ANNUAL PROGRESS REPORT

2005

NLR SUPPORTED LEPROSY

CONTROL PROGRAM

SOUTH EAST SULAWESI PROVINCE

Kendari, 21 Febuari 2006

South East Sulawesi province Health Office
JL. Dr. Sam Ratulangi No 17
Kendari

Annual progress report/Sultra/2005

 Table of contents
List of abbreviations................................................................................................1
Summary................................................................Error! Bookmark not defined.
1 Introduction......................................................................................................3
1.1 Geographical characteristics....................................................................3
1.2 Infrastructure of the health care system...................................................3
1.3 The NLR supported Leprosy Control Program........................................3
1.3.1 Structure of the Leprosy Control Program........................................3
1.3.2 Human resource................................................................................4
2 Analysis of activities........................................................................................5
2.1 Case finding, diagnosis and classification...............................................5
2.2 Chemotherapy and case holding (treatment)...........................................5
2.3 Prevention of disabilities..........................................................................5
2.4 Care and rehabilitation.............................................................................6
2.5 Planning and organization (incl. integration)............................................6
2.6 Training.....................................................................................................6
2.7 Health education to the general public.....................................................7
2.8 Supervision...............................................................................................7
2.9 Recording and reporting...........................................................................8
2.10 Laboratory services..................................................................................8
2.11 Monitoring and evaluation........................................................................8
2.12 Logistics and maintenance.......................................................................8
2.13 Staff employment.....................................................................................9
3 Epidemiological developments......................................................................10
3.1 Overview last ten years..........................................................................10
3.2 Overview last year per district................................................................12
4 Other developments......................................................................................15
4.1 Care and rehabilitation...........................................................................15
5 Conclusions and recommendations..............................................................16
6 Successes.....................................................................................................17
Annex 1 ILEP B form........................................................................................18
Annex 2 Overview of NLR personnel and inventory.........................................19

Annual progress report/Sultra/2005

List of abbreviations
HC : Health Centre
Monev : Monitoring and Evaluation
NLR : Netherlands Leprosy Relief
POA : Plan of Action
RFT : Released from treatment
RVS : Rapid village survey
CDR : Case Detection Rate

Annual progress Repor 2005 - South East Sulawesi 1

SUMMARY
Leprosy Control Program in south East Sulawesi Province has been assisted by
NLR ( Netherlands Leprosy Relief ) since 1991. In 2001, this support was stopped, and
than continue again in 2002, however only covered for two districts (Konawe and
kendari). NLR started supporting for all districts since July 2004.

1. CDR.

There are 267 leprosy new cases were found during 2005 (CDR: 14 per 100.000
populations). It increased 62 % (102 cases) to compare the previous year. There are
. HCs that was no leprosy patient before were report the new cases in this year.
Even thought leprosy program activities was not optimal due to limitation of resource
but it seem that leprosy cases in South East SUlawesi is still high. Several possibility
why CDR was increased during this year are as increase the trained HC staff, Health
education activity through radio spot, operational fund for HC staff was available and
improve the supervision from district wasor.

2. PREVALENS

Prevalence Rate on 31 December 2005 was 1.44 per 10.000 populations (276
cases); It is increase 42 % to compare with the previous year. The reason for
increasing the register prevalence is the same with CDR. The number of register
prevalence is more than the number of new case mean that some leprosy cases
from 2004 is still in register until the end of 2005 due to irregular taking MDT

3. Case Finding
During January December 2005, we found 267 leprosy new cases, among
them, 73% were found by voluntary reporting, 9% by contact examine. The
child proportion 9.4% and disability grade 2 proportion 8.2 %.

4. Case Holding

The RFT Rate in the entire province for PB cases in cohort 2004 was 100 %
and for MB cases in cohort 2003 was 93%.

5. Prevention of Disability

There was no patient both PB cases in cohort 2004 and MB cases in cohort
2003 was increase disability during treatment.

Annual progress Repor 2005 - South East Sulawesi 2

INTRODUCTION

1.1 Geographical characteristics

Number of inhabitants 1,915,490

Number of districts
% urban area
% remote area (difficult to reach)
Other specific characteristics
10
20 % consisted of 2 cities with
population ..
30 % island, consisted of 3 district with
population .
20 % land remote area
3 islands districts only can be reached
by boat during good weather.

