NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NRHM – Common Review Mission) 3-11-2009

1. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME(NRHM – Common Review Mission)3-11-2009

2. Overview of NVBDCP • Vector borne diseases include: • Malaria, • Filariasis, • Kala-azar, • Dengue, • Chikungunya and • Japanese Encephalitis (JE)

3. Malaria Targets: Annual Blood Examination Rate: 10% or above Malaria Mortality Reduction : 50% up to 2010, additional 10% by 2012. • Various initiatives for strengthening surveillance, early detection and complete treatment of malaria cases including Pf: • Strengthening of Human Resource by providing Contractual MPW male, Lab Technicians, Distt. VBD Consultants, MTS • Involvement of ASHAs for surveillance and treatment. • Upscaling use of Rapid Diagnostic Test Kits • Introduction of effective anti-malarial - ACT for Pf Cases • Upscaling of bednets use and introduction of Long Lasting Insecticide Nets (LLIN) for use in programme. • Focused intervention in high malaria endemic districts • Intensified supervision and monitoring • Additional inputs through, external support from GFATM and World Bank are also being provided.

4. Malaria- Prevention & Control Strategy PARASITE ELIMINATION AND DISEASE MANAGEMENT Early case detection and complete treatment Use of new diagnostic tools & combination therapy Epidemic preparedness and rapid response INTEGRATED VECTOR MANAGEMENT Indoor Residual Spraying in selected high risk areas Use of Insecticide treated bed nets Use of Larvivorous fish Anti larval measures in urban areas SUPPORTING INTERVENTIONS: Human Resource Development through capacity building Behaviour Change Communication Monitoring and evaluation

5. List of States & Districts for Malaria under GFATM Project

6. List of States & Districts for Malaria under World Bank Project

7. List of States & Districts for Malaria under World Bank Project

8. List of States & Districts for Kala-azar under World Bank Project

9. ELIMINATION OF LYMPHATIC FILARIASIS Elimination of LF : LF ceases to be a public health problem, when the number of microfilaria carriers is less than 1% and the children born after initiation of ELF are free from circulating antigenaemia . Goal: Global goal to eliminate Lymphatic Filariasis (LF) as public health problem by 2020 The National Health Policy (2002) has set the goal of Elimination of Lymphatic Filariasis in India by 2015.

10. IMPORTANT ACTIVITIES States to initiate preparatory activities for MDA to be observed in November & December Timely completion of activities, adequate social mobilization, training & IEC activities for better drug compliance. Drug distributors at sub centre and village level including MPWs, ANM, Aganwadis, ASHA & volunteers need to be identified & trained. Lymphodema & hydrocele cases in each village need to be line listed and accordingly States to intensify the hydrocele operations and home based management for lymphoedema patients.

11. Control Strategy for Kala-azar VECTOR CONTROL: • Indoor Residual Spraying with DDT up to 6 feet height from the ground twice annually • Hygiene and environmental sanitation • PARASITE ELIMINATION: • Early case detection and complete treatment • Introduction of Kala-azar rapid test - rk39 for use at peripheral level • Introduction of oral drug – Miltefosine on pilot basis as first line treatment SUPPORTIVE INTERVENTIONS: • IEC/BCC & Inter-sectoral collaboration • Capacity Building • Monitoring and supervision

12. Initiatives • Incentives to Patient for loss of wages @Rs. 50/- per day during the period of treatment • Free diet support to patient and one attendant • Incentive to Kala-azar activist / health worker@ Rs. 100/- for referring a suspected case and ensuring complete treatment. • Arrangement of Separate Patient Boxes • Line listing of cases • Patient Coding Scheme

13. EPIDEMIOLOGICAL PROFILE Dengue Chikungunya

14. Strategies for Dengue/ Chikungunya • Effective disease & vector surveillance. • Selective & stratified integrated vector control through community participation & inter-sectoral coordination. • Emergency preparedness & response. • Clinical diagnosis & case management by strengthening diagnostic services • Capacity building and social mobilization through BCC for community involvement. • Rapid response teams at state and district level • Monitoring and supervision

15. Initiatives Taken for Dengue & Chikungunya • Govt. of India has prepared a Strategic Action Plan for prevention & control of Dengue & Chikungunya in the country and sent to the state (s) for implementation. • Guidelines on clinical management of Dengue/DHF cases sent to the states for wider circulation. • Apex Referral laboratories an adequate supply of diagnostic kits to these sites. • Sero-surveillance activities at regular intervals. • NIV Pune entrusted to supply ELISA test kits to these institutes. • Contingency grant made available. • Intensive social mobilization campaigns through IEC/BCC activities for community involvement. • Monitoring vector population in vulnerable areas.

