Planning, Management & Policy

of VBD Control Programme

NVBDCP

Vector Borne Diseases (under NVBDCP)

• Prevention and control of VBDs under NVBDCP: – Malaria – Lymphatic Filariasis – Kala-azar – Dengue – Chikungunya &– Japanese Encephalitis (JE)

• NMEP changed to NAMP in 1997 and was renamed as NVBDCP in 2003

NVBDCP

• NVBDCP - umbrella programme for prevention & control of VBD

• an integral part of NRHM. • the Millennium Development Goal of halting

and reversing the incidence of malaria and other vector borne diseases by the year 2015 towards reduction of poverty.

Principle

• In All these diseases some vector is involved

• So, the disease control includes control of disease as well as the control of respective vectors

And so, the planning and management of these diseases’ control includes:

• Planning for the vector control measures as well as

• Planning for the disease control

Planning and Management

• Situation Analysis– Disease trend– Available resources (man, money, material, mechanisms)– Available & established strategies

• Need Assessment– Man, Money, Material, Mechanisms

• Make available the resources• Implement strategies• Monitor and assess the impact• Revise the strategies based on experience

VBD Control Strategies

The three pronged strategy for prevention and control of VBD is:

1. Integrated Vector Control2. Early Diagnosis and Prompt Treatment3. Supportive interventions

1. Integrated Vector Control

• Indoor Residual Spray• Insecticide treated Bednets (ITNs) & Long

Lasting Insecticidal Nets (LLINs)• Source Reduction

Why vector control ?

• VBDs are of major Public Health importance in rural and Urban areas

• In addition to Case Management – prevention is also essential

• Vector control will help in reduction of transmission and /or prevention of VBDs

What should guide vector control?

• Apply methods that are cost-effective (cost & impact under programme settings)

• Must have health systems to deliver such tools/interventions– Technical – capacity to plan & implement – incl.

M&E– Optimum Trained Human Resources– Physical infrastructures

• M&E – from planning to impact assessment

Control Measures

• Larval and adult control impact on vector densities

• Effectiveness of larval control methods depends on types of breeding sites

• IRS and ITNs/ LLINs reduce vector survivorship • ITNs reduces man/vector contact• Important to consider cost & community

acceptance• Use of safe chemicals for VC

Planning a spraying programme• Determine areas to be sprayed - stratification• Number of houses/structures/units/surface

areas to be sprayed – geographical mapping• Logistics• Estimate (insecticides, equipment, transport),

train spray teams, supervisors• Provide awareness/community campaigns to

enhance compliance

Improving quality of IRS

• Ensure timely application of insecticides• Continuous training of spray teams• Appropriate application of insecticides • Proper maintenance and storage of

equipment and insecticides• Strengthening supervision and reporting

Scaling up of ITNs/LLINs

• Limited experience with ITNs• Where implemented – coverage is low• As part of going to scale – need clear

outcomes– Increasing coverage of ITNs for epidemiological

impact– Increasing re-treatment rates –innovative

approaches and/or LLINs

What is a long lasting insecticidal net?

A net treated at factory level with an insecticide

Either incorporated into or coated around fibres

Which resist multiple washes Whose biological activity lasts as long as the

net itself 3 to 4 years for polyester nets4 to 5 years for polyethylene nets

Why do we need LLINs?

Conventional dipping: insecticide is rapidly removed by washing or degraded by detergents

Factory pre-treated nets (conventional dipping) are not reliably treated

Dipping of coloured nets: a potential problem...

2. Early Diagnosis and Prompt Treatment

• Case Detection & management • Disease Surveillance• Epidemic Preparedness

Case Detection and Management• Diagnostic services at HCs and village levels

– Laboratory facilities: Establish / strengthen /improve quality / supervision/ monitoring

– RDTs at the village /periphery level– Quality Assurance of diagnostic services

• Treatment of cases– Adopt evidence based drug policy / feasibility– Assess the requirement / availability/ resistance

monitoring– Ensuring provision of drugs /treatment services from

Hospital to the village level– Procurement and supply chain management– Deployment and Training of service providers

Disease Surveillance

• Active surveillance– In high risk areas– Assess cost-effectiveness

• Passive surveillance– Service provision at Health Centers – Data recording and reporting

• Sentinel surveillance– Establish SS centers– Data recording and reporting

Epidemic preparedness

• Establish early detection mechanism by monitoring the trend (weekly / fortnightly/ monthly trend of the disease)

• Timely and correct reporting• Planning in advance for managing epidemics

– Buffer stock– Team formation– Action guidelines

3. Supportive interventions

• Training & Capacity Building• Behaviour Change Communication• Inter-sectoral Collaboration• Community Participation• Public Private Partnership (eg. NGO/ CBOs/ IMA etc.)• Monitoring, Evaluation & Supportive Supervision• Legislation

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Points for drafting Action PlanPoints for drafting Action Plan

• Situation analysis of the disease• Specific Constraints for implementation of the programme• Prioritization of the areas including the criteria of

prioritization• Strategy & innovations proposed.• Requirement for commodity as per technical norms and

considering balance of stores, consumption capacity and justification.

