SFT Orientation 8th Feb 2008 NVBDCP

1. SFT Orientation 8th Feb 2008 NVBDCP

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

3. PROGRAMME IMPLEMENTATION • For 2008-09, the States/UTs are requested to include the full action plan of NVBDCP along with the justified proposal on the basis of technical assessment. • 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.

4. Malaria Programme Objective Prevention of deaths due to malaria Reduction in malaria morbidity

5. MALARIA CONTROL IN INDIA SIGNIFICANT DEVELOPMENTS 1953 - Estimated Malaria Cases in India 75 Million Estimated Deaths Due to Malaria – 0.8 Million Launching of NMCP 1958 - Launching of NMEP 1966 - Cases Reduced to 0.1 Million Early 70’s - Resurgence of Malaria 1976 -Malaria Cases 6.46 Million and 59 Deaths 1977 - Modified Plan of Operations Introduced 1977 - Pf Monitoring Team - Parasite Sensitivity of anti-malarials 1981- National Drug policy for Treatment of Malaria - Introduced 1984 - Annual Malaria Incidence Reduced to 2.2 Million Cases 1984 -1998 - Annual Reported Incidence Within 2-3 Million Cases 1994 - Resurgence of Malaria outbreaks in Some States 1995 - Expert Committee on Malaria 1997 - World Bank Assisted Enhanced Malaria Control Project 2006- onwards WB agreed for Retroactive financing 2004 -Introduction of ACT for Pf cases in drug resistance areas 2005 ( July) – GFATM- IMCP- (106 districts of 10 states ) 2007- National Drug policy revised 2008- New project on Malaria Control & Kala Azar Elimination with World Bank Assistance is likely to start

6. STRATEGIES FOR MALARIA CONTROL • Surveillance - Early Diagnosis and Prompt Treatment- Alternative drugs for drug resistant cases. • Selective Vector Control (Integrated Vector Control Measure) • Promotion of Personal Protection Methods - Bed Nets • Management Information System (MIS) • Early Detection & Containment of Epidemics • IEC/BCC - Community Involvement • Capacity Building • Monitoring and Evaluation - CMIS

7. STRENGTHENING OF EDPT To trained laboratory technicians by induction level and reorientation courses. Private sector involvement for laboratory services Involvement of private medical practitioners from all disciplines MOs and LTs of Military & Para-military training Rapid diagnostic kits for remote and inaccessible high risk pockets Contd.

8. SELECTIVE AND INTEGRATED VECTOR CONTROL Indoor Residual Spray (IRS) by prioritizing the area Insecticide treated bed nets/Long lasting Insecticide Nets Source reduction methods - Anti-larval Measure Environmental methods through minors modifications in irrigation channels, proper drainage and source by filing/elimination of ditches. Larvivorous fish In urban areas, implementation of bye laws

9. INTEGRATED VECTOR CONTROL ( Larvivorous) Use of larvivorous fish being promoted Suitable for use in urban areas and selected rural areas

10. IVM (INSECTICIDE TREATED BED NETS) • Bed nets for high risk rural tribal areas. • Priority beneficiaries - Below Poverty Line population especially pregnant women and children. • Involvement of civil society organizations in distribution/insecticide treatment of bed nets.

11. IEC/BCC ACTIVITIES & INTERSECTORAL COLLABORATION Development of States specific communication strategies and media plan, especially focusing on specific strategies Participation by elected representatives and faith based organization/community based organization for community involvement Involvement of NGOs, CBOs, FBOs, Panchayat Involvement of private sector Involvement of professional bodies Involvement of tribal schools, public health engineering Deptts., railways, information & broadcasting, military, para-military, fisheries depatt. water resource management, rural development, etc.

12. Malaria Contribution in Prioritized Areas (2006)

13. CHLOROQUINE RESISTANCE AREAS • 20 states/285 PHCs declared CQ resistant • SP-Artesunate Combination Therapy (ACT) introduced as first line treatment in the Chloroquine resistance foci and surrounding cluster PHCs • Piloting of ACT treatment to all Pf cases in the entire districts

14. Multiple paradigms (Rural malaria; Urban malaria; Forest malaria; Industrial malaria; Border malaria; Migration malaria) Remote, inaccessible, tribal areas Rapid urbanization with large scale & unplanned developmental projects (dams, roads, buildings, etc.), migration of labour, deficient water and solid waste management systems Emerging drug resistance, insecticide resistance Vacant posts of key workers : MPW (Male), Health Asstt. (Male), Lab. Technician. Disease burden estimation, Micro stratification Health Impact Assessments Procurement & supply management Timely release and optimal utilization of funds Strengthening M&E - Dedicated Programme Managers, Staff ISSUES

15. GFATM • Title of the Project: Intensified Malaria Control Project (IMCP) • Project Period : 5 Years starting from July 2005 to June 2010 in • Financial Outlay: US $ 63 million • Implementation Plan : In two Phases • Phase I July 2005 to June 2007 with a budget outlay of US $ 30.16 million (13 Million US $ Released). • Phase II – July 2007 to June 2010 with a budget outlay of US $ 50 million. • Goal: • To reduce malaria morbidity and mortality in 100 million population in 10 states by 30% in 5 years.

