Annual Progress Report

2006

Leprosy Control Program

South East Sulawesi Province

22 Februari 2007
Table of contents
List of abbreviations.........................................................................................................1
Summary.......................................................................................................................... 2
1 Introduction.............................................................................................................. 4
1.1 Geographical characteristics............................................................................4
1.2 Infrastructure of the health care system............................................................4
1.3 The Leprosy Control Program...........................................................................4
1.3.1 Structure of the Leprosy Control Program.................................................4
1.3.2 Human resource.......................................................................................5
2 Analysis of activities.................................................................................................6
2.1 Case finding, diagnosis and classification...........................................................
2.3 Prevention of disabilities.....................................................................................
2.4 Care and rehabilitation........................................................................................
2.5 Planning and organization (incl. integration).......................................................
2.6 Training...............................................................................................................
2.7 Health education to the general public................................................................
2.8 Supervision.........................................................................................................
2.9 Recording and reporting.....................................................................................
2.10 Laboratory services............................................................................................
2.11 Monitoring and evaluation...................................................................................
2.12 Logistics and maintenance.................................................................................
2.13 Staff employment................................................................................................
2.14 New initiatives.....................................................................................................
3 Epidemiological developments.................................................................................6
3.1 Overview last ten years..................................................................................10
3.2 Overview last year per district.........................................................................12
4 Other developments...............................................................................................16
4.1 Care and rehabilitation........................................................................................
5 Conclusions and recommendations........................................................................16
6 Successes.............................................................................................................. 18
Annex 1 ILEP B form................................................................................................19
List of abbreviations

CDR : Case Detection Rate

HC : Health Centre
MB : Multi Basiler
Monev : Monitoring and Evaluation
NLR : Netherlands Leprosy Relief
PB : Pauci Basiler
PHO : Provincial Health Office
POA : Plan of Action
RFT : Released from treatment
RVS : Rapid village survey

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. Case Finding
During January December 2006, we found 258 leprosy new cases, among
them, 69% were found by voluntary reporting, 4% by contact examine. The
child proportion 10% and disability grade 2 proportion 10 %.

2. CDR.

There are 258 leprosy new cases were found during 2006 (CDR: 13 per 100.000
populations). It decreased 3 % (9 cases) to compare the previous year. There are 2
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.

3. PREVALENS

Prevalence Rate on 31 December 2006 was 1.3 per 10.000 populations (264 cases);
It is decrease 4,3 % (12 cases) to compare with the previous year. The number of
register prevalence is more than the number of new case mean that some leprosy
cases that was found before 2006 were still in register till the end of 2006 due
to irregular taking MDT .

4. Case Holding

The RFT Rate in the entire province for PB cases in cohort 2005 was 100 %
and for MB cases in cohort 2004 was 91%.

5. Prevention of Disability

There was no patient both PB cases in cohort 2005 and MB cases in cohort
2004 was increase disability during treatment.

6. Care and Rehabilitation

Generally, the treatment (perawatan) on leprosy-patients has been conducted
by individual ot Public Health Center, not conducted in group. In 2007, it will
planned to form the Self Care Group. Surveillance after RFT has already
conducted for rehabilitation activities, but not entirely district sent the data
because of technical reasons in field.

2
CONCLUSIONS
Sum up aid of NLR fund is still less
but its helpful to do the P2 leprosy
program in south east province
The number of trained HC juru was
increased to be 73 % however the
number of trained HC doctor are
still very few due to hight turn over
IEC material ( poster, leaflet, lembar
balik etc) about leprosy is still less
in HC
National guide line book is still less.
Leprosy provincial team are still
weak due to project leader and
provincial wasor were very busy
with other program and there is still
no provincial doctor
3
RECOMMENDATIONS
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.
Orientation session about leprosy
program for the new HC doctor
during orientation phase in the
province before go to their HC and
during regular district meeting
IEC material is better be multiplied
by leprosy subdit and distributed
with flattened at all of HC
National guide line 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.
The idea to involve other doctor ( dr,
Juriadi) as project coordinator with
clear job description and formal
letter from the head of PHO should
be seriously considered
1 Introduction
1.1 Geographical characteristics

Number of inhabitants 1,965,158

Number of districts
Number of municipalities
% urban area
% remote area (difficult to reach)
Other specific characteristics
10
Kendari City and Bau Bau
20 % consisted 2 cities w1th population
340,002
30 % island, consisted of 3 district with
population 664,432
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 No
Total number of puskesmas 160

1.3 The Leprosy Control Program

1.3.1 Structure of the Leprosy Control Program

The Leprosy Control Program is combined with
the TB Program
Number of Puskesmas with registered leprosy
patients
Number of Puskesmas with NO registered
leprosy patients
Yes, almost all aspect in puskesmas,
district level and only some part in
provincial level
99 include 2 general hospitals
61

4
1.3.2 Human resource

Total Total
number number
trained
Provincial Wasors 1 1
involved in Leprosy
Control Program
District Wasors 11 11
involved in Leprosy
Control Program
Available facilitators 4
(trained through TOT)

