National Project Implementation Plan - NVBDCP

1.4.1. Key Program Constraints – Malaria
a) Technical
Rapidly emerging chloroquine resistance in Pf and insecticides resistance
in vectors.
Incomplete treatment or poor treatment compliance.
Use of irrational anti-malaria drug regimens by the public and private
sector.
b) Operational
Inadequate surveillance and case detection in large number of states.
Six states record ABER of less than 5%.
Heavy work load imposed by active surveillance on the microscopists
increases the backlog and thereby resulting in delayed reporting of
blood smear collected from patients currently suffering from fever.
Due to shortage of microscopy centers, the Health Workers carry blood
smears to the PHC/ CHC once a week and collect the report in the
subsequent week. This again delays the treatment as well as early
confirmation of an outbreak.
Delays in reporting of blood smears, treatment and referral to hospitals
increases the risk of severe malaria and consequent complications.
Inadequate strategies for delivery of services in remote and inaccessible
areas where there is severe shortage of public health outreach services 1 .
Despite existence of good program guidelines innovations such as social
marketing for rapidly up-scaling ITNs usage has not taken place.
Weak coordination with Integrated Disease Surveillance leading to
overload of information and poor or delayed local response to suspected
outbreaks.
Shortage of male Multi Purpose Workers (MPW) for routine surveillance
activities in Blocks/PHC plays an important role in detecting the malaria
cases.
Inability of states to buy Malathion 25% and Synthetic Pyrethroids for
IRS operations in DDT resistant areas (since it is a decentralized item).
Non-cooperation/ apathy of community towards IRS and insufficient
demand for diagnostic and treatment services.
Inadequate entomological monitoring in states with highest burden of
malaria due to inability of states to fill the posts of entomologists.
Inadequate supervision and monitoring including National Anti Malaria
Management Information System (NAMMIS).
c) Management
Frequent delays in release of program funds to the endemic districts by
states.
Delays in procurement of supply of goods (drugs, insecticides,
laboratory commodities etc).
Delays in payment of seasonal staff who undertake the IRS operations.
Non-submission of statement of expenditure (SOE’s) & utilization
certificate (UCs) by the States thus hampering release of funds by the
GOI.
1 Several malaria high endemic states have shortage of sub-centers as per national norms.
For example, the states of Arunachal Pradesh and Assam have only half of the required
sub centers while Orissa, Nagaland and West Bengal have about three fourths.
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