India’s real malaria figures have always been a matter of dispute between the government and global development agencies but come February 11, India will launch an ambitious programme that seeks to eliminate malaria by 2027.
The WHO’s global target for malaria elimination is 2030.
Under the National Framework for Malaria Elimination, now in final stages of planning ahead of a formal launch soon, states have been divided into three categories based on their annual parasite incidence (API). Elimination will be undertaken in a phased manner, and states with low incidence rates taken first, followed by the high-incidence ones.
Malaria elimination is defined as a situation where a given area — district or state — records no indigenous transmission of Plasmodium vivax and Plasmodium falciparum, the two parasites responsible for the disease. Once all districts achieve that, a country is said to have eliminated malaria.
Official estimates suggest nearly 1 million malaria cases are reported annually across the country, but this is widely regarded an underestimate, as 60 to 80 per cent patients in urban areas are treated by private doctors or health establishments, most of whom do not notify cases. Although malaria is a notifiable disease, it is only voluntary notification; there are no penalties for doctors or hospitals not doing so.
Under the new framework, category-1 states should have API of one (number of cases per 1,000 population annually) at both state and district levels. There are 15 such states/union territories: Goa, Haryana, Himachal Pradesh, Jammu and Kashmir, Kerala, Manipur, Punjab, Rajasthan, Sikkim, Uttarakhand, Chandigarh, Daman and Diu, Delhi, Lakshadweep, and Puducherry.
In category-2 are states where overall API is less than one but in some districts it is more than one. The 11 states are Nagaland, Gujarat, Andhra Pradesh, Assam, Bihar, Karnataka, Maharashtra, Tamil Nadu, Telangana, UP and West Bengal.
The last category comprises states where API is more than one at both state and district levels: Madhya Pradesh, Chhattisgarh, Arunachal Pradesh, Meghalaya, Mizoram, Odisha, Tripura, Andaman and Nicobar Islands, and Dadra and Nagar Haveli.
Under the programme, accredited social health activists will be equipped with special kits for quick diagnosis of malaria. Distribution of mosquito nets will be stepped up. The current standard of insecticide spray will be brought down to one.