AP Projects
- Introduction
- Goals/Objectives & Activities
- Acheivements
- Case Study & Photogallery
Introduction
Project SAMASTHA-AP is a Community Based Care, Treatment and Support Project being implemented in 5 coastal districts (Krishna, Guntur, Prakasam, East & West Godavari) of Andhra Pradesh with the support from KHPT/UoM/USAID in coordination with APSACS
LEPRA is working with 4 FBOs in the selected 5 districts of AP, apart from setting up & manage 3 DICs (direct implementation) for PLHIV and OVC in 12 Mandals. LEPRA India provides techno and managerial support to community care centres and drop in centres to ensure comprehensive care to PLHIV & OVC |
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Services Provided |
Target Group |
1. Psychosocial Support
2. Medical Care
3. Nutriton Support
4. Advocacy & Legal Support
5. Home base Care
6. Referral Services
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HIV Infected & Affcted |
- Men
- Women
- Children
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| |
S.No. |
Coverage Mandal |
#. Of villages |
District |
Organization |
1 |
Yeleswaram |
18 |
East
Godavari |
SJH * |
2 |
Kotananduru (LEPRA DIC) |
20 |
LEPRA |
3 |
Tuni (LEPRA DIC) |
45 |
4 |
Pedapadu |
17 |
West
Godavari |
DLC * |
5 |
Jangareddigudem |
11 |
6 |
Koyyalagudem |
12 |
7 |
Pedana |
24 |
Krishna |
AH * |
8 |
Manginapudi |
12 |
9 |
Challapally (LEPRA DIC) |
27 |
LEPRA |
10 |
Narsaraopet |
26 |
Guntur |
SXH * |
11 |
Vinukonda |
42 |
12 |
Markapur (DIC by LEPRA) |
22 |
Prakasam |
LEPRA |
Total |
12 |
290 |
5 |
4 CCCs & 3 DICs |
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Goal
To ensure comprehensive, competent, compassionate care in all Community Care Centers
Objectives
To operationalize and further develop national guidelines for comprehensive care, treatment and support interventions in Andhra Pradesh within and from community care centre settings
To develop human capacity & systems for improved continuum of care as per NACO CCC guidelines
- Improve quality of clinical care services
- Consolidate HIV related community outreach with tracked referrals
- Implement Computerized MIS that supports generation of NACO indicators, program planning and measures impact on individuals & families
- Develop an experiential learning site in one CCC
- To engage and develop ownership of Project Samastha with APSACS
- Activities
- Strengthening systems in Community Care Centres
- Capacity Building to CCCs & DICs
- Mentoring support to CCCs
- Technical Support to CCCs & DICs
- Advocacy with APSACS/DAPCU
- Technical Assistance to other CCCs
- Strengthening health systems
- Referrals & Linkages
- No. of PLHA & OVC reached: 2461
Support Group:
Peer sharing, increased confidential level among PLHIV
- Oriented PLHIV on preparation of low cost nutrition food
- Reduced stigma at village level through participation in support group meets and increased in accessing services
- Some PLHIV became role models and educating, bringing other PLHIVs to service points
- Developed internal linkages among PLHIVs – participated in funerals and social functions
- Leveraged resources for nutrition support
- Increased knowledge levels on HIV related health problems i.e TB, ART, Nutrition, seasonal health problems etc.,
- Started savings by Support Group members
- Awareness levels increased on rights
- Initiation of support group meetings had brought a significant change in the attitude of PLHIV towards positive living, reduced stigma, a sense of binding among PLHIV and has developed among peer group. This was also a base for identifying the PLHIV who are in real need and who wants to initiate a small petty business through providing microloans which has enabled PLHIV to live on their own without depending on others. Through effective outreach community was also linked to facility to provide care
Clinical Care:
- Improved health seeking behaviour
- Mentoring support initiated on Clinical care
- The Medical Officers also well trained in all the components (Team training/HIV-TB CO Infection, ) documenting has improved, clinical staging & diagnosis is improved
- Improved Clinical & comprehensive care, systematic data is capturing
- The sequence of care is placed – PLHIVs are benefiting good quality of care
- Training program on Infection Prevention & Stigma Discrimination to whole team of CCC
- IP practices are initiated after series of trainings and established internal monitoring system to monitor practices through IP committee
- Increased CTX prophylaxis, TB diagnosis and referrals has been increased, Cross referrals
- Minor symptomatic cases treated by nurses
- Clinical stages has helped in identifying seriousness of patients and refer appropriately
- Documentation regarding clinical care has improved
CMIS:
- Centralized CMIS
- Good documentation
- Data analysis and linking this program planning
- Able to know the condition of PLHIVs through data
