Abstract of Dissertation


Objective : General Objectives 1) To study the ongoing strategies for kala azar elimination in Purnia district of Bihar State. 2) To analyze strengths, weakness, opportunity and threats of current strategies in Purnia district of Bihar. Specific Objectives 1) To assess the preparedness of PHCs for the Indoor Residual Spray strategy. 2) To find out involvement of ASHA s in VL control strategy

Background : Bihar is believed to house more than 90% of India's Kalaazar burden [7, 37] (or about 270,000 new cases per year). Disease affects mostly poorest of the poor specially Mushahar Community. About 34.65 million populations is at risk, having 11,500 (approx.) villages in 429 PHCs. State has commitment to achieve National Kala-azar Elimination goal set for 2015 by GOI i.e. reducing incidence of KA by 1 case per 10,000 population at sub-district level

Methodology : The study was conducted in Purnia district of Bihar. Primary data was collected from the field through semi-structured questionnaires for ASHAs, in depth interviews of stakeholders (DMO and MOIC) and checklist for PHCs. For facility assessment 14 PHCs were chosen from the district and in depth interview were done for DMO, MOIC. Sample of 100 ASHAs was chosen randomly from two highly endemic blocks of district.

Findings : It can be interpreted that there is total lack of micro planning at PHC level. Out of 14 PHCs none had availability of materials (pumps, buckets, PPE) atleast 15 days before IRS. The spray dates are not identified even 15 days before for the kala azar endemic villages. Non involvement of ASHA for IEC, lack of training of squads and absence of IEC materials like leaflets, posters and cards at PHCs can be seen. ASHAs were hardly given any specific training on kala azar. Among those who detected cases only 2 ASHA received incentives. This demotivates them and is one of the biggest constraints in case detection and community mobilization. Conclusion: From the above study it can be concluded that there is an urgent need to focus on strengthening IRS strategy by streamlining micro planning at block level and ensuring monitoring and supervision during IRS activities. In VL control, ASHAs provide a so far largely untapped resource that can make a major contribution.