Total Number Total number trained

number trained in
reporting year
In Puskesmas In Puskesmas with NO
with registered registered leprosy
leprosy patients patients
Doctors 134 19 32 20

Jurus
160 92 99 49

5
2 Analysis of activities
2.1 Case finding, diagnosis and classification

nr. POA Activities Plan Results Remarks

1.1 contact examination for 834 contacts was The number of contacts
165 index examined and found 11 examined was more then planned
cases (2310 contacts), new cases because it was agree to do
70 % of total new intensification contact ( new
cases and RFT below 5 years).
cases

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 34 PB ( cohort 34 PB cases were RFT RFT rate for PB is 100 % and
2005 and 171/147 MB and 155 MB cases RFT RFT rate for MB is 91 %
(cohort 2004)
Lowly pod scoping as many
Health education for new Not realization. sufferers who do not come
patients regularly to th public health center
with various reasons, such as
isolated, far, and hardly reached
from the public health center, and
lowly motivation to take reliever

2.3 Prevention of disabilities

nr. POA Activities Planned Results Remarks

3.1 To do VMT-ST every 88 MB and 11 PB cases 1 districts have not
month for 147 MB and 18 were done (> 70 % well) reported yet. Response has
PB patients VMT-ST been done from the province to
the district.
Depend on the
supervising quality of district
wasor. So that in future, we
strive for the quality of
technical supervision, by
district wasor , will be
conducted mare optimally
Monthly medicine
withdrawal is often represented
by their families as the sufferer
cant come to the public health
3.2 To treat 25 leprosy 45 leprosy patient was center
patients with severe detected and treated Among them, 25 were type 1 and
reaction that need steroid 20 were type 2 reaction. 7

6
 and 5 patients need reaction cases were after RFT
clofazimin

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

2.4 Care and rehabilitation

nr. POA Activities planned Results Remarks

2 glasses 0 The surveillance data on sufferer after RFT is
25 protective footwear 0 not already adequate. Among three district
1 unit health 0 that send the data, there is no sufferer who
education tools need safe device.
25 patien with care 0
ulcer

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 Advocacy meeting have
enough fund from local been attended by vice
government for leprosy governor, local
program was got. government planning
depart, local parliament
members, Social depart,
Welfare biro and others
decision makers.

5.3 Once time meeting HC
staff at district
Comitment to integrated The meeting was attended
leprosy program in other by public health centers
programs was got doctors and jurus
throughout Southeast
sulawesi.

2.6 Training

nr. POA Activities planned Results Remarks

6.3 2 batch training for HCs
jurus (60 jurus)
5 batch training for HC 3 more batches training
jurus have been done (92 was done by
jurus) additional funding from
NLR due to high number of
untrained jurus

One participant does not

6.5 1 batch training for HCs 1 batch training for HCs complete the training
doctors (20 doctor) doctors have been done because of ill
(19 doctors)

7
2.7 Health education to the general public

nr. POA Activities planned Results Remarks

That planned by six times
broadcasting, but as the
7.1 fund of broadcasting is
6 times radio spot 12 times radio spot
excess, then the
broadcasting was
continued

2.8 Supervision

nr. POA Activities planned Results Remarks

8.4 Supervision PL to
Provincial Supervisor for
9 days
8.5 Supervision by prov team
to 6 endemic high
endemic district for 36
days
8.6 Supervision by prov team
to 4 endemic district for
16 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
5 district was supervised in
9 days
6 districts was supervised
in 36 days
4 district was supervised in
16 days
96 HCs was supervise by
district wasor in 384 days
64 HCs was supervise by
district wasor in 87 days
gradually minimized.
Supervision PL and
Wasor provincial 10 district.
The district supervision
on the public health center
exceeds the target as there
are the cases addition on the
public health center that
having no confirmation of
diagnosis by the wasor. While
the supervision of structural
officers was conducted to
solve the problem that
occurred in the public health
center, either related with
employment or with the public
health center, performance in
leprosy control. Nevertheless,
in the future, it seek for that
supervision of district
structural officers will

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 25 skin smear 30 slit skin smear have Most of district wasor dont
been done aware and motivation to do
skin smear

8
2.11 Monitoring and evaluation

nr. POA Activities Results Remarks

11.1 Project leader Meeting Have been attended

11.2 Insentive for timely

submission of annual
report
11.3
Incentive for POA
11.5 1 times monev meeting 1 times monev meeting The budget is from APBD.
with district wasors in have been conducted, and The main topic in both
province attended by prov team and meeting is program
all district wasors evaluation, supervision,
refreshing.

2.12 Logistics and maintenance

nr. POA Activities Results Remarks

12.2 Maintenance and fuel for Have been
provincial car purchased according
to the need
12.3 Maintenance and fuel for There was no budget
districts motorcycle No budget for
transportation for district
maintenance and fuel
for districts motorcyle wasor supervision so we
12.4 Office stationary and cost in used ilef 12.2 for
province Have been purchased maintenance and
according to the need transport provincial

2.13 Staff employment

nr. POA Activities planned
13.1 Allowance for project
leader and book keeper
Results Remarks
Have been pay according Since May 2006, NLR
to the plan supported project have the
new book keeper.
There is still no allowance
for wasor

3 Epidemiological developments
There are 258 leprosy new cases were found during 2006 (CDR: 13 per 100.000
populations). It decreased 3 % (9 cases) to compare the previous year. There are 2 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.

