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uttar PraDesh establishing encePhalitis treatMent centers in enDeMic Districts 82 | MAkING A Difference : Good, Replicable and Innovative Practices
The JE vaccine coverage increased from 24.7% to 91% for the first dose and for second dose it increased from 33.6% to 66%. JE positivity rate has also come down from 9% to 2.2% ProbleM stateMent In 2005, a massive outbreak of Acute Encephalitis Syndrome/Japanese Encephalitis (AES/JE hit several districts in eastern Uttar Pradesh (U.P.) and the adjoining districts of Bihar. AES outbreaks are still being reported from seven endemic districts of eastern U.P. of Gorakhpur and Basti division (Gorakhpur, Maharajganj, Deoria, Kushi Nagar, Basti, Sant Kabir Nagar and Siddharth Nagar) with high mortality. In these districts the main cause of high mortality was found to be the prolonged time taken to transport the patient over long distances without proper basic supportive medical care i.e. first aid/oxygenation up to the tertiary facilities. Added to this is the inadequate clinical infrastructure and non-availability of trained staff. To combat this problem, GoUP developed innovative ideas for early referral and prompt treatment of AES cases to prevent mortality due to AES. PrograMMe DescriPtion In 2013, GoUP convened an expert group which recommended that an Encephalitis Treatment Centre (ETC) model should be used for clinical care management of AES cases to reduce mortality and disability. This model worked on the two principles: early oxygenation and quick transportation/referral to a health facility within 10 kms, which not only reduced the mortality of the AES/ JE but also brought down the severity. By leveraging funds from the National Health Mission (NHM), by July 2014, 104 primary and secondary health centres were upgraded as ETCs across the 7 districts of Gorakhpur and Basti division. 10 ICUs equipped with ventilators, supplemented with 24x7 availability of trained government health personnel were established. Linkages were established with the existing free 108/102 ambulance service to transport suspected AES patients to the ETCs within minimum time. Intensive IEC was done through various IEC/audio visuals material and media sensitisation workshops. Vaccine availability and the logistics management system were strengthened to ensure immunisation of beneficiary with JE vaccine in the Universal Immunization Programme (UIP). Using the cascade training model, over 30,000 health personnel were trained in the 7 districts on communication for managing AES outbreaks and AEFI with JE vaccine. Special JE vaccination catch campaigns were conducted to cover the left-out children. PrograMMe outcoMes In the intervention area (7 Districts) during 2013-14: • The JE vaccine coverage increased from 24.7% to 91% for the first dose JE vaccine and for second dose of JE vaccine, from 33.6% to 66%. • CFR from AES has reduced from 21% to 15% and the CFR for JE has reduced from 35% to 28%. • JE positivity rate has also come down from 9% to 2.2%. • The number of referrals from the field through ambulances and number of patients seeking treatment increased. iMPleMenting Partner PATH scalability The ETC model is a low-cost model which can be easily scaled-up with limited resources. Way forward Strengthening and expansion of ETCs with additional interventions: • Rehabilitating children disabled with AES/JE. • Conducting mass community awareness campaigns in affected districts. • Strengthening Vector Borne Disease Surveillance Units in affected divisions. conclusions/lessons learnt The ETC model is a cost-effective and workable model. its visible impact can be demonstrated by reduction in the mortality due to AeS and Je whereby millions of innocent lives of children can be saved. Contact MD, NHM, U.P. Email: mdupnrhm@gmail.com
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© Ministry of Health and Family We
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InTrOdUCTIOn healTh SySTeMS STrenGT
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Introdu Ministry of Health and Fami
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Health Stren
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JharkhanD strengthening rMnch+a suP
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kerala coMPrehensive health Plan 10
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MaDhya PraDesh integrateD referral
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oDisha 360-Degree coMMunication aPP
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aJasthan MukhyaMantri nishulk Dava
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aJasthan MukhyaMantri nishulk Janch
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chhattisgarh role of Mitanin in coM
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JharkhanD sahiya helP Desk ProbleM
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aJasthan asha soft- online PayMent
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wEst bEngal Fair PriCE raDiologY Di
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EmErging initiativEs Health Insuran
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