NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NRHM – Common Review Mission) 25-11-2008

1. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME(NRHM – Common Review Mission)25-11-2008

2. Overview of NVBDCP • Vector borne diseases include: • Malaria, • Filariasis, • Kala-azar, • Dengue, • Chikungunya and • Japanese Encephalitis (JE)

3. Malaria Programme Objectives • Reduction in malaria morbidity • Prevention of deaths due to malaria

4. STRATEGIES FOR MALARIA CONTROL • Surveillance - Early Diagnosis and Prompt Treatment- Alternative drugs for drug resistant cases. • Selective Vector Control (Integrated Vector Control Measures including spray & use of larvivorous fishes) • Promotion of Personal Protection Methods - Bed Nets (for high risk rural tribal areas & priority beneficiaries are Below Poverty Line population especially pregnant women and children) • Management Information System (MIS) • Early Detection & Containment of Epidemics • IEC/BCC - Community Involvement • Capacity Building

5. STRATEGIES FOR ELF Interruption of transmission of filariasis by Annual MDA for 5 years or more to the population except: children below 2 years pregnant women seriously ill persons (DEC + Albendazole in selected distt & DEC in other distt) Morbidity Management Home based management of lymphoedema cases and upscaling of hydrocele operations in the identified CHCs / District hospitals/ medical colleges.

6. IMPORTANT ACTIVITIES Completion of preparatory activities before MDA such as Adequate social mobilization, training & IEC activities. Identification & training of Drug distributors at sub centre and village level including MPWs, ANM, Aganwadis, ASHA & volunteers. Monitoring of MDA and coverage. Monitoring of Drug Compliance Intensification of hydrocele operations and home based management for lymphoedema patients.

7. KALA-AZAR ENDEMIC AREAS (52 Districts) • Goal: • Improving the health status of vulnerable groups and at risk population living in Kala-azar endemic areas of India by elimination of Kala-azar by 2010. • Target: • To reduce the annual incidence of Kala-azar to less than one per 10,000 population at the sub-district level preferably by 2010, towards elimination of Kala-azar in South East Asia region by 2015. 4 dist. Pop. – 11 mill.. 4 districts Pop. – 6.7 mill. 11 dist. Pop.50 mill. 33 dist. Pop. – 62.3 mill.

8. THREE-PRONGED STRATEGY • PARASITE ELIMINATION • Early case detection and complete treatment • Introduction of Kala-azar rapid test - rK39 for use at peripheral level & Introduction of oral drug – Miltefosine on pilot basis as first line treatment • Strengthening of referral services • VECTOR CONTROL • Indoor Residual Spraying with DDT twice annually. • Hygiene and environmental sanitation • Advocacy for use of Insecticide treated bed nets/Long Lasting Insecticide Nets. • SUPPORTIVE INTERVENTIONS: • Communication for Behaviour Impact • Inter-sectoral collaboration • Capacity Building • Monitoring and supervision with periodic reviews/evaluations

9. IMPORTANT ACTIVITIES • Introduction of new diagnostic tool – rK39 and oral drug – miltefosine on pilot basis in 10 districts in three states. • Free diet to kala-azar patient and one attendant • Incentive to kala-azar patient @ Rs. 50/- per day towards loss of wages • Incentive to kala-azar activist / ASHA for Rs. 100/- per case to refer and ensure complete treatment • Construction of Pucca houses for Mushar community in collaboration with Ministry of Rural Development • Village-wise GIS mapping in Bihar for focused intervention • Active case search twice a year • Patient coding scheme initiated. • Tool kit with flip charts, posters made available to states. • Prototypes on kala-azar for spots in T.V. / radio sent to states for translating into local language for target groups • Central teams supervised & monitored IRS activities in high endemic districts in Bihar state. • Third Party supervision & monitoring of IRS by RMRI Patna.

