Malaria Control Programme, Orissa CDMO Conference Jan, 2010

Declining trend with hopes for control Maps with API: 2005, 2008 and 2009 YearDists. with API < 2 Dists. with API 2-5 Districts with API 5-10 Dists. with API >

Epidemiological situation, Year+vePFDeathsABERSPRPf% API (provisional)

Districts with high mortality, 2007 to 2009 Sl. NoDistricts % Increase(+) / decrease (-) in 2009 over Kandhamal Keonjhar Rayagada Sundargarh Nuapada Sonepur Koraput Nawarangapur Balasore* ??? There is no death investigations – * In Balasore out of 6 malaria deaths reported during the month of November only one could be ascertained due to malaria.

LLIN distribution : GFATM districts SL NO.DIST LLINs ALLOTED Supply of LLINs to districts (at Block level) No. of LLINs distributed to beneficiaries Expected allotment in Angul Bargarh Bolangir Boudh Deogarh Dhenkanal Nayagarh Sonepur Balasore Bhadrak Cuttack Ganjam Jajpur Khurdha Total

LLIN distribution World Bank Districts SL NO. DISTLLINs ALLOTED Supply of LLINs to districts (at Block level) No. of LLINs distributed to beneficiaries Expected allotment in Gajpati Jharsuguda Kalahandi Kandhamal Koraput Keonjhar Malkangiri Mayurbhanj Nawrangpur Nuapada Rayagada Sambalpur Sundargarh Total

Key features of the state LLIN guidelines – Criteria - sub-centre is the unit and in the first phase SCs with API >5 – SCs with API 3-<5 will be included when more LLINs will be available – All villages in a SC irrespective of API status of the village – Cluster approach: to protect entire population in defined high transmission area. Clusters may be intra or inter block, intra or inter-dist. All families irrespective of BPL and APL will be given LLIN Avg. LLIN calculation : 1 LLIN/ 2.5 Persons +3% extra [ 1 LLIN for 1-2 persons, 2 LLINs for 3-5 persons, 3 LLINs for 6-7 persons, 4 LLINs for 8-10 persons.]

Key features ……… contd  Identification of cluster areas was done through regional level workshops with state level facilitation. (representatives of 4-5 contiguous districts present at each workshop)  Survey of households in villages under a cluster through Gaon Kalyan Samitis (GKS) for identifying actual need  Distribution by GKS members under the active supervision of block, district and state.  List of beneficiaries to be maintained in designated registers.

LLIN Distribution format Block:__________ SC:___________________ Village:_________________ Sl No. Head of the HH Total No. of family members No. of pregna nt women No of U-5 Children No. of LLIN Supplied to HH Sl. No of LLIN Rupees received as contribution Date of Distributi on Sign./thumb impression of the receiver 1 2 Database to be maintained at Block, District and State level. BPO in coordination with MTS and VBD Consultant will maintain the data Data will be uploaded at Dist. & State Health Department Web Site * In the format one extra column has been added to collect the data on under five children in the household who are being protected by LLIN

Distribution of lakh GoI LLIN in Nominal contribution to be collected as a symbol of ownership GKS will collect Rs per LLIN from BPL and Rs from APL persons - But no one to be left out if unable to contribute. This fund will be used by GKS for malaria control activities, replenishing nets if torn out and BCC at village level.

MO- MASHARI – the state initiative Objective: to protect the following special groups by LLINs with special message of ownership 1. Pregnant women in high burden areas (family size LLIN) – LLIN distribution at the time of antenatal registration as a component of ANC package. – This is expected to cover pregnant women during pregnancy and mother and child after delivery lakh LLINs already in the distribution process in five high endemic districts and another 2 lakh LLIN will be procured in Boarders of Tribal Residential Schools (single size LLIN) – The boarder will own the LLIN, can take home during vacations and permanently after leaving the school - “will act as the agent of change in his/her community”. Distribution through Headmaster/Headmistress of tribal schools.

