1.3 Submitted / written by 1.4 Date written 1.5 Project duration From: Jan (month) 2014 (year) To: Dec (month) 2016 (year)

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1 Summary 1.1 Project Title Advocacy for Empowerment Project (AEP) 1.2 Project Location Country: Bangladesh Region / District: Countrywide Village / Town / City: 1.3 Submitted / written by 1.4 Date written 1.5 Project duration From: Jan (month) 2014 (year) To: Dec (month) 2016 (year) 1.6 Report period From: Jan (month) 2014 (year) To: June (month) 2014 (year) Narrative Summary Report overview Please provide a clear and concise summary of the work carried out in the reporting period: AEP is a 2 nd phase of CAN project supporting by TLM Netherlands along other Dutch partners since The aim of AEP to Creating a right conscious enabling environment particularly for those affected by leprosy, disability and disadvantaged people as well. AEP is working for advocacy, nationwide awareness and strengthen capacity of organization formed by People with Leprosy and disability. The activities focus on sensitize policy makers, increase awareness of communities, develop positive attitude of medical personnel, NGOs and communities on leprosy issue and rights of people with leprosy and disabilities (disability: general and disability resulting from leprosy). Project is also following partnership approach to cover underserving district in Barisal and Khulna division. CSS, HEED Bangladesh and Church of Bangladesh are working with GoB for leprosy elimination in the undercover 6 districts e.g. Borguna, Potuakhali, Bhola Barisal, Bagerhat, Satkhira by involving their existing project staffs. Since March 2014, project started full phase implementation of activities with 3 member s project team. The major progress of this period as below : Organization of National Level Advocacy Seminar: The national level advocacy workshop focused on Equal Health Service for All was organized jointly with Health Alliance Bangladesh (HAB), Directorate General of Health Services (DGHS) under Ministry of Health and The Leprosy Mission International-Bangladesh on April 28, Where 109 representatives were present from, GoB, NGOs and Local Government institutions. The HAB consists of four development NGO of Bangladesh e.g. Christian Service Society, Child Sight Foundation, Centre for Disability in Development and The Leprosy Mission International- Bangladesh who are aimed to ensure the health service of people affected by leprosy, HIV AIDS, general disability, safe motherhood and underprivileged in society. The Chief guest was Dr. Shubash Kumar Saha, Additional Director General (Admin), of Directorate General of Health Services (DGHS) and Ms. Judith van den Bogaard, Coordinator Policy Influencing, Woord en Daad. Mr. Jacob Jan Vreugdenhil, WASH Program Officer, Woord en Daad, Rev. Matthew S. Halder, Country Director, TLMIB, Professor Mohammad Muhit, Honorary Executive Director, CSF were the special guest on the occasion. Multi Year Project Six Monthly Report (v ) Page 1 of 9

In addition Officials from DGHS, Like minded NGOs, Beneficiaries, electronic and print media, representative of Union Parished, representative from DPO were present and participated in the workshop.

2 In addition Officials from DGHS, Like minded NGOs, Beneficiaries, electronic and print media, representative of Union Parished, representative from DPO were present and participated in the workshop. The key note of the workshop was read out by Dr. Sabur, external resource person. The key papers highlighted gradually reducing GoB budget for health since 1997, role of private service provider, effectiveness of private service, recent GoB initiative for health system development, and different problems in Mother and Child Care, people with disability, leprosy and HIV/AIDS. Particularly he also mentioned the lack of Leprosy Control Assistant to identify new leprosy case smoothly. He urged authority to recruit TLCA for leprosy service and ADG was agreeing for the recruitment. The workshop was presided over by Dr. Chad Sultana, Director, planning and research, DGHS. Training of Partner Organizations Staffs Three faith based partner organizations are working on leprosy in under coverage area in Barisal and Khulna division under Advocacy for Empowerment Project (AEP). AEP facilitated 3 batches of training for PNGOs where 92 partner s staffs were participated among 31 were female. The objective of these training was to enhance knowledge and skill on leprosy case detection, process of community awareness, sigma reduction and community meeting facilitation. After basic training, partners are introducing leprosy issues with existing program activities e.g. monthly meeting with community groups, as agenda of staff meeting, meeting with GoB staff etc. Up to now AEP trained 220 partner s staff and they are working for leprosy awareness along with their existing work. It is mentionable that three partners are working in group approach and they have to organize group meeting for awareness, empowerment and saving and credit. All the partners are working with vulnerable communities in remote area e.g. transport labour, floating Commercial Sex-Worker, brothel, fisher man and rickshaw pullers. Training of Volunteers (CRP) Three batches of trainings were organized by the PNGOs where 70 Community Recourse Person (CRP) were participated, among 52 were female. AEP team facilitated those training with the support of PNGOs. The ultimate objectives for CRP training were; to enhance knowledge and skill on leprosy for leprosy case dictation, support PNGOs for conducting contact and extended contact survey, and capacity to refer suspect case for registration and treatment. Our expectation that CRP will continue their support for community in absence of staff and they will play vital role for stigma reduction on leprosy. PNGOs are also trying to include them with other program activities considering their potentiality. HEED Bangladesh assigned two of them as a paid volunteer for leprosy and community awareness activities. Extended contact survey and new patients identification A total of 51 trained volunteers have undertaken a survey in the remote villages of the areas of partner organizations. The volunteers visited the houses of selected villages and interviewed the families based on prescribed format furnished by TLMI. CRPs were survey of total 4468 households and examined 16,819 populations in 22 Upazilas under six districts of Khulna and Barisal division. Among the total examined population 7717 male, 9102 female. About 1 male (MB-registered) and 4 female (PB) new case was confirmed by the expert and suspect case approximately 24 male, 10 female. It is notable that according the GoB record, no new cases was registered since Details data of Extended contact survey as below; Multi Year Project Six Monthly Report (v ) Page 2 of 9

