National Project Implementation Plan - NVBDCP

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Type of Vector Borne Disease Description of the Vector and Causative Agent Description of the Infection and health impact Geographical dispersion Causative Agent: Leishmania donovani, a parasite mainly residing in bone marrow, spleen and liver. No intermediate host is known in India (i.e. humans are the only hosts). P. argentipes is the only vector responsible for Kalaazar in India Kala-azar is characterized by irregular bouts of fever, darkening of the skin substantial weight loss, enlargement of the spleen and liver, and anemia. If left untreated, the case fatality rate can be as high as 100% within two years. Patients with PKDL are not in danger of dying from the disease, but are contagious 1.2 Malaria Control in India The National Malaria Control Programme (NMCP) started in 1953 and subsequently changed in 1958 to National Malaria Eradication program. Since then there have been many achievements as well as set backs in the program. The incidence of malaria reached to all time low of 0.1 million cases in 1965. However, this has subsequently increased to 6.47 million cases in 1976. The Modified Plan of Operation (MPO) launched in 1977 in response to reemergence of malaria in the country successfully brought down annual incidence of malaria from 6.47 million (0.85 million P. falciparum) in 1976 to 2.18 million cases (0.65 million P. falciparum) by 1984. Modified plan of Operation (MPO), 1977 envisaged a major strategic shift by integrating malaria program with the primary health care delivery system and changing the concept of blanket Indoor Residual Spraying (IRS) to selective IRS by stratifying the areas based on number of cases reported per 1,000 population in a year [the Annual Parasite Incidence (API)]. IRS was limited to areas reporting API of 2 and above. The Urban Malaria Scheme (UMS) was launched in 1971 with the objective to control malaria by reducing the vector population in the urban areas through recurrent anti-larval measures complemented by detection and treatment of cases through the existing health services. The scheme was sanctioned for 181 towns spread over 17 states and two union territories. However, it has so far been implemented in 131 towns only covering a population of 101.1 million in 2005 4
The Enhanced Malaria Control Project (EMCP) was implemented with the support of the World Bank during 1997 to 2005 with the objectives of creating an enhanced and more effective malaria control program focusing on the tribal areas with high disease burden and supporting the introduction of mix of cost-effective and sustainable strategies. The Project was implemented in 1045 Primary Health Centers (PHCs) in 100 districts of 8 states (Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh Maharashtra, Rajasthan and Orissa) predominantly inhabited by tribal population. In the EMCP areas, the number of cases have declined from 1.17 m in 1997 to 0.76 m in 2005 (44% decline) and deaths from 522 to 301 (42%). The Pf cases reduced from 0.71 m to 0.51 m (28%). India adopted WHO- RBM strategy and was successful in bids during the GFATM Round IV. Under GFATM, NVBDCP is supporting malaria control in the states of Assam, Arunachal Pradesh, Meghalaya, Tripura, Nagaland, Mizoram, Manipur, West Bengal, Jharkhand and Orissa. 1.3. Kala-azar Control in India Kala-azar has been endemic in India for a long time and earliest outbreaks date back to early nineteenth century. With the implementation of successive National Malaria Control operations from 1953, the disease declined to negligible proportions due to collateral benefit of IRS. However, withdrawal of IRS from some erstwhile malaria endemic areas resulted into a gradual build up of vector population that ultimately led to resurgence of kala-azar in seventies initially in 4 districts of Bihar. Slowly the disease started spreading to other areas in Eastern India. Concerned with the increasing incidence of Kala-azar, the GOI launched a centrally sponsored Kala-azar Control Program in the year 1990-91. The initial success of the program resulting in a significant decline in Kala-azar morbidity could not be sustained by the states. An expert committee chaired by the Director General of Health Services reviewed the program in 2000 and recommended the feasibility of eliminating Kala-azar from India and the NHP (2002) has endorsed this recommendation and set a goal for eliminating Kala-azar by 2010. 1.4 Program Constraints The NVBDCP is also affected by the generic constraints of public health system in India such as large number of vacant staff positions, weak program management capacities, delays in procurement, ineffective distribution of supplies, weak financial management, and insufficient supervision and monitoring. Further, non- engagement and lack of oversight of private sector plays an important role in the diagnosis and treatment of malaria and Kala-azar cases. 5
Page 1 and 2: Project Credit No.: 4461-IN Project
Page 3 and 4: TABLE OF CONTENTS Abbreviations and
Page 5 and 6: CHAPTERS Page. No. 13. Governance a
Page 7 and 8: Abbreviations and Acronyms ABER ACD
Page 9 and 10: Chapter 1 Situational analysis Intr
Page 11: The following matrix summarizes the
Page 15 and 16: Inadequate attention to mosquitogen
Page 17 and 18: Current Malaria Treatment Policy in
Page 19 and 20: chloroquine in P. falciparum cases
Page 21 and 22: the in depth review in 2006, the co
Page 23 and 24: incentives to assist kala-azar pati
Page 25 and 26: provision of general health service
Page 27 and 28: f. The project will introduce a sen
Page 29 and 30: Where microscopy result is not avai
Page 31 and 32: e. Supporting interventions for Kal
Page 33 and 34: The following table summarizes the
Page 35 and 36: e available within 24 hours. In oth
Page 37 and 38: 4. Behavior Change Communication A
Page 39 and 40: and also support the implementation
Page 41 and 42: Chapter 5 Malaria Control 5.1 Proje
Page 43 and 44: Result Indicator Activity Severe ca
Page 45 and 46: contact key informants in the villa
Page 47 and 48: coverage and its quality. Other tha
Page 49 and 50: 5.2 Other Issues 5.2.1 Therapeutic
Page 51 and 52: Chapter 6 Elimination of Kala-azar
Page 53 and 54: Table - 1 Activity schedule for the
