Note4Students

Malaria is a major public health problem in India but is preventable and curable. Malaria interventions are highly cost-effective and demonstrate one of the highest returns on investment in public health. The National Framework for Malaria Elimination (NFME) outlines India’s strategy for elimination of the disease by 2030. It’s important to its objectives, various provisions, challenges and way forward.

Introduction

1. 1. Disease burden due to malaria in India has been reduced significantly over the years with an overall decline in malaria–related morbidity and mortality. This has been made possible by a series of interventions such as the introduction of artemisinin-based combination therapy (ACT), malaria rapid diagnostic tests (RDTs) ,revision of the National Drug Policy for malaria in 2013 etc. However, a number of challenges have emerged in recent years which pose a threat to the country’s progress in its fight against malaria. These include the development of antimalarial drug resistance and insecticide resistance, development of malaria multi-drug resistance including ACT resistance in neighbouring countries, emergence of malaria in urban areas, existence of high endemic malaria pockets in hard-to-reach areas and in tribal populations, climate change and increased tourism and migration.

 

• In order to address these challenges, a national strategy for malaria elimination has been envisaged prompting the development of the National Framework for Malaria Elimination in India 2016–2030.

 

Vision

1. Eliminate malaria nationally and contribute to improved health, quality of life and alleviation of poverty.

Goals

1. Eliminate malaria (zero indigenous cases) throughout the entire country by 2030; and
2. Maintain malaria–free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria.

Objectives

The Framework has four objectives:

1. Eliminate malaria from all 26 low (Category 1) and moderate (Category 2) transmission states/union territories (UTs) by 2022;
2. Reduce the incidence of malaria to less than 1 case per 1000 population per year in all states and UTs and their districts by 2024;
3. Interrupt indigenous transmission of malaria throughout the entire country, including all high transmission states and union territories (UTs) (Category 3) by 2027; and
4. Prevent the re-establishment of local transmission of malaria in areas where it has been eliminated and maintain national malaria-free status by 2030 and beyond

Key strategic approach

1. Programme phasing considering the varying malaria endemicity in the country
2. Classification of States/UTs based on API as primary criterion (Category 0: Prevention of re- introduction phase; Category 1: Elimination phase; Category 2: Pre-elimination phase; Category 3: Intensified control phase)
3. District as the unit of planning and implementation
4. Focus on high endemic areas
5. Special strategy for P. vivax elimination.

Short term milestones

1. By end of 2016, all states/UTs are expected to include malaria elimination in their broader health policies and planning framework
2. By end of 2017, all states are expected to bring down API to less than 1 per thousand population
3. By end of 2020, 15 states/UTs under category 1 (elimination phase) are expected to interrupt transmission of malaria and achieve zero indigenous cases and deaths due to malaria.

Challenges

• Population movements, often uncontrolled across states/UTs, and sharing of large international borders with neighbouring malaria endemic countries
• Shortage of skilled human resources

 

1. Insecticide resistance: The extensive use of insecticides, particularly DDT, under the vector control programme controlled malaria to a great extent but exerted high selection pressure on the vector population to develop resistance.
2. Access to conflict-affected tribal areas and to areas with a high malaria endemicity is a problem
3. High endemicity states include those in the Northeast, which share borders with neighbouring countries like Bangladesh, where the prevalence of malaria is high.
4. Neglect of malaria and unreliable data:
   • There is no reliable data to know how many people suffer from this disease annually as estimates do not take into account the 60-80% patients in the urban area who gets treatment from private hospitals
5. Although malaria is made as a notifiable disease, penalties are not imposed on doctors and hospitals if they are not notifying.

Way forward

1. With the availability of medicines and diagnostic kits, the delivery mechanism has to be streamlined to enable access to them.
2. Overburdened staffs tend to underperform. So, more community health workers and supporting staffs need to be appointed and trained to function effectively.
3. Budgetary allocation for the programme in specific and overall health care in general has to be increased.
4. Secure and sustain adequate financial resources for implementing the elimination programme through domestic funding.
5. Additionally, innovative financing models, partnerships and integration with other government departments has to be explored.
6. Also, steps have to be taken to create awareness among the people so as to ensure their active participation.
7. Lastly, there is a need for community mobilization and sustenance of efforts to make this program successful.

Questions

1. Discuss the objectives and provisions of National Strategic Plan for Malaria Elimination
2. How should India address the rising challenge of Malaria?