GFATM Funding Support Intensified Malaria Elimination Project (IMEP) (Jan 2018 - March 2021) Principal Recipient: Dte. NVBDCP, MOHFW GOI Govt. Sub-Recipients: 7 NE States & Madhya Pradesh Non-Govt. Sub-Recipients: Bakdil, Meghalaya and Centre for Peace & Development (CPD), Mizoram Dr Avdhesh Kumar Additional Director Dte National Vector Borne Disease Control Programme
Introduction Global Fund is supporting the country Malaria programme. Intensified Malaria Control Project, Round IX: covered high endemic 7NE states (Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Tripura) for 5 years (Oct. 2010 Sep. 2015). IMCP-3, New Funding Model: 27 months (Oct. 2015 Dec. 2017) 7 NE States and Odisha. IMEP: 39 months (Jan 2018 Mar 2021) 7 NE states & MP Target group/beneficiaries: marginalized groups, tribal population, women and children & other key population like Jhum cultivators, forest workers, migrants and mobile population (especially in border areas).
Achievements under IMCP-3 Significant decline in malaria cases & deaths in NE states. 7.24 million LLINs distributed in 7 NE states through mass campaign in 2015-2016 for universal coverage of all sub centers with API >1. 11.34 million LLINs distributed in Odisha. 11.27 million LLINs distributed in Jharkhand & Chhattisgarh: under pipeline for distribution. 95% of ASHAs trained in 7 NE states & Odisha on malaria prevention & control from October 2015-March 2017. 97.5% of total budget for PR1 utilized.
Deaths Cases NE States: Malaria Cases & Deaths, 2009-2017* 250000 600 200000 487 500 400 150000 290 300 100000 222 200 50000 162 113 119 135 76 100 *Provisional 0 2009 2010 2011 2012 2013 2014 2015 2016 2017* Total Cases PF Cases Deaths 19 0 2017 Vs 2009: decline 84% in cases, 83% in Pf cases & 96% in deaths.
Shrinking Malaria Map, NE States, 2009-2017 Dibang Valley Upper Siang Upper Subansiri West Siang Lower Dibang Valley ARUNACHAL PR. Kurung Kumey East Siang Anjaw Lower Subansiri Lohit Towang Dhemaji Tinsukhia East Kameng Changlong West Kameng Lakhimpur Dibrugarh Papumpare Sibsagar Tirap Chirang Baksa Udalguri Sonitpur Jorhat Mon Kokrajhar Darrang Barpeta GolaghatMokokchung Bongaigaon Kamrup NagaonASSAM WokhaNAGALAND Dhubri Goalpara Marigoan Karbi Anglong Tuensang Ri-Bhoi Kohima Kiphire East Garo Hills NE States Phek MEGHALAYA Jaintia Hills Peren West Khasi Hill N. Cachar Hills API - 2009 South Garo Hills East Khasi Hill Senapati Ukhrul Tamenglong Cachar Imphal Karimganj MANIPUR Churachandpur Kolasib Chandel Tripura North Aizawal East Dhalai Mamit Champhai Tripura TRIPURA South Serchhip N MIZORAM Lunglei W E S Saiha Lawngtlai 2009 2017 API < 1 25 75 <1 >1-2 >2-5 >5-10 >10 & Above DHALAI AIZAWAL EAST MAMIT TRIPURA CHAMPHAI TRIPURA SOUTH SERCHHIP MIZORAM MANIPUR IMPHAL DIBANG VALLEY UPPER SIANG ARUNACHAL PR. UPPER SUBANSIRI WEST SIANG KURUNG KUMEY EAST SIANG CACHAR LUNGLEI SAIHA LAWNGTLAI S API wise distribution of districts W UKHRUL CHURACHANDPUR KOLASIB CHANDEL ANJAW LOHIT TOWANG DHEMAJI TINSUKHIA EAST KAMENG DIBRUGARH CHANGLONG WEST KAMENG PAPUMPARE SIBSAGAR TIRAP SONITPUR BAKSA JORHAT MON KOKRAJHAR ASSAM GOLAGHAT CHIRANG KAMRUP NAGAON DHUBRI NAGALAND BARPETA TUENSANG KARBI ANGLONG RI-BHOI KIPHIRE EAST GARO HILLS PEREN PHEK WEST MEGHALAYA KHASI HILL N. CACHAR HILLS SOUTH GARO HILLS JAINTIA HILLS SENAPATI N E TAMENGLONG NE State API -2017 <1 >1-2 >2-5 >5-10 >10 & Above API 1 To 2 14 7 Gomti, Khowai, N Tripura, S Tripura; E Siang,; Kokrajhar; Jaintia Hills API 2 To 10 23 7 W Garo Hills, W Khasi Hills, E Garo Hills; Lunglei, Mamit, Saiha; Dhalai API > =10 24 2 S Garo Hills; Lawngtlai Total 86 91
Intensified Malaria Elimination Project Project Areas : 7 North Eastern States & Madhya Pradesh (for only LLINs); Odisha LLINs (partially) under PAAR Project Period: Jan 2018 to March 2021 (39 months) TRP & Grant Approval Committee (GAC) of Global Fund (GF): technically sound and strategically focused. GF did not agree for Caritas as Non-Govt. PR, instead agreed for supporting two Local NGOs as SRs for high endemic districts of Meghalaya & Mizoram (Geographical Coverage: 1447 villages in high endemic selected 145 sub-centres (API>10) in 5 districts of 2 states) (i) Bakdil, Tura, Meghalaya (for two high endemic districts of Meghalaya namely East Garo Hills and South Garo Hills). (ii) Center for Peace and Development (CPD), Aizawl, Mizoram (for three high endemic districts of Mizoram namely Lunglei, Lawngtlai and Mamit).
