National programme for prevention and control of deafness - NPPCD

NPPCD

1. NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF DEAFNESS DR Mohammed N ishad n

2. INTRODUCTION Hearing loss is the most common sensory deficit in humans today and is the second leading cause for ‘Years Lived with Disability (YLD)’ , the first being depression. As per WHO estimate, in India there are approximately 63 million people who are suffering from significant auditory impairment. There are 291 persons per 1 lakh population who are suffering from severe hearing loss. Noise is the insidious of all industrial pollutants involving every industry and causing severe hearing loss in every country in the world.

3. Occupational hearing loss includes acoustic , traumatic injury and noise induced hearing loss . Noise induced hearing loss is the second most c o mmon a c qu i red he a ri n g lo s s after age re l at e d los s . 50% of causes of hearing impairment are preventable and can be corrected surgically and can be rehabilitated with the use of hearing aids , speech and hearing therapy.

4. NPPCD The Program was initiated in 2007 on pilot mode in 25 districts of 11 State/UTs. In first phase manner , the program was extended to 203 districts of 20 State/UTs by 2012. In 12 th five year plan, its proposed to expand the program to additional 200 districts in a phased manner probably covering all the states and union territories by 2017.

5. OBJECTIVES LONGTERM To reduce the total disease burden by 25 % the by the end of 1 2 th five year plan. IMMEDIATE Early identification, diagnosis and treatment of ear problems responsible for hearing loss and deafness. To prevent the avoidable hearing loss on account of the disease/injury.

6. To medically rehabilitate persons of all age groups suffering with deafness. To strengthen the existing intersectoral linkage for continuity of the rehabilitation program. To develop institutional capacity for ear care services by providing support for equipment, material and training personnel.

7. STR A TEGIES To strengthen the service delivery for ear care To develop human resources for ear care services To promote out reach activities and public awareness through innovative and effective IEC strategies with special emphasis on prevention of deafness . To develop institutional capacity of DHs,CHCs,PHCc selected under the programme

8. ORGANISATIONAL STRUCTURE

9. Health Minister Additional Secretary Joint Secretary Central Coordination Committee Secretary Health & Family Welfare Additional Director General Director General of Health Services Deputy Director General Director (Public Health ) Under Secretary(Public Health) Program Manager Chief Medical Officer

10. COMPONENTS OF THE PROGRAM Training of all the manpower Infrastructure Building Service provision IEC activities

11. CENTRAL LEVEL Central Coordination Committee will be constituted at the central level. This will consist of following members : Representative of DGHS - 2 Representative of WHO - 1 ENT specialists and experts - 2 Audiologists and speech therapists - 2 Public Health expert - 1 Representative of Rehabilitation Council of India (RCI) - 1

12. This Committee will evaluate and monitor the implementation plan for program . Central Cell will be set up at the central level in the DGHS to provide necessary leadership, technical support to the State and District level functionaries.

13. STATE LEVEL State Health Society and Program Committee is placed under NRHM It will function for …. Preparation of district plans for implementation of NPPCD , Monitoring and supervise implementation of program , Release and Monitoring of flow of funds to the District Health Societies.

14. State Technical Committee will have State Nodal Officer ; ENT Specialist / Surgeon Audiologist - 1 to provide technical guidance and expertise to the State Health Society

15. DISTRICT LEVEL At the district level , the District Health Society and Program Committee will function for ….. Planning and Implementation &monitoring of the program , Financial and material management , Social mobilization and public awareness , Orientation of various functionaries of health , Arrangement for Screening camps and monitoring the activities for NGOs

16. District Hospital will post … District Nodal Officer ; ENT Surgeon - 1 Audiologist - 1 and they will be the key persons for the implementation of the program in the district. They can also employ additional staff: Teacher for young hearing impaired – on contractual basis, to look after the therapy and training of young hearing impaired children at district level.

17. PROGRAM IMPLEMENTATION Center of Excellence – The State Medical College – which supports the program Main Focus of Activity of the Program - The District Hospital The program will be strengthened through training of … - ENT doctors - Audiologist They would be provided with equipment for proper diagnostic, therapeutic, & rehabilitation activities.

18. The doctors at PHC & CHC will also be given training as well as the basic diagnostic equipment to enable them to diagnose, treat & refer the patients requiring treatment . The Multipurpose workers at the sub central level and the gross level functionaries (AWWs, ASHA), including Mahila Mandals will be sensitized about the program which would facilitate in creating awareness and mobilizing the communities. The School Health system will play a very important role in the program. The ear check up will be done by the PHC or CHC doctors

19. SCREENING TESTS OAE PTA BERA ( Brainstem Evoked Response Audiometry) Simple Automated Reliable But COST is prohibiting factor to make it available in all the places

20. Behavioral Observation Audiometry (BOA) Assess the baby’s response to different frequency intensity and duration of sounds presented Respond to 70db noise :- a new born baby – eye blink , eye widening or startle between age of 6 – 16 weeks – arousal , eye blink or eye shift can be useful to detect to indicate hearing impairment in early life

21. ACHIEVEMENTS Modules of training of doctors , multipurpose workers and technicians have been developed. In some places such as Delhi, training of trainers has been started. In many districts, hearing aids are distributed to poor children. This program is integrated with the NRHM framework.

22. THANK U

23. Percentage of hearing handicap can be calculated by the following formula:- Degree of handicap The average pure tone hearing level in the 3 speech frequencies 500,1000 & 2000 Hz is calculated. If this average is ‘X’, then 25 is deducted from it eg. X-25.This value is then multiplied by 1.5. [Average of 3 speech frequencies minus 25] multiply by 1.5. Similarly, the percentage of hearing impairment is calculated for the other ear. The total hearing handicap of a person is then calculated as follows: [(Better ear % x 5) + (Worse ear %)] ÷ 6

24. THANK YOU