Malaria causes prominent mortality and morbidity every year. In the last few years, the global malaria scenario has been decreasing and several endemic nations are heading towards the elimination of malaria. Nevertheless, decreasing the number of cases looks to be more convenient than sustained elimination.
Therefore to attain the objective of complete elimination and keep up with the elimination status, it is important to assess the gains that took place this year. We will see the progress and the initiatives in malaria elimination with respect to India.
Malaria Elimination: Overview
With the inclining global help and the efforts of the WHO (World Health Organisation), the control programs have been implemented efficiently in several endemic nations. Provided the aroused interest and investment into malaria elimination programs at the global level, the goal of complete elimination appears feasible.
Sustainable interventions have played a crucial role in malaria contraction, however, insecticide and drug resistance, cultural and behavioral beliefs, social demographics, and unreformed health infrastructure could pull back on the progress achieved so far. Ignoring such hindering factors bundled with several region specific factors may jeopardize our potential to abide righteous track to attain global elimination of malaria parasite.
Even though support beyond the territories is crucial, a well handled integrated vector management approach at the country and regional level using scrupulously chosen area specific interventions targeting both parasite and vector along with the involvement of the community is crucial.
National Framework For Malaria Elimination
The National Framework for Malaria Elimination (NFME) 2016-2030 portrays the strategy of India for the elimination of the disease by 2030. The framework has been generated with an aim to eliminate malaria from the nation and contribute to enhanced quality and health of life and alleviation of poverty.
The NFME document clearly illustrates the objectives, goals, targets, strategies, and also the timelines, and that will serve as a roadmap for planning and advocating the elimination of malaria in the nation in a phased manner. Important guidance is expressed for conducting the strategies and associated interventions in every state or union territory according to respective epidemiological situations.
With respect to the WHO Global Technical Strategy for Malaria 2016–2030 (GTS) and also the Asia Pacific Leaders Malaria Alliance Malaria Elimination Roadmap, the aims of the National Framework for Malaria Elimination in India 2016–2030 are as follows:
- Eliminate malaria (zero indigenous cases) across the whole nation by 2030; and
- Maintain malaria – free status in regions where malaria transmission has been hindered and prevent re-introduction of malaria.
The objectives of malaria elimination in India include:
- Eliminate this disease from all low and moderate and endemic states or UTs (26) by this year.
- Decrease incidence of malaria to less than 1 case every 1000 population in all States or UTs and the districts and elimination of malaria in 31 states or UTs by 2024
- Hinder indigenous transmission of malaria in all States or UTs (Category 3) by 2027
- Stop the re-establishment of local transmission of malaria in regions where it has been prevented and maintain the malaria-free status of the nation by 2030.
Key Strategic Approaches Defined
The key strategic approach of the National Framework for Malaria Elimination (NFME) 2016-2030 includes:
- Program phasing considering the distinct malaria endemicity in the nation
- Classification of States and UTs based on API as the basic criterion
- The district as the unit of implementation and planning
- Aim at high endemic areas
- Special malaria elimination strategy for P. vivax elimination.
National Strategic Plan (NSP) For Malaria Elimination (2017-2022)
Over the last 15 years, India has made considerable growth in decreasing its malaria burden. It has a view of a malaria-free nation by 2027 and elimination by 2030. However, the nation still faces daunting hindrances as malaria epidemiology portrays huge complexity and heterogeneity. The disease is mainly focused on tribal and remote regions of the nation.
The National Strategic Plan For Malaria Elimination 2017-22 has been generated based on the NFME of the NVBDCP (National Vector Borne Disease Control Programme), Ministry of Health & Family Welfare (MoHFW), Government of India and malaria elimination target WHO (World Health Organisation) Global Technical Strategy for Malaria Elimination (2016-2030).
The aim of the NSP strategy is the phased elimination of malaria in this country. NFME (National Framework for Malaria Elimination) in India has kept 2030 as eliminating this disease and the goals of NSP are in consonance with whole goals
- Eliminate malaria in Category 1 districts (API <1) by 2020 and Category 2 districts (API 1-2) by 2022,
- Decrease transmission in Category 3 districts to stabilize APIat <1 by 2022.
Specific Objectives Of NSP
- Attain global coverage of case treatment and detection services in endemic districts to assure 100 percent parasitological diagnosis of all suspected malaria scenarios and full treatment of all confirmed cases.
- Strengthen the supervision system to for detecting, notifying, investigating, classifying, and responding to all scenarios and foci in all districts to move towards the elimination of malaria.
- Attain near universal coverage of the population at risk of malaria with an ideal vector control intervention.
- Attain near universal coverage by ideal BCC activities to enhance awareness, knowledge, and responsive behavior regarding efficient curative and preventive interventions for malaria elimination.
- Offer effective national malaria elimination program coordination and management at all levels to deliver a mixture of targeted interventions for the elimination of malaria.
The intervention tools presently available can most likely decrease transmission but eliminating malaria epicenters from where the disease can flare up at any time, is not feasible without the involvement of the local population. Nevertheless, keeping up with zero malaria transmission and checks on the import of malaria in declared malaria free nations, and further speeding up of the interventions to prevent transmission in eliminating nations are most desirable. Effective collaboration backed by enough financial and political support among the nations with a common aim at malaria elimination must be on top priority.