Current distribution plan under Mo Mashari for pregnant women, Sl NoName of the DistrictLLIN Allotment 1Kandhamal Keonjhar Rayagada Malkangiri Nawarangpur19000 Total Another 10 high burden districts will be covered in 2010

Important activities around LLIN State team will monitor district LLIN implementation Computerized data base of LLIN distribution – BPO are to be involved for data entry at block level which will be consolidated at DPM unit for the districts. – MTS of concerned blocks and VBD consultants of WB Districts will coordinate with BPO and DPM units respectively. Districts while distributing will document with photographs Professional process documentation of LLIN activities will be done by T & MST

Important activities …………….. – Appropriate IEC / BCC like use of folk media and other methods along with distribution of LLIN or after the distribution depending upon the ground reality, so that by the peak transmission season, people are in habit of sleeping under LLINs and do not misutilise Dy MEIO/ BEE must be involved in the IEC/BCC activities and whole process – Pre-distribution information on village-wise days of distribution and post- distribution information of number of LLINs given village-wise will be displayed on the swathya kanthas and documented with photography.

Important activities …………….. Network and established civil society organisations will be involved for social mobilization around LLIN who will also give hand holding support to GKS – State level initiatives will be taken to involve Red Cross, NYKS, Kalyanee clubs, MNGOs etc. Summary of nets distribution status would be uploaded on the health department website and updated regularly

IRS in LLIN areas In 2010, IRS will also be conducted in LLIN areas – This will be done since we are not sure about the extent of acceptance and usage of LLIN in the first year – Accordingly the IRS action plan will revised A total district wise readiness plan will be developed by 1 st week of Feb 2010 so that 1 st round IRS can be conducted with full preparedness by 15 th May – IRS Action plan meetings will be conducted from 27 th to 29 th Jan, – VCRC, NIMR, RMRC and RD office will be involved from the beginning in planning and monitoring

GKS fund to meet IRS wages & operational cost for bednet impregnation IRS wages The wages for IRS will be met from GKS fund in Necessary communication will be made soon In an average Rs 6000/- may be needed per 2 rounds of spray in a village of average 1000 population Net impregnation: Similarly in Non-IRS villages GKS fund can be used for impregnation of community bed nets – Some GKS show interest to impregnate without operational cost– they need only training and SP flow – Hence local appropriate measures can be adopted – SP flow is available in plenty and can be supplied on indent

Issues on IRS Non submission of 2 nd round IRS report: – Following district have not submitted the 2 nd round IRS report: Anugul, Dhenkanal, Gajapati, Ganjam, Jharsuguda, Kalahandi, Keonjhar, koraput, Malakanagiri and Nawarangpur, Nuapda, Samblapur, Sundargarh Dhenkanal not submitted both 1 st &2 nd round IRS report

Human resource LTs against regular posts: retired LTs will be posted against the vacant posts – communication will be made soon Additional manpower: Districts lagging behind: MTS : Bhadrak (1), Koraput (1) Malkanagiri (1), Baragarh (1), LT: Nayagarh(1), Gajapati (2), Koraput (1), Balasore (1) – As Koraput has not yet recruited 1 LT and such LTs are meant for sentinel sites, this position will be diverted to another dist MPW (Male): Baragarh (35),Ganjam (34), Mayurbhanj (98), Nawarangpur (22), Koraput (43), Rayagarh (40). Dist. Malaria Officer will be posted as per the new cadre structure.

MPHW - Male (567poated /816) DistsSancd Rctd Dists SancdRctd Angul7069Nayagarh88 Balasore30 27Sonepur42 Bargarh35Scr Gajpati3824 Bolangir1918Jharsuguda148 Boudh66Kalahandi37 Deogarh66Kandhamal36 Dhenkanal34 Keonjhar66 Ganjam34 scr Koraput43Scr Malkangiri3125Rayagada40Scr Mayurbhanj98Court caseSambalpur55 Nawrangpur22 scr Sundargarh45 Nuapada57 55 More 184 sanctioned for and will be posted in high burden areas only

