug & reagen t estimates for 2005 for
selected divisional Hospitals in Anuradhap ura District -
PDHS/DPDHS
A'pura
2
Requisition of revised Drug & reagent estimates for 2005 for
selected divisional Hospitals in Polonnaruwa District -
PDHS/DPDHS
Polon'ruwa
3
Provision of Laboratory Equipment to selected ho spitals in
Anuradhapu ra District -
PDHS/DPDHS
A'pura
4
Provision of Laboratory Equipment to selected ho spitals in
Polonn aruwa Districts -
PDHS/DPD
Polon'ruwa
1
Requisition of Human Resources for selected hosp itals in
Anuradhapu ra District -
PDHS/DPDHS
A'pura
2
Requisition of Human Resources for selected hosp itals in
Polonnaruwa District -
DPDHS
Polon'ruwa
2008
Out put - 1.1 Strengthened Drug avail abil ity Investigation facili ties
Out put 1.2 Adequate Human Resource available
20072006
OBJECTIVE NO 1. Reduced incidence of CRF in NCP
1. Intermediate Objective - To improve the Secondary Care Facili ties at selected Divisi onal Hospitals
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 18/24
1Requisition of revised drug & reagent estimates for 2005 forG.H. Anu radhap ura MS GH - A'pu ra
2
Requisition of revised drug & reagent estimates for 2005 for
G.H. Polonnaruwa
MS GH-
Polon'ruwa
3 Provision of Laboratory Equipment to G.H. Anuradhapu ra MS GH - A'pura
4 Provision of Laboratory Equipment to G.H. Polonnaruwa
DPDHS/MS
GH- Polon'ruwa
Total
1 Provision of 08 Haemodialysis Unit to G.H. Anuradhapu ra 16,000,000.00
MS
GH - A'pura
2 Provision of 02 Haemodialysis Unit to G.H. Polonnaruwa 4,000,000.00
DPD/MS
GH-Polon'ruwa
3 Provision of 02 water Treatment Plant to G.H. Anuradhapu ra 3,000,000.00 MS GH - A'pura
4 Provision of 01 water Treatment Plant to G.H. Polonnaruwa 1,500,000.00 PD/DPD/MS
5 Establish ment of a Rena l Care & Research Centre at Provincial level 150,000,000.00 PD/MS
Total 174,500,000.00
1
Renovation and Conversion of ICU to Haemodialysis Unit at
G.H. Polonnaruwa 6,000,000.00
DPD/MS
GH-Polon'ruwa
2
Extention o f the building of the Haemodialysis un it at
G.H. Anu radhap 2,000,000.00 MS GH - A'pura
Total 8,000,000.00
2.Intermediate Objective - Renal Care facilities improved at General Hospitals
Out put -2.3 Improved Infrastructure Facilities
Out put 2.1 Secondary Care Facilities Strengthen
Out put -2.2 Tertiary Care Facilities Strengthen
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 19/24
1 Requisition of Human Resources for G.H. Anuradhapura MS GH - A' pura
2 Requisition of Human Resources for G.H. Polonnaruwa District
DPD/MS
GH - Polon'ruwa
Sub Total 182,50 0,000.00
1
Conduction of Screening Clinics at Divisional levels in
Anuradhapura Districts RRT/DPD A'pura
2
Conduction of Screening Clinics at Divisional levels in
Polonnaruwa Districts
RRT/DPD
Polona'ruwa
3 Strengthen the SMI to Screen students for Proteinuria DPD A'pura/Polo
Total
Out put -3.1 Patients wi th early signs of CRF identifi ed
Out Put 2.4 Adequate Human resource avail able
3. Intermediate Objective - Strengthen the early identification of Renal disaese
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 20/24
1
Construct ion of Clinic Buildings with Inve stigat ion Facilities at
Divisional Hospitals in Anuradhapura District 3,000,000.00
PDHS/DPDHS
A'pura
2
Construct ion of Clinic Buildings with Inve stigat ion Facilities at
Divisional Hospitals in Polonnaruwa District 2,000,000.00
PD/DPDHS
Polon'ruwa
3
Construction of quarters buildings for Health staff at divisional
hospitals in A'pura District 4,000,000.00
PD/DPDHS
A'pura
4
Construction of quarters buildings for Health staff at divisional
hospitals in Polon'ruwa District 3,000,000.00
PD/DPDHS
Polon'ruwa
Total 12,000,000.00
1
Conduction of Programmes on Management update Protocols in
CRF in Anuradhapura District. 50,000.00
2
Conduction of Programmes on Management update Protocols in
CRF in Polonnaruwa District 25,000.00
Total 75,000.00
1
Conduction of Programmes to other Health staff on management of
CRF 30,000.00
DPDHS A'pura /
Polon'ruwa
otal 30,000.00
Sub otal 12,105,000.00
Out put 1.3 Improved infrastructure f aci lities provided
Out put - 1.4 Improved knowledge & skill s on CRF among MOO in NCP
MS / DPD
/A'pura /
