India’s National Health Policy calls for reducing malaria deaths by 50 percent and eliminating kala azar by 2010. It also calls for the eradication of polio.  The World Bank supports the government’s efforts to achieve these goals through the National Vector Borne Disease Control and Polio Eradication Suport Project that has been designed in cooperation with the Government of India, World Health Organization (WHO), and the Global Fund to fight AIDS, Tuberculosis and Malaria:
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Malaria, Kala Azar and other Vector-Borne Diseases
India reports some 2 million malaria cases each year with about half being caused by Plasmodium Falciparum (Pf), a severe and an often fatal strain that is spreading rapidly. India also bears a high burden of other vector borne diseases (VBD) such as dengue, Japanese encephalitis, lymphatic filariasis, and the sandfly-transmitted kala azar which affects the poorest of the poor who live in unhygienic housing conditions.  Although India has achieved considerable success against malaria in recent years – with the number of malaria cases having declined significantly from 2.66 million in 1997 to 1.86 million in 2003 - success has not been uniform. Orissa, Jharkhand, and Chhattisgarh now account for the large majority of malaria cases, and other states are at risk of epidemics. India’s urban areas are also witnessing a rise in the incidence of malaria and dengue.  The poor are at greater risk of contracting these diseases and suffering complications and death because of limited access to effective prevention and treatment. Tribal districts are most at risk.  The project aims to prevent and control malaria and other VBDs through common strategies - such as the management of unhygienic environmental conditions, the use of larvivorous fish, indoor residual spraying with better pesticide management, and personal protection strategies including the use of insecticide treated bed-nets. It also aims to improve diagnosis by making rapid diagnostic test kits available in rural areas where microscopy is not accessible. Confirmed cases of Pf malaria, which are increasingly resistant to chloroquine, will be treated with the highly cost-effective Artemisinin Combination Therapy (ACT).  The project will be implemented in 93 of the most malaria endemic districts in eight states, reaching over 100 million people. The kala azar component will focus on 46 districts in Bihar, Jharkhand, and West Bengal, the three states that account for practically all such cases in the country.  Polio
The project also aims to help the government eradicate polio. While most parts of India today are polio free, UP and Bihar – which together comprise 25 percent of India’s population - remain endemic. This is largely because of poor environmental sanitation, high population density, high illiteracy, low coverage of routine immunization and high birth rates.  The project supports the WHO-launched Global Polio Eradication Initiative - the world’s largest public health initiative ever - which has successfully eliminated polio from all but four countries - India, Pakistan, Afghanistan and Nigeria.  India joined the global polio eradication efforts in 1995 by starting the ‘National Immunization Days’. During these days, nearly 2.3 million vaccinators reach more than 170 million children across the country. Efforts progressed well until 2002 when a major increase of polio cases in Uttar Pradesh caused a set-back.  The project aims to improve the availability of the polio vaccine as, with the global need for the vaccine reducing rapidly, the number of suppliers is on the wane making it difficult for the government to ensure adequate supplies. The project will also monitor the quality of the vaccines supplied. Polio vaccines are purchased through UNICEF from WHO prequalified manufacturers, and each batch is tested by the National Laboratory in Kasauli. The project allows for flexibility in using different types of oral polio vaccines depending on the local epidemiology.  |
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