Nepal

Activities

Support for pharmacovigilance in VL endemic districts
  • Case management
Outputs

The revised National Strategic Guideline on VL Elimination Program has recommended various new regimens of anti-VL drugs: Liposomal Amphotericin B, Amphotericin B, Paromomycin and Miltefosine. KalaCORE has supported the Nepal government to continue VL-focused pharmacovigilance (VLPV) activities in VL endemic districts by collecting data through specially developed forms, conducting routine monitoring and supervisory visits to sites, conducting 6-month follow up and review meetings, and undertaking PV signal analysis and sharing results with the national committee.

Developing and implementing a national IEC/BCC strategy
  • Health education
Outputs

IEC/BCC activities in Nepal started with the development of a national IEC/BCC strategy together with national stakeholders. The IEC/BCC messages for VL control were endorsed by government stakeholders, including the Epidemiology & Disease Control Division, and the National Health Education, Information & Communication Centre and the WHO country office for Nepal.

Female Community Health Volunteers (FCHVs) and Community Health Workers (CHWs) have been trained on VL/PKDL identification. IEC/BCC materials were developed following a review of the strengths and weaknesses of existing communication materials. New materials produced over the years include posters, leaflets and flip books which have been distributed for the training of communities in the early identification of VL. TV spots and radio messages have also been broadcasted. By Oct 2018, we estimate that about 6.5 million people have been reached by IEC/BCC activities in Nepal.

Developing strategic capacity for surveillance, monitoring and evaluation appropriate response to emerging outbreaks
  • Improving surveillance
Outputs

KalaCORE have developed comprehensive VL outbreak response strategies that also include vector control guidelines. By October of 2018, the Kala Azar outbreak assessment guidelines were approved and endorsed by the national programme and were incorporated into the National Guideline on Kala-azar Elimination Programme in Nepal.

 

Early into the programme, VL Surveillance and M&E Officers were put in place within the national programmes. Since the development of the Outbreak assessment guidelines, KalaCORE has led sensitisation meetings to orient district rapid response team/outbreak response team members on the guidelines and strengthen the capacity of the health system at the district level on vector surveillance. By Oct 2018, another 23 vector control officers and entomologists have also been trained on sand fly collection and preservation to strengthen capacity of health systems during outbreak response.

 

Outbreak investigation and response activities have also been conducted. By April 2018 these have included investigation and assessment of cases from non-endemic districts.

 

VL surveillance strengthening has been supported by KalaCORE in collaboration with the WHO. Nepal is currently using multiple reporting systems for VL. KalaCORE is working to improve the use and uptake of the Early Warning, Alert and Response System (EWARS) for outbreak reporting and the District Health Information System 2 (DHIS2) for routine disease surveillance.

Improving case detection of VL and PKDL through the training of healthcare providers
  • Case management
  • Improving surveillance
Outputs

By October 2018, KalaCORE has supported the training of a total of 10,263 health workers. A full review of available training materials was conducted at the beginning of programme implementation in Nepal, in order to identify and fill gaps in standard resources. Task-specific training has been provided to a range of health professionals – including frontline workers such as female community health volunteers, and clinicians working in both public and private health facilities in VL endemic districts.

Further training on active case detection has been provided to vector control and public health officers, including case-based surveillance strategies of VL & PKDL at district level. 

Improve access to diagnosis, treatment and cross-border sharing of information
  • Case management
  • Improving surveillance
Summary

Objectives

  • Improve the existing VL case management regarding diagnosis, treatment and follow up along the Indian-Nepalese border.
  • Establish baseline data on VL patients' cross border movements.
  • Understand health-seeking behaviour of migratory VL patients
  • Develop mechanisms for further and sustained active cross-border collaboration of health authorities in the affected areas.
Outputs

KalaCORE coordinates with WHO and Epidemiology & Disease Control Division (EDCD) to assist with the training of health workers in the use of AmBisome, which arrived in Nepal in October 2015. These training sessions were delivered successfully, and as a result, treatment with AmBisome in Nepal has been well underway.

The AmBisome roll-out has resulted in an expansion in access to treatment by marginalised communities residing in difficult-to-reach VL endemic areas. Results of a recent analysis indicate that, within 90 highly endemic blocks in Bihar, all but 3 blocks were situated within 30km of the nearest upgraded treatment centre.