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 Control 2.Early Diagnosis and Prompt Treatment 3.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 nets  4 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

21 Points 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.

22 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 nets Office maintenance & expenses AMC of computers and recurring cost of internet and contingencies GoI fund DDT Larvicides (decentralized & cash assistance provided for it) Drugs ( some decentralized & cash assistance provided for it) Pattern of Assistance ( Malaria) – Domestic support

23 Special Assistance (High malaria endemic districts) – Domestic support Contractual MPWs Contractual MPWs Incentive to ASHAs Incentive to ASHAs

24 World Bank Capacity Building (as per NVBDCP guidelines) - by GOI Monitoring & Evaluation and Mobility - by GOI Human Resource - by GOI BCC at National Level - by GOI GFATM Human Resource - by GOI Planning & Administration - by GOI Monitoring & Evaluation - by GOI Operational Cost - by GOI Training - by GOI IEC - by GOI Pattern of Assistance ( Malaria) – External support

25 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 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 Chairperson Check List for Review of Malaria

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 Chairperson Check List for Review of Malaria

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 Chairperson Check List for Review of Malaria

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 Chairperson Check List for Review of Malaria

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