Page 55 and 56: partner with the private and NGO se
Page 57 and 58: strategy will help economize insect
Page 59 and 60: esearch proposed for kala-azar will
Page 61 and 62: implementation of good pesticide ma
Page 63 and 64:
Activity (include s malaria and kal
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Activity Sub Activity Tools Interna
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Environmental studies and impact of
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7.1.1.4.2 Assess drug quality This
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1. as staff responsible for providi
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S. No. Supportive Staff Designation
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The key malaria control and kala-az
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Project Districts for malaria contr
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and appraisal. Additional technical
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Sl. No. 1 2 3 4 5 6 7 8 9 10 11 Act
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Sl. No. 23 24 25 26 27 28 29 Activi
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Cost Summary of Training Training C
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area, and a strengthened supply cha
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Chapter 9 MONITORING AND EVALUATION
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year, covering all endemic district
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treat malaria correctly. Modules fo
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insecticides in use in 200 sites, w
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Purpose Level Person Frequency Comm
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Monitoring and Evaluation will incl
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finger-prick blood sample taken by
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A Total mid-year population B Total
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2a. Elimination of kala-azar a.i. P
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Arrangements for Outcome and Result
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Component Three: Policy and Strateg
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Project Steering Committee: A steer
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service delivery in public and priv
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2 Additional Staff in District VBD
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The quality of Diagnostic Kits on t
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Percentage of individuals in projec
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11.2 Financial Management at the Ce
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separate financial management cell
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World Bank will review of the annua
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In parallel and in support of enhan
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Risk Residual Risk Rating Risk Miti
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Chapter 12 Procurement Arrangements
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agencies for taking up inspections
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contractor/supplier. However, the v
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12.3.4 Procurement Methods The tabl
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(commercial or UN agency acting as
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procurement agent) which are not pr
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B) Consultancy Services (>US$200,00
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4. Contract Awards for Consultancie
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monitoring of procurement undertake
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Topic Type of risk Mitigating Actio
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Page 153 and 154:
use, fraud, corruption may still re
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Page 157 and 158:
Chapter 14 Economic and Financial A
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diagnosis and treatment, causing su
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Table 1: Estimated Costs of Current
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Table 3: Estimated Incremental Cost
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Chapter 15 Safeguard Policy Issues
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State/Uni on Territory Number of Pr
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15.3.1 Surveillance, Case Diagnosis
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eluctant to allow their homes to be
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equipment, optimal coverage and qua
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Social Devpt. and BCC Consultants a
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Action to be Taken supportive drugs
Page 179 and 180:
Action to be Taken Distributing LLI
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Action to be Taken At what Level 17
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National Level: As the Borrower is
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vulnerable groups. estimates. Table
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Routine Program Monitoring: At the
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15.11.4 Application activities: Saf
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For effective implementation of the
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Action Responsibility By When Cost
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procured under the project; (6) bi-
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of each identified district to succ
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Annexure 1 MALARIA CASES & DEATHS S
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Annexure 2 KALA-AZAR CASES & DEATHS
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National Project Implementation Plan - NVBDCP

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