Abstract of Dissertation

Agency : Kala Azar Programme, Supervisory Mechanisms, Indoor Residual Spray Strategy, IRS Strategy

Objective : The objectives of this study are to review the supervisory mechanisms (roles and responsibilities, meetings, interactions, reporting, etc.) under IRS strategy under Kala-Azar programme, to identify the stakeholders and their coordination mechanisms at various levels of health system, to analyze weakness of the indoor residual spray strategy to contribute in reduction of Kala-Azar prevalence.

Background : Visceral Leishmaniasis or more widely known as Kala-Azar is a slow progressing indigenous disease caused by a protozoan parasite of genus Leishmania (L.Donovani in India). It is the second largest parasitic killer in the world, only after malaria. It is one of the World’s 31 most neglected and poverty-related diseases, affecting the poorest people. In India, Bihar alone carries disease burden of 80-85 percent. GOI under Kala-Azar elimination programme is following various strategies and one of the strategies for vector control is IRS. The IRS happens every year but still many new cases and new villages are still found every year gives rise to question whether due to the poor quality and coverage which happened due to lack of supervision. This study is an attempt to review the supervisory mechanism under IRS strategy followed for Kala-Azar prevention in Vaishali District, which is among the high focus districts for Kala-Azar in Bihar, India

Methodology : This was a descriptive cross sectional study. The study was conducted in Vaishali District, in Bihar. The sample covered 39 supervisors and 50 supervisee that are the government officials at district and PHC level and members of different squads respectively. The data collection tool was interview schedule collecting qualitative and quantitative data through a semi structured questionnaire.

Findings : Results revelaed that the supervisory mechanism is there in the district initiated right from the diagnosis and complete treatment of Kala-Azar patients and preparation of the preventive measures like IRS (pre, during and post preparations for activities including line listing, the selection of villages to be sprayed, microplan preparation, annual budgets, arrangements for logistics, equipments and material availability and organizing preparatory meetings for IRS and IEC preparation and other awareness campaigns, preparation of and submission of reports and maintenance of equipments and records and their analysis so as to make improvement for next round of IRS. It was found that the activities are not performed within the set time frame as a result the IRS happens in a uncoordinated manner due to lack of supervision at every step. In between Care India has emerged as a stakeholder giving technical support in pre IRS preparations to the post IRS activities.

Recommendations :

An established supervisory system is existing in the district for Kalazar. However the coordination mechanism needs to be established as Care India has recently entered in to the project. The weakness in the supervisory system is that it is not followed as per set norms.