NPPCD

NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS (NPPCD), MIZORAM

Introduction

• Hearing loss is the most common sensory deficit in humans today.
• As per WHO estimates, there are approx 278 million people worldwide and 63 million people in India, who are suffering from significant auditory impairment (6.3% of Indian population). Currently there are 291 persons per one lakh population who are suffering from severe to profound hearing loss (NSSO, 2001). Of these, a large percentage is children between the ages of 0 to 14 years.
• An even larger percentage of our population suffers from milder degrees of hearing loss and unilateral (one sided) hearing loss
• Over 50% of the causes are preventable or treatable by surgical methods or rehabilitated with use of hearing aids, speech and hearing therapy.
• There is inadequate health resources related to hearing and speech in terms of man power and infrastructure.With this in mind, the Ministry of Health & Family Welfare, Govt. of India launched National Programme for Prevention and Control of Deafness (NPPCD)

PROGRAMME HIGHLIGHTS

• NPPCD was launched in India, on a pilot basis since August, 2006.
• The Programme was initiated in 25 districts over 10 states – Andhra Pradesh, Assam, Gujarat, Karnataka, Manipur, Sikkim, Tamil Nadu, Uttaranchal, Uttar Pradesh, New Delhi and 1 UT – Chandigarh.
• In 2008, the pilot phase has taken the shape of a full fledged National Programme and is to be expanded gradually to include 200 districts by end of 12^th Five Year Plan (March, 2017) and was also been integrated with NRHM.
• It was started in Mizoram since August, 2014

PROGRAMME EXECUTION & EXPANSION

• The Programme was a 100% Centrally Sponsored Scheme during 11th Five Year Plan.
• However, in as per the 12th Five Year Plan, the Centre and the States will have to pool in resources financial norms of NRHM mutas mutandis.
• In the 12th Plan, it is proposed to expand the Programme to additional 200 districts in a phased manner probably covering all the States and Union territories by March, 2017.

OBJECTIVES OF THE PROGRAMME

1.To prevent avoidable hearing loss on account of disease or injury.

2. Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness.

3. To medically rehabilitate persons of all age groups, suffering with deafness.

4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitation programme, for persons with deafness.

5. To develop institutional capacity for ear care services by providing support for equipment, material and training personnel.

Long term objective: 

To prevent and control major causes of hearing impairment anddeafness, so as to reduce the total disease burden by 25% of the existing burden by the end of 12th Five Year Plan.

COMPONENTS OF THE PROGRAMME

1) Manpower training and development 

2) Capacity building – for the district hospital, community health centers and primary health center in respect of ENT/ Audiology infrastructure.

3) Service provision–Early detection and management of hearing and speech impaired cases and rehabilitation, at different levels of health care delivery system.

4) Awareness generation through IEC/BCC activities – for early identification of hearing impaired, especially children so that timely management of such cases is possible and to remove the stigma attached to deafness.

SERVICE COMPONENTS

• Early detection
• Ear Screening Camps
• Early Treatment
• Referral Linkages
• Rehabilitation and Hearing Aid Provision
• Awareness creation among Parents/Community

1. Early Detection

• The detection would be by sensitized personnel at grass root level including family members/parents, selected school teachers, MPWs at subcentre level, Public Health Nurses & medical officers in PHCs and CHCs and district level
• House to house surveys will be conducted by the AWWs & ASHAs, under the supervision of the male and female MPWs for detection of cases of hearing impairment and deafness. The deafness cases will be noted in the disability column of ANM’s village register.
• The MPWs will maintain records of each family based on a Family performa provided to them.
• The District level Pediatricians and Gynecologists will be responsible for referring any child born of a high risk pregnancy or delivery, as well as other children who are exposed to a high risk factor in infancy and who show features suggestive of hearing impairment.
• These children will be screened by the district level ENT doctor / Audiologist with OAE and then subjected to diagnostic tests.
• School teachers will undertake to screen the children in the school with the help of pre-prepared proformas. These will help to identify children with any ear or hearing problem. They will then be referred.

2. Ear Screening Camps

• Screening camps will be organized in collaboration with NRHM (RBSK)/ SWD at the PHC/CHC and District level for screening the general population in respect of ear problems, hearing impairment and deafness.
• Ear screening camps will be conducted by the PHC/CHC doctors and district level ENT specialists, trained under the programme.
• One screening camp will be organized per month at any PHC or CHC or District hospital by rotation.