Polon'ruwa
Out put - 1.5 Improved knowledge & skill s on CRF among Other HealthStaff in selected Hospitals
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 21/24
1 Preparation of Printed materials 300,000.00
2 Preparat ion and fixation of permenent display boards 270,000.00 3 Production of Audio-Video documentries 25,000.00
4 Preparation of Mobile exhibition s ets 100,000.00
Total 695,000.00
1 Provision of 2 Malt imedia Projecters at dist rict level 450,000.00
2 Provis ion of 2 VCD Players at dis trict lev el 10,000.00
3 Provis ion of flip chart boards a t Divis iona l Leve l 15,000.00
Total 475,000.00
1 Conduction o f Advocacy Programmes for NGOO & GOO 20,000.00
2 Conduction of A dvocacy Programmes for Education Depart. 25,000.00
3 Conduction of Med ia conference at District level 30,000.00
Total 75,000.00
1
Conduction of TOT Programmes to Health/Others staff at District &
divisonal level. 150,000.00
2
Conduction of A wareness Programmes to Community Leaders at
District & divisonal level. 150,000.00
3 Conduction of awareness to School Childern
4 Conduction of Radio Quiz Programme at Divisional Level 200,000.00
5 Conduc tion o f Schoo l Post er/ Es say Competitions 50,000.00
Total 550,000.00
Sub Total 1,795,000.00
DPDHS/HEO
OBJECTIVE - NO 2.Established programme to prevent R enal disease in NCP
Out put -2.1.1 Tools used in IEC/BCC activiti es developed
1.Intermediate Objective - To Improve the K nowledge, attitudes & Practices about the R enal Disease among the Community
PDHS/DPDHS/HEO
DPDHS
Polon'ruwa
Out put -2.1.3 Intersectrol coordination established
Out put -2.1.4 IEC/BCC Programme conducted
DPDHS/HEO
Out put -2.1.2 Equipment / Materials used inHealth Education provided
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 22/24
1 Mapping of water resources in Anuradhapura district
2 Mapping of water resources in Polonnaruwa district
3
Establishment of a water treatment training centre in A nuradhapura
District 25,000,000.00
4Provision of laboratory equipment and cons umables for the watertreatment centre 400,000.00
5 Manufacturing of water filters 2,400,000.00
6 Conduction of training on water treatment t o st aff/community
7 Provision of required filters to the community
8 Establishment of GIS Data bas e on water s ources PDHS/ DPDHS
Sub Total 27,800,000.00
Out put -2.1 Vulnerable water resources identified
NWSDB/WR B &
PDHS
2. Intermediate Objective - To improve the provision of safe drinking water
8/7/2019 Original Plan -RDPP
http://slidepdf.com/reader/full/original-plan-rdpp 23/24
1 E s tablis hm ent o f a web s ite 10,000.00 P D H S
2 P ro vis io n o f in te rn et f ac ilit ie s a t d is tric t le ve l 1 0, 00 0. 00 D P D H S
3 Conduc tion of e-c onferenc e m onth ly DP DH S
T o tal 20,000.00
1 C o n du c t io n o f a m e e t in g t o e s t a bl is h t h e R e n al r e aa e rc h t e a m 5 , 0 00 . 0 0 P D H S / M S
2 C o nd u ct io n o f r ev ie w m ee t in g s o f t h e R e na l r es e ar c h t e am 4 , 00 0. 0 0 P D H S / M S
T o tal 9,000.00
1 P ro vis ion o f ut enc ils f or trans porting s pec im en 5, 000. 00 D P D H S / M S
2 P ro vis ion o f c he mic als f or t he pres erv ation of s pec im en D PD HS /M S
3 R e cr ui tm e n t o f a m e s s en g er f o r t h e t ra n sp or t o f s p ec i m en 2 4, 0 00 . 00 D P D H S / M S
T o tal 29,000.00
1 P ro vis io n o f c he mic als t o t he la bo ra to ry a t G .H . A nu ra dh ap ura M S
2
Provision of equipment to the laboratory at G.H.
A nuradhapura M s
3
Univers ity o f P eradeniya for Im munochemica l invest igat ion
fac ilit ies M S
S u b T o tal 58,000.00
1. In te rm ed ia te Ob jec t ive - Research & Su rvey launched t o f ind the under l ine cause o f CRF
O B J E C T I V E - N O 3 .R e a s e r c h & S e r v e y e s t a b l is h e d t o f in d t h e u n d e r l in g c a u s e o f C R F
Out pu t - 3 .1 .3 Research ac t iv i t ies on Post m o r tem spec im en es tab l i shed
Out pu t - 3 .1 .4 Research on C l in ica l Rena l B iops ies es tab l i s hed
Out pu t - 3 .1.2 Rena l r esearch team es tab l i shed at Prov inc ia l leve l
Ou t pu t - 3 .1.1 Research Oppor t un i t ies adver t i sed