Marching towards a malaria-mukt Bharat

India can be proud to have sustained a steady decline in malaria cases even as the Covid-19 pandemic disrupted health programmes and reversed progress made in elimination efforts around the world. Globally, eighty-five malaria endemic countries witnessed 26 million more cases in 2020 than 2019, with deaths due to malaria also increasing. In the same period, India witnessed a 44 percent decrease in cases, and numbers dropped further in 2021.

However, now is not the time to rest on our laurels as we stand at a critical juncture in our drive toward ending malaria. Malaria elimination efforts in India took off from 2015, following the 2014 global call to end malaria once and for all. Extensive consultations and collaborations with experts resulted in the creation of the National Framework for Malaria Elimination 2016-2030 and National Strategic Plan (NSP) for Malaria Elimination 2017-2022, outlining key strategies for the next five years.

Subsequently, people-centric approaches were adopted, tailored to address local factors contributing to disease transmission. Upscaling proven interventions such as insecticide spraying became an integral part of our approach. This was supported by the concerted efforts of the Indian government to enhance access to key resources like long-lasting insecticidal nets and rapid diagnostic kits in high-endemicity states. All these steps led India to an 86.12 per cent decline in malaria cases and a 76.56 per cent drop in malarial deaths between 2015 and 2021.

Disease burden

Despite these achievements, challenges remain. India continues to account for 83 per cent of malaria cases and 82 per cent of malarial deaths in the World Health Organization’s South-East Asia Region. States like Odisha, Chhattisgarh, Jharkhand, Mizoram and Tripura account for nearly half (53.86 per cent) of these cases. The difficult terrain and fragile health infrastructure in these regions have diminished the impact of anti-malaria interventions.

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This year, India is poised to develop the 2023-2027 NSP and there can be no better opportunity to strengthen our resolve to ending malaria. The previous NSP (2017-2022) aimed to achieve zero indigenous transmission of malaria in low burden regions, by ensuring 100 per cent diagnosis of suspected cases, treatment completion, improved detection, notification, and classification. Key to this was also providing universal health coverage to those most at risk. Going forward, the focus must be on last-mile delivery of diagnostics, treatment and preventive interventions.

This means strengthening systems, especially within districts in India, which are the base operational units for malaria elimination. Improving primary health infrastructure for early case detection is vital to catching the disease in its nascent stages and preventing its evolution into a severe or even fatal illness. Here, state governments can play a pivotal role in engaging health and welfare centres (HWC) to detect and treat malaria among local populations.

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Strengthening frontline health workers’ capacity lies at the heart of a robust programme that connects people with health services and improves community awareness about preventable vector-borne diseases. State and district officials can play a vital role in ensuring the validation and certification of zero indigenous cases, in reporting regions, to ensure the highest standards of case reporting and data collection. This could mean that corresponding interventions are rolled out to ensure there is no transmission from neighbouring regions that may not have achieved zero malaria.

“1-3-7” surveillance

District and state-level health workers can also contribute to malaria elimination by organizing sanitation for mosquito-free surroundings, conducting home visits with symptomatic patients, and facilitating focused testing during outbreaks in malaria-prone regions. These workers are also critical to implementing the “1-3-7” surveillance strategy, where a malaria diagnosis must be reported in a single day, confirmed in three days, and the spread of the disease checked in seven days.

Given their role as last-mile links to health care for a vast majority of the country’s population, health workers’ contributions go beyond medical and programmatic activities into the realm of social mobilization as well. Affecting social and behaviour change communications (SBCC) campaigns is an integral part of their role, as community mobilizers, and frontline workers are the primary channels of dissemination of creative collaterals like posters, flipbooks, games, question-and-answer booklets and other informational materials.

In keeping with the regional focus of malaria elimination, equally critical is the enhanced cross-border collaboration with neighbouring malaria-endemic nations. This contributed to better monitoring of vector breeding sites and reducing the threat of imported cases. Cross-border cooperation has been a key priority for India, which is part of the Asia Pacific Leaders Malaria Alliance (APLMA) that brings together 22 countries in the region committed to eliminating malaria by 2030. These countries have pledged to collaborate on joint cross-border elimination plans where officials on either side work together to ensure the effective implementation of harmonized policies.

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What is critical to take away from these learnings is that malaria elimination cannot be achieved via the health department’s interventions alone. We must strengthen inter-departmental coordination between convergent ministries, particularly the Tribal Affairs ministry and the Rural Development Housing and Urban Affairs, and Water & Sanitation ministry to create a 360-degree strategy to address diverse factors responsible for malaria transmission. For example, malaria in India is often most prevalent in hilly, tribal areas where access to prevention and care services is low. Scaling up existing interventions in these areas could be pivotal to in reducing malaria deaths.

We look forward to a year of prioritizing malaria elimination after the devastating impact of the Covid-19 pandemic. World leaders met at the Kigali Summit on Malaria and NTDs, on June 23, to pledge their commitment to ending these diseases and showcase how integrated efforts to eliminate Malaria and NTDs like Lymphatic Filariasis and Visceral Leishmaniasis can unlock the potential to build a safer world for everyone, everywhere. We are at an important crossroad that could determine the future of malaria elimination. Armed with a strong commitment to ending malaria by 2030, the hope is for a healthier and stronger India.

(The writer is the Director of the National Centre for Vector Borne Disease Control (NCVBDC). Views expressed are personal.)

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