1.2 Infrastructure of the health care system

Number of government hospitals 1 prov. hospital, 5 district hospitals, 2

military hospitals
Number of private hospitals 1
Leprosy hospital 0
Total number of puskesmas 157
Total number of Sub HC 442

1.3 The NLR supported Leprosy Control Program

1.3.1 Structure of the Leprosy Control Program

Year in which NLR became involved in the 1991, stopped in 2001 and started
Leprosy Control Program again 2002 but only 2 district. All
districts were supported again in
2004

The Leprosy Control Program is combined - Yes, almost all aspect in

with the TB Program puskesmas, district level and only
some part in provincial level
Number of Puskesmas with registered 96 include 2 general hospitals
leprosy patients
Number of Puskesmas with NO registered 63
leprosy patients

Annual progress Repor 2005 - South East Sulawesi 3

1.3.2 Human resource

Total Number
number trained
Provincial Wasors
involved in Leprosy 2 2
Control Program
District Wasors
involved in Leprosy 16 16
Control Program

Total Number
number trained
In Puskesmas with In Puskesmas with NO
registered leprosy registered leprosy
patients patients
HC Doctors 140 32 6
HC Jurus + 2 159 59 11
Hospital

Annual progress Repor 2005 - South East Sulawesi 4

2 Analysis of activities
2.1 Case finding, diagnosis and classification

nr. POA Activities Plan Results Remarks

1.1 Contact examination for 10.059 contacts was The number of contacts
60 % of 220 index cases examined and found 25 examined was more then
(2.640 contacts) new cases planned because it was
agree to do intensification
contact ( new cases and
RFT below 5 years) due to
ineffective RVS in last
year

1.2 RVS for 20 villages Was not done The approved fund was re
allocate for contacts
examination and training
for HCs jurus

2.2 Chemotherapy and case holding (treatment)

nr. POA Activities Plan Results Remarks

To treat all new cases All new cases was treat
with MDT with MDT on time

To tread 15 PB ( cohort 15 PB cases were RFT RFT rate for PB is 100 %

2004 and 153 MB (cohort and 143 MB cases RFT and RFT rate for MB is 93
2003) %

2.3 Prevention of disabilities

nr. POA Activities Planned Results Remarks

3.1 To do VMT-ST every 102 MB and 20 PB cases 3 districts have not
month for 188 MB and 32 were done (> 50 % well) reported yet. Response
PB patients VMT-ST has been done from the
province to the district.

3.2 To treat 29 leprosy 39 leprosy patient was Among them, 29 were

patients with severe detected and treated type 1 and 10 were type 2
reaction reaction. 10 reaction
cases were after RFT

Annual progress Repor 2005 - South East Sulawesi 5

3.3 To provide 50 % of 5.000 tab of prednisone
emergency stock have been purchased for
prednisone the district where
prednisone was not
enough.
Actually, leprosy patients
have the same right to use
every facilities in HC
include anti reaction drug.
But some district/HC still
have problem with the
shortage of drug.

2.4 Care and rehabilitation

nr. POA Activities planned Results Remarks

In 2005, leprosy control in SE sulawesi
still put more emphasis in case finding,
case holding and POD. Rehabilitation
program will be plan in near future

2.5 Planning and organization (incl. integration)

nr. POA Activities planned Results Remarks

5.2 Meeting district health
manager for advocacy
and planning
Commitment for allocation
enough fund from local
government for leprosy
program was got.
Advocacy meeting have
been attended by vice
governor, local
government planning
depart, local parliament
members, Social depart,
Welfare biro and others
decision makers.

5.3 Once time meeting HC This meeting was not

staff at district done due to shortage of
budget

2.6 Training

nr. POA Activities planned Results Remarks

6.3 2 batch training for HCs 2 batch training for HC Sharing budget that was
jurus (40 jurus) jurus have been done (41 required from local
jurus) government was not
available. The additional
fund was got from RVS
and the remaining doctors
training budget