3 AREA Borguna and Potuakhali Bhola area Upazilla of 154 Barisal(Sadar,Agoilj 0 hara, uzirpur and Gournadi) including Suagram of Kotalipara, Gopalganj TOT AL TOTAL POP TOT AL EXAMINE POPULATION SUSPECT CASE CASE TYPE REMARKS HO USE 935 M F M 1440 F 1612 Tot 3052 M 16 F 8 M 1 F 0 MB 1 PB 0 1 patient registered at UHC of Amtoli, Borguna new case found (including Suagram) Bagerhat Satkhira Will start from August,2014 Total Leprosy training for GoB health staffs: AEP team facilitated 3 batches of training on leprosy for Government health personnel under Barisal, Bagerhat and Burgona districts. Partner NGOs coordinated with Civil Surgeon and he issued a letter to all health staffs for their participation on leprosy training. About 101 (male 85, female 16) GoB health personnel participated including Upazila Health and Family Planning Officer (UHFPO), medical officer, assistant health inspector, TB-leprosy control officer and Community Health Care Provider (CHCP) of community Clinic. Recently GoB introduced Community Clinic (CC) for 6000 population in rural area, where community will get basic health service. AEP initiated to train 13 (female 3) CHCPs on leprosy. This is the first initiative for GoB health staff to train on leprosy. Partners have built very good relation with GoB health department and we observed a positive response from health personal. The objectives of this training to sensitised GoB health personnel on leprosy and they will be able in patient s identification, treatment, management and refer in appropriate authorities. Staff Nurse Training of GoB and NOGs Leprosy Hospital The four days Leprosy training for staff nurses posted in GOB and NGO Leprosy Hospitals was held successfully at Nilphamari Training centre, in association with DBLM hospital Doctor and nurses. About 15 nurses were participated among 12 are from GoB hospitals e.g. Mohakhali, Sylhet and Nilphamari Leprosy Hospital and 3 from NGOs clinic and hospital e.g. Dhanjuri and Pime Sister. Following issues were discussed: Introduction to leprosy, Signs & symptoms, MDT, reactions, neuritis, Reasons for admission, Nursing observations, assessment of patient`s needs, arranging discharges, Medicines commonly used in leprosy, Introduction to septic surgery and RCS in leprosy, show pts. Eye problems in leprosy and practical session on show skin lesions, typical results of NFI, Observe & Assist in ward round or dressings etc. NLEP issued official order to hospital authority to ensure Nurses participation in the training. It was first training for nurses especially for leprosy care and management. AEP expected that this training will improve quality of service to people with leprosy. It was also contributed lot for their attitude change towards leprosy patients. Skin camp for leprosy screening The Skin Camp for screening leprosy was arranged in Isakati Koloni, 5 Km. from Barisal town jointly with dermatology department of Government Sher-e-Bangla Medical Hospital, Barisal, Civil Surgeon Office and Church of Bangladesh Social Development Programme (CBSDP). Honourable Civil Surgeon of Barisal (District Head of Health and Family Planning) was inaugurated the camp and three medical doctors from GoB medical collage provided treatment to 138 patients with different skin disease. Beside the treatment leprosy messes, Multi Year Project Six Monthly Report (v ) Page 3 of 9