- Good monitoring system for outreach
- CMIS – NACO Report Generating
Other activities:
- Provided technical support to all CCCs & DICs to improve the quality of program i.e. effective outreach systems, ART adherence, quality clinical care, CMIS management once in every two months
- Conducted SAMASTHA CMIS demonstration and detailed the advantages of CMIS & Samastha capacity building modules to 5 DAPCU teams of East & West Godavari, Krishna, Guntur & Prakasam Districts. 4 ADMHOs, 5 DPMs, 5 M&E Officers from DAPCUs
- Regional Manager & Project Coordinator have participated in the Annual Action plan exercise of APSACS for 2010-11
- Regional Manager has gone for CCC assessment in Uttarpradesh & Uttarakhand and Project Coordinator has gone for CCC assessment and assessed the performance of CCCs in Karnataka
RV Chandravadhan, PD-APSACS visited Assisi hospital and had interaction with team of CCC and Samastha. Dr. Karthikeyan and Mr. Rambabu explained about series of capacity building programs followed by mentoring support and CMIS in CCCs through Samastha |
| Key Achievements |
Community Outreach:
- Through Micro Planning tools, tracking of LFU, increase CD4 tests (once in a 6 months), prepare proper action plan to prioritize based on need of PLHIV (priority wheel)
- Increase access to services for PLHIV to ensure continue of care
- Increased ORW to PLHIV ratio from 1:16 to 1:100 simultaneously LFUs within Samastha covered Mandals were reduced from 111 to 12 in last 3 years.
- OVC were linked to Govt schemes like ICDS (255), schools (528) and education support was provided to 749
- 429 young widows were linked to widow pension schemes, 19 were provided housing loans and 72 have received loans.
- Through effective linkages with community and other stake holders an amount of Rs 57,56,016 was leveraged in the form of cash, kind and other support
- Through effective linkages referrals have increased from and to ICTCs, DMC, ART centres, CD4 testing, Govt schemes.
- Through regular home visits, home based care has been provided to PLHIV and community has been linked to facility.
- Through community linkages, project was able to link with social entitlements like widow pensions, housing schemes, loans and improved livelihoods
- Children were benefited through nutrition and education support
- Improving of income sources through micro loans by running small petty trades to young widows
- Confidence levels increased among counsellors to dealt with difficult cases through positive prevention tool kits
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Future plan
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Technical Support to Samastha and Non Samastha CCCs
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Capacity building to Non Samastha CCCs
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Mentoring support to Samastha & Non Samastha CCCs
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Strengthening government health systems
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Advocacy with NACO/APSACS/DAPCU/NRH
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| Case Study |
Emerging Winners – A Story of Unity |
Mr. Shashank (name changed) is a thirty eight year old and hails from Brahmapuram village in Pedana Mandal, Andhra Pradesh. He is married to a beautiful young woman called Ms. Lalita (name changed) and they have two children. The first child is a fourteen year old boy, who suffers from Muscular Dystrophy and is unable to walk, while the second one is a girl, who is studying in the nearby village school.
Mr. Shashank is a weaver by profession and is not very well to do, but together with his wife, they made ends meet and were a relatively happy family. However, his health began to deteriorate, as he would get fever and cough frequently. Worried about the state of his health, Mr. Shashank visited the nearby Government Hospital and tests showed that he was HIV positive. Shattered and upset, he did not know what to do. At a time, when most walk away, Ms. Lalita was a pillar of support to him.
The doctor at the Government Hospital referred Mr. Shashank to the Community Care Centre in Assisi hospital on 5th February 2009 and was registered under Samastha-AP Project. Mr. Shashank met the Samastha project staff for the first time. Samastha is a rural HIV/AIDS prevention, care and support program funded by USAID implemented in Karnataka’s twelve high prevalent districts, three urban centers and five coastal districts of Andhra Pradesh (AP). The lives of many HIV positive persons have been changed through the project’s activities.
Mr. Shashank was admitted to the hospital for two weeks where he underwent various tests to understand his current medical condition. Investigations showed that he was suffering from a co-infection and had abdominal TB. He was then referred to the DOTS center in Pedana for treatment of his TB in the abdomen.