16. INDIA – 106 Districts Proposed for GFATM Round IV (2005-2010) (100 million population) • 10 States • 106 Districts • 100 million Population SELECTION CRITERIA OF IMCP AREAS (FOR GFATM FUNDS) • Poor and vulnerable groups settled in the poorest parts of the country in 10 states (106 districts). • High disease burden : 9.76% of population contribute to 25% morbidity and 47% mortality due to malaria in the country. • About 24 million population under the project are living along the international borders with Bhutan, Bangladesh Myanmar and Nepal .

17. SELECTION CRITERIA OF IMCP AREAS (FOR GFATM FUNDS) • Poor and vulnerable groups settled in the poorest parts of the country in 10 states (106 districts). • High disease burden : 9.76% of population contribute to 25% morbidity and 47% mortality due to malaria in the country. • About 24 million population under the project are living along the international borders with Bhutan, Bangladesh Myanmar and Nepal .

18. Programme Components • Human Resource: Hiring of Consultants & support staff for Project Monitoring units • Capacity building of MO/ LTs/ FTDs/ DDCs/ Volunteers etc • Commodity & Products: Procurement of ITNs, synthetic flow for treatment of bednets for interruption malaria transmission and 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 • Planning & Administration including M&E: • Supervision- Mobility support • Monitoring- Reviews at NVBDCP, State & District level • Evaluation- Internal through field visits & Independent through hiring agencies • Operational Research- Drug Resistance studies & Entomological Studies

19. Additional inputs during Phase-II Additional Lab Technician Additional Malaria Supervisor and Field Supervision Malaria Technical Supervisors (MTS)

20. Additional Human Resources inputs under the phase-II of the project State level consultant through NHRSC District level VBD consultants Logistic consultant at State & District level NGO consultant at HQ & State Status of engagement of these to be monitored.

21. Monitoring utilization of funds under GFATM Needs to be monitored Operational cost for treatment of bednets Review meeting of the District by the states (twice a year) Field review details Timely submission of SOEs UCs & Audit Reports.

22. Monitoring by the state coordinator Utilization of RDKs mainly for improving the diagnostic facilities is remote, in accessibility areas by volunteers Skills of ASHA in conducting RDKs kits & use of Antimalarials Physical verification of distributed bednets in high disease burden areas Transportation plan for transportation of slides from village to nearest PHC with the Public/Private transport system Availability of Antimalarials at all levels Supply chain of Antimalarials.

23. PROPOSED VBD PROJECT UNDER WORLD BANK • World Bank support to NVBDCP for two diseases: • Malaria control & Kala-azar elimination • Duration of project – Five years • Expected date of starting – April 2008 • Expected fund flow from Bank – US$ 200 million for 5 years • GoI contribution – US 20 million • Malaria – US 130 million • Kala-azar – US 40 million • Project management – US 50 million • Under malaria, 100 districts selected in 13 states covering a population of 185 million • Initial two years – 50 districts in 5 states • In third year onwards – 50 more districts in 8 states • Under kala-azar all 52 districts • 1st year – 15 distt, 2nd year – 18 distt, 3rd year – 19 distt

24. LIST OF 100 DISTRICTS UNDER WORLD BANK NEW PROJECT • Selection criteria : Pf cases >1000 Pf> 25% SFR >0.2%

25. STRATEGIES FOR NEW PROJECT UNDER MALARIA

26. Contd…. STRATEGIES FOR NEW PROJECT UNDER MALARIA

27. W.B. SUPPORT UNDER KALA-AZAR All 52 kala-azar endemic districts in four states (Bihar, Jharkhand, Uttar Pradesh & West Bengal) shall be included under World Bank project Strategies shall be focused on: Strengthening of human resource components at blocks & district level - Positioning of Kala azar Activist at endemic areas - District Coordinator Introduction of treatment card Diagnosis of cases through rapid diagnostic test Treatment of KA cases with newer drug miltefosin on pilot basis in 10 endemic districts Enhanced BCC/IEC and capacity building through training

