When externally funded global health programmes contract, the dengue burden does not — it shifts onto frontline community workers. This manual consolidates surveillance, prevention, and reporting guidance for ASHA workers and NGO staff already doing that work in Pune District.
Built specifically for Pune District, Maharashtra — with local data, Marathi-language resources, and the PMC/NCVBDC reporting chain. Designed as a replicable template: see the localisation guide.
Six sections, organised around what a community health practitioner in Pune District actually does. This site consolidates and synthesises existing guidance — it does not replace official protocol or local training.
Why this manual exists
Dengue in urban Pune is both a disease of poverty and a failure of governance. The 2025 contraction of Western-funded global health infrastructure did not make the disease go away. It displaced the work of responding onto community actors who are already under-equipped and over-stretched.
Climate change is making Pune one of India's leading hotspot for dengue outbreaks — dengue mortality is projected to rise 13% by 2040, 23–40% by 2060, and up to 112% by 2100. More than 80% of dengue deaths in Pune District occur after monsoon onset in June.
Since January 2025, USAID-supported NGOs, technical units, and surveillance partnerships in India lost funding abruptly. WHO reported over 70% of surveyed country offices saw service disruptions, with vector-borne disease programmes among the hardest hit.
Dengue concentrates in Pune's lower-income informal settlements where intermittent municipal supply forces water storage. Wealthier housing societies in Pune often resist PMC vector control entry. Pune tops Maharashtra's district rankings for dengue-related mortality.
In Karanjawane village in Pune District, the ASHA team at the Primary Health Centre is already doing this work. ASHA worker Manisha Ratan Nidhalkar, with over a decade of experience, teaches residents to identify Aedes larvae on sight — with a torch, because phone lights are insufficient. Community awareness has reached the point that regular citizens can spot larvae themselves.
But the resource gap is stark. Laboratory Scientific Officer Bharti Mali at the same PHC notes that her facility receives only 100 rapid antigen tests per year from the local government. As externally funded NGO infrastructure disappears, this community capacity exists — but is operating without the tools and structured support it needs.
Source: Sweta Daga, "Dengue Risk in India Is Rising," Gavi/VaccinesWork, 6 May 2025Section 02
Surveillance is the early-warning system. Household larval surveys let community workers detect mosquito breeding before cases reach the clinic. These three indices are the standard measures used in NCVBDC vector-borne disease programmes — they turn a walk through a Pune neighbourhood into data a Primary Health Centre can act on.
Over 80% of dengue deaths in Pune District occur after monsoon onset in June. Intensify household surveys from June through November. SATHI field data from Pune confirms the double-bind: water storage during dry months (often March–May) and monsoon puddles (June–October) both sustain breeding year-round.
Record these during routine household visits. Together they answer: how widespread is breeding, and how intense?
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 — the most informative single measure for outbreak risk.
A repeatable routine any trained ASHA can carry out. Key Pune-specific adaptations below each step.
Define the houses to be covered and note which days the municipal supply runs in each area. Pune informal settlements often receive water 3–5 days per week — surveys on the day after a supply gap often find more stored water and more breeding sites.
Check all containers holding water, indoors and outdoors. Aedes larvae sit just below the surface and dart down when disturbed. Phone lights are not bright enough to see larvae in dark containers — Karanjawane ASHA teams confirmed this and always carry a dedicated torch.
Note each container type (drum, overhead tank, cooler, flower pot) positive for larvae or pupae. Tally houses and containers for the three indices. In Pune informal settlements, overhead water storage tanks and plastic drums are the most common positive sites.
Empty or treat positive containers immediately where possible. Explain to the household why — in Marathi, using familiar language about children's health rather than technical terminology.
Submit index data to the supervising Primary Health Centre. In Pune District, suspected samples are tested directly at NIV Pune — the PHC Medical Officer coordinates with the District Surveillance Officer for formal outbreak reporting via IHIP.