Within a month of starting the treatment, Mr. Shashank’s medical condition started improving. The project also provided him with regular counseling services and nutritional support, which enhanced his recovery. In the meanwhile, the staff suggested that even his wife and children get tested for HIV. As a result, all the three of them were sent for testing and they were found to be negative. |
While Mr. Shashank was recovering his health in hospital, the family began to face a financial crisis, as he was the bread-winner for the house. Ms. Lalita was finding it very difficult to manage the house and the children’s education with just one person’s salary. Thus, they requested for an IGP revolving loan to buy a hand weaving machine for a sum of Rs. 3000/-, which was provided for, by the Samastha project. |
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| Now Mr. Shashank and his wife are working with the new machine and making sarees as well as bed-sheets and selling it in the market. They earn enough to maintain their family and their children’s education is being looked after by the Samastha-AP educational funds. Despite all the turbulence in their lives, this family has emerged as one unit and is grateful to the project for all the support. |
| At the End of Every Long Night, There is Always Dawn |
Ms. Janaki is twenty five years old and her husband is Mr. Bhaskar (names changed). The couple hails from a small village in Pedana Mandal, Andhra Pradesh and have two children. The boy, Sree is five years old and is studying in the first standard, while the girl Anisha, is seven years old and is studying in the second standard (names changed).
Mr. Bhaskar would frequently fall sick and one day, he died. After her husband’s death, Ms. Janaki also began to have recurrent fever and body pain. She was taken for treatment and was diagnosed as being HIV positive at the Government Hospital in January 2008. She was depressed and refused to take any treatment, despite many suggesting that she should not delay it any more.
Ms. Janaki was scared of being stigmatized and discriminated against and as a result, she wanted to keep her positive status a secret. It was around this time, when she first heard of the Samastha project. Samastha is a rural HIV/AIDS prevention, care and support program funded by USAID implemented in Karnataka’s twelve high prevalent districts, three urban centers and five coastal districts of Andhra Pradesh (AP). The lives of many HIV positive persons have been changed through the project’s activities. |
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| The Samastha project outreach workers (ORWs) visited Ms. Janaki in her house. She was very hesitant and did not entertain them. But gradually, as the ORWs made regular visits, she began to trust them. Finally, after immense efforts, Ms. Janaki was ready to break the ice. She agreed to visit the Assisi Hospital, get registered in the Samastha project and started taking treatment. |
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| Ms. Janaki now actively follows up her medication and has become a member of a support group. She also regularly attends these support group meetings, which give her immense strength to deal with all the challenges posed by life. Even though her life had turned a new leaf, she was under going a major financial crisis. Her salary, which came as a daily wage laborer working in a Kalamkari cloth printing factory, would not suffice in running the household and looking after the several needs of her children. Ms. Janaki therefore expressed her wish to get a loan from the Samastha project to facilitate an increase in income. As a result, she was granted a sum of Rs. 3000/- as a revolving loan. Currently, she is doing the Kalamkari work in her own house and earns anywhere between Rs. 80/- to Rs. 100/- per day and manages to run the household successfully. |
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Case Studies
The support restored the Childhood |
Kumari Jyotsna sethi, 14 years old, daughter of Banamali sethi belongs from Rajanpali village of Boudh district. She is the only child of her parents and that is why she gets all the affection from her parents. She grows up with much love in the family. She studies in class 8th at Butupalli, High school of Boudh district.
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Her father is a small farmer with one acre of agriculture land. The annual income is not sufficient to manage the family economy. However, with the income from his own agriculture land as well as labour work sometimes, her father manages the family and the education of Jyotshna.
Time passes and one day her mother observes that Jotshna is not able to tracing the things and domestic appliances properly and father also observes the same. School teachers complains that Jyotshna is not keeping any interest on study. Her father also observes the same. The school teacher says that she is not able to look at the black board and reading properly. Subsequently, friends and neighbours starts to address her as the blind Girl in the community. Gradually Jyotshna becomes depressed and stops going to play with her friends and avoids the gathering in the community. She also expresses her unwillingness for study. One of the neighbors observes a white spot on the right eye pupils. Her father contacts the local traditional healer for treatment who fails to recover the same through his treatment. The parents make lots of expenses for the treatment of Jyotshna. Then they takes Jyotshna to Boudh District Head Quarter Hospital for treatment. The doctor diagnoses her with immature cataract and asked them for contacting the Mahanadi Netra Chikitsalaya of Birmaharajpur of Sonepur district.
