National Project Implementation Plan - NVBDCP

Similar conclusions are reached by a recent publication21 in which the authors
study five insecticide-treated net programs (Eritrea, Malawi, Tanzania, Togo,
Senegal) and two indoor residual spraying programs (Kwa-Zulu-Natal,
Mozambique). The study concludes, “In any case, all these vector control
programs are excellent public health investments and more such investments
should be made as soon as possible. This is a time of unprecedented
opportunities for malaria control, with expanding global interest and resources,
and also increased commitment by endemic country governments. It is time to
substantially bring down the unacceptable burden of disease due to malaria.”
On the case management side, the project supports a shift from the current
presumptive treatment with chloroquine to treating all confirmed P falciparum
malaria cases with ACT. A review of international evidence suggests that a
switch from chloroquine to ACT is highly cost-effective at all initial levels of
chloroquine resistance above 37 percent. However, this analysis does not take
into account non-health related benefits, especially evidence of income gains or
prevention of income losses. Nor does it takes into account the costs of health
systems strengthening required to make effective use of ACT. Inclusion of nonhealth
related benefits only increase the attractiveness of switching to ACT. The
health systems strengthening costs, on the other hand, may be significant but
given the current Indian context in which public health services are being
strengthened under NRHM, the system strengthening costs should be relatively
low.
On the second disease covered in the project, kala azar affecting the poorest
segments of rural populations in southern Asia, eastern Africa, and Brazil
(Yamey and Torreele 2002).22 In India, kala azar is confined mainly to 52
districts across 4 states of India. In 2006, around 39,000 kala azar cases were
reported in the country. However, the joint monitoring mission, carried out by
several national and international agencies in 2 of the 9 most endemic districts
in 2007, found about 10 fold underreporting of kala azar!
About 60-70% of kala azar cases access private sector for the diagnosis and
treatment. In addition to wage loss for a significant period, the high cost of
diagnosis and treatment tend to impoverish families. JMM team reported that a
household spends anywhere between INR 7000 and 10,000 for the diagnosis
and treatment of kala azar. Similar findings have been reported in other
studies as well. For example, a study examining the epidemiologic, social, and
economic impact of KA in a village in Bangladesh found the high cost of
21 Yukich, J. et al. (2007), “Operations, costs and cost-effectiveness of five insecticide-treated net
programs (Eritrea, Malawi, Tanzania, Togo, Senegal) and two indoor residual spraying programs
(Kwa-Zulu-Natal, Mozambique),” Swiss Tropical Institute, Basel, Switzerland.
22 Yamey G, Torreele E., (2002). The world’s most neglected diseases. BMJ 325: 176-177.
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