What did Odisha do?

Odisha’s efforts toward lymphatic filariasis (LF) elimination benefited from the convergence of two LF elimination programs—the National Filaria Control Programme (NFCP) and from the Elimination of Lymphatic Filariasis (ELF) program.

In 1955, the NFCP was launched nationwide and was implemented until 1960, when it was withdrawn due to community resistance and operational lapses. Odisha, however, used its state health budget to continue implementing activities under the NFCP. In 2004, as part of India’s revitalization of its commitment to eliminate LF, the country designed the ELF program and launched it in all endemic states with funding from the National Health Mission. Odisha integrated implementation of the ELF program into its efforts of the previous program, the NFCP. The activities undertaken by both NFCP and ELF created synergies across both programs that contributed to Odisha’s success toward eliminating LF.

Control measures undertaken through the NFCP continue to be an important component of Odisha’s LF response to date. These measures, carried out through survey units, control units, and night clinics, include mass administration of diethylcarbamazine (DEC), conducting night blood surveys, antilarval measures in urban areas, and indoor residual sprays in rural areas. Odisha benefited from the continuation of these control measures, as it was able to assess endemicity across districts, identify hotspots, identify cases and treat them at hospitals, and conduct vector management activities like spraying insecticides and clearing stagnant water. Findings from the NFCP also provided a benchmark to measure progress of the ELF program.

Launched in 2004, the ELF program aimed to accelerate the path to LF elimination through two main pillars: preventive chemotherapy via mass drug administration (MDA) and alleviation of chronic illness through morbidity management and disability prevention. Figure 2 below depicts this twin pillar strategy. While MDA focused on interrupting community transmission through supervised administration of drugs, morbidity management and disability prevention focused on alleviating the suffering of affected populations through surgery and home-based treatment. Odisha launched MDA in 2004 using a single-drug therapy, administrating DEC, with the launch of the ELF. By 2009, Odisha transitioned to a double-drug therapy of DEC and albendazole, which was proven to be more effective in eliminating LF. Most recently, in 2019, the state introduced a triple-drug therapy of ivermectin, DEC, and albendazole, the impact of which has yet to be documented.

Since 2004, Odisha has conducted MDA through collaboration across multiple stakeholders at the regional, state, district, block, and community levels. These stakeholders are represented in Figure 3 below.

Part of Odisha’s success was streamlined planning and management. The state and implementation units established clear roles and responsibilities for each stakeholder to ensure that MDA was implemented according to detailed plans. Figure 4 sets forth each stakeholder’s position, role, and responsibilities in the hierarchy. The section that follows describes the key steps that these stakeholders implemented throughout the MDA campaign cycle.

MDA is a six-step process with activities that fall broadly in three stages:

• Pre-MDA––planning, drug procurement, training, and social mobilization. Preparation for the actual MDA campaign is the most critical stage for building momentum across stakeholders to ensure successful program implementation.
• MDA administration––includes the annual administration of drugs to the entire population as well as the supervision and reporting of administration.
• Post-MDA––monitoring and evaluation after MDA surveys and reporting to the state along with third-party MDA assessments for tracking drug coverage and addressing gaps in the campaign. The MDA stages are illustrated in Figure 5 below.