28. Elimination of Lymphatic Filariasis

29. Govt. of India is signatory to the WHA Resolution 1997. The WHA 1997 vide No. 50.29 resolved to globally eliminate lymphatic filariasis as a public health problem. WHO aims to Eliminate Lymphatic Filariasis by 2020. National Health Policy (2002) envisages the goal of Elimination of Lymphatic Filariasis by 2015. MDA was initiated as pilot in 13 districts of 7 states in 1997 & extended to 30 districts by 2003. MDA was expanded in 2004 in 202 filaria endemic districts in 20 states/UTs Genesis of ELF Programme

30. FILARIA ENDEMICITY MAP Endemic districts: 250 (in 20 States/UTs), Population: 583 million 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 • up-scaling of hydrocele operations in the identified CHCs / District hospitals/ medical colleges.

31. UPSCALING OF MDA IN INDIA SINCE 1997 *Orissa (4), UP (1), Bihar (2) did not observe MDA MDA Coverage Line listing of LF Cases

32. Line listing of LF Cases MDA Coverage

33. Our Role for Improvement Make ourselves well versed with the Implementation strategy Guidelines FAQs and Answers Assessment methodology Selection of sentinel sites Updating lymphoedema and hydrocele cases

34. ELF Activities Pre MDA Activities

35. ELF Activities

36. ELF Activities

37. ELF Activities During MDA Activities

38. ELF Activities Post MDA Activities

39. IMPORTANT POINTS States to initiate preparatory activities for MDA to be observed on 11 November Timely completion of activities, adequate social mobilization & IEC activities for better drug compliance. Drug distributors at sub centre and village level including MPWs, ANM, Aganwadis, ASHA & volunteers need to be identified & trained. States to intensify the hydrocele operations and home based management for lymphoedema patients.

40. KALA-AZAR - Milestones 1953, 1958 Insecticide Residual spraying with DDT under National Malaria Eradication Programme resulting in marked decline in disease incidence 1970s Resurgence of Kala-azar subsequent to withdrawal of IRS Initially reported in four districts of Bihar and then from other parts 1992 High incidence at 77102 cases and 1049 deaths Launched centrally sponsored Kala-azar Control Programme

41. MILESTONES 2000 Recommendation for elimination of Kala-azar by Expert Committee 2002 National Health Policy set the goal for Elimination of KA by 2010 2005 Tripartite Memorandum of Understanding signed between India, Bangladesh and Nepal for elimination of Kala-azar by 2015

42. Kala-azar in India 42

43. STRATEGY: THREE-PRONGED • VECTOR CONTROL • Indoor Residual Spraying with DDT up to 6 feet height from the ground twice annually. • Hygiene and environmental sanitation • Advocacy for use of Insecticide treated bed nets. Contd…/-

44. STRATEGY: THREE-PRONGED 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 Contd…/-

45. Contd…/- SUPPORTIVE INTERVENTIONS: • Communication for Behaviour Impact • Inter-sectoral collaboration • Capacity Building • Operational research • Close monitoring and supervision with periodic reviews/evaluations Expert Committee on Kala-azar under the Chairpersonship of the DGHS, Govt. of India, reviews Programme policy and strategies

46. KALA-AZAR ELIMINATION PROGRAMME: GOAL and TARGET 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.

47. INITIATIVES 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

48. INITIATIVES 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. First installment of 12.03 crores released to the state of Bihar under Indira Vikas Yojna Village wise GIS mapping in Bihar Focused intervention strategy

49. INITIATIVES Active case search twice in a year. Adequate supply of anti kala-azar drugs. Vector Control, diagnosis & treatment, kala-azar fortnight, use of Miltefosine & rK39, Roadmap, patient coding scheme Circulated. Tool kit with flip charts, posters made available to state. 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 9 highly endemic districts in Bihar state during Feb.- March 2007. Third Party supervision & monitoring of IRS by RMRI Patna. Contd….

50. Initiatives Taken Implementation of strategic Action Plan for prevention & control of Chikungunya by the State Govt. Identified 13 Apex Referral Laboratories for advanced diagnosis and regular surveillance of Dengue, Chikungunya and JE fever cases. NIV Pune has been entrusted to supply ELISA test kits to these institutes. Contingency grant made available to meet the operational cost of the Sentinel Surveillance hospitals and Apex Referral Laboratories. Guidelines on clinical management of Dengue/DHF cases sent to the states for wider circulation. Continuous monitoring of the situation. Dissemination of detailed guidelines and advisories. Identified 110 sentinel surveillance hospitals for proactive surveillance for Dengue, Chikungunya and JE. 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. Supply of logistics like larvicides and adulticides in affected states.