Demonstration of cost-effective and sustainable alternatives for DDT in vector borne disease control in the Indian sub-continent with emphasis on Integrated Vector Management (IVM) in the Visceral Leishmaniasis (VL) Elimination Programme (Rejected)

Project General Information


Demonstration of cost-effective and sustainable alternatives for DDT in vector borne disease control in the Indian sub-continent with emphasis on Integrated Vector Management (IVM) in the Visceral Leishmaniasis (VL) Elimination Programme(Rejected)


Harmful substances and hazardous waste

Persistent Organic Pollutants


Efforts to find alternatives in DDT use, particularly in the context of IRS (Indoor Residual Spraying) are mainly focusing at malaria control. The here presented GEF project is looking at another vector born disease, Visceral Leishmaniasis (VL), which affects particularly the poorest of the poor (Alvar et al. 2006) and has one of the most important global foci in the Indian sub-continent (corner between India, Bangladesh and Nepal). VL, locally named Kala-azar, is a parasitic disease, fatal if untreated, and transmitted by sandflies (Phlebotomus argentipes). Approximately 200 Million people in the region are at risk of getting the disease including 46 districts in India, 45 districts in Bangladesh (14 of them highly endemic, the others with sporadic cases) and 12 in Nepal which are reporting VL cases.  In 2005 Bangladesh, Nepal and India agreed to initiate a VL elimination program with a high level political commitment. Cornerstones of the elimination program are vector control, early case detection and treatment and operational research to develop more cost-effective intervention strategies.


The indoor residual spraying (IRS) as the preferred method of vector control in India and Nepal is done by spray squads using in India stirrup pumps to apply DDT 50% and in Nepal compressor pumps to apply  pyrethroid insecticides. However, recent operational research has shown that only very little insecticide is actually sprayed on the wall (6% of the expected value) due to poor performance of sprayers and deficient training and supervision (Chowdhury et al 2010) and that compressor pumps are superior to stirrup pumps (Kumar et al 2011, in press).. Furthermore DDT resistance in the VL endemic areas of India is spreading (Chowdhury et al 2011). The annual expenditure for IRS in India is approximately 4 Million US Dollar and in Nepal approximately 2 Million US Dollar. In Bangladesh vector control in VL areas has practically been abandoned for decades and is just being re-vitalized in the context of the VL elimination strategy (Mondal et al. 2006), using IRS with pyrethroids as the main strategy. In inter-governmental discussions the question comes back and back again, if the three countries should apply the same vector control strategy and copy India with its long history of successful DDT spraying. In India the NVBDCP (National Vector Borne Disease Control Programme), the Ministry of Health and ICMR (Indian Council for Medical Research) have expressed their interest in this project as the results will be directly relevant for the country.

The project proposed here will show in 46  highly endemic districts of India, 14 of Bangladesh and 12 in  Nepal new avenues for a cost-effective elimination ("attack phase") and maintenance of VL transmission at low levels ("maintenance phase") by replacing DDT and other POPs with EVM (environmental management such as lime plastering of house walls, a traditional practice which in some settings has also demonstrated significant potential for vector control) and measures which reinforce the judicious use of insecticides), and other vector control measures, including the required institutional changes. Without a strong GEF component and the scientific evidence produced by the here proposed interventions, it would be most unlikely that the existing strategies -how inefficient they might be- will be replaced by new ones. The finding will also be relevant for the districts of lower VL endemicity but also for other vector borne diseases, particularly malaria and Lymphatic Filariasis. The added value by this GEF project for the whole region  in terms of ‘global environmental benefit’ will be enormous.

In inter-governmental discussions held so far with WHO-TDR and in the context of the VL elimination campaign on the Indian Subcontinent, the direction of vector control policy currently is moving towards a unified approach, whereby all  three countries would  apply the same vector control strategy – and in fact might copy India with its long history of successful DDT spraying.

However, for sustainable and successful vector borne disease control (like the case of kala-azar), the vector borne disease control units in the relevant Ministries should prepare for the maintenance pahse which (in the case of Kala-azar) will follow the attach phase to reach the elimination goal in 2015. Then the focus should be less on routine IRS application but rather on a timely response to vector management issues through appropriate use of M&E tools and  interaction with decision makers in VL endemic districts. This will result in a durable and sustainable behavior change in terms of rational use of available information and analytical  skills.

Even countries which are actually not applying DDT, should perform this change in institutional setting resulting in a sustained behavior change in order to be effective in the application of alternatives to DDT on the longer term, and to exclude the potential risk of reverting to DDT via IRS.


Full Size Project(FSP)


Asia and the Pacific

Bangladesh, Nepal, India

GEF Trust Fund

Stage Grant to UNEP Grant to other IA Co-Financing UNEP Fee Other IA Fee
$ 2,000,000.00 $ 0.00 $ 8,445,106.00 $ 200,000.00 $ 0.00


United Nations Environment Programme (UNEP)

Jan Betlem



Executing Agency Category
Nepal: Ministry of Health
National Government Agency
India: Ministry of Health
National Government Agency
Bangladesh: Ministry of Health
National Government Agency

Partner Category

Name Category Period
Jan Betlem

As the proposed GEF project depends very much on the interaction of national policy makers, program officers at district/sub-district level on the one hand and on academic institutions on the other hand, changes in personnel and interest can always negatively or positively influence the progress of the GEF project. Fortunately through WHO, particularly SEARO and RTAG a certain level of continuity is guaranteed and decisions, once they are taken, will be implemented. Counterpart funding is fairly secure, at least with respect to the TDR contributions. But also the country contributions (mainly staff time) are considered to be stable given the political interest in the VL elimination program. Climate change may have sometimes a negative and sometimes a positive effect on vector breeding and disease transmission. Increased monsoons with flooding of VL endemic villages are very bad for the population but usually have e depleting effect on the vector populations. On the other hand, increased humidity and temperature may lead to a proliferation of the vector population and extension to new areas (Lindgren et al. 2006) which would make GEF project findings even more relevant for the region.


Fiscal Year Project activities and objectives met

$ 0.00