India
India remains the main focus of visceral leishmaniasis (VL) disease burden in the South Asia. The States of Bihar and Jharkhand remain the most endemic for VL infection.
India has made good progress towards VL elimination. In 2013, 13,869 cases were reported, representing a drop of over 50% from 2010. Since 2013, absolute case-load has decreased (6,245 cases were reported in 2016) owing to significant control efforts. A number of factors are likely to have contributed to this fall in numbers, however, one of which is the natural epidemiological trend of VL.
The department overseeing India’s VL strategy is the National Vector Borne Disease Control Programme (NVBDCP). Major components of the stretegy have been the introduction of single day AmBisome treatment and the change of insecticides. KalaCORE was responsible for rolling out of the first component. In early 2017, the NVBDCP published a new roadmap for the elimination of VL in India as a public health problem in the ‘Accelerated Plan for Kala-Azar Elimination’).
As the 2017 elimination target approaches, there is an increasing sense of political urgency for this goal to be met. It has become clear was that there also needs to be a focus on sustaining elimination targets so that a resurgence does not occur in the mid-long term; or if it does, that cases are detected early and managed appropriately.
Challenges
- Quality of Indoor Residual Spraying.
- Capacity gaps. Our baseline survey suggested limited awareness of VL and a limited capacity to provide quality care at Public Health Centre (PHC) level. Lack of behaviour change communication (BCC) with community health workers and community members has also contributed to a limited awareness of VL and what to do when people have symptoms.
- Knowledge gaps around post kala azar dermal leishmaniasis (PKDL). PKDL remains an unknown entity from a multitude of perspectives. Its importance as a reservoir is unknown and the impact of the newer treatment regimens on prevalence and incidence of PKDL is unclear.
- Under-reporting and parallel private healthcare systems. The high level of dependence on private healthcare providers in India means they play an important role and need to be fully engaged in the national VL response. This will ensure that practitioners are adequately trained, are able to treat or refer appropriately and that VL cases are reported correctly.
- Inadequate surveillance systems. Surveillance has relayed heavily on passive case detection. KalaCORE aims to increase active case detection in order to detect cases earlier and reduce transmission times, and strengthening passive surveillance at the same time.
- Poor coordination.
Building on opportunities
- High level joint planning. The original and then accelerated roadmap for VL elimination detailed all the components of the programme that would be required to achieve sustainable elimination and allocated responsibility to specific stakeholders with clear timelines. KalaCORE were major contributors into the development of these roadmaps, while various, Memorandums of Understanding (MoUs) was signed between the NVBDCP, states and KalaCORE.
- Responding to national priorities. The focus of KalaCORE's approach in India is to ensure better treatment, primarily by building capacity into the system
- Working with key partners.