10. EPIDEMIOLOGICAL PROFILE Dengue Chikungunya

11. Initiatives Taken for Dengue & Chikungunya • Strategic Action Plan for prevention & control of Dengue & Chikungunya circulated. • Guidelines on clinical management of Dengue/DHF cases sent to the states for wider circulation. • Identified 13 Apex Referral Laboratories for advanced diagnosis and regular surveillance of Dengue & Chikungunya. • Identified 137 sentinel surveillance hospitals for proactive surveillance for Dengue & Chikungunya . • NIV Pune entrusted to supply ELISA test kits to these institutes. • Contingency grant made available. • Emphasized on intensive IEC/Behaviour Change Communication activities through print, electronic media, Inter-personal communication, outdoor publicity as well as Inter-sectoral collaboration with civil society organizations (NGOs/CBOs/Self-Help Groups), Panchayati Raj Institutions (PRIs), for taking community based measures.

12. INITIATIVES FOR PREVENTION CONTROL OF JE • Strengthening of AES/JE surveillance through: • 50 sentinel sites • 12 Apex Referral Laboratories for advanced diagnosis • Standard Guidelines for AES/JE surveillance • “Vector Borne Diseases Control Surveillance Unit” set up at BRD Medical College, Gorakhpur, UP – continued in 2008 • Sub-office, ROH &FW, Lucknow functioning in Gorakhpur • NIV unit established in BRD Medical College, Gorakhpur. Funds four functioning of this unit are being released by GoI through ICMR • JE vaccination in age group 1-15 years: • During 2006- 11 districts in 4 states (Assam, Karnataka, Uttar Pradesh, West Bengal) covered. • Left out & new cohorts are being covered under routine immunization. • In 2007- Expanded to 27 districts in 9 states • In 2008, 23 districts in 9 states are covered

13. INTEGRATION UNDER NRHM • At Village Level • Monthly meetings of Village Health & Sanitation Committee serve as a platform for health education and counseling of community on prevention and control of VBDs, treatment compliance, service delivery and morbidity management. Involvement of ASHA as • surveillance worker to inform any increase in fever cases including Dengue/Chikungunya and J.E. • FTD for early detection of suspected malaria cases and treatment • linkage between ANC services and prevention & treatment of malaria • drug distributor on National Filaria Day every year. • counselor for Filaria cases to practise home based management. • community volunteer for identification of kala-azar cases and facilitating complete treatment. • organizer, motivator and trainer in village level meetings/training workshops. • At PHC/CHC level • Ensure timely treatment before case is referred to CHCs/District Hospital . • Training of health workers/volunteers on VBDs along with other health programmes besides specialized training. • Financial Integration • Release of funds through State Health Society under NRHM • Use of NRHM untied funds for additional requirement in local situation and meeting the emergent needs

14. PROGRAMME IMPLEMENTATION • The States/UTs are requested to include the full action plan of NVBDCP in PIP. • The financial proposal should include the balance available out of the funds released under the programme. • The requirement for additional items (not approved under the programme) need to be projected under NRHM additionality.

15. APPROVED PATTERN OF ASSISTANCE UNDER NVBDCP • The component based support provided under NVBDCP is as under: • Blood slides, reagents, etc. - State • Microscopes & parts - State • Mobility POL/Diesel Except externally funded Project - State • Kerosene oil for mixing with Pyrethrum Extract • for space spraying - State • Insecticides (Malathion/Synthetic Pyrethroids) - State • Spray wages except kala-azar - State • Pumps, accessories etc. - State • DDT as per approved Norms - GoI • Synthetic pyrethroids (under project) - GoI • Drugs except quinine & primaquine tablets - GoI • Diagnostic kits (under project) - GoI • Cash assistance for malaria 100% in NE States and in externally funded projects as per agreed norms under project • Cash assistance for kala-azar programme, filaria elimination activities, JE, dengue & chikungunya

16. Additional support under externally funded projects • Human Resource: Hiring of Consultants & support staff • Capacity building of MOs/ LTs/ FTDs/ ASHA/ Volunteers, etc • Bed nets, synthetic flow for impregnation • RD Kits for strengthening diagnosis at peripheral areas • Drugs: Injection Arteether for treatment of severe & complicated malaria, Artesunate SP(ACT) for treating P. falciparum cases in chloroquine resistant areas • Insecticides: Synthetic Pyrethroids & spray wages • Planning, Administration & Monitoring and Evaluation including mobility support

17. Check list for Malaria for project states under GFATM & World Bank states GFATM States : 7 NE States and part of Jharkhand, West Bengal & Orissa WB States : AP, Jharkhand, Chhattisgarh, MP, Orissa, Maharashtra, Karnataka & Gujarat Contd…..