Geographical Coverage States: 8 Districts: 147 Popn.: 127 million
Goal: To reduce malaria related morbidity and mortality by at least 70% in project areas (9 states=7 NE+MP+Odisha) by 2020. Objectives: 1. Achieve universal coverage of population at risk of malaria with an appropriate vector control intervention (LLIN). 2. Achieve universal coverage of case detection and treatment services at all levels in project areas to ensure 100% parasitological diagnosis of all suspected malaria cases and complete treatment of all confirmed cases. 3. Strengthen the surveillance to detect, notify, investigate, classify and respond to all cases and foci in all districts (in project areas) to move towards malaria elimination. 4. Achieve universal coverage in project areas by appropriate BCC activities to improve knowledge, awareness and responsive behaviour regarding effective preventive and curative interventions. 5. Ensure effective programme management and coordination to deliver a combination of interventions for malaria elimination.
IMEP: Strategies/ Activities a) Early diagnosis and complete treatment b) Human resource & capacity building c) Vector Control including LLINs Mass campaign d) IEC/BCC e) Health Information System and Monitoring & Evaluation f) Programme Management including Infrastructure and other Equipments g) Coordination and partnership development
Inputs under the Project -1 Human resource & capacity building Commodities/ Equipments: RDK (bivalent) ACT-AL for Pf cases Artesunate injection for severe malaria cases LLINs Mobility support for M&E Support for IEC/ BCC/ Social Mobilization Operational Research
Inputs under the Project - 2 Human Resource National level: M&E, training, finance, PSCM State level: Public Health, M&E, Finance, Procurement and IEC-BCC consultants District: VBD consultants Sub-district level: Malaria Technical Supervisor (MTS) with bike Sentinel hospitals: MO, Laboratory technicians to enhance surveillance
IMEP: Budget Approved by GF (Jan 2018-March 2021) Approved Funding (PR/SR) Amount in USD Amount in INR Dte. NVBDCP (PR) 63.46 million 412.48 crores Local NGOs (Non-Govt. SRs) 1.55 million 10.06 crores Total 65.01 million 422.54 crores Approved Funding (PR/SR) Amount in USD Amount in INR PAAR Procurement of LLINs for Odisha in 2020 Implementation of HMIS 49.40 million 321.10 crores
Summary Budget (IMEP-39 months) - 1 S. N o Module Amount in USD (In Million) 1 Vector Control 52.33 % of Budget Activities 81% 1. 9.65 million LLINs for MP (2018); 5.71 million LLINs for NE States (2019), 2.33 million LLINs for Odisha (2020) 2. Distribution cost for MP and NE States (excl. ASHA Incentives). 3. IEC/BCC Activities. (Flex boards (schools), Public Address System, Miking Activity and local school activity in high endemic areas by two local NGOs-Meghalaya & Mizoram) 2 Program Management 3.87 6% 1. Remuneration for Distrcit VBD Consultants, Acct Asstt. Cum DEO. 2. Remuneration is kept as 100% for Yr-1; 70% in Yr 2 ; and 50% in Yr 3 3. Regional Review Meetings and State Review Meetings. 4. Office cost of local NGOs
Summary Budget (IMEP-39 months) - 2 S. No. Modules 3. RSSH: Human resources for health (HRH), including community health workers 4 RSSH: Health management information systems and M&E TOTAL USD (In Million) 6.76 2.05 65.01 % of Budget Remarks 10% 1. Remuneration cost for MTS and LTs and mobility for State & District consultants and MTS. 2. Remuneration is kept as 100% for Year 1; 70% in Year 2 ; and 50% in Year 3 as recommended by GAC 3. Remuneration cost for Field supervisors & CHVs and their Capacity Building for Local NGOs. 3% 1. Large Scale population Surveys, Operational Research and LQAS. 2. Consultation with Private Sector (Trainings & Meetings). 3. Infrastructure Equipments (Computers) at PHC level 4. Travel related and other costs for local NGOs 100
High Malaria Endemic Areas in India LLINs supplied/proposed and % contribution of Population(compared to country total) States % Population LLINs supplied (million) N.E. States (7) 4 7.24 + 5.7 (approved in IMEP) Odisha (1) 3.5 11.34 + 10.13 (proposed under PAAR in IMEP) Chhattisgarh +Jharkhand (2) 5 11.27 Madhya Pradesh (1) 6 9.7 (approved in IMEP) Other states & Union Territories (25) NE States+ MP (proposed) 81.5 5+5 million 10.0
