World bank EMCP malaria project in Orissa, India — A field reality

BACKGROUND: Under the National Vector Borne Disease Control Program, the Enhanced Malaria Control Project (EMCP) with World Bank assistance was implemented in India, in the eastern state of Orissa. AIMS: This article tries to analyze the possible reasons for the poor performance of EMCP in a few states of India. SETTINGS AND DESIGN: The eastern state of India is taken as a case study for looking into systemic, human resource, and logistics related issues that could explain the poor performance of EMCP in a few states of India. MATERIALS AND METHODS: Field visits were made to some selected EMCP areas in the state of Orissa. Operational issues-related implementation of various components of the project were scrutinized. STATISTICAL ANALYSIS: Not Applicable. RESULTS: While the project was highly successful in a few states of India, it had limited success in some states. It was learnt that the honorarium meant for Fever Treatment depot [FTD] work was divided among all the malaria workers. In high-risk areas, presumptive radical treatment was being carried on by malaria workers for every case of fever. Using Rapid Diagnostic Tests (RDTs) in such areas seemed to have no relevance. The laboratory technician ignored malaria work, due to a high work load and no additional incentive. In the Primary Health Centers (PHCs) the Medical officers had either not visited the village under indoor residual spray or symbolically visited only five to six houses. Cement tanks had to be built for larvivorus fish breeding. However, they had not been mad. CONCLUSIONS: The success of a public health program is dependent more on project implementation, management, monitoring, and evaluation of project activities than the volume of financial resource allocation.