4 leaflet, poster also distributed to 470 communities. It was help us to build good relation with Medical collages authorities and create opportunities to orient them on leprosy. Observed World Leprosy Day World leprosy Day year 2014 was observed on 26 th January in 5 districts of Khulna, Bagerhat, Barisal, Barguna and Patuakhali with the cooperation of three PNGOs e.g. HEED Bangladesh, Church of Bangladesh Social Development Programme (CBSDP) and CSS. PNGOs were coordinated and managed the total program. Deputy Commissioner (Head of District Administration) of Khulna, Civil Surgeon of Barguna, Bagerhat and Barisal inaugurated the rally and discussion session. The key events were rally, discussion meeting/session, writing articles in newspapers, essay completion on leprosy issues by the students, leaflet distribution, and telecast the TV-spot/advertisement on local TV cable network for mass awareness on leprosy in the working areas. The theme of the World Leprosy Day was Joining Forces Accelerating Leprosy Programme. Government health officials, local Government representatives, NGOs representatives, staff, representative from civil society, journalists, students, and community participated in rally and discussion meeting. All the rallies walked through the key parts of cities with colourful cap, poster, festoons and banners. Leaflet, poster also distributed among interested people. This is the first time the World Leprosy Day was observed in five districts of Southern parts of Bangladesh e.g. Khulna, Bagerhat, Barisal, Barguna and Patuakhali with the active role of partners and Government health Department. At least 10 newspapers the published WLD reports among one the National English daily newspaper (The Daily Financial Express). Discussion in TV on leprosy AEP coordinate and facilitated to organize TV discussion on leprosy for the occasion of World Leprosy Day ANT News one of the popular TV channel in Bangladesh allocated free time to discussion leprosy issues for public awareness. Dr. Wahida Khan Chowdhury, Associate Professor and Head of Department (Dermatology & Venerology) of Sahabuddin Medical Collage and Hospital was the key expert of this discussion. It was 18 minutes session to discussion leprosy for mass awareness free of cost. Dr. Wahida Khan Chowdhury was Medical Officer of Dhaka Program. This is the first time that leprosy was discussed in mainstream electronic media for mass awareness without cost. Community Session: It is very valuable inputs from partners, that they conducted 461 (CSS 309, HEED 152) community meeting/ courtyard meeting where 4780 (CSS 2953 Heed 1827) communities were present, among (CSS 1126, HEED 1451) 2577 were female. Partner s staffs also examine people to identify the suspect. Leprosy suspected cases were identified by the PNGOs staff along with their existing plan work. These suspected yet need to reexamine by the medical doctor. It is appreciable that they are disseminating leprosy messages and examine new community in southern part of Bangladesh. It is demonstrated we can reach huge number of new communities in undercover remote area in partnership with potentials with a minimum cost. Multi Year Project Six Monthly Report (v ) Page 4 of 9

5 Were there any unexpected results, either positive or negative? Project had brought out following positive changes to have long lasting outcome from project intervention which were as follow: Very positive response from partners in organizing World Leprosy Day Response from GoB, journalist, NGOs and local government institutions was very encouragement. Leprosy training for the Nurses posted in Government hospital was very new initiative and successful. Partner s staffs are disseminating leprosy message to their project participants and they are integrated leprosy issues with their existing program. PNGOs staff conducted 461 (CSS 309, HEED 152) community meeting/ courtyard meeting where 4780 (CSS 2953 Heed 1827) communities were participated. Have very positive support from Barisal and Khulna Medical collage authorities. Project Activities Please provide a clear and concise summary of the activities carried out in the reporting period: SL No Activity Name Training of GoB health personnel specially in under cover area. Train the staff of the selected partners and other stakeholders (NGOs, Churches, CBOs and Civil society organization) specially who are working out of our project area Train the volunteers of the selected partners and other stakeholders (NGOs, Churches, CBOs and Civil society organization) specially who are working out of our project area Conduct extended contact survey/survey in under cover area with the support GoB health and NGOs for regular updating leprosy situation in under serve area Skin camp for patients screening jointly with Achievement Participants Male Female Total Remarks Organized by partners NGOs and project team facilitated with active support of Civil Surgeon These staff are conducting meeting, identify suspected, link with GoB along with their existing day to day activities. With the support of Barisal Medical collage and Civil Multi Year Project Six Monthly Report (v ) Page 5 of 9