Prevalence Rate on 31 December 2006 was 1.3 per 10.000 populations (264 cases); It is
decrease 3 % to compare with the previous year. The reason for decreasing 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 2005 is still in register until the
end of 2006 due to irregular taking MDT

9
 The year of 2006 there are 1 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.

Child proportion among new cases is still high. The highest is in Northern Kolaka
21%, Buton 13%, Kolaka 12%, Wakatobi 11%,Muna 10%, Konawe Selatan 10%,
Bombana 10% , Bau - bau 8%, Konawe 4% and Kendari City 4%.

Proportion of leprosy patients MB type is still very high ( 80%). 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 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Total population x 1000 1,632 1.673 1,689 1,690 1,815 1,815 1,825 1,874 1,915 1,965

New detected cases PB 92 40 63 55 42 29 22 18 34 52

New detected cases MB 212 156 191 201 174 151 151 147 233 206
Total 304 196 254 256 216 180 190 165 267 258

CDR per 100.000 19 12 15 15 12 10 10 9 14 13

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

% females in new cases 38% 34%

Registered cases PB 74 20 44 29 27 13 20 13 11 31
Registered cases MB 216 195 221 225 191 179 208 181 265 233
Total 290 215 265 254 218 192 228 194 276 264

Prevalence per 10.000 1.78 1.29 1.57 1.50 1.20 1.06 1.25 1.04 1.44 1,3

Treatment completion 80.7 87.6 94.0 90 86.5 89.6 90 87 93 91

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

Number of cases with 67 48 39 18 19 29 22 56 39 45

reaction
Number of relaps cases 1 1 2 0 2 3 2 3 2 1

Case finding method

Passive Case Finding 181 139 187 125 167 134 140 121 189 177
Contact Examination 29 103 7 7 13 9 14 11 25 11
School Survey 0 0 0 0 0 0 0 0 0 0
Other Surveys 94 55 60 59 0 0 4 1 1 0

Data of hospitals are included YES Since year: 1996

10
In 2005 - 2006 CDR and PR was increase due to improvement of activity to compare the
previous year.

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

11
3.2 Overview last year per district

12
13
14
3.2.1 Mapping

15
4 Other developments
4.1 Care and rehabilitation

Generally, the treatment (perawatan) on leprosy-patient has been conducted by

individual at Public Health Center, not conducted in group. In 2007, it will planned to
form the Self Care Group, particularly on the district having high prevalence in last years.
Surveillance after RFT has already conducted for rehabilitation activities, but not entire
district sent the data because of technical reasons in field.

The rehabilitation activities has tried being more optimally conducted, particularly for
RFT sufferer who still have problems, but not entirely regions sent the data because of
technical reasons in field:
1) High population mobility, many sufferer having unclear address or moved
without confirmation.

2) The patients is difficultly reached because of geographic isolation.

3) The patients is tend to avoid the officials.

5 Conclusions and recommendations

STRENGTHS WEAKNESSES

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.
Leprosy pogram are run well in
provincial city hospital and kendari
Leprosy Program in all districts isnt a priority
program
Very high turn over of HC dovtor ( only
connracted for 6 12 month ).
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
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

INTERPRETATION

Commit of leprosy program activity in south east province is better than previous year. The
commitment increases in all, both provincial and district level.

16
CONCLUSIONS
Sum up aid of NLR fund is still less
but its helpful to do the P2 leprosy
program in south east province
The number of trained HC juru was
increased to be 73 % however the
number of trained HC doctor are
still very few due to hight turn over
IEC material ( poster, leaflet, lembar
balik etc) about leprosy is still less
in HC
National guide line book is still less.
Leprosy provincial team are still
weak due to project leader and
provincial wasor were very busy
with other program and there is still
no provincial doctor
17
RECOMMENDATIONS
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.
Orientation session about leprosy
program for the new HC doctor
during orientation phase in the
province before go to their HC and
during regular district meeting
IEC material is better be multiplied
by leprosy subdit and distributed
with flattened at all of HC
National guide line 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.
The idea to involve other doctor ( dr,
Juriadi) as project coordinator with
clear job description and formal
letter from the head of PHO should
be seriously considered
6 Successes

a. Increased publich helath centers skilled jurus form 35% to 89% in the end
of year 2006. Nevertheless, they need guidance, support as well as
continually motivation from the head of public health center and district
wasor
b. Implemented leprosy control in the some provincial hospital and kendari
city hospital is the entry poin for integrated reference service.

18
Annex 1 ILEP B form

Name and signature of the Project Leader

La Djabo Buton, SKM. M. Kes

Name and signature of the Kepala Dinas Kesehatan Propinsi.

H.La Ode Hamiru

19