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2. DANIDA's involvement in NLEP in India
Dr. Sjoerd Postma, Chief Advisor, DANLEP/DANIDA
Danish Assistance to the National Leprosy Eradication Programme (DANLEP)
Introduction
DANLEP started in India in 1986 with the objectives to assist the NLEP in eliminating leprosy and developing strategies to prevent a possible subsequent resurgence. In addition to support at GoI level, it also focussed on the then hyper-endemic states of Tamil Nadu, Orissa and Madhya Pradesh (which was later divided into MP and Chhattisgarh). It is being implemented in phases, phase 1 and 2 covered the period 1986 to 1998. Phase 3 is the last phase for a period of 5 year; it started in 1998 and DANLEP will gradually phase out its support to NLEP and the leprosy elimination efforts by November 2003. By that time over DKK 200 Million or Approximately US$ 40 Million will have been spent on the programme.
Danida's institutional philosophy is to support and promote sustainable development, with a special focus on gender equity and poverty reduction. DANLEP works within and through the government system, playing a catalytic and coordinating role, providing financial, logistic and technical support. Danida is a member of the Global Alliance for the Elimination of Leprosy (GAEL) and DANLEP collaborates with other development agencies such as the World Health Organization (WHO), the World Bank (WB) and leprosy specific NGOs, such as Lepra, Leprosy Mission and others.
DANLEP has focused on institutional capacity building to improve access and quality of leprosy cure and care, Information, Education and Communication (IEC) to improve awareness and reduce stigma, encouraging community partnership and participation for sustainability and addressing gender issues and women's empowerment. Health systems research, to feed into the development of appropriate and innovative approaches has been one of the latest thrust areas.
Major Areas of Inputs
Develop, Promote & Support innovative approaches in
･ Infrastructure - support to organizational development, especially the state and district societies, as well as guiding the process of integration;
･ Human Resource Development; training both NLEP and GHC staff in issues of leprosy control and management. Of late there has been a tremendous effort to training community members to take on roles in leprosy detection and control and thus reducing the stigma, unfortunately, still existing in the society;
･ Integration; Using the Tamil Nadu experiences in other states for slow integration in the General Health Care system;
･ IEC; many methods, messages and training packages have been developed over the years and widely disseminated, including adoption by Gol for the World Bank projects;
･ Case detection and POD; Support provided to all leprosy detection campaigns and using POD as conduits for community counseling and involvement;
･ Monitoring & Evaluation; support provided to various information systems developed and piloted over the years;
･ Health Systems Research; as part of the documenting and policy development process HSR has played a major role in feeding back appropriate practices to policy makers.
Best Practices
･ Encouraged states/GoI to recognizes the need to coordinate all supporting agencies in NLEP;
･ Concept of district leprosy societies to facilitate funds flow, that later adopted by GOI for other programmes as well; Leading to creation of State Health Societies;
･ Creation of needs based and diversified IEC Packages;
･ Use of evidence based data to persuade Governments to focus their programme;
･ Cross fertilization to leprosy programmes of other donors;
･ Use of GIS to make indicators and achievements visual.
Lessons Learnt
･ Cascade training is less effective than core group training
･ Long-term commitment ensures partner confidence and participation
･ Structural change should be carefully planned, but not always possible
･ Basic Health problems, also Leprosy neglected in urban and difficult areas; this needs refocusing of programmes
Phasing Out
The Danish Government/Danida has decided to phase out DANLEP by the end of 2003. In the remaining period, DANLEP will focus on
･ Consolidation of current outputs, i.e. activities/achievements, including those not yet achieved;
･ Limited functional expansion: Reaching the Un-Reached in tribal, border and urban pockets;
･ Internalization of DANLEP'S role and achievements into the government system, in collaboration with other partners;
･ Documentation and dissemination of the DANLEP experiences, to share with all partners and the public at large.
DANLEP Contact Address:
A1/148 Safdarjung Enclave, New Delhi - 110029, India
Tel: (91) 11618-1909/7339/7340
Fax: (91) 11618-1099
Chief Advisor: Sjoerd Postma
HSR Advisor: Chitra Sundaram
Senior Advisor: SKM Mohanty
Monitoring Officer: Nanda Paithankar
For contact addresses in the supported states please contact the Delhi office (above)
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