06 07 08 GoB and Medical collage/ngo at Barisal district based Training the GoB nurses working with leprosy hospital for post-operative care and management National level Advocacy Workshop on Equal

6 GoB and Medical collage/ngo at Barisal district based Training the GoB nurses working with leprosy hospital for post-operative care and management National level Advocacy Workshop on Equal Health Service for All World Leprosy day and disability day observation Surgeon office. Three Doctors were present from Medical collage Rally 440, discussion meeting 440, Awareness meeting 500 Monirul Becomes Happy Now Monirul Islam, a 65 years old man from Southern part of Amtoli under Borguna District is a day labour. He lives in this village with his wife and one divorced daughter. His son separated from him and lives nearby village with his own family. Few years ago he noticed some pale patches on his neck and back. His wife and daughter thought it could be fungal infection. So, Monirul did not give attention on it. A few months later the patches were increasing and new many patches appeared on his body. Then he went to the village Doctor (quack) and the quack harassed and cost him lot but no improvement seen. Then he went to the Upazilla Health Complex and the Doctor advised him to go to the Barisal Medical College Hospital Meanwhile, he felt numbness to his both hand and feet. Saving some money lastly he went to the Barisal Medical College to show his problem in The Doctor of College made a medical team and diagnosed him as a multibacillary leprosy patient. But what was the real thing? There was no MDT in this Medical College! They advised him to go to Dhaka Mohakhali Leprosy Hospital for MDT. Monirul poor guy had no enough money to go to Dhaka for leprosy treatment. So he stayed at his home without leprosy treatment (MDT). This year, on May 11 to 2014, there was an Extended Contact Survey done in this area by the partner organization HEED Bangladesh supported by the Advocacy for Empowerment Project, TLMI-B and found Monirul Islam as an untreated multibacillary person affected by leprosy. Since 2012 he remained untreated means spread leprosy bacilli to healthy person already. However, TLMI-B and HEED staff managed to start MDT through the UH&FPO of Upazilla Health Complex Amtoli, Borguna on May 13, Multi Year Project Six Monthly Report (v ) Page 6 of 9

Photo of AEP Activities Fig: A rally of sex

nurse rally, HEED-B, Barguna, WLD, 2014 Fig:

Fig: WLD discussion meeting by CS, 2014 Fig:

Civil Surgeon addressing in the volunteer

PNGOs Fig: Volunteer training, PNGOs Multi

7 Photo of AEP Activities Fig: A rally of sex worker, CSS, WLD, 2014 at Khulna Fig: A nurse rally, HEED-B, Barguna, WLD, 2014 Fig: A rally of hospital nurse, Barguna, WLD 14 Fig: WLD discussion meeting by CS, 2014 Fig: Staff training of partner organizations Fig: Civil Surgeon addressing in the volunteer Training Figure 18: Volunteer training, PNGOs Fig: Volunteer training, PNGOs Multi Year Project Six Monthly Report (v ) Page 7 of 9

8 Fig: Disseminating leprosy information for Effective ECS Fig: Early signs and symptoms of leprosy shown by Volunteer Fig: New MB case found at Bhola Sadar Fig: Suspected cases sensation is tested by Volunteer Fig: C. Survey CBSDP, Barisal Fig: A newly detected leprosy patients with volunteers Fig: Training with GoB, Civil Surgeon Office, Bagerhat Fig: UH&FPO, Medical Officer and other Health Multi Year Project Six Monthly Report (v ) Page 8 of 9

9 Fig: MDT treatment by UH & FPO, Barguna, Fig: Civil Surgeon of Bhola introducing himself Fig: Nurse training of GoB Leprosy Hospital Fig: Practical session with Patient with complicated ulcer Figure: During skin camp with Civil Surgeon & P.O, Barisal Figure: Screening during skin camp, Barisal Fig: Provided medicine during skin camp, Barisal Fig: Doctors of Barisal Medical College in skin camp, Barisal Figure: National Advocacy Workshop jointly with HAB and TLMI-B, 2014 Multi Year Project Six Monthly Report (v ) Page 9 of 9

Guidelines for Performance based Payment for ASHA under National Leprosy Eradication Programme

Guidelines for Performance based Payment for ASHA under National Leprosy Eradication Programme Introduction: Under Health System, Multi-purpose Workers (MPW- Male & Female) at the sub- centre act as the