A comparative study of the cost and effectiveness of a modified system of MDT drug delivery system in a high endemic district (Nalagonda) of South India.

ABSTRACT

Fall in the case load (from 17,000 to 4,500), has changed the disease profile and introduction of fixed duration Therapy (FDT) has made management of leprosy cases rather easy in Nalgonda, a backward district in Andhra Pradesh. The system of drug delivery which was conceived for managing large case load, however, remains unchanged, thereby resulting not only in considerable wastage of resources but also in hampering other activities like case detection and patient care. This study was undertaken to develop and assess a modified system of drug delivery in terms of the cost and effectiveness, its overall effect on other activities in the programme and its acceptability by the field staff. Four Leprosy Control Units (LCUs) were selected and were randomly assigned either to study (Gudibanda, Suryapet) or control (Nalgonda, Bhuvanagiri) group. In the study group the modified drug delivery system replaced the existing system. The modified system consisted of the para medical worker being made responsible for patients at all the DDPs in his subcentre. The clinics were managed alternately by medical officers and non medical supervisors every month. In the control group each clinic was managed by medical officers every month and it covered two sub centers with each drug delivery point being assisted by a para medical worker. The study revealed that the modified system resulted in a saving of 130 man-days a month, a 30% saving in use of vehicle, a 30% saving in POL and improvement in case detection. There was no change in the clinic attendance and drug consumption compliance in the units where modified system was introduced.