LLINs Distribution and Usage
Activities budgeted under IMEP (Jan 2018-March 2021) Cost Categories Procurement of LLINs (MP) approx. 30 million USD Human resource Regional Review Meetings (4 monthly) State Review Meetings (quarterly) Training cum workshop of IMA & IAP (State level) to sensitize Pvt. Practitioners for generating malaria data Training cum workshop of IMA & IAP (district level) to sensitize Pvt. Practitioners for generating malaria data Consultation with Private Sector (at block level) Communication Material & Publications (CMP) Operational Research & Large Scale Population Surveys Computers at PHC level (@ Rs. 32250/-; budgeted in Year 2) LLINs NE states (Yr 2); Odisha (Yr 3) NGO SRs In place Status In progress 1 st meeting held, Apr, Itanagar State-wise held; planned In progress 2 nd & 3 rd Year Approved, MoU being signed
Challenges Way Forward To sustain the gains achieved so far Human Resource: timely recruitment; retention/ attrition; monitoring & supervision; Inter-state non uniformity in remuneration mainstreaming the DMOs, MTS, and ASHAs Procurement: timely procurement/ stock outs; inventory management IMS Entomological Support: not only for malaria but all VBDs - State/Zonal; District Involving Other Sectors: other Govt. organizations; NGOs; Private Sector (formal & non-formal) Financial Resources Utilization: Treasury route; Tally; PFMS NFME: Launching at state/district; Ownership PIP Action Plan: additional activities curtailed; HR remuneration Monitoring & Supervision: LLIN usage etc., etc.
Intensifying the Fight Against Malaria THANK YOU kavdheshnvbdcp@gmail.com Acknowledgements: IMEP Team
Impact Indicators Indicators-Impact, Outcome & Coverage Malaria I-1: Confirmed malaria cases (microscopy/rdt): rate per 1000 persons per year Malaria I-2(M): Inpatient malaria deaths per year: rate per 100,000 persons per year Malaria I-3: Malaria test positivity rate Outcome Indicators Malaria O-1a: Proportion of population that slept under an insecticide-treated net the previous night Malaria O-1b: Proportion of children under five years old who slept under an insecticidetreated net the previous night Malaria O-1c: Proportion of pregnant women who slept under an insecticide-treated net the previous night Coverage Indicators VC-1(M): Number of long-lasting insecticidal nets distributed to at-risk populations through mass campaigns.
State Specific targets for Impact Indicators (1) : Malaria I-1: Confirmed malaria cases (microscopy or RDT): rate per 1000 persons per year State 2017 2018 2019 2020 Arunachal Pradesh 1.07 0.74 0.47 0.32 Assam 0.16 0.11 0.07 0.05 Manipur 0.03 0.02 0.01 0.01 Meghalaya 5.11 3.53 2.24 1.48 Mizoram 4.94 3.41 2.17 1.43 Nagaland 0.20 0.14 0.09 0.06 Tripura 1.81 1.25 0.80 0.52 Total 0.76 0.53 0.33 0.22
State Specific targets for Impact Indicators (2) : Malaria I-2(M): Confirmed malaria deaths per year Zero Death reporting states need to ensure their zero status by strengthening the surveillance & response State 2017 2018 2019 2020 Arunachal Pradesh 0 0 0 0 Assam 0 0 0 0 Manipur 0 0 0 0 Meghalaya 12 8 5 4 Mizoram 0 0 0 0 Nagaland 1 0 0 0 Tripura 6 4 3 2 Total 19 12 8 6
State Specific targets for Impact Indicators (3) : Malaria I-3: Malaria test positivity rate State 2017 2018 2019 2020 Arunachal Pradesh 1.01 0.71 0.45 0.30 Assam 0.20 0.14 0.09 0.06 Manipur 0.07 0.05 0.03 0.02 Meghalaya 3.90 2.73 1.76 1.17 Mizoram 2.68 1.87 1.21 0.80 Nagaland 0.16 0.11 0.07 0.05 Tripura 1.87 1.31 0.84 0.56 Total 0.86 0.60 0.39 0.26
Outcome Indicators Indicator 2017 2018 2019 2020 1 2 3 Proportion of population that slept under an insecticide-treated net the previous night Proportion of children under five years old who slept under an insecticide-treated net the previous night Proportion of pregnant women who slept under an insecticidetreated net the previous night 66.9% 80% 85% 90% 57.8% 80% 90% 100% 71.3% 80% 90% 100%