A cross-sectional 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 outdoor breeding sites. This gap between general awareness and specific action knowledge is the exact thing ASHA household visits close. The study found literacy was strongly associated with knowledge — reinforcing the value of in-person demonstration over written materials alone.
Source: Savitribai Phule Pune University community study published via medRxiv, 2020Section 03
Aedes aegypti breeds in clean, still water close to homes and bites mainly during daytime hours — 6–9am and 4–6pm are peak biting periods in Pune. In urban informal settlements where PMC supply is intermittent, stored water is unavoidable and a daily survival strategy. Source reduction, not blame, is the goal.
Pune's informal settlements receive municipal water 3–5 days per week on average. Residents have no choice but to store water in drums, pots, and tanks — this is not negligence, it is adaptation to intermittent supply. Effective source reduction works with this reality: covering, treating, and scrubbing regularly rather than eliminating storage containers that families depend on. SATHI's Pune field work documents that messaging that ignores this double-bind immediately loses community trust.
If it holds water for more than a few days, check it. In Pune, PMC field surveys consistently find overhead and ground-level storage tanks as the highest-positivity container type.
The PMC-endorsed Dry Day routine is the core prevention practice. Align with the city campaign and reinforce it in every household visit.
PMC runs anti-dengue Dry Day campaigns across Pune city. Community workers should reinforce the same message: it takes 7–10 days for the mosquito life cycle to complete, so weekly scrubbing breaks the cycle. Scrubbing matters because Aedes eggs cling to container walls and survive drying — just emptying without scrubbing is not enough.
Tightly cover storage tanks and large drums with lids or mesh so mosquitoes cannot access the water surface to lay eggs. PMC has issued mesh covers in some areas — check what is currently available from your ward-level PMC health office.
For overhead tanks that cannot be emptied, temephos (Abate) larvicide is the NCVBDC-approved treatment. This should only be applied under guidance from the PHC or District VBD programme. Do not use unapproved products.
Construction activity is a major driver of dengue in Pune's fast-expanding periphery. Stagnant water in construction pits is a high-yield breeding site. ASHAs can report active construction sites with uncovered water accumulation to the PMC Health Department for formal notice issuance.
Organise mohalla-level drives targeting tyres, litter, and open drains — especially in the two weeks before monsoon onset (late May/early June in Pune). Mahila Arogya Samitis are the most effective organising unit for this in Pune informal settlements.
Section 04
Surveillance and source reduction only work if households cooperate. Effective communication in Pune is in Marathi, delivered by trusted neighbours, and names the real constraints people face — especially intermittent water supply — rather than pretending they don't exist. Research from Pune slums shows the gap between awareness and action is not a knowledge problem; it is a trust and resources problem.
In Pune, as in other Indian cities, dengue surveillance and enforcement are applied unequally. PMC notices go predominantly to construction sites and informal settlements. Wealthier residential societies — which may have significant rooftop water storage, terrace gardens, and AC systems — are often able to resist municipal vector control entry. This is not incidental to the disease burden; it is structural. ASHA workers and NGO staff should be aware that their communities bear a disproportionate enforcement burden alongside a disproportionate disease burden.
The goal of community communication is not compliance enforcement — it is shared ownership of a shared problem. Framing prevention as something the community is doing for its own protection, rather than something being done to it by the municipality, consistently produces better and more sustained results in field settings across urban India.
Use existing materials rather than designing from scratch. PMC Health Department has produced the following resources in Marathi — confirm current availability at your ward-level PMC office:
Section 05
Dengue is a notifiable disease in India under the Integrated Disease Surveillance Programme (IDSP). Timely reporting connects a single ASHA's observation in Pune to a coordinated district-level response. As externally-funded technical units disappear, the official government reporting chain becomes more important — it does not require donor funding to function.
