National Framework for Malaria Elimination in INDIA
The NFME 2016–2030 was developed in close alignment with the Global Technical Strategy for Malaria 2016–2030, Action and Investment to defeat Malaria 2016–2030 and the Asia Pacific Leaders Malaria Alliance Malaria Elimination Roadmap.
VISION
Eliminate malaria nationally and contribute to improved health, quality of life and alleviation of poverty.
GOALS
In line with the WHO Global Technical Strategy for Malaria 2016–2030 (GTS) and the Asia Pacific Leaders Malaria Alliance Malaria Elimination Roadmap, the goals of the National Framework for Malaria Elimination in India 2016–2030 are:
• Eliminate malaria (zero indigenous cases) throughout the entire country by 2030; and
• Maintain malaria–free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria.
OBJECTIVES
The Framework has four objectives:
- Eliminate malaria from all 26 low (Category 1) and moderate (Category 2) transmission states/union territories (UTs) by 2022;
- 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;
- Interrupt indigenous transmission of malaria throughout the entire country, including all high transmission states and union territories (UTs) (Category 3) by 2027; and
- 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.
STRATEGIC APPROACHES
1. Programme phasing
- Malaria elimination in India will be carried out in a phased manner because various parts of the country differ in their malaria endemicity due to differences in their eco-epidemiological settings, socioeconomic conditions, health system development and malaria control accomplishments.
- Malaria incidence in high transmission areas (Category 3) must be lowered first before it is possible and rational to investigate each case.
- States/UTs will be subdivided into four categories with annual parasite incidence (API) as the primary criteria, and the annual blood examination rate (ABER) and slide positivity rate (SPR) as secondary criteria.
- Category-specific milestones and targets will be set up and strategies implemented subsequently.
| Category of districts | Definition |
| Category 0: Prevention of re-establishment phase | States/UTs with zero indigenous cases of malaria. |
| Category 1: Elimination phase | States/UTs (15) including their districts reporting an API of less than 1 case per 1000 population at risk . |
| Category 2: Pre-elimination phase | States/UTs (11) with an API of less than 1 case per 1000 population at risk, but some of their districts are reporting an API of 1 case per 1000 population at risk or above. |
| Category 3: Intensified control phase | States/UTs (10) with an API of 1 case per 1000 population at risk or above. |
2. District as the unit of planning and implementation
- Apart from the category to which they belong, each state/UT will be advised to further classify their districts so that even if a state/UT is not yet in the elimination phase, but has some districts with an API below 1 case per 1000 population at risk, those may be considered eligible for initiating elimination phase activities provided they meet the secondary criteria.
- In addition, states/UTs may also sub-classify districts into community health centres, community health centres into primary health centres, primary health centres into sub-centres, and sub-centres into villages for localized planning and implementation.
3. Focus on high transmission areas
- The majority of malaria is being reported from states in the eastern, central and north-eastern part of the country, such as Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra, Tripura and Meghalaya.
- Most of these states are characterized by widespread hilly, tribal, forested and conflict-affected areas which are pockets of high malaria transmission.
- An aggressive scaling up of existing interventions, intensification of all malaria control activities and innovative strategies and partnerships will be carried out in these high endemic pockets to rapidly reduce malaria morbidity and mortality.
4. Special strategy for P. vivax elimination
- According to the World Malaria Report 2015, more than 80% of the global P. vivax burden is contributed by 3 countries including India .
- This serious challenge to malaria elimination efforts within the country will require special measures to be undertaken, such as good quality microscopy to detect all P. vivax infections, operational research to estimate prevalence of G6PD deficiency in the population, appropriate vector control measures, and ensuring good compliance to 14-day radical treatment with primaquine in affected individuals.
- These measures are in line with the WHO Control and Elimination of Plasmodium vivax Malaria – A Technical Brief.
MILESTONES AND TARGETS
By end of 2016
- All states/UTs have included malaria elimination in their broader health policies and planning frameworks.
By 2020
- Transmission of malaria interrupted and zero indigenous cases and deaths due to malaria attained in all 15 states/UTs under Category 1 (elimination phase) in 2014 (base year).
- All 11 states/UTs under Category 2 (pre-elimination phase) in 2014 enter into Category 1 (elimination phase).
- Five states/UTs under Category 3 (intensified control phase) in 2014 enter into Category 2 (pre-elimination phase).
- Five states/UTs under Category 3 (intensified control phase) in 2014 reduce malaria transmission but continue to remain in Category 3.
- An estimated reduction in malaria of 15–20% at the national level compared with 2014.
- Additionally, progressive states with strong health systems such as Gujarat, Maharashtra and Karnataka may implement accelerated malaria elimination programmes to achieve interruption of transmission and demonstrate early elimination followed by sustenance of zero indigenous cases.
By 2022
- Transmission of malaria interrupted and zero indigenous cases and deaths due to malaria attained in all 26 states/UTs that were under Categories 1 and 2 in 2014.
- Five states/UTs which were under Category 3 (intensified control phase) in 2014 enter into elimination phase.
- Five states/UTs which were under Category 3 (intensified control phase) in 2014 enter into pre-elimination phase.
- An estimated reduction in malaria of 30–35% at the national level compared with 2014.
By 2024
- All states/UTs and their respective districts reduce API to less than 1 case per 1000 population at risk and sustain zero deaths due to malaria while maintaining fully functional malaria surveillance to track, investigate and respond to each case throughout the country.
- Transmission of malaria interrupted and zero indigenous cases and deaths due to malaria attained in all 31 states/UTs.
- Five states/UTs which were under Category 3 (intensified control phase) in 2014 enter into elimination phase.
By 2027
- The indigenous transmission of malaria in India interrupted.
By 2030
- The re-establishment of local transmission prevented in areas where malaria has been eliminated.
- The malaria-free status maintained throughout the nation.