18. Check List - Review of Malaria • Programme Implementation • State action plan -Developed and its basis? • 2. Case Detection & Management indicators • Surveillance- minimum 10% population being screened for malaria in a year ? • Trained lab technicians - deployed at microscopy centres • RD test kits (Pf predominant areas) - Distributed and being used or not • Supply of anti-malarial including ACT being monitored at PHC , Sub centre & ASHA level. • If there is an increase in malaria incidence and give reason? • 3. Integrated vector control measures • High risk Population -covered under IRS • Community mobilization activities - for households acceptance of IRS • Timely recruitment of spray squads- training- deployment of insecticides - identified areas, • Bed nets treatment - distribution • Plan for insecticide treatment/community owned bed nets/adequate SP liquid - supplied NB: Yellow Color indicates additional inputs under GFATM & World Bank supported projects

19. Check List - Review of Malaria Contd…… • 4. Financial • Funds recd. And if not whether Audited UC sent for 2006-07 and SOE for 2007-08 • 5. Logistics • Adequate Logistics available? • Monitoring of its distribution and its feedback to centre? • 6. Human Resources / Training • Vacancy of all levels of health care workers addressed? • MPW allocated to state have been engaged ? • staff present are trained? • Availability of staff in high risk areas as per need? • Staff under the projects at PMU ( State HQ) – Sanctioned / Engaged ? • LTs & MTS allocated to GFATM & World Bank States have been deployed & trained. • ASHAs trained in use of RDT and delivery of SP-ACT in endemic districts. NB: Yellow Color indicates additional inputs under GFATM & World Bank supported projects

20. Projects States {GFATM (106 Districts ) & World Bank (93 Districts)} GFATM States : 7 NE States and part of Jharkhand, West Bengal & Orissa WB States : AP, Jharkhand, Chhattisgarh, MP, Orissa, Maharashtra, Karnataka & Gujarat

21. Check list for Malaria for project states under GFATM & World Bank states • CASE DETECTION & MANAGEMENT INDICATORS • Whether surveillance is up to the mark in terms of minimum 10% population being screened for malaria in a year? • Whether the trained lab technicians are deployed at microscopy centres? • Whether adequate numbers RD test kits are being received and distributed to the remote inaccessible Pf predominant areas with no microscopy facilities for use by ASHA, FTD. • Whether the chain of supply of anti-malarials including ACT in Chloroquine resistance areas are being maintained and monitored monthly up to PHC, Sub-centre & ASHA level. • If there is an increase give reason? Contd…..

22. Check list for Malaria for project states under GFATM & World Bank states • INTEGRATED VECTOR CONTROL MEASURES • Whether the population to be covered under IRS has been identified based on the high risk population as reflected in action plan? • Whether the community mobilization activities is being carried out for informing households in advance as well as acceptance of IRS? • Whether the action plan reflects timely recruitment of spray squads, their training, deployment of insecticides in the identified areas, check of spray equipment, supervision of spray teams etc? • Have block level, micro action Plan have been developed? • Whether the plan of bed nets treatment and distribution is kept ready for the allotted numbers of bed nets under the programme? • Whether the plan for insecticide treatment of community owned bed nets have been prepared and adequate SP liquid have been supplied in the identified areas? Contd…..