6.5 2 batch training for HCs 1 batch training for HCs Sharing budget that was

Annual progress Repor 2005 - South East Sulawesi 6

 doctors (40 doctor)
2.7 Health education to the general public
nr. POA Activities planned
7.1 12 time radio spot
2.8 Supervision
nr. POA Activities planned
8.4 Supervision PL
8.5 Supervision by prov team
to 5 endemic high
endemic district for 60
days
8.6 Supervision by prov
team to 5 endemic district
for 45 days
8.9 Supervision by prov
Kadiskes and Kasubdin
in 10 days
8.7 Supervision in high
endemic district by wasor
to 69 HCs for 276 days
8.8 Supervision in low
endemic district by district
wasor to 77 HCs in 77 in
days
8.9 Supervision by district
Kadinkes and Kasie to 81
HCs in 81 days
Annual progress Repor 2005 - South East Sulawesi
doctors have been done required from local
(19 doctors) government was not
approved. The remain
budget was switch for
HCs jurus training
Results Remarks
1 times radio spot during
30 days
Results Remarks
5 districts was supervised
in 60 days
5 district was supervised
in 50 days
21 days supervision by
kadinkes, wakadinkes and
kasubdin.
96 HCs was supervise by Some part of budget was
district wasor in 384 days from district meeting
64 HCs was supervise by
district wasor in 87 days
96 HCs was supervise by
district kadinkes, kasubdin
and kasie in 96 days
7
2.9 Recording and reporting

nr. POA Activities Planned Results Remarks

Even though, the reporting material
was needed, there is no printing
material have been produced in this
year due to no budget were available
from local government or NLR.

2.10 Laboratory services

nr. POA Activities Results Remarks

10.1 29 skin smear 10 slit skin smear Most of district wasor dont
have been done aware and motivation to do
skin smear

2.11 Monitoring and evaluation

nr. POA Activities Results Remarks

11.1 Project leader Meeting Have been attended

11.5 2 times monev meeting 2 times monev meeting
with district wasors in have been conducted,
province and attended by prov
team and all district
wasors
The budget is from NLR
and APBN.
The main topic in both
meeting is program
evaluation, supervision,
refreshing.

2.12 Logistics and maintenance

nr. POA Activities Results Remarks

12.2 Maintenance and fuel Have been purchased
for provincial car according to the need

12.3 Maintenance and fuel Have been purchased

for districts motorcycle according to the need

12.4 Office stationary and Have been purchased

cost in province according to the need

Annual progress Repor 2005 - South East Sulawesi 8

2.13 Staff employment

nr. POA Activities planned Results Remarks

13.1 Allowance for project Have been pay Since May 2006, NLR
leader and book keeper according to the plan supported project have
the new book keeper.

Annual progress Repor 2005 - South East Sulawesi 9

3 Epidemiological developments
There are 267 leprosy new cases were found during 2005 (CDR: 14 per 100.000
populations). It increased 62 % (102 cases) to compare the previous year. There are .
HCs that was no leprosy patient before were report the new cases in this year. Even
thought leprosy program activities was not optimal due to limitation of resource but it
seem that leprosy cases in South East Sulawesi is still high. Several possibility why CDR
was increased during this year are as increase the trained HC staff, Health education
activity through radio spot, operational fund for HC staff was available and improve the
supervision from district wasor.

Prevalence Rate on 31 December 2005 was 1.44 per 10.000 populations (276 cases); It
is increase 42 % to compare with the previous year. The reason for increasing the
register prevalence is the same with CDR. The number of register prevalence is more
than the number of new case mean that some leprosy cases from 2004 is still in register
until the end of 2005 due to irregular taking MDT

The year of 2005 there are 5 district which reporting that there arent patient is commit of
disability GR.2 but according to result of supervision thet is still a lot of jurus doest do
the assessment disability level so thet disability number reported isnt accurate yet.

New patient invention number of age faction under 15 years old still be high enough in
Soth east provinsce, that wakatobi distict 40%, Bau-bau- 15.8%, Muna 12% Kendari
12%, Konawe Selatan 10.5%, buton 7,2% and Kolaka 2.4%, while 2 district ( Bombana
and Konawe) there are not child patient.

Proportion of leprosy patients MB type is still very high. This matter is possibility caused
by a lot of jurus arent got training yet so that wrong grouping the leprosy type or
hesitating they are direct group as MB.

3.1 Overview last ten years

Indicators 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Total 1,532 1,632 1.673 1,689 1,690 1,815 1,815 1,825 1,874 1,915
population x
1000

Registered 36 74 20 44 29 27 13 20 13 11
cases PB
Registered 321 216 195 221 225 191 179 208 181 265
cases MB
Total 357 290 215 265 254 218 192 228 194 276

Prevalence 2.33 1.78 1.29 1.57 1.50 1.20 1.06 1.25 1.04 1.44
per 10.000

New detected 50 92 40 63 55 42 29 22 18 34
cases PB

Annual progress Repor 2005 - South East Sulawesi 10

New detected 171 212 156 191 201 174 151 151 147 233
cases MB
Total (*) 221 304 196 254 256 216 180 190 165 267

