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National Strategic Plan for Malaria Elimination (2017-22)
Jul 19, 2017

Union Minister of Health and Family Welfare launched the National Strategic Plan (NSP) for Malaria Elimination (2017-22) on 12th July. The Strategic Plan gives year wise elimination targets in various parts of the country depending upon the endemicity of malaria in the next 5 years.

  • The NSP is a year-wise roadmap for malaria elimination across the country and it is based on National Framework for Malaria Elimination 2016, which itself was spurred by World Health Organisation’s Global Technical Strategy for Malaria, 2016-2030.
  • The strategies involve strengthening malaria surveillance, establishing a mechanism for early detection and prevention of outbreaks of malaria, promoting the prevention of malaria by the use of Long Lasting Impregnated Nets (LLINs), effective indoor residual spray and augmenting the man-power and capacities for effective implementation over the next five years. 

Incidence of Malaria in India

  • In India, malaria is commonly caused by the parasites Plasmodium falciparum (Pf) and Plasmodium Vivax (Pv). Pf is found more in the forest areas, whereas Pv is more common in the plains. 
  • The disease is mainly concentrated in the tribal and remote areas of the country. The majority of reporting districts are in the country’s eastern and central parts — the largest number of cases are found in Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, and the Northeastern states of Tripura, Mizoram and Meghalaya.

What is this plan to eradicate malaria?

  • The NSP divides the country into four categories, from 0 to 3. Category ‘0’ has 75 districts that have not reported any case of malaria for the last three years. Category ‘1’ has 448 districts in which the annual parasite incidence (API, or the number of positive slides for the parasite in a year) is less than one per 1,000 population. In Category 2, which has 48 districts, the API is one and above, but less than two per 1,000 population. Category 3 has 107 districts, reporting an API of two and above per 1,000 population.
  • The plan is to eliminate malaria (zero indigenous cases) by 2022 in all Category 1 and 2 districts. The remaining districts are to be brought under a pre-elimination and elimination programme.
  • The NSP also aims to maintain a malaria-free status for areas where transmission has been interrupted. 
  • It seeks to achieve universal case detection and treatment services in endemic districts to ensure 100% diagnosis of all suspected cases, and full treatment of all confirmed cases.
  • The plan has four components, based on WHO recommendations: diagnosis and case management; surveillance and epidemic response; prevention — integrated vector management; ‘cross-cutting’ interventions, which include advocacy, communication, research and development, and other initiatives. 

Significance of the NSP

  • For the first time, the union Health Ministry has come up with a roadmap for elimination of malaria in the country. Before this, the effort was to “control” malaria under the National Vector Borne Disease Control Programme. 
  • The NSP is a detailed strategy with operational guidelines for Programme Officers of all states towards set targets. 

Challenges 

  • One of the biggest challenges is the shortage of manpower. 
  • Other problems include access to conflict-affected tribal areas, and to areas with a high malaria endemicity and insecticide resistance. High endemicity states include those in the Northeast, which share borders with neighbouring countries like Bangladesh, where the prevalence of malaria is high.

World Malaria Report 2016

  • According to the WHO’s World Malaria Report 2016, India contributed 89% of the incidence of malaria in the South-East Asia region. As per the provisional epidemiological report 2016, there were over 10 lakh positive cases in India’s 36 states and UTs, which caused 331 deaths. The Indian record stands in sharp contrast to some of its neighbours — the Maldives was certified malaria-free in 2015, and Sri Lanka followed in 2016.

 

Lessons from Sri Lanka in curbing Malaria

In November 2016, the World Health Organisation certified that Sri Lanka is a malaria free nation. It is the second country to eradicate malaria in the region after Maldives, which has been free of the disease since 1984. No locally transmitted cases of malaria had been recorded in the country for three-and a-half years. 

How Sri Lanka won the war against malaria? 

Web-based surveillance: All fever cases were tested for malaria and each case notified with the Anti Malaria Campaign (AMC) at the ministry of health. People with a travel history to countries with malaria transmission were closely tracked for symptoms, as were people in the armed forces on peacekeeping missions, immigrants, emigrants, tourists and pilgrims.

Rationing medicines: Anti-malarial medicines were only available with the AMC, which compelled the private health sector to notify all cases. 

24x7 hotline: AMC ran a 24-hour hotline to notify, track and treat the patient in isolation to stop further spread of infection.

Parasite-control strategy: In the early1990s, the AMC changed from vector-control (mosquito control) to parasite control strategy to contain infection.

Health access: A strong public health system, sanitation and roads lowered mosquito breeding and took treatment to people in the remotest of places. Early diagnosis and prompt treatment by trained health workers with focus on high-risk areas lowered disease and deaths.

Stakeholder partnerships: Intensive disease surveillance, integrated vector management, rigorous community engagement and research increased social, technical and financial support for eradication.


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