Status of Submission of GIS Data S.noDistrict Sub centre dataVillage dataREMARK 1Angul submitted not in format 2Balasore not submitted 3Baragarh submitted not in format 4Bhadrak submitted 5Bolangir submitted not in format (given only 2008) 6Boudh submittednot submitted 7Cuttack not submittedsubmittednot given all village data 8Deogarh not submitted 9Dhenkanal not submittedsubmittednot in format 10Gajapati not submittedsubmitted not in format (given only 2008) 11Ganjam not submitted 12Jagatsinghpur submitted not in format 13Jajpur not submitted 14Jharsuguda submittednot submitted 15Kalahandi submitted not in format (given only 2008)

Status of Submission of GIS Data S.noDistrict Sub centre data givenVillage wise dataREMARK 16Kandhamal not submittedsubmitted 17Kendrapara not submitted 18Keonjhar submittednot submitted 19Khurda submittednot submitted 20Koraput not submittedsubmittednot in format 21Malkangiri not submittedsubmittednot in format 22Mayurbhanj submittednot submitted 23Nabarangpur submitted 24Nayagarh not submittedsubmitted 25Nuapada not submittedsubmittednot in format 26Puri not submitted 27Rayagada not submittedsubmittednot in format 28Sambalpur not submittedsubmittednot in format 29Subarnapur not submitted 30Sundargarh submittednot submitted Total 1317

Issues on sentinel sites Trained LTs (Contractual) should be placed in identified Sentinel Sites (Avg. 2 per districts) Data in proper format to be collected, compiled, analysed and feedback to be submitted to the concern Blocks Sentinel site formats are given in ME Module – And in Dec- Jan all sentinel site LTs have been given reorientation training – They have been given the copies of the formats

Quality microscopy Microscopy is said to be the gold standard for malaria diagnosis, but unfortunately we have ??? on the quality In many labs the discrepancy rate is very high (In many cases the +ve slides are –ve as observed by RD Lab.) – which is misleading the malariometric indicators and there is complaint that GoI supplied RDTs are not good as they show -ve results in such cases. Due attention must be given at each level to see the quality aspects of each malaria lab and the skill of the technicians – Malaria technicians will be retrained where their skill is doubtful – All efforts are being taken to supply Lens, reagent etc. – Fund will be provided to districts to procure quality reagent and meet the microscope repair cost – Where non functional microscopes are not in repairable stage new microscopes will be provided – Hence urgent review of all malaria labs to be done by the district authority

Other issues NAMMIS: All IDSP data entry operators will be trained (many have already been trained) and they will be responsible for NAMMIS M 1 and other new Surveillance format will be printed at district level to meet another 3 months’ requirement All efforts to be taken to make ACT and RDT available at Sub centre and trained FTD (ASHA) level Trainings: training of MPW (male) and rest of the ASHAs and VSS animators Regular monthly review of VBDs, MTS, LTs and MPW(male) and sorting out their genuine difficulties All malaria death must be investigated as per the guideline using the death investigation format : – A simple malaria death investigation format has been developed by Dte. NVBDCP, GOI and will be sent soon

Financial issues Except Deogarh, Jharsuguda, Kandhamal, Kendrapada, Keonjhar, Mayurbhanj, Nawarangpur, Nayagarh, Nuapada & Sundergarh other districts have low expenditure under WB (<10%) GFATM districts under with <5% expenditure: –Angul, Balasore, Bhadrak, Boudh & Khurda : <5% –Dhenkanal is with <10% expenditure SOE & UC of 1 st round IRS : Only Dhenkanal, Malkangiri, Bolangir & Angul & Sonepur have submitted- others are yet to submit SOE & UC of the fund under DBS : Districts have not submitted. All measure be taken to submit SOE by 5 th of every month –Is being submitted to GoI, by 10 th of every month