CDR per 14 19 12 15 15 12 10 10 9 14
100.000

% disability 10 6.3 9.2 5.5 4.3 12.5 7.2 4.2 7.3 8.2
grade 2 in
new cases
% children < 15.4 15.1 7.1 11.0 0.8 4.2 7.2 8.9 9.7 9.4
15yr in new
cases

Treatment 85 80.7 87.6 94.0 90 86.5 89.6 90 87 93

completion
rate MB
Treatment 81 94.1 82.8 92.3 90 98.5 100 100 100 100
completion
rate PB

Case finding
method
Passive Case 199 181 139 187 125 167 134 140 121 189
Finding
Contact 19 29 103 7 7 13 9 14 11 25
Examination
School 0 0 0 0 0 0 0 0 0 0
Survey
Other 3 94 55 60 59 0 0 4 1 1
Surveys

Annual progress Repor 2005 - South East Sulawesi 11

During 2001 2004, the CDR and PR declined. This condition was not reflected to the real
epidemiological situation but because of reducing the activity since no support from NLR. In
2005 CDR and PR was increase due to improvement of activity.

In generally child and disability proportion is still between 5-10 % during the last 4 years
and it seem that there is no significant changes during the last 10 years

3.2 Overview last year per district

Annual progress Repor 2005 - South East Sulawesi 12

Annual progress Repor 2005 - South East Sulawesi 13
Annual progress Repor 2005 - South East Sulawesi 14
4 Other developments

4.1 Care and rehabilitation

This activity is not walked in an optimal yet, treatmen only at patients that knew by
jurus in its job region but this year of 2006 it has been planned to do commit the
monitoring to all patients of RFT.

Annual progress Repor 2005 - South East Sulawesi 15

5 Conclusions and recommendations
STRENGTHS
There is a support from the lead
of duty health
The available of operational fund
from NLR, APBN.
There is consultant NLA
There are wasor P2 leprosy
trained in district and province.
There are facilitators of leprosy
coach.
The available of drugs P2
leprosy in each district.
There is a good reporting and
recording system that is
following the national guideline.
INTERPRETATION
Commit of leprosy program activity in south east province is better than previous
year.
CONCLUSIONS
Annual progress Repor 2005 - South East Sulawesi
WEAKNESSES
Leprosy Program in all districts
isnt a priority program
There is still high number of HC
juru and doctors are untrained in
Leprosy program.
Reporting and recording is not
keep in correctly and constantly
in some of districts and HCs
Some district wasor and HCs
jurus dont do properly and
regularly the nerve fanction test
according to guideline
Supervision activity by province
and district leprosy team is not
run effectively
The operational fund P2 Leprosy
from APBN isnt available.
Prednisone drug is not available
free in some district so that
dependence of NLR very high.
Rehabilitation activity is not run
yet.
Poster P2 Leprosy is still less in
district/ Hc
There is no permanent reference
book nasional
RECOMMENDATIONS
16
 Sum up aid of NLR fund is still
less but its helpful to do the P2
leprosy program in south east
province
Some of HC jurus and doctors
are trained yet
Poster about leprosy is still less
in HC
Permanent reference book
national is still less.
6 Successes
Annual progress Repor 2005 - South East Sulawesi
Sum up aid of budget have to
free doesnt constant just like the
years before because this matter
caused the left behind province
will be left behind continue and
the province go forward to more
and more to go forward but must
be based of analysis requirement
and province willingness to go
forward.
Fund for the training of juru and
doctors many as 3 generation.
Poster is better be multiplied by
leprosy subdit and distributed
with flattened at all of HC
National reference book and
pocket for Jurus HC that is
produced by by Subdit Kusta
should be distributed to all HC,
district and province as soon as
possible.
17
Annex 1 ILEP B form

Annual progress Repor 2005 - South East Sulawesi 18

Annex 2 Overview of NLR personnel and inventory

Personnel year started

Description year of acquisition

1 Car (Toyota Kijang) is still in good condition 1997
9 Motorcycle
1 desktop computer (work very slow) 1994
1 Telephone machine 1993

Name and signature of the Project Leader

La Djabo Buton, SKM. M.Kes

Name and signature of Kepala Dinas Kesehatan Propinsi

Dr. H. L. M. Izat Manarfa, M. Sc

Annual progress Repor 2005 - South East Sulawesi 19