When the funding for global health programmes disappears, the disease doesn't. The work just lands on whoever is already there. This manual is for you, ASHA workers, supervisors, and NGO staff in Pune District. Everything you need in one place.
Built for Pune District, Maharashtra, with local data, Marathi-language resources, and the full PMC/NCVBDC reporting chain. Other districts can adapt it too. See the localisation guide.
Six sections built around what you actually do in the field. The guidance here draws from existing official sources. It's not here to replace your training or district protocol, think of it as a quick reference you can actually use on the job.
Why this manual exists
Dengue in Pune is a disease of poverty and a failure of governance. In January 2025, USAID got dismantled. The funding that held up global health surveillance went with it. The disease didn't go anywhere. That work landed on community health workers, people who were already underfunded and stretched too thin.
Climate change is turning Pune into one of India's worst dengue hotspots. Mortality is projected to rise 13% by 2040, up to 112% by 2100. Over 80% of dengue deaths in Pune District happen after monsoon onset in June, that's your window.
Since January 2025, USAID-supported NGOs and surveillance partnerships in India lost their funding overnight. WHO reported that over 70% of country offices saw service disruptions. Vector-borne disease programmes took some of the hardest cuts.
Dengue concentrates in lower-income informal settlements, because intermittent water supply means people store water at home. Wealthier housing societies in Pune regularly refuse PMC vector control entry. Pune tops Maharashtra's district rankings for dengue-related mortality.
In Karanjawane village, the ASHA team at the Primary Health Centre is already doing this work. ASHA worker Manisha Ratan Nidhalkar, over a decade in the field, teaches residents to identify Aedes larvae by eye, with a torch, because phone lights don't cut it. People in that community can now spot larvae themselves. That's what good community training looks like.
But the resource gap is real. Laboratory Scientific Officer Bharti Mali at the same PHC gets exactly 100 rapid antigen tests a year from the government. For the whole year. That's what "underfunded" actually means in practice.
Source: Sweta Daga, "Dengue Risk in India Is Rising," Gavi/VaccinesWork, 6 May 2025Why this website exists
In January 2025, the US government dismantled USAID. That decision cut an estimated 87% of global epidemic and disease surveillance funding overnight. In India, that meant NGOs, technical units, and surveillance partnerships that supported community health workers lost their funding in one go.
Dengue didn't get that memo. India already carries 33 million apparent dengue infections a year, the highest national burden in the world. Climate change is making it worse. Pune District is one of the hardest hit areas in Maharashtra.
This site exists because the work of preventing dengue didn't go away when the funding did. It just shifted to ASHA workers and NGO staff who were already overstretched and underfunded. This manual is the centralised operational resource those workers never had. No donor funding required to access it. No external infrastructure needed to run it.
Section 02
Surveillance is your early warning system. A household larval survey catches breeding before it becomes a case at the clinic. These three indices are the national standard under NCVBDC programmes. You walk through a neighbourhood. You count. You get data your PHC can actually act on.
Over 80% of dengue deaths in Pune District happen after monsoon onset in June. Step up your household surveys from June through November. But here's the thing, SATHI field data from Pune shows it's a year-round problem. Water storage during dry months (March to May) keeps breeding going just as much as monsoon puddles (June to October) do.
Record these on every household visit. Together they tell you how widespread the breeding is and how bad it's getting.
Percentage of houses inspected with at least one container positive for larvae or pupae.
Percentage of all water-holding containers inspected that are positive for larvae or pupae.
Number of positive containers per 100 houses. This is your most useful single number for outbreak risk.
Any trained ASHA can run this. These steps are adapted for Pune specifically, the differences matter.
In Pune's informal settlements, municipal supply comes 3 to 5 days a week. Survey the day after a supply gap. You'll find more stored water and more breeding sites.
Check all containers indoors and outdoors. Aedes larvae sit just below the surface and dart down when you disturb them. Phone lights are not bright enough for dark containers. The ASHA teams in Karanjawane confirmed this and always carry a dedicated torch.