Dist (GFATM Fund) Delay in SOE / UC Low expenditure (%) Dist (WB Fund) Delay in SOE / UC Low expenditure (%) Angul-Do-2.38 Jharsuguda -Do Balasore-Do-0.00 Gajapati -Do Bhadrak-Do-0.87 Kalahandi -Do Boudh-Do-0.00 Rayagada -Do Dhenkanal-Do-9.49 Sambalpur -Do Khurda-Do-3.98 Koraput -Do- 00 Sonepur-Do Malkanagiri -Do-.74 Total(all dist) 24.88Total(all dist) 14.57

GFATM Fund Position (April to Sept), Odisha Sl No Name of the District Opening Balance Fund Released Total SOE Submitted Closing Balance %age of Expenditure Angul Balasore Bargarh Bhadrak Bolangir Boudh Cuttack Deogarh Dhenkanal Ganjam Jajpur Jagatsingpur Kendrapara Khurda Nayagarh Sonepur District Total

PROGRESSIVE SMCS & DMCS(NVBDCP) in the state of Orissa for the month of Nov-09 SL. No. District Amount carried down from the prv.Financial year(O.B as on ) Amount recived during the current year up to the immediate last month Funds recived during the current mounth including misc.receipt Total funds available during the financial year till month (A+B+C) Expn.for the year from April 1(Current financialyear till the prv.M onth ending Expn.During the current month (as per the annexure encloseed) Progv.Expn for the current financial year till current month Balance % of Expenditur e ABCDEF G H I 1 Angul Balasore Baragarh Bhadrak Balangir Boudh Cuttack Deogarh Dhenkanal Gajapati Ganjam Jagatsinghpur Jajpur Jharsuguda Kalahandi

SL. No. District Amount carried down from the prv.Financial year(O.B as on ) Amount recived during the current year up to the immediate last month Funds recived during the current mounth including misc.receipt Total funds available during the financial year till month (A+B+C) Expn.for the year from April 1(Current financialyear till the prv.M onth ending Expn.During the current month (as per the annexure encloseed) Progv.Expn for the current financial year till current month Balance % of Expenditur e 16 Kandhamal Kendrapada Keonjhar Khurda Koraput Malkangiri Mayurbhanj Nawarangpur Nayagarh Nuapada Puri Rayagada Sambalpur Sonepur Sundargarh Dist. Total SMCS Grand Total

IRS Fund Release & Expenditure SL. No.District OHSPDBS 1st RoundExpenditure2nd RoundExpenditureIRS IECMPW Salary Expenditu re 1Angul ,882 SOE NOT SUBMITTED 42,032 33,60,000 SOE NOT SUBMITTED 2Balasore0 9,100 22,100 9,00,000 3Baragarh ,544 30,344 10,50,000 4Bhadrak0 4,200 12, Balangir ,32,980 1,01,080 9,12,000 6Boudh ,250 27,584 2,88,000 7Cuttack ,688 29, Deogarh ,280 19,928 2,88,000 9Dhenkanal ,204 33,554 16,32,000 10Gajapati ,23,080 51,072 18,24,000 11Ganjam ,04,704 99,736 10,20,000 12Jagatsinghpur0 2,100 11, Jajpur0 8,400 19, Jharsuguda ,886 20,836 5,64,000 15Kalahandi ,65,403 1,07,204 17,76,000 16Kandhamal ,65,904 84,332 17,28,000 17Kendrapada , Keonjhar ,42,865 69,070 31,68,000 19Khurda0 9,800 20, Koraput ,14,984 1,80,380 12,90,000 21Malkangiri ,95,470 90,412 14,88,000 22Mayurbhanj ,77,500 1,26,678 29,40,000 23Nawarangpur ,69,485 1,30,560 6,60,000 24Nayagarh ,154 31,820 3,84,000 25Nuapada ,72,201 57,100 27,36,000 26Puri Rayagada ,16,682 1,74,590 12,00,000 28Sambalpur ,15,745 75,298 2,40,000 29Sonepur ,386 22,228 20,16,000 30Sundargarh ,74,881 1,45,504 21,60,000 Dist. Total

Thanks