16. JE – Prevention & Control Strengthening of Surveillance to detect all Acute Encephalitis Syndrome (AES) cases and Laboratory confirmed JE cases. Vaccination : Vaccination with single dose vaccine to children 1-15 years of age under UIP (60 districts covered till 2008). A rapid response team constituted in all JE endemic districts to monitor the JE situation and outbreak in their areas. Proper case management at PHC/CHC Strengthening of referral services

17. INITIATIVES FOR PREVENTION CONTROL OF JE • Strengthening of AES/JE surveillance through: • 51 sentinel sites • 13 Apex Referral Laboratories for advanced diagnosis • Standard Guidelines for AES/JE surveillance • One vector Borne Disease Surveillance Unit (VBDSU) and one JE Sub-office was established at BRD Medical college, Gorakhpur (U.P) Which is most endemic state. • Sub-office, ROH &FW, Lucknow functioning in Gorakhpur • Further, for establishing 50 badded AES/JE treatment facility at BRD medical college Gorakhpur, an amount of RS 5.88 crores have been allocated under NRHM during 2009-10. • JE vaccination in age group 1-15 years: • During 2006- 11 districts in 4 states (Assam, Karnataka, Uttar Pradesh, West Bengal) covered. • Left out & new cohorts are being covered under routine immunization. • In 2007- Expanded to 27 districts in 9 states • In 2008, 24 districts in 10 states are covered • In 2009, 30 districts in 30 states are covered

18. Check list for Malaria for project states under GFATM & World Bank states • GFATM States : 7 NE States and part of Jharkhand, West Bengal & Orissa • WB States : AP, Jharkhand, Chhattisgarh, MP, Orissa, Maharashtra, Karnataka & Gujarat • PROGRAMME IMPLEMENTATION • Whether state action plan developed based on the districts’ micro action plan • Whether supervision and monitoring plan for implementation of action plans at various levels is being carried out? Contd…..

19. Check list for Malaria for project states under GFATM & World Bank states • CASE DETECTION & MANAGEMENT INDICATORS • Whether surveillance of minimum 10% population being screened per year? • Whether the trained lab technicians are deployed at microscopy centres? • Whether adequate RD test kits are being received and distributed to the remote inaccessible Pf predominant areas with no microscopy facilities for use by ASHA, FTD. • Whether the chain of supply of anti-malarials including ACT in Chloroquine resistance areas are being maintained and monitored monthly up to PHC, Sub-centre & ASHA level. • If there is an increase in malaria, give reason? Contd…..

20. Check list for Malaria for project states under GFATM & World Bank states • INTEGRATED VECTOR CONTROL MEASURES • Whether the population to be covered under IRS has been identified based on the high risk population as reflected in action plan? • Whether the community mobilization activities is being carried out for informing households in advance as well as acceptance of IRS? • Whether the plan of bed nets treatment and distribution is ready for the allotted numbers of bed nets under the programme? • Whether plan of LLIN distribution is ready?

21. Check list for Malaria for project states under GFATM & World Bank states • FINANCIAL • Whether the districts are being allocated and release funds in accordance with the approved action plan in time? • Whether the SOEs are being obtained from districts on monthly basis? • Whether UCs and audit reports are sent to NVBDCP in time? • LOGISTICS • Have adequate Logistics been arranged? • Is district wise monitoring of logistics being done? • Are monthly stock sent by districts & state to Dte NVBDCP? Contd…..

22. Check list for Malaria for project states under GFATM & World Bank states • HUMAN RESOURCES/TRAINING • Whether step initiated for filling up vacancies? • Is adequately trained staff present against sanctioned posts? • Has the existing staff been rationally deployed? • Has state PMU been fully established project state? • Whether LTs & MTS allocated to GFATM & World Bank States have been deployed & trained. • Whether ASHAs have been trained in use of RDT and delivery of SP-ACT in endemic districts? • Whether integration of LTs under different programmes for utilizing their services as multi purpose LTs, been done? • Whether MPW allocated to state have been engaged.

23. Check list for Malaria for non-project states • PROGRAMME IMPLEMENTATION • Whether state action plan developed based on the districts’ micro action plan • Whether supervision and monitoring plan for implementation of action plans at various levels is being carried out? • CASE DETECTION & MANAGEMENT INDICATORS • Whether surveillance of minimum 10% population being screened per year? • Whether the chain of supply of anti-malarials are being maintained and monitored monthly basis up to PHC level, Subcentre & ASHA level. Contd…..