• Cash assistance required from Centre and unspent balance available with State

• Assistance for Capacity Building and IEC/BCC/PPP activities may be incorporated.

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State Resources

Blood Slides Lancets, Regents, Microscope , Lenses and maintenance. Mobility, POL/Diesel

Malathion/Synthetic Pyrethroid.Spray wages, Pumps, accessories etc. Synthetic Pyrethroid in externally assisted project states

Bednets(except project state)Synthetic pyrethroid liquid for treatment of mosquito netsOffice maintenance & expenses AMC of computers and recurring cost of internet and contingencies GoI fund DDTLarvicides (decentralized & cash assistance provided for it)Drugs ( some decentralized & cash assistance provided for it)

Pattern of Assistance ( Malaria) – Pattern of Assistance ( Malaria) – Domestic support Domestic support

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Special Assistance Special Assistance

(High malaria endemic (High malaria endemic districts) – Domestic support districts) – Domestic support

• Contractual MPWsContractual MPWs

• Incentive to ASHAs Incentive to ASHAs

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World BankCapacity Building (as per NVBDCP guidelines) - by GOIMonitoring & Evaluation and Mobility - by GOIHuman Resource - by GOIBCC at National Level - by GOIGFATM Human Resource - by GOIPlanning & Administration - by GOIMonitoring & Evaluation - by GOIOperational Cost - by GOITraining - by GOIIEC - by GOI

Pattern of Assistance ( Malaria) Pattern of Assistance ( Malaria) –External support –External support

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Operational cost for Kala-Azar elimination

-100% by GOI

Elimination of Lymphatic Filariasis

– 100 % by GOI for preparatory activities and MDA

For AES/JE and Dengue/Chikungunya

-by GOI as per budget availability

Pattern of Assistance ( Other Pattern of Assistance ( Other VBDs)VBDs)

• What is the status of following Case Detection indicators?• ABER(Surveillance), Total Malaria Cases, Pf Cases, Deaths;

compared to the same period of last year• Financial • Have the SOEs of the last quarter / UCs of the last year been

submitted by the district to the state?• Is the audit of the district society for the last financial year complete?• Have Funds been received from State society and other sources

timely and are they adequate?• Logistics• Have adequate Logistics been received from center and other

sources?• Have logistics been distributed to all implementation points (PHCs,

SCs, ASHAs, FTDs) on the basis of technical rationale?• Are monthly logistics report being submitted by the district on time?• Have all the consignee receipts been submitted?

District Collector/Zilla Parishad ChairpersonCheck List for Review of Malaria --------1

• Human Resources / Training• Is adequately trained staff present against sanctioned

posts?• Has the existing staff been rationally deployed so that

least vacancies are present in high risk areas?• Are trained LTs present in all PHCs?• Whether LTs are being used as multi purpose LTs at

PHCs?• Are RD Kits being provided to remote and inaccessible

areas?• Have ASHAs been trained on the use of RDTs? How

many are yet to be trained?

District Collector/Zilla Parishad ChairpersonCheck List for Review of Malaria --------2

• Programme Implementation• Has the District Action Plan been prepared(Nov) and

submitted by the district?• Has the district completed preparation of District Micro-

plan(pre-transmission season) for IRS? Is the micro-plan based on GIS mapping?

• Are the spray squads been trained/reoriented for IRS (before commencement of spray)?

• Has all the spray equipment been checked and certified?• Have personnel been nominated for supervision of IRS, area-

wise?• Specific activity monitoring• What is the status of GIS mapping? Has the village wise data

been sent to SPO?

District Collector/Zilla Parishad ChairpersonCheck List for Review of Malaria ---------3

• IEC/BCC• What are specific BCC activities that have been undertaken

in last one quarter?• Is the community being given prior information of spray

rounds to improve acceptance of IRS(transmission season)? If yes, who is doing this?

• Inter- sectoral coordination• How many NGOs/ CBOs/ Military & Para- military Hospitals

are involved in the programme in the district? How many of these have been involved in the last quarter?

• Whether state transport corporation & other public transport are being used for transportation of blood slides and getting results?

District Collector/Zilla Parishad ChairpersonCheck List for Review of Malaria --------- 4

Thank You