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Systems for disease vector control should be effective, efficient, and flexible to be able to tackle contemporary challenges and threats in the control and elimination of vector-borne diseases. As a priority activity towards the strengthening of vector control systems, it has been advocated that countries conduct a vector-control needs assessment. A review was carried out of the perceived needs for disease vector control programs among eleven countries and subnational states in South Asia and the Middle East. In each country or state, independent teams conducted vector control needs assessment with engagement of stakeholders. Important weaknesses were described for malaria, dengue and leishmaniases regarding vector surveillance, insecticide susceptibility testing, monitoring and evaluation of operations, entomological capacity and laboratory infrastructure. In addition, community mobilization and intersectoral collaboration showed important gaps. Countries and states expressed concern about insecticide resistance that could reduce the continued effectiveness of interventions, which demands improved monitoring. Moreover, attainment of disease elimination necessitates enhanced vector surveillance. Vector control needs assessment provided a useful planning tool for systematic strengthening of vector control systems. A limitation in conducting the vector control needs assessment was that it is time- and resource-intensive. To increase the feasibility and utility of national assessments, an abridged version of the guidance should focus on operationally relevant topics of the assessment. Similar reviews are needed in other regions with different contextual conditions. Author summary: Vector control can play a major role in the control and elimination of vector-borne diseases, such as malaria, dengue, leishmaniases and other vector-borne diseases. However, to reach its potential, national vector control systems should be adequately supported by vector surveillance, community participation and intersectoral collaboration. As a step towards strengthening vector control, it has been advocated that countries conduct a vector-control needs assessment. The authors reviewed the needs or gaps as perceived by stakeholders of disease vector control programs in eleven countries and subnational states in South Asia and the Middle East. Programs for control and elimination of malaria, dengue and leishmaniases had major shortcomings in vector surveillance and entomological capacity. This was a concern because vectors develop insecticide resistance which, if unchecked, could reduce the effectiveness of interventions. Also, attaining elimination of disease demands enhanced vector surveillance support. There were major gaps in community mobilization and intersectoral collaboration. The findings imply that vector control systems should adapt to the changing disease situation and adopt a cross-disease mandate. The authors propose improvements to the methods of needs assessment. [ABSTRACT FROM AUTHOR]