National Project Implementation Plan - NVBDCP

Training and regular reorientation were emphasized as ways to remove some
of the deficiencies noted in service delivery especially in tribal areas. This
would also prevent indiscriminate use of drugs, incomplete treatment and drug
resistance. Health worker training to support the efforts of doctors in
developing local strategies and planning was also mentioned.
15.3.5 Integrated Vector Management
Insecticide-Treated Bed-Nets (ITNs) have been distributed free of cost to the
very poor by the Government. The BPL and APL (Above Poverty Line)
populations were charged highly-subsidized costs of USD 0.25 and 0.50
respectively. Along with health workers and volunteers, panchayats were
involved in ITN distribution and in educating communities about the use of
nets, precautions and re-treatment of nets. However, bed-net use ranged from
about one-third to two-thirds of those who received them. In tribal
communities, the use was particularly low on account of the habit of sleeping in
the open, and the traditional belief that forbids sleeping under a ‘foreign’ object
such as a roof or net. Because of crowded housing conditions (families have an
average of five members), sleeping under one bed net was infeasible. There
was also a lack of perceived benefits. Nevertheless, during a malaria epidemic
in some villages, children were encouraged to sleep under bed nets. Although
bed-nets were reportedly purchased from the market as well, there was very
little information on community-owned bed-nets. About one-half of community
members expressed their willingness to pay for ITNs supplied by the
government. It was recommended that areas be prioritized for bed-net
distribution on the basis of risk, a high proportion of Pf cases, and
inaccessibility for indoor residual spraying.
Social marketing was recommended to increase access to ITNs and other
health products and services.
Some positive traditional practices were mentioned such as driving away
mosquitoes by burning neem leaves, other forest herbs, cow dung or paddy
stubble. Some tribes use repellant body oils.
Although it was widely known that mosquitoes cause malaria, there was little
knowledge of mosquito breeding habits. Only in one study area were people
aware of the need to cover stored water, spray kerosene oil over stagnant
water, etc. Given open drainage systems, garbage disposal and ‘toilets’, the
need to address environmental sanitation and personal hygiene to reduce
vector-borne diseases was discussed.
Some villages had not been sprayed for a year or so. Lack of advance
information for IRS reduced its coverage. However, tribal people were also
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