World Bank Support

July 31, 2008 - The World Bank today approved a US$520.75 million IDA credit to India in a major new attack on three diseases still killing thousands and affecting the lives of millions in poor and tribal communities. The credit also has tough new safeguards in place to prevent corruption.

The National Vector Borne Disease Control and Polio Eradication Support Project - designed in collaboration with the Government of India, World Health Organization (WHO), and the Global Fund to fight AIDS, Tuberculosis and Malaria - will significantly boost effective prevention, diagnosis, and treatment services for malaria and kala azar in remote and backwards areas especially, and increase polio vaccinations.

Challenges

India’s public healthcare system reports around two million malaria cases every year. However, the actual number of those afflicted with malaria is much higher as many people receive treatment outside government hospitals and dispensaries. About half of all reported malaria cases are Plasmodium falciparum (Pf), a severe and often fatal strain of malaria.

The most malaria-prone areas in India are also among its poorest. Out of all reported malaria cases in India, nearly half are from Orissa, Jharkhand, Chhattisgarh and Uttar Pradesh. The World Bank supported Vector Borne Disease Control Project, to be implemented in 93 of the most endemic districts in eight states, will help the Government of India improve malaria prevention and treatment for over 100 million people among the poorest of the poor.

Given the widespread prevalence of the disease, malaria also places a high cost on the productivity of the Indian economy in terms of workdays lost. Each year up to 79 million productive days of work are lost due to malaria.

"Malaria continues to be a major threat to the lives of millions of poor Indians through premature death, disability, and unnecessary suffering. This project uses the latest science on malaria control, including a new highly effective drug regimen, to effectively address this problem,” said Isabel Guerrero, World Bank Vice President for South Asia. “India, along with Nigeria, Pakistan, and Afghanistan, remains the only country still affected by the scourge of polio that shatters the future of hundreds of people, mostly young children. With this operation, we hope India will take the final step towards eradicating polio".

New Approach

The project supports the Government of India’s new policy of phased introduction of improved malaria diagnosis and treatment. This involves treating all confirmed Pf malaria cases with the highly cost-effective Artemisinin Combination Therapy (ACT). This major policy change was prompted by new evidence suggesting growing resistance to chloroquine, previously the primary malaria drug in India.

The treatment policies under the new project are based on the recommendations of a Joint Monitoring Mission (JMM) of Vector Borne Diseases Control led by the World Health Organization (WHO) in February 2007. The JMM comprised national and international experts who reviewed the program by visiting six states. The Government of India approved a phased introduction of the new policies starting with 200 most malaria-endemic districts under operations supported by the World Bank and the GFATM (Global Fund for AIDS, Tuberculosis and Malaria). These policies specifically focus on increasing effectiveness against the more fatal Pf malaria.

- Project Documents