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>kj[k. M ljdkj National Vector Borne Disease Control Programme, Jharkhand Elimination of Lymphatic Filariasis IDA –MDA Simdega IDA (Ivermectin + DEC+ Albendazole) Thoughtful Introduction 1

• Lymphatic Filariasis: Global elimination by 2020 as per World Health Assembly (WHA) Resolution -1997 • India contributes about 45%s of global burden of Lymphatic Filariasis. • Lymphatic Filariasis is endemic in 256 districts in 16 states and 5 Union Territories • India is a signatory to WHA Resolution (1997) for elimination of Lymphatic Filariasis as public health problem. • WHO has come up with there new NTD goal of 2030.

• ELF Strategy of MDA with single drug DEC launched in India in 2004 and subsequently with Co administration of 2 drugs (DEC + Albendazole) • Jharkhand was one of LF endemic states • Progress of reported Drug coverage of 80% did not help in interruption of transmission to desired level in the state. • Research on alternate strategy to achieve faster impact and realize goal of elimination has been adapted in 2018.

Triple Drug Therapy IDA in Simdega • Out of 24 districts in Jharkhand, 17 are LF endemic • 7 non-endemic districts also contributes 30% of clinically manifested cases in state. • Two drug therapy (DEC & Albendazole) was implemented since 2007 17 endemic districts. • Simdega (non-endemic) with population of 6. 5 lakhs chosen for implementation of Triple Drug therapy (DEC, Albendazole & Ivermectin) for Pilot. 4

Implementation of Triple Drug Therapy IDA in Simdega Challenges Innovation Programme Approach - All AWC identified as Booth - School / Colleges as Booth - PHCs and HSCs as Booth - Door to door activities for mop-up - Finger marking of the beneficiaries Daily reporting during campaign Simplified Formats – IDA 1 – Format for Drug Administrator deputed 2 in each Booth IDA 2 - Format for Drug Supervisor deputed 1 for 5 Booth IDA 3 – Format for Block level Supervisor for receiving report from Drug Supervisor in evening during the campaign IDA 4 – Format for DHQ to send report 5 to SHQ

Implementation of Triple Drug Therapy IDA in Simdega Challenges Quality Training Innovation - All State Level Consultant / Staff deployed in District and Blocks for imparting training. - Simplified training manuals prepared in Hindi IEC/ BCC - Sensitization of DC by State Health Team - District level Task Force Meeting done twice with different department prior to the campaign in presence of State representatives - Special School Awareness programme ‘ Bhag Filaria Bhag’ in all schools started 15 days prior to IDA - Press release every evening 30 days prior to 6 IDA and during IDA Campaign

Implementation of Triple Drug Therapy IDA in Simdega Challenges IEC/ BCC Innovation -Sensitization of 400 block level public representatives which includes Mukhiyas, Ward Parshad, Van. Samiti, Adivasi Vikas Samiti by DC , CS Cum DMO & NGO workers -Advocacy of Faith Based Organizations (Maulwis, Bishop, Ram Rekha Dham) -Posters , Banners in all Booth. Hoarding at major public places. - Miking with specific route charts. -Involvement of JSLPS -High profile launch of the campaign by DC at District HQ in presence of GOI Team and in Block by BDO in presence of State Team. - “Bhag Filaria Bhag” Cap for all volunteers. 7

Implementation of Triple Drug Therapy IDA in Simdega Challenges Innovation Functional Rapid Response Team (RRT) - RRT headed by Medical Officer with mobility support was identified in each block. -In big blocks, 2 RRT identified. - Medical Officers were pooled from nearby district, Gumla, Khunti, West Singhbhum during campaign. - All adverse events were immediately attended in the field. -Serious adverse events were immediately hospitalized. 8

Implementation of Triple Drug Therapy IDA in Simdega Challenges Innovation Monitoring & Supervision - Daily reporting from each Block was ensured every day and was reviewed in presence of State and District team at 8. 00 PM by DC. - BDOs of poor performing blocks were directed to review the progress themselves. - State Consultant stationed in the District during the entire campaign. - All reports were shared with Health Sec. on daily basis by SPO (VBD) 9

Scaling up of Triple Drug Therapy IDA - Suggestions • Consumption of 8 medicines at a time is a big challenge. instead Age wise Blister pack for MDA may be introduced. • Availability of RRT in field plays major role in drug compliance. • Advocacy and Involvement of District Administration is key for successful implementation • Success of Triple Drug Therapy (IDA )over MDA (Twin drug Therapy) shows that MDA should be done in phase with maximum 3 - 4 districts at a time for focussed approaches 10

Inaugural Ceremony DC Mr. Jatashankar Chaudhary inaugurated the Ceremony by consuming Anti Filarial Drug 11

Bhag Filaria Bhag- A School programme launched by the DC, Simdega in all Govt. & Pvt. Schools (approx. 377 in nos. ) in mission mode for awareness regarding MDA. Filaria Rally & Media Sensitization Workshop 12