Details for Reform Option "Malaria eradication, Maharashtra"
Navi Mumbai, a new municipality adjacent to Greater Mumbai, is a city under construction. The need for construction workers has prompted a massive movement of labour with migrant workers flooding in from all over the country. The majority of them have settled in temporary accommodation on the building sites or quarries where there are large water pits. In addition, approximately 40% of the population lives in slums. Slum residents commonly store water in open drums for regular domestic use. Anophelis larvae (malaria-carrying mosquito) breed in clear water in uncovered containers and despite receiving health education, people refuse to empty these drums.
Also, because the land in the area is low lying and marshy, there is much stagnant water. This, added to the lack of sanitation in the slums and quarries, creates numerous breeding places for mosquitoes and leads to a high incidence of malaria.
In 1992 when the Navi Mumbai Municipal Corporation (NMMC) came into existence, the situation was serious. There was no anti-larval activity and minimal surveillance was carried out.
IN 1992 NMMC began a programme of anti-larval activities on a contract basis. All manpower and instruments are supplied by the contractors and larvicides by the NMMC. The operations are monitored and supervised by a team consisting of a Medical Officer (MO) from an Urban Health Post (UHP), the contractors’ supervisor, an Insect Collector and a Malaria Officer.
(i) Weekly anti-larval programmes at UHPs, in which breeding places are allotted to workers each day. In the early morning, supervisors distribute larvicides and workers conduct anti-larval activities in their allotted area, covering all the breeding sites.
(ii) Minor engineering activities, guppy fish introduction activities and overhead tank inspections in the afternoons.
(iii) Fogging activities in the morning particularly in closed drains and a foot pump programme in the afternon.
(iv) Cross checking activities by the insect collector of NMMC by calculating larval density, adult mosquito density and conducting an evening survey to judge mosquito nuisance.
A review is held fortnightly with the contractors and monthly with Insect Collectors and MOs at NMMC head office.
Surveillance activities are monitored and supervised by MOs from UHPs of NMMC. They consist of two types:
(i) Active surveillance - where NMMC health workers go from house to house collecting blood smears from fever cases and administering presumptive treatment.
(ii) Passive surveillance - where patients with fever come voluntarily to hospitals and health centres for blood testing and treatment. One general hospital, five maternal and child health centres and 13 urban health posts carry out this activity.
In addition, workers visit construction sites twice a week and areas considered to be less high risk such as villages and slums, once a fortnight
Whenever any positive malaria case or suspected dengue case is detected, the following preventive and curative activities are carried out in and around the 100 surrounding houses:
(i) House to house breeding places survey
(ii) Indoor residual spraying with synthetic pyrethroid
(iii) Survey of fever cases, blood smear collection and administration of presumptive treatment
(iv) Indoor fogging with pyrethrum. In cases of suspected dengue, fogging is done on three consecutive days to kill any residual adult Ades (dengue-carrying) mosquitoes.
Presumptive treatment is given to all fever cases at the time of collection of a blood smear. Radical treatment of five days of primaquine is given to all Plasmodium Vivax cases (one type of malaria), and for Plasmodium Falciparum cases treatment is verified with a follow up and contact smears.
There are 124 drug distribution centres in NMMC situated at high risk areas such as construction sites and quarries. All private nursing homes and labs are instructed to give reports of malaria cases and their details.
Annual Parasite Incidence has dropped from 18 in 1997 (when record-keeping began) to 1.92 in 2004. The slide positivity rate has fallen from 7.87% in 1997 to 1.36% in 2004. The total number of positive malaria cases identified was 9,024 in 1997. By 2004 it had decreased to 1,231.
There were 300 suspected cases of dengue in 2003, and 250 in 2004 (dengue was not effecitively monitored in previous years).
The larvicides and diesel or petrol for fogging machines are procured by the NMMC for use by the contractor.
Required equipment is supplied by the NMMC on a rental basis.
Annual budgetary provisions under the Malaria Control Programme are approximately INR 4 crores. This is broken down as follows:
Anti-larval activity – approximately INR 2 crores.
Larvicide purchase and fogging – approximately INR 2 crores
Contract workers are paid the mimimum wage of INR 123 per day. Extra necessities, such as uniforms and gumboots are covered in a levy of 46% paid to the contractors.
Navi Mumbai Municipal Corporation, Maharashtra
Three months: Two months to formulate terms and conditions of contract. Another six weeks for tender process.
Cost effective: Reduces financial burden of the Corporation by removing necessity of having staff on payroll assigned to malaria control.
Efficiency: Performance-orientated terms of contract mean output of contractors can be effectively monitored and supervised.
None perceived. Since the NMMC only came into existence in 1992, the question of existing employees missing out on job opportunities does not arise.
Sanction by the General Body of the Municipal Corporation
Who needs to be consulted
State Government technical authorities: To guide local governments in areas such as manpower, necessary equipment, purchasing requirements.
Field officers and grass root level health workers, particularly at planning stage: To quantify the workload and availability of manpower. Amounts of larvicides and equipment needed can be calculated accordingly.
Standardisation of all anti-larval activities should be ensured to guide the terms and conditions of this type of contract.
It is self sustaining and will definitely be continued in the future. Funds come from local government but there is still a need for assistance from State and Central govt for effective continuing of contract services.
Chances of Replication
Good. The initiative has been replicated in Nashik, Aurangabad district, Maharashtra.
Difficulties could arise were there are existing staff who could be responsible for antilarval activities
According to Central and State labour laws, orders of court can terminate the contract system. This means that any legal authority can direct local government to stop the contracting out of services. This is considered to be a hindrance by the NMMC because it can be forced to make workers permanent if they take their claim to court.
Tessa Laughton, Research Consultant, ECTA, New Delhi. February 2005