Project Title: STI Service Program.

GOAL, STRATEGIES AND ACTIVITIES OF PROJECT

Goal:

The goal of this intervention is to improve the health status of the communities situated in the Terai along the E-W (East-West) highway between Jhapa to Rupandehi, by reducing the rates of STD in groups at increased risk of infection by reason of their sexual behavior, and in so doing ultimately to reduce the rate of transmission of HIV.

Strategies:

The strategies of program is to continue to promote appropriate STD health care seeking behavior through the FHI BCI partners and to provide ready access to acceptable, affordable and effective STD case management to FSWs and their clients by means of complementary components:

a)     A STD Project Management Team (SPMT): A SPMT is established in a project office at Hetauda.

b)     A MHC (Male Health Clinic): This MHC is sited at Hetauda Truck Park of Narayani Transport Entrepreneurs Association (NTEA), a junction point on the E-W highway for the transport workers. This Clinic Has been providing routine and general health check up and by doing so be able to offer STD Management.

c)      Two mobile clinics serving FSWs: These mobile clinics are operated from Hetauda, where the project office is located and at the other end from AMDA BCI (Behavior Change Intervention) office at Itahari. They are working in very close co-ordination with the existing FHI BCI partners. The FSWs identified by the BCI partners are encouraged to attend the mobile clinic when it is closer to their areas. A RTI (Reproductive Tract Infection) case management service has been provided free of charge and the medicines required are given to STI patient at subsidized rates.

Activities:

a)     Central management:

The AMDA central office in Kathmandu is the central coordination point and has been working for the overall support to STD program management, coordination, monitoring and evaluation.

b)     Field management:

AMDA-Nepal is managing the fieldwork of the project for both components through the SPMT at an STD project office in Hetauda, Makwanpur District.

c)      Male Health Clinic (MHC):

Physical facilities for the MHC are being provided by NTEA in the Truck Park. The MHC has been offering a general health check up, first aid and basic medical treatment. This is sited at Hetauda truck-park of the NTEA, a junction point on E-W highway where all transport workers and their assistants meet. It is estimated that around 300-600 trucks pass through Hetauda truck-park each day. It is estimated that around 2,500 truckers are member of NTEA.

The MHC Clinical Team consists of:

Þ    A medical Officer,

Þ    A STD trained Health Assistant,

Þ    A Laboratory Technician,

Þ    Two Peer Communicator,

Þ    A Laison Officer recruited from NTEA to co-ordinate between AMDA-Nepal and NTEA.

The MHC is offering a general health check up, First Aid and basic medical treatment. Patient requiring more specialized treatment has been doing refer to nearby governmental/non-governmental health facilities. Laboratory equipments and reagents are being provided by AMDA-Nepal as mentioned in memorandum of understanding of AMDA-Nepal and NTEA for the following tests:

i) Gram Stain

ii) Wet Mount

iii) Whiff Test

iv) Rapid Pleasure Reagin (RPR)

v) TPHA (Treponema Pallidum Haem-agglutination)

Other than above-mentioned tests if necessary, both reagents and laboratory equipment will be provided by NTEA e.g. blood grouping, stain for AFB, DC, TC, urine R/E-M/E , stool R/E-M/E etc.

The provision of drugs for MHC:

The basic drugs necessary for MHC is being provided and managed by NTEA on cost recovery basis by revolving fund.

Medical staffs and medical equipment are being provided by AMDA-Nepal for regular conduction of MHC. AMDA-Nepal has been providing medical services at MHC till the period of STI Service Program run by AMDA-Nepal. Regular meetings are being conducted between AMDA-Nepal and NTEA. MHC is also providing medical services to near by community people around the area of MHC for humanitarian viewpoint by mutual understanding of AMDA-Nepal and NTEA. A copy of MHC prescription, ledger style and brochure of AMDA-Nepal etc. are also attached with this request letter. 

d)     Mobile Teams:

The BCI partners have identified about 1,000 FSWs in the 16 districts. It is believed that many more full or part time and opportunistic FSWs exist in the six million populations of the 16 districts. A well -received, acceptable RTI/STD service is encouraged attendance at the mobile clinics. Two mobile units, therefore, will provide reproductive tract infection (RTI) care, primarily to the FSWs who work along the E-W highway between the eastern point at Kakarvitta, Jhapa and the western one at Butwal, Rupandehi – a covering distance of about 650 kilometers. Other women and clients are also being served as well but the main target group will be FSWs.

Team A is based at the Project office at Hetauda and covers the eight districts from Rautahat to Rupandehi. Team B is based at the Project field office at Itahari and covers the eight districts from Jhapa to Sarlahi.

Each field team consists of a medical officer, a staff nurse, a laboratory technician, a helper and a driver. Each mobile team has conducted fifteen to twenty visits per month in their respective areas in close cooperation and coordination with BCI partners. The mobile team is offering an RTI assessment based on modified syndromic approach including an external and internal examination. Simple laboratory tests are included: wet mount, gram staining, RPR and TPHA.

Standard operative procedures has developed, revised after field-testing and finalized. The routine for each mobile team is:

1)           Referral of FSWs (or other person) by BCI.

2)         Registration – details of patient taken into a confidential register and unique numbering allocated. This number will code all notes, investigations, etc. however the names have never be mentioned. (See confidentiality below).

3)      Case management according to the SPOP based on the modified syndromic case management developed by the MoH consultation. This will include:

·        History /risk assessment

·        Examination

·        Specimen taking

·        Laboratory work

·        Diagnosis based on history, risk assessment, clinical examination, laboratory investigations

·        Provision of treatment

1)     Interview with educators/counselor (‘4Cs’)

2)     Next appointment

Linkages with other interventions and activities

The STD Project collaborates and coordinates with the FHI BCI interventions which is being implemented in all 16 districts as follows:

By AMDA:      Jhapa, Siraha, Sunsari, Morang and Saptari

By GWP:        Mahottari, Dhanusa, Sarlahi, Routahat, Bara, Parsa, Makwanpur, Chitwan and Dhading

By WATCH:   Rupandahi,

By Trinetra:    Nawalparasi

 Close linkage is being established between the STI Program and NTEA, SMD (Social Marketing and Distribution), DACC (District Aids Coordination Committee), DHO (District Health Office) and other governmental and non-governmental organizations. 

CONTACT ADDRESS:

The Project Manager

AMDA/FHI STI Service Delivery Project

Hetauda Makawanpur, Nepal

Tel: 977-57-20281

Fax: 977-57-20281

E-mail: amda_sti@mos.com.np