23. Check list for Malaria for project states under GFATM & World Bank states • FINANCIAL • Whether the districts are being allocated and release funds in accordance with the approved action plan in time? • Whether the SOEs are being obtained from districts on monthly basis? • Whether state and district audits have been conducting for the previsous financial years and UCs and audit reports are being sent to NVBDCP by the stipulated time? • LOGISTICS • Have adequate Logistics been received from center and other sources? • Have logistics been distributed to the districts on the basis of technical rationale? • Is district wise monitoring of logistic position being done? • Are monthly logistics report being submitted by districts & state on time and being communicated to Dte NVBDCP regularly by 15th of following month? • Have the consignee receipts been submitted to Dte. NVBDCP for the items received up to the previous month? Contd…..

24. Check list for Malaria for project states under GFATM & World Bank states • HUMAN RESOURCES/TRAINING • Whether the vacancies are being monitored and step initiated for filling up? • Whether deployment of staff is being done as to fill up vacancies in the problematic areas on priority basis? • Is adequately trained staff present against sanctioned posts? • Has the existing staff been rationally deployed so that least vacancies are present in high risk areas? • Have block level micro action plan been developed? • Has state PMU been fully established project state? • Whether LTs & MTS allocated to GFATM & World Bank States have been deployed & trained. • Whether ASHAs have been trained in use of RDT and delivery of SP-ACT in endemic districts? • Whether integration of LTs under different programmes for utilizing their services as multi purpose LTs, been done? • Whether MPW allocated to state have been engaged.

25. Check list for Malaria for non-project states • PROGRAMME IMPLEMENTATION • Whether state action plan has been developed based on the districts’ micro action plan? • Whether NRHM PIP has properly incorporates the malaria and other vector borne disease control action plan? • Whether supervision and monitoring plan for implementation of action plans at various levels is being carried out? • CASE DETECTION & MANAGEMENT INDICATORS • Whether surveillance is up to the mark in terms of minimum 10% population being screened for malaria in a year? • Whether the trained lab technicians are deployed at microscopy centres? • Whether the chain of supply of anti-malarials are being maintained and monitored monthly basis up to PHC level, Subcentre & ASHA level. Contd…..

26. Check list for Malaria for non-project states • INTEGRATED VECTOR CONTROL MEASURES • Whether the population to be covered under IRS has been identified based on the high risk population as reflected in action plan? • Whether the community mobilization activities is being carried out for informing households in advance as well as acceptance of IRS? • Whether the action plan reflects timely recruitment of spray squads, their training, deployment of insecticides in the identified areas, check of spray equipment, supervision of spray teams etc? • Have block level, micro action Plan been developed? • 4. FINANCIAL • Whether the districts are being allocated and release funds in accordance with the approved action plan in time? • Whether the SOEs are being obtained from districts on monthly basis? • Whether state and district audits have been conducting for the previous financial years and UCs and audit reports are being sent to NVBDCP by the stipulated time? Contd…..

27. Check list for Malaria for non-project states • LOGISTICS • Have adequate Logistics been received from center? • Have logistics been distributed to the districts? • Is district wise monitoring of logistic position being done? • Are monthly logistics report being submitted by districts & state by 15th of following month? • Have the consignee receipts been submitted to Dte. NVBDCP? • HUMAN RESOURCES / TRAINING • Whether the vacancies are being monitored and step initiated for filling up? • Whether deployment of staff is being done as to fill up vacancies in the problematic areas on priority basis? • Is adequately trained staff present against sanctioned posts? • Has the existing staff been rationally deployed so that least vacancies are present in high risk areas? • Have block level micro action plan been developed? • Whether integration of LTs under different programmes for utilizing their services as multipurpose LTs, been done?