3. Treatment

• Public Health Nurses and MPWs – treatment of common ear ailments such as Wax, Acute Suppurative Otitis Media etc
• Trained PHC/CHC doctors will provide early diagnosis of ear diseases and treatment of all common ear ailments.
• The District level ENT doctors and Audiologists will provide comprehensive preventive, promotive and curative and medical rehabilitative services. Wherever feasible, suitable linkages would be developed with the NIOH / SWD
• The District level Paediatricians will also be responsible for treating ear diseases such as Acute Otitis media, so that progress to Deafness can be prevented

4. Referral services:

• Effective linkages would be developed from peripheral level to district level with the help of functionaries and personnel from grass root level (AWW, ASHA and sensitized parents and PRIs), subcentre level (Male and female MPWs), PHC level medical officers, Public health nurses, School teachers and School health doctors, ENT private practitioners and District level officers.

5. Rehabilitation and Hearing Aid provision:

• All patients who are identified as having an ear problem that either requires surgery, hearing aid fitting or rehabilitative therapy will be referred to the ENT doctor and Audiologist at the district level.
• Patients who suffer with Sensorineural hearing loss that is not amenable to medical or surgical correction and which requires hearing aid, will be fitted with the same at the district level which will be provided by Ministry of Social Justice & Empowerment. This will include children who are suffering with Bilateral sensorineural hearing loss.
• The requirement for Speech therapy and Hearing therapy will be met with by the Audiologist at the District level.

6. Awareness Creation among Parents/ community:

• Community level health workers and doctors will undertake this activity on a continuous basis. This will also form a part of the IEC activities at various levels.

1. NPPCD was launched in Mizoram since April, 2014 and currently, the Programme is implemented in nine (9) districts namely Aizawl East, Aizawl West, Champhai, Kolasib, Lawngtlai, Lunglei, Mamit, Serchhip and Siaha District. 

1. Procurement of equipments:

Myringotomy Surgery Set for Aizawl East, Champhai, Lunglei, Serchhip & Lawngtlai ongoing.

1. Review Meeting was held on 7^th November, 2022 at Auditorium, Directorate of Hospital & Medical Education, MINECO, Aizawl.

1. One Day Refresher Training of Specialist, Medical Officer from District Hospitals, Sub District Hospitals, CHCs & UPHCs was held on 9^th November, 2022 at Auditorium, Directorate of Hospital & Medical Education, MINECO, Aizawl.

1. Hands On Training of Dr. Lalramhluna Tochhawng, MS (ENT), DNO NPPCD, District Hospital, Lawngtlai, on Audiology & Disability Certification at ENT Dept., Civil Hospital, Aizawl from 10^th& 11^th, 14^th - 16^th November, 2022 (Thursday till Wednesday).

1. One Day Refresher Training for DEOs from nine (9) Districts on Reporting Format under NPPCD on 8^th December, 2022 

1. Observation of World Hearing Day on 2^nd March, 2023.

1. Stakeholder Meeting under NPPCD on 14^th March, 2023.

1. Talk Show at Zonet Cable TV on 20^th March, 2023 (Observance of World Hearing Day on the theme “Ear and Hearing Care for All”)

1. Printing of Leaflets.

 Case Detection FY 2022-23 : (District Wise)

Screening Camp FY2022-23 : (District Wise)

ACHIEVEMENTS 2021-22

• Renewal of Registered Medical Institute License (RMI) for procurement, storage and dissemination of Morphine for9 district Hospitals namely – Civil Hospital Aizawl, Mizoram State Cancer Institute (MSCI), State Referral Hospital Falkawn, District Hospital – Champhai, Kolasib, Mamit, Lawngtlai, Lunglei and Siaha had been completed.

• Procurement of equipments andfurnituresfor Siaha District completed.&  disseminated to district.

• World Hospice and Palliative Care Day was observed on 10^th October, 2020. TV Spots on Palliative Care was broadcast on Local Cables and Article on Palliative Care was published at Local Newspaper.

• OPD Services availableat District Palliative Care Unit.
• In Patient Service – 10 Bedded Palliative Ward at MSCI, Zemabawk and 4 Bedded Palliative Ward at Lunglei District Hospital available.
• Home Visit – By Doctor & Nurses under District Palliative Care Cell for bed ridden cancer patients to offer supportive care and psycological and moral support for the affected family.

• Case Detection Status :  A total of 2090 OPD cases were seen, 209 IPD cases and 532 New cases, Home Visit could not be carried out in most Districts and therefore, only 41 patients were visited at home.60 Palliative patients died in the Hospital whereas 87 patients died at home.

• Dissemination of Home Based Care Kit to districts.
• Two Days Training of Doctors & Nurses of Lawngtlai&Siaha District on Palliative Care 10^th& 11^th March, 2022 Auditorium, Directorate of Hospital & Medical Education, MINECO, Aizawl.

• Hands On Training Staff Nurses on Home Based Palliative Care at MSCI, Zemabawk on 14th - 19th March, 2022.

• Stakeholder Meeting cum Review Meeting on 22nd March, 2022 at Auditorium, Directorate of Hospital & Medical Education, MINECO, Aizawl.