She comes to MNC 5th August 2009 and was admitted for cataract surgery. Her Uncle and Parents are counseled by the Ophthalmic Assistant for the surgery. The cataract surgery is conducted on her right eye on the same day through phaco with the intra ocular lens (IOL) in free of cost. Free spectacles and medicines are provided to her as per the prescription of the Ophthalmologist of the Mahanadi Netra Chikitsalaya of LEPRA Society. After the successful surgery, her parents express their happiness and gratitude to LEPRA Society as well as the person or institution who provides support for this noble work. Jyotshna is now very happy she becomes able to see. Now she has got back her earlier life stile i.e. in relation to continuing her study, playing with friends and joining the community gathering. |
The support could provide relief in old age by restoring the vision |
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Basanti Mahananda, 65/F, she is an old widow lady belongs to very poor family of the Menda village of Tarabha Blcok of Subarnapur District. Long back her husband dies due to heart stroke. She has 3 daughters only without a son who already have married. So, Basanti is living alone and manages her by wage works in different households. She is landless. |
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| However, she gets the oldage pension which is Rs. 200/- (Rupees Two Hundred only) per month. Suddenly, she feels vision problem which increases gradually. She becomes unable to see and work properly. Cooking for herself and earning for herself becomes difficult. As her daughter are in their in-laws’ house, there is no scope of getting support from them. In the course of time, Basanti loses his complete vision. She could know about the community eye screening camp of Mahanadi Netra Chikitsalaya of LEPRA Society at Tarava. She requests her elder son-in-law to guide her to the screening camp. Basanti attends the screening camp and diagnosed with matured cataracts. She is brought to the Mahanadi Netra Chikitsalay by the project outreach bus on 13th August 2009 and was registered for cataract surgery. On 14th August 2009, her right eye is operated through the use of phaco and operating microscope and IOL is implanted. The surgery becomes successful and Basanti gets back her vision in the right eye. After seven days of her surgery, her vision is tested and found with very good vision. She also expresses her happiness as she is able to see the things and do her daily activities independently. She is waiting eagerly for the surgery in her left eye. |
Restoration of Childhood |
Sumanta Beriha,7/M of C/O Bhagban Beriha, hails from Jatasingh village of Boudh District. He is the youngest son of his parents with three brothers and only one sister. Being the youngest son of his parents Sumanta is being loved by everybody in the family. His elder brother was having eye diseases which led him to incurable blindness. Sumanta was all of sudden lost his vision at the age only 4 years. His father is a farmer and also works as a labourer. The mother is a house wife and sometimes works as labourer. When Sumanta is admitted into the school, the irony that he is found to have very low vision in both of his eyes for which he faces lot of problems in reading and writing. Gradually Sumanta was pushed into more and more darkness. Sumant is not able to carry out independently the daily activities, reading and playing. Gradually he stopped school going, playing with friends. He loses his childhood. The parents have no money for the treatment of their beloved son and because of the same reason and ignorance their elder son becomes blind. They have to only cry and blame their lucks. The parents go to the District Head Quarter Hospital, Sonepur but, the treatment could not be possible as the hospital is not having facilities for children surgery.
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In course of time, his uncle who is staying nearby MNC informs his parents to come to MNC for treatment. The parents come with the son on 7th February 2009 and Sumanta is registered bearing the MR No 47526/09. He is detected with congenital cataract in both his eyes. Parents and the uncle are counselled for the surgery. Sumanta is admitted on the same day. His right eye is being operated with Small Incision Cataract Surgery (SICS) with IOL on 8th February 2009. His vision is improved to 6/18 in his right eye.
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Now, he is able to play, read and write and he is happier that his vision has again restored. His parents are too happy as the childhood of their beloved son is getting restored and have expressed their gratitude to MNC for great support to their child and family. After few days, his left eye will be operated. |

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Resources |
Infrastructure: The hospital is housed in its own two storied building having a covered area of 5000 sq. ft.. MNC has accommodation for 30 beds, suitable surgical and therapeutic equipment are available for providing eye care. The hospital has a minibus for outreach activities and transportation of patients identified with cataract to the base hospital for surgical intervention.
Physicians/Staff:
There are 30 full time/part time workers at the MNC hospital. These include one full time doctor, nurses, paramedical staff and non-clinical personnel. The physicians are well supported by a multitude of staff members such as nurses, refractionists and technicians who actively participate in the health care team
Work Times: The hospital works six days (Mon-Sat). Patients usually come at 9 a.m. and the work day ends at 5 p.m.
Food: Breakfast, lunch and dinner are also provided free of cost to the patients and their attendants. On an average food is provided to 30 numbers of people per day at MNC. |