Note which container tested positive, drum, overhead tank, cooler, flower pot. Tally houses and containers for your three indices. In Pune, overhead storage tanks and plastic drums are the most common positive sites.
Empty or treat positive containers right there if you can. Tell the household why, in Marathi, framed around children's health, not technical language.
Submit your index data to the supervising Primary Health Centre. In Pune District, suspected samples go to NIV Pune. Your PHC Medical Officer coordinates with the District Surveillance Officer for formal outbreak reporting via IHIP.
A study of five Pune slums (Savitribai Phule Pune University, 2017–18, n=309) found that while 81% of residents knew to prevent standing water, only 26.1% knew about indoor breeding sites and only 38.1% knew about outdoor ones. General awareness is high. Specific, actionable knowledge is not. That gap is exactly what your household visits close. Literacy was also strongly linked to knowledge, which is why showing people in person works better than handing out a leaflet.
Source: Savitribai Phule Pune University community study published via medRxiv, 2020Section 03
Aedes aegypti breeds in clean, still water near homes. It bites during the day, peak hours in Pune are 6 to 9am and 4 to 6pm. In informal settlements where PMC supply is intermittent, stored water is not optional. It's how people get through the week. Your job is source reduction, not blame.
Pune's informal settlements get municipal water 3 to 5 days a week on average. People store water in drums, pots, and tanks because they have to, not because they don't know better. Telling them they're negligent doesn't work and it's not true. Effective source reduction works with this reality. You cover, treat, and scrub on a regular schedule rather than trying to eliminate containers families depend on to survive. SATHI's Pune field work is clear, messaging that ignores this loses community trust fast.
If it holds water for more than a few days, check it. PMC field surveys in Pune consistently find overhead and ground-level storage tanks as the top positive container type.
The PMC Dry Day routine is the core. Align with the city campaign and reinforce it every time you visit a household.
PMC runs this campaign city-wide. Your job is to reinforce the same message: the mosquito life cycle takes 7 to 10 days, so scrubbing weekly breaks it. Scrubbing is not optional, Aedes eggs stick to container walls and survive drying. Just emptying the container is not enough.
Storage tanks and large drums need tight lids or mesh so mosquitoes can't get to the water surface. PMC has issued mesh covers in some areas. Check what's available from your ward-level PMC health office.
For overhead tanks that can't be emptied, temephos (Abate) is the NCVBDC-approved larvicide. Only apply it under guidance from your PHC or District VBD programme. Don't use unapproved products.
Construction is a major dengue driver in Pune's fast-expanding periphery. Stagnant water in pits is a high-yield breeding site. ASHAs can report uncovered water accumulation at active construction sites to the PMC Health Department for formal notice issuance.
Target tyres, litter, and open drains, especially in the two weeks before monsoon onset (late May to early June in Pune). Mahila Arogya Samitis are the most effective organising unit for this in Pune's informal settlements.
Section 04
Your surveillance data and source reduction work means nothing if households aren't on board. In Pune, that means talking in Marathi, through people the community already trusts, and being straight about the constraints people are actually living with. Research from Pune slums is clear on this: the gap between awareness and action is not a knowledge problem. It's a trust problem.
In Pune, dengue enforcement doesn't fall equally. PMC notices go predominantly to construction sites and informal settlements. Wealthier residential societies, with rooftop storage, terrace gardens, and AC systems, can and do refuse municipal vector control entry. That's not incidental to the disease burden. It's part of why the burden is distributed the way it is. Your communities carry a disproportionate enforcement burden on top of a disproportionate disease burden.
The goal of community communication is shared ownership of a shared problem. Frame prevention as something the community is doing for itself, not something the municipality is doing to it. That framing produces better results.
Use what already exists. PMC Health Department has produced these resources in Marathi. Confirm current availability at your ward-level PMC office before you try to make your own.
