New perspectives of malaria control in India under World Bank Project

The World Bank has been assisting Government of India (GoI) for a number of years with development of effective health services for the control of vector borne diseases (VBDs). An Enhanced Malaria Control Project (EMCP) under financial assistance from Bank was implemented in selected tribal states and districts from 1997 to 2005. While most of the project districts did report a decline in malaria incidence, the Implementation Completion Report (ICR) highlighted the need for major reform. Plasmodium falciparum (Pf) malaria, which accounts for almost all malaria related mortality, has been increasing in India and there is widespread resistance to chloroquine. The needed reform would require, first and foremost, updating of policy on malaria case management in public and private sectors. Also needed are innovative approaches for promoting the use of insecticide treated nets (ITNs) and strengthening institutions at the district and state levels for effective implementation of new policies. Several important changes in the policy on diagnosis and treatment of malaria are being implemented in this new project. The most important of these are: Use of artesunate combination therapy (ACT) as the first line treatment for all confirmed Pf malaria cases, introduction of rapid diagnostic kits for quick diagnosis of Pf cases, promotion of long lasting insecticide treated bed nets (LLINs) in vulnerable population. Supervision and monitoring will be strengthened by deployment of Malarial/Kala azar Technical Supervisors (MTS/KTS) and VBD consultants at district level. The project has also envisaged two important components like Environment Management Plan (EMP) for safe use of insecticides and materials and Vulnerable Community Plan (VCP) for the benefit of underprivileged population.