24. Check list for Malaria for non-project states • INTEGRATED VECTOR CONTROL MEASURES • Whether the population to be covered under IRS has been identified based on the high risk population as reflected in action plan? • Whether the community mobilization activities is being carried out for informing households in advance as well as acceptance of IRS? • 4. FINANCIAL • Whether the districts are being allocated and release funds in accordance with the approved action plan in time? • Whether the SOEs are being obtained from districts on monthly basis? • Whether UCs and audit reports are sent to NVBDCP in time? Contd…..

25. Check list for Malaria for non-project states • LOGISTICS • Have adequate Logistics been arranged? • Is district wise monitoring of logistics being done? • Are monthly stock sent by districts & state to Dte NVBDCP? • HUMAN RESOURCES / TRAINING • Whether step initiated for filling up vacancies? • Is adequately trained staff present against sanctioned posts? • Has the existing staff been rationally deployed? • Whether integration of LTs under different programmes for utilizing their services as multipurpose LTs, been done?

26. Check list for Kala-azar • Disease Trend • Reasons for increase, if any • Steps taken by the State. • Drugs availability • Insecticide availability • Infra-structure • Patients treated and followed up. • Incentives to patient for loss of wages • Free diet to patient and attendant • Involvement of Kala-azar activist / ASHA • Timely DDT spray activities • Quality and coverage • Mobility • Monitoring and supervision mechanism • Reporting formats (MIS)

27. Check list for Lymphatic Filariasis • Whether State /District Action Plan for MDA prepared? • Whether State level meetings & Training were held? • Whether funds released from State to District? • Whether District action plan prepared? • Whether Rapid Response Teams at districts were formed ? • Whether line listing and mapping of Lymphoedema and Hydrocele cases were done? • Whether microfilaria survey (night blood survey) in sentinel and spot check sites in each filaria endemic district as per guidelines was done? • Whether drug distributors including ASHA were trained before MDA? • Whether adequate IEC activities were done? • What was the coverage during MDA? • Whether reports were submitted by districts & states?

28. Check list for JE • 1. SURVEILLANCE • Whether guidelines on AES/JE surveillance have been received from NVBDCP/State, if so whether surveillance is carried out in accordance with these guidelines • Whether Daily**/monthly reporting of cases/deaths with correct and complete addresses is being done • ** In case of out break prone states like Assam, Bihar, Haryana, • Kanataka and Uttar Pradesh • 2. CASE MANAGEMENT • Are the JE treatment guidelines available at all the treatment centres •  Is there adequacy in case management at different levels of health care • Are essential drugs for treatment of JE available • Have rehabilitation centres with trained specialists been established for treatment of sequeale in JE patients • Is there adequate infrastructure for clinical management Contd…..

29. Check list for JE • 3. FACILITIES AT SENTINEL SITES • Are the sentinel sites functional ? Is there availability of adequate trained manpower and equipments including J.E. test kits • 4. VECTOR CONTROL MEASURES • Preparation of action plan at micro level • Availability of insecticides and functional equipments • ENTOMOLOGICAL SURVEILLANCE • Whether trained manpower available for entomological surveillance, If not how this is done • IEC ACTIVITIES • Have IEC activities been planned in advance • Whether contents commensurate with technical aspects of the disease • What about the quality of printing • What are the various IEC measures undertaken like(display of banners, distribution of pamphlets, posters etc

30. Check list for Dengue & Chikungunya • Whether calendar of activities to be carried out at each level as per long term action plan is available or not? • Whether Contingency plan for emergency hospitalization is prepared and approved by respective state health authorities or not? • Is the budgetary planning for each activity has been planned with justification for each component? • Whether media plan has been prepared or not? • Whether functioning Rapid Response Team is available in each district and State HQ or not? • Whether the Sentinel Surveillance Hospitals identified are functioning or not (like availability of ELISA facility, trained man power, no. of IgM test kits received from NIV, Pune, samples tested etc.) ? Contd…..

31. Check list for Dengue & Chikungunya • Whether necessary diagnostics and drugs for symptomatic treatment of Dengue and Chikungunya are available in each hospital or not? • Whether Clinical Guidelines for management of Dengue/DHF/DSS is available in each hospital or not? • Whether Fever Alert surveillance through grass root level health workers is in place or not? • Whether functioning entomological team in each district is in place or not? • Whether monthly/ quarterly monitoring of programme implementation is being carried out?

32. THANK YOU