Section 05
Dengue is a notifiable disease in India under the Integrated Disease Surveillance Programme (IDSP). When you report, what you observe in one household in Pune connects to a coordinated district-level response. As external technical support disappears, this official government chain matters more than ever, not less. It runs on government infrastructure, not donor funding.
Don't wait for confirmed cases. A cluster of fever cases in one area, larval indices above Moderate (BI above 5), or any suspected severe dengue case, bleeding, persistent vomiting, rapid breathing, all mean escalate now. In Pune, suspected samples go to NIV Pune, which gives you the fastest diagnostic turnaround in the district.
Follow this in sequence. Each step has someone responsible for the next action. Know your place in the chain.
Most districts in India don't have this. The National Institute of Virology (NIV), India's premier virology research institute, is based in Pune. Suspected dengue samples in Pune District go directly to NIV, which gives you faster and more comprehensive serotyping than most district labs can offer. A 2024 Frontiers in Public Health study on Pune found that NS1 alone missed 43% of confirmed dengue cases. IgM alone missed 25.5%. You need both tests. When you're advocating with your PHC for proper testing, use that research.
Source: Mishra et al., "Dengue in Pune city, India (2017–2019)," Frontiers in Public Health, September 2024Before you begin
This site pulls together existing guidance for Pune District. It's a companion to official protocol, not a replacement for it. Where your district health authority's instructions differ from what's here, follow those. This is built to be adapted too. If you're working in a different district, the localisation guide in Section 06 walks through exactly what to swap out.
Official NCVBDC and PMC protocol takes precedence over anything here. Use this as a quick reference, not the final word.
Larval index thresholds, reporting contacts, and IEC language all vary by district. This is built for Pune. Section 06 has the guide for adapting it elsewhere.
Everything here uses the public system and government protocol. It's designed for exactly the moment when NGO infrastructure isn't there anymore.
Section 06
The authoritative sources for Pune District. Government guidelines, reporting systems, and contacts you can actually reach.
The national body for dengue control. Integrated Vector Management guidelines, larval survey protocols, and the 2023 National Dengue Clinical Management Guidelines all live here.
ncvbdc.mohfw.gov.inIEC materials in Marathi available via Maharashtra State VBD Programme or directly from the NCVBDC portal.
The national outbreak-detection system all PHC surveillance data feeds into. The IHIP mobile app lets you report from the field in real time. S-Form, P-Form, and L-Form templates are here.
ihip.nhp.gov.inPune-specific anti-dengue campaigns, Dry Day materials, IEC in Marathi, and your ward-level Health Officer contact network.
pmc.gov.in/en/healthRequest Marathi IEC materials from your ward PMC Sub-Health Centre.
India's premier virology lab, right here in Pune. Suspected dengue samples in Pune District are tested here. Your PHC Medical Officer coordinates dispatch. Request both NS1 and IgM tests.
niv.icmr.org.inPune-based health organisation supporting public health systems in Maharashtra. A lot of the Pune-specific community communication research in this manual comes from their field work.
sathicehat.orgGlobal technical guidance on dengue surveillance, vector management, and clinical case definitions. The WHO Global Vector Control Response 2017 to 2030 is the framework the NCVBDC programme aligns with.
WHO Dengue Fact SheetThis site is a template. If you're adapting it for a district other than Pune, here's exactly what to replace and where to find what you need.
1. Larval index thresholds. Confirm BI/HI alert thresholds with your district VBD Officer or your state's NCVBDC operational manual. These are district-specific and reviewed annually.
2. Reporting contacts. Replace NIV Pune with your district's designated diagnostic lab. Replace Dr. Aparna Patil's name with the current officer from your District Health Office.
3. Language. Replace Marathi with the primary language in your district. Check what IEC materials your State Health Department has already produced.
4. Water supply context. Find out the intermittency pattern in your district's informal settlements. That shapes which container types are highest risk and how you frame conversations about water storage.
5. Local NGOs. Replace SATHI with the community health organisations active in your district. Your State NRHM office can point you to district-level networks.