Protecting the Vulnerable: Odisha’s Multi-sectoral LLIN Distribution Initiative in Tribal Regions

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Project Details

Category: Healthcare
Project Title: Long Lasting Insecticidal Nets (LLIN) Distribution in Tribal Areas of the State with Multisectoral Approach
Department or District: National Vector Borne Disease Control Programme (NVBDCP), Odisha
State: Odisha
Start Date of the Project: 1st January 2017
Website: https://health.odisha.gov.in/healthnationaldiseasecontrol/national-vector-borne-disease-control-programme-nvbdcp

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Tribe(s) that the Project Covers: The LLIN project covered a wide range of tribal communities across Odisha, particularly in 17 high malaria-burden districts. These districts are characterized by forested and hilly terrain, making them home to significant tribal populations with high vulnerability to malaria.

Keywords: LLIN, Tribal Health, Malaria Control, Vector-Borne Diseases, GKS, ASHA, Community Participation, Innovation

Odisha, with its diverse geography and climatic conditions, has long been a hotspot for malaria, particularly falciparum malaria, which is more severe and often fatal. The state’s forested and tribal-dominated regions have consistently recorded high malaria morbidity and mortality, compounded by limited access to health infrastructure, poor health-seeking behaviour, and low literacy levels. Traditional control methods like Indoor Residual Spray (IRS) proved inadequate, necessitating a shift to a more sustainable, community-driven intervention. The introduction of Long Lasting Insecticidal Nets (LLIN) provided an effective vector control tool. With large-scale LLIN distribution beginning in 2017 and continuing in 2021, the project focused on achieving universal coverage in high-risk areas while embedding the distribution within a multisectoral and community-led governance framework.

The Project

The project, led by the National Vector Borne Disease Control Programme under the Directorate of Public Health, Odisha, aimed to significantly reduce the malaria burden through strategic LLIN deployment and promotion of its sustained use. The intervention was planned in two major phases—2017 and 2021—supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFTAM) and Domestic Budget Support (DBS). With meticulous planning and a focus on vulnerable populations, the project distributed over 2.69 crore LLINs across high-endemic districts, reaching a population of nearly 5.82 crores. The initiative was unique in its use of Gaon Kalyan Samitis (GKS) for grassroots implementation and integrated behaviour change campaigns to ensure long-term adoption of LLIN use.

Problems that it Intends to Solve

The primary problems targeted included the heterogeneous malaria paradigms caused by Odisha’s ecological and climatic diversity, a persistently high burden of falciparum malaria, poor access to healthcare in hard-to-reach tribal regions, and high mortality due to delayed treatment. In addition, the growing challenge of urban malaria in construction sites and among mobile populations complicated the disease ecology. A “one-size-fits-all” strategy had proven ineffective in such a complex setting.

What was the Need

Given that malaria cases in Odisha were once over 4 lakh annually, there was an urgent need for a robust and scalable intervention. LLINs offer a scientifically validated, low-maintenance, and long-term solution. They were especially suitable for tribal communities, where access to regular health services was limited, and night-time vector control was crucial. The protective nature of LLINs made them a vital tool in reducing malaria transmission and associated fatalities.

What Hindered its Introduction

Several challenges hindered the initial rollout. Logistical complexities in transporting and distributing LLINs across rugged and remote terrains were significant. Social resistance and unfamiliarity with net usage posed behavioural barriers. Moreover, a lack of experience with large-scale net distribution meant the project required new planning models, training, and community trust-building measures, particularly in tribal belts where historical distrust toward state-led interventions existed.

Process Followed for Implementation

The government took a lead role in implementing the project by forming LLIN steering committees at state, district, and block levels. These committees coordinated planning, oversaw logistics, and facilitated inter-departmental collaboration. The distribution model relied heavily on grassroots structures like the Gaon Kalyan Samitis (GKS), which were empowered to conduct micro-planning, ensure transparency through rigorous record-keeping, and monitor net usage post-distribution. Political representatives and local panchayat members were also engaged in the launching and sensitization activities to enhance community buy-in. Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWWs) were trained to disseminate information, conduct home visits, and organize awareness events. The strategy included a single-day distribution format at the village or sector level to ensure maximum reach, zero pilferage, and facilitate easier mop-up operations.

• Government Involvement
  • The Odisha government, through the Directorate of Public Health and NVBDCP, provided leadership in planning, financing, and coordinating with district and block-level functionaries. It ensured alignment with national health strategies while tailoring approaches to suit Odisha’s unique geographical and demographic challenges. Regular review meetings and data sharing were integral to ensuring state-level oversight.
• Involvement of NGO
  • While the documents do not explicitly list NGO participation, the project’s implementation structure allowed space for civil society and development partners to participate in IEC/BCC campaigns and field support activities, enhancing reach and community engagement.
• Involvement of Community
  • Community involvement was central to the project’s success. GKS, functioning under the National Health Mission, played the most pivotal role in planning, distributing, and monitoring LLINs. Their familiarity with local dynamics enabled swift identification of needs and grievances. ASHAs and AWWs conducted wall writings, distributed handbills, and used traditional communication tools like drum-beating to mobilize participation. Local leaders participated in launching events, reinforcing community ownership.