Do not wait for confirmed cases before reporting. A cluster of fever cases in one area, larval indices rising above the Moderate threshold (BI > 5), or any suspected severe dengue case (bleeding, persistent vomiting, rapid breathing) are signals to escalate immediately. In Pune, suspected dengue samples are tested at NIV Pune — the fastest diagnostic route in the district.
Follow this chain in sequence. Each step has a formal role responsible for the next action.
Pune District has a significant advantage that most of India does not: the National Institute of Virology (NIV), India's premier virology research institute, is based in Pune. Suspected dengue samples in Pune District are tested at NIV directly, which provides faster and more comprehensive serotyping than most district-level labs can offer. The Frontiers in Public Health (2024) Pune study found that using NS1 alone missed 43% of confirmed dengue cases, and IgM alone missed 25.5% — both tests should be used together. When advocating with your PHC for adequate testing, this research supports requesting both tests for suspected cases.
Source: Mishra et al., "Dengue in Pune city, India (2017–2019)," Frontiers in Public Health, September 2024Before you begin
This site consolidates and synthesises existing guidance for Pune District. It is a companion to official protocol and local training, never a replacement for them. It is designed as a replicable template — the localisation guide below explains how to adapt it for another district.
Always follow your district health authority's current instructions where they differ from what is here. Official NCVBDC and PMC protocol takes precedence over anything in this site.
Larval index thresholds, reporting contacts, and IEC language vary by district. This toolkit is built for Pune — see the localisation guide in Section 06 if you are adapting it for another district.
Every method here is designed to work without external donor funding — using the public system, community capacity, and government protocol that remain even as NGO infrastructure contracts.
Section 06
This section points to the authoritative sources for Pune District practitioners — government guidelines, reporting systems, and the local organisations you can actually contact.
The apex body for dengue control in India. Integrated Vector Management guidelines, larval survey protocols, and the National Dengue Clinical Management Guidelines (2023 edition).
→ ncvbdc.mohfw.gov.inIEC materials available in Marathi — request via Maharashtra State VBD Programme or download from NCVBDC portal
The national outbreak-detection system that all PHC surveillance data feeds into. The IHIP mobile app enables ASHA-level real-time reporting. S-Form, P-Form, and L-Form templates available.
→ ihip.nhp.gov.inPune-specific anti-dengue campaigns, Dry Day initiative materials, IEC in Marathi, and the ward-level Health Officer contact network. PMC has issued enforcement notices and anti-mosquito campaigns since 2024.
→ pmc.gov.in/en/healthMarathi IEC materials: request from your ward PMC Sub-Health Centre
India's premier virology lab, based in Pune. Suspected dengue samples in Pune District are tested at NIV. PHC Medical Officers coordinate sample dispatch. Both NS1 and IgM tests should be requested for suspected cases.
→ niv.icmr.org.inPune-based health organisation that supports public health systems in Maharashtra. SATHI's field workers document the water-storage double-bind in Pune informal settlements and provide community health training support.
→ sathicehat.orgGlobal technical guidance on dengue surveillance, vector management, and clinical case definitions. The WHO Global Vector Control Response 2017–2030 is the framework that the NCVBDC national programme aligns with.
→ WHO Dengue Fact SheetThis site is a replicable template. If you are adapting it for a district other than Pune, here is what to replace and where to find it:
1. Larval index thresholds: Confirm BI/HI alert thresholds with your district VBD Officer or from 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 laboratory. Replace the District Malaria Officer name with the current officer from your District Health Office.
3. Language: Replace Marathi with the primary language(s) of your district. Check what IEC materials the State Health Department has produced in your language.
4. Water supply context: Investigate the specific intermittency pattern in your district's informal settlements — this shapes which container types are highest risk and how to frame the conversation about water storage.
5. Local NGOs: Replace SATHI with the community health organisations operating in your district — district-level NGO networks can usually be identified via your State NRHM office.
This localisation guide responds to the professor's observation that depth of a worked example (Pune) and reach of a generalizable model can coexist — Project Proposal, GLB HLT 191, Spring 2026