28. Check list for Kala-azar • Disease Trend • Reasons for increase, if any • Steps taken by the State. • Drugs availability • Insecticide availability • Infra-structure • Patients treated and followed up. • Incentives to patient for loss of wages • Free diet to patient and attendant • Involvement of Kala-azar activist / ASHA • Timely DDT spray activities • Quality and coverage • Mobility • Monitoring and supervision mechanism • Reporting formats (MIS)

29. Check list for Lymphatic Filariasis • Whether State level training/re-orientation was done? • Whether funds released from State to District? • Whether line listing and mapping of Lymphoedema and Hydrocele cases were done? • Whether hydrocelectomy intensified? • Whether microfilaria survey (night blood survey) as per guidelines was done? • Whether drug distributors including ASHAs were trained before MDA? • Whether adequate IEC activities were done? • What was the coverage during MDA? • Whether mop up rounds of MDA were done to improve coverage and compliance? • Whether any side reaction was reported and rapid response team could manage? • States where MDA was observed on 11th November : Andhra, Goa, Gujarat, Karnataka, Kerala, Maharashtra, Jharkhand, • Puducherry, Daman & Diu, Dadra Nagar Haveli & A& N Islands

30. Check list for JE • 1. SURVEILLANCE • Whether guidelines on AES/JE surveillance have been received from NVBDCP/State, if so whether surveillance is carried out in accordance with these guidelines • Whether reporting of cases/deaths is being done • (out break prone states like Assam, Bihar, Haryana, • Kanataka and Uttar Pradesh) • 2. CASE MANAGEMENT • Are the JE treatment guidelines available at all the treatment centres •  Is there adequacy in case management at different levels of health care • Are essential drugs for treatment of JE available • Have rehabilitation centres with trained specialists been established for treatment of sequeale in JE patients • Is there adequate infrastructure for clinical management Contd…..

31. Check list for JE • 3. FACILITIES AT SENTINEL SITES • Are the sentinel sites functional ? Is there availability of adequate trained manpower and equipments including J.E. test kits • 4. VECTOR CONTROL MEASURES • Preparation of action plan at micro level • Availability of insecticides and functional equipments • ENTOMOLOGICAL SURVEILLANCE • Whether trained manpower available for entomological surveillance, If not how this is done • IEC ACTIVITIES • Have IEC activities been planned in advance • Whether contents commensurate with technical aspects of the disease • What about the quality of printing • What are the various IEC measures undertaken like(display of banners, distribution of pamphlets, posters etc

32. Check list for Dengue & Chikungunya • Whether calendar of activities to be carried out at each level as per long term action plan is available or not? • Whether Contingency plan for emergency hospitalization is prepared and approved by respective state health authorities or not? • Is the budgetary planning for each activity has been planned with justification for each component? • Whether media plan has been prepared or not? • Whether functioning Rapid Response Team is available in each district and State HQ or not? • Whether the Sentinel Surveillance Hospitals identified are functioning or not (like availability of ELISA facility, trained man power, no. of IgM test kits received from NIV, Pune, samples tested etc.) ? Contd…..

33. Check list for Dengue & Chikungunya • Whether necessary diagnostics and drugs for symptomatic treatment of Dengue and Chikungunya are available in each hospital or not? • Whether Clinical Guidelines for management of Dengue/DHF/DSS is available in each hospital or not? • Whether Fever Alert surveillance through grass root level health workers is in place or not? • Whether functioning entomological team in each district is in place or not? • Whether monthly/ quarterly monitoring of programme implementation is being carried out?

34. Checklist of items for CRM Teams • Malaria • Is there increase in malaria case and Deaths and its reason • Availability of Drugs and insecticides • Use of RD Kits • Completion of Spray and its coverage • Bednets supplied and being used or not • Funds recd. And if not whether Audited UC sent for 2006-07 and SOE for 2007-08 • Filaria • When MDA was observed and • What is the coverage and compliance • Kala Azar • Whether kala azar cases are increasing or decreasing and its reason ( better facility in PHCs/CHCs or incentives) • Availability of drugs • rk-39 for diagnosis is available and being used or not • Incentive to patients are given or not for loss of wages • Spraying completed or not

35. Checklist of items for CRM Teams • Dengue & Chikungunya • Reporting of cases through sentinel surveillance hospitals being done or not ? • Sentinel surveillance hospitals functional ? • Diagnostic Kits availability? • Adequate IEC for source reduction ? • JE/AES • Timely reporting of cases ? • Sentinel surveillance hospitals functional ? • Facility of Case Management ? • Vaccination planned and done ? • IEC activities ?