National Project Implementation Plan - NVBDCP

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Chapter 2 Key Findings and Recommendations of Joint Monitoring Mission (JMM) of NVBDCP At the behest of GoI, a Joint Monitoring Mission (JMM) led by WHO which included over 30 national and international experts undertook a comprehensive review of NVBDCP during the months of January and February 2007 and made important recommendations on policy and strategy. Further, the NVBDCP in collaboration with Indian Council of Medical Research has undertaken in-depth reviews (IDR) of malaria and Kala-azar interventions in 2006. This section summarizes the key findings and recommendations of the JMM and IDR. 2.1. Current Policies for Malaria Control 2.1. a. Case Management The current policy for malaria diagnosis and treatment in the public sector varies according to whether a given area is classified as a low malaria risk area or a high-risk area. Primary health centers are classified as high malaria risk areas if any of the following applies (otherwise it is classified as low risk area): Deaths due to malaria have been reported (on clinical diagnosis or microscopic confirmation). The Slide Positivity Rate (SPR) has doubled during the last three years, provided the SPR in the second or third year reaches 4% or higher; or the average SPR of the last three years is 5% or higher. Of all reported malaria cases the proportion of P. falciparum proportion is 30% or higher, provided the SPR is 3% or higher during any of the last three years. Any area having a focus of Chloroquine-resistant P. falciparum. Agglomeration of migrant labor in endemic/receptive and vulnerable areas. High-risk areas are further divided, for the purposes of malaria diagnosis and treatment, between those areas where a high (greater than 10%) level of resistance to chloroquine in P. falciparum cases has been ascertained and those areas where such high level of resistance has not been ascertained. However, it has been very difficult to successfully undertake and complete a large number of studies on drug resistance as such studies require a lot of effort, especially for ensuring follow up of enrolled patients. The following flow-charts summarize current malaria treatment policies; (i) low-risk areas and (ii) high-risk areas where chloroquine resistance levels greater than 10% has been ascertained; and high-risk areas where levels of chloroquine resistance has not been ascertained. 8
Current Malaria Treatment Policy in Low Risk Areas Persons with Fever FEVER TREATMENT DEPOTS IDENTIFED THROUGH ACTIVE SURVEILLANCE SELF REPORTING AT PUBLIC FACILITIES SELF REPORTING AT PRIVATE FACILITIES Blood Smear Collection + Presumptive Rx Single dose of Chloroquine 600mg Blood Smear Collection + Presumptive Rx Single dose of Chloroquine 600 mg Blood Smear Collection + Presumptive Rx Single dose of Chloroquine 600 mg If Blood Smear is Positive for PV, MPHW/S to provide Radical Rx Chloroquine 600mg+ Primaquine 15 mg 1 st day Followed by Primaquine 15 mg for 4 days If Blood Smear is Positive for PF in area where malaria case loa PF cases also provided Radical Rx Chloroquine 600mg+ Primaquine 45 mg 1 st day If there is no treatment response patient is treated with 2nd li S P single Dose d is high ne drug Current Malaria Treatment in High Risk Areas where high level of Resistance to Chloroquine in P. falciparum cases is either 10% or higher or has not been ascertained Persons with Fever FEVER TREATMENT DEPOTS IDENTIFED THROUGH ACTIVE SURVEILLANCE SELF REPORTING AT PUBLIC FACILITIES SELF REPORTING AT PRIVATE FACILITIES Blood Smear Collection + Presumptive Rx Chloroquine 1500 mg + Primaquine 45 mg Blood Smear Collection + Presumptive Rx Chloroquine 1500 mg + Primaquine 45 mg Blood Smear Collection + Presumptive Rx Chloroquine 1500 mg + Primaquine 45 mg If Blood Smear is Positive for PV, MPHW/S to provide Primaquine 15 mg for 5 days If Blood Smear is Positive for PF, and if there is no response o t presumptive treatment, patient is treated with ACT as 2nd line drug 9
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 and 12: The following matrix summarizes the
Page 13 and 14: The Enhanced Malaria Control Projec
Page 15: Inadequate attention to mosquitogen
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
Page 65 and 66: Activity Sub Activity Tools Interna
Page 67 and 68:
Environmental studies and impact of
Page 69 and 70:
7.1.1.4.2 Assess drug quality This
Page 71 and 72:
1. as staff responsible for providi
Page 73 and 74:
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
Page 81 and 82:
Sl. No. 1 2 3 4 5 6 7 8 9 10 11 Act
Page 83 and 84:
Sl. No. 23 24 25 26 27 28 29 Activi
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Cost Summary of Training Training C
Page 87 and 88:
area, and a strengthened supply cha
Page 89 and 90:
Chapter 9 MONITORING AND EVALUATION
Page 91 and 92:
year, covering all endemic district
Page 93 and 94:
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
Page 109 and 110:
Component Three: Policy and Strateg
Page 111 and 112:
Project Steering Committee: A steer
Page 113 and 114:
service delivery in public and priv
Page 115 and 116:
2 Additional Staff in District VBD
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The quality of Diagnostic Kits on t
Page 119 and 120:
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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