Solutions Implemented

The key solutions included the wide-scale implementation of LLIN distribution in two phases, supported by state-specific guidelines to ensure saturation coverage. Intensive IEC and BCC activities focused on promoting net use, addressing myths, and demonstrating proper maintenance. The campaign adopted a village-wide distribution model that ensured 100% coverage in a single day. Continuous follow-ups, household visits, and community theatre were employed to reinforce behaviour change and promote consistent LLIN usage.

Details of the Coverage

The project achieved full saturation in 17 high-endemic districts and partial saturation in 4 more. The first round in 2017 distributed 1.13 crore LLINs covering 2.82 crore individuals. The second round in 2021 scaled up to 1.56 crore LLINs, benefiting over 3 crore people. The distribution model ensured that each household received the appropriate number of nets based on family size, with detailed records maintained at the village level.

Innovation and Unique Features

One of the most innovative aspects of the project was the decentralization of responsibilities to community-level institutions like GKS. The campaign mode of distribution, with festive elements and direct community engagement, differentiated it from earlier top-down health initiatives. The use of local dialects, folk theatre, and traditional media for awareness campaigns ensured that messages resonated with tribal communities. Furthermore, the pre-publicity strategy created anticipation and demand for LLINs, which was crucial for high uptake.

• New Approaches: Tech integration, capacity building, culturally sensitive methods
  • The project emphasized capacity building through structured training of health workers and GKS members. Although technology use was limited in documentation, the organized and data-driven approach to planning, distribution, and monitoring reflected systems thinking. The entire strategy was designed with a sensitivity to tribal socio-cultural norms, using inclusive messaging and locally accepted practices.
• Co-creation: How tribal knowledge or leadership shaped the solution
  • The involvement of GKS ensured that tribal leadership and local knowledge were incorporated into planning and execution. Micro-planning at the village level was shaped by insights from community representatives, ensuring that no household was overlooked and any barriers to LLIN adoption were addressed in real-time.
• Any adaptations: How the project evolved during implementation
  • The project evolved from partial district-level saturation in the initial stages to full coverage in subsequent phases. Based on community feedback and performance assessments, messaging strategies were modified, and distribution mechanisms were refined to minimize dropouts and maximize usage.

Challenges Faced Before Implementation

Internal challenges included limited experience with community-led LLIN deployment and inadequate staffing in remote regions. Externally, varied malaria ecologies and resistance to behaviour change created substantial hurdles. Community apathy and low literacy levels impeded initial mobilization efforts.

These challenges were addressed by empowering GKS, training ASHAs, and simplifying messaging. Using local tools and platforms for communication, the project succeeded in making LLIN use both a household priority and a community norm.

Challenges Faced During Implementation

Internally, inventory tracking and data accuracy across such a large population base were difficult. Externally, adverse weather and difficult terrain delayed logistics in some areas. The team also encountered hesitation among beneficiaries unfamiliar with nets.

Logistical challenges were tackled through pre-planned single-day distributions and mop-up rounds. Reluctance toward usage was mitigated through repeated household visits, community theatre, and the active involvement of influential community leaders.

Outcomes

• Quantitatively, the project achieved a remarkable 94% reduction in malaria cases, from 4,44,842 in 2016 to 25,503 in 2022. Deaths declined by 83%, from 77 to just 13. These numbers reflect not just distribution efficiency but a real behavioural change in malaria prevention.
• Qualitatively, it brought about improved trust in public health systems, stronger community engagement, and a replicable model for health delivery in underserved areas.
• Monitoring was conducted through record-keeping by GKS, follow-ups by ASHAs, and oversight by district health staff. The single-day distribution model allowed easier evaluation and rectification of any gaps through mop-up operations.

Beneficiaries

The primary beneficiaries were tribal communities in malaria-endemic regions. Special attention was given to vulnerable subgroups such as children, pregnant women, and mobile populations including mine workers and daily labourers.

Replicability / Scalability / Sustainability

The project’s design and execution make it highly replicable in other tribal and remote regions, both within and outside Odisha. Its scalability is evident from its expansion over five years, while its sustainability is reinforced by institutional ownership through GKS and continued state budget support.

• Policy Integration
  • The intervention aligns with the broader goal of achieving malaria elimination under the National Vector Borne Disease Control Programme. It complements national efforts through a localized and participatory model.
• Financial Sustainability
  • Future expansion has already been budgeted, with an allocation of ₹500 lakh. The state’s continued commitment ensures financial sustainability, backed by donor support and political will.
• Replication
  • The LLIN distribution model of Odisha stands as a blueprint for tribal health interventions. With strong community ownership, robust governance, and evidence-based planning, it offers a pathway for similar vector control programs across India.

Presentation

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