• Workshop on Strengthening & Promoting Palliative Care Services on 17^thMarch, 2022 at Conference Hall, Aijal Club, Treasury Square, Aizawl.

 Achievements : 2020-21

Case detection status:

1. No. of patients examined : 15067
2. Morbidities Detected : 8885
3. Hearing Loss : 2651
4. Referral for Hearing Aid / Rehabilitation : 1038
5. Ear Surgeries : 117
6. Ear Diseases / Problems : 6369
7. Investigation Performed : 3891
 8. Others -

• In Patient Service – 10 Bedded Palliative Ward at MSCI, Zemabawk and 4 Bedded Palliative Ward at Lunglei District Hospital.
• Home Visit – By Doctor & Nurses under District Palliative Care Cell for bed ridden cancer patients to offer supportive care and psycological and moral support for the affected family (currently carried out only at MSCI Zemabawk). 
• Procurement of Morphine & Home Based Care Kit – ongoing.
• Renewal of RMI License completed.
• World Hospice and Palliative Care Day was observed on 10^th October, 2020. TV Spots on Palliative Care was broadcast on Local Cables and Article on Palliative Care was published at Local Newspaper.

Achievements during 2019-20

• At present, 9 district Hospitals namely – Civil Hospital Aizawl, Mizoram State Cancer Institute (MSCI), State Referral Hospital Falkawn, District Hospital – Champhai, Kolasib, Mamit, Lawngtlai, Lunglei and Siaha had been given  Registered Medical Institute License (RMI) for procurement, storage and dissemination of Morphine.
• Formation of Palliative Care Committee in all implemented districts along with appointment of District Nodal Officer and Medical Officer i/c NPPC
• Morphine is procured and made available at District Hospitals. Palliative Patients can recieve free Morphine using Morphine Dispense Card.
• Sensitisation of District Hospital, Mamit staff on 17^th May, 2019 at Mamit.
• Stakeholder Meeting on 20^th June, 2019 at White Stone Conference Hall, Ramhlun.
• Training of Doctors & Nurses under Mamit District @ DHS Conference Hall on 17^th September, 2019.
• World Palliative Care Day observed at Taxation Audiotorium, New Capital Complex on 12^th October, 2019 on the theme “My Care, My Right”.
• TV Spot based on Promoting Palliative Care Facility – released on World Palliative Care Day observation.
• Palliative Care Workshop for Specialist and Medical Officers was organised at Annexe Conference Hall on 4^th Feb, 2020.
• Home visits carried out in 4 districts currently – MSCI, Lunglei, Champhai & Kolasib.

Achievements/activities dung 2017-18 

•  ·         Currently 8 districts (except Lawngtlai) are covered. 
• ·         24 contractual staff are currently employed (5 doctors, 3 Audiologists, 7 Audiometric Assistants, 7 Hearing Instructor, 1 Programme Assistant, 1 DEO). 
• ·         Audiometry Room (Sound Proof Room) constructed at Aizawl, Lunglei & Falkawn. 
• ·         Following equipments procured 
• ·         for Civil Hospital Aizawl- Microdrill,Impedance Audiometer, Indigenious Audiometer, OAE Analyzer, Otoscope, Headlight, Brainstem Evoked Potential (BERA) 
• ·         for Falkawn - Impedance Audiometer, Indigenous Audiometer, Otoscope, Headlight, Otoendoscope, Cell Seeker, Crocodile Forcep (Micro), House Microcurette, Aural Syringe, Jobson Horne Probe 
• ·         for Lunglei - Impedance Audiometer, Indigenous Audiometer, Audiometry Room, Otoscope, Headlight, Otoendoscope, Crocodile Forcep (Micro), House Microcurette, Aural Syringe, Jobson Horne Probe 
• ·         for Champhai - Impedance Audiometer, Indigenious Audiometer, OAE Analyzer, Headlight, Otoendoscope, Crocodile Forcep (Micro), Aural Syringe, Jobson Horne Probe 
• ·         for Kolasib - Impedance Audiometer, Indigenous Audiometer, Otoscope, Headlight, Otoendoscope, Cell Seeker, Crocodile Forcep (Micro), House Microcurette, Aural Syringe, Jobson Horne Probe
  
• ·         for Mamit - Impedance Audiometer, Indigenous Audiometer, Otoscope, Headlight, Otoendoscope, Cell Seeker, Crocodile Forcep (Micro), House Microcurette, Aural Syringe, Jobson Horne Probe 
• ·         In addition, Otoscope, Headlight and Aural Syringe distributed to 8 CHCs and 52 PHCs 
• ·         Training for staff, Specialists, Medical Officers, nurses, Health workers, ASHAs conducted 
• ·         During 2017-18, under NPPCD 25,442 patients were seen, 14,151 morbidities were seen, and 2365 Hearing Impaired were detected 
• ·         IECs & Camps are conducted regularly