WHO Global Technical Strategy for Malaria 2016-2030 National Framework for Malaria Elimination in India (2016–2030)

1. WHO Global Malaria Control
Strategy: It’s need and
implementation
Dr. Shaan Ahmed
PGT, Community Medicine ,
NMCH

2. Introduction
• Malaria is caused by parasites of the
Plasmodium family and transmitted by female
Anopheles mosquitoes.
• There are four different human malaria
species (P.falciparum,P. vivax, P. malariae and
P. ovale),
• P. falciparum and P. vivax are the most
prevalent and P. falciparum the most
dangerous.

3. • Despite being preventable and treatable, about
3.2 billion people were at risk of the malaria in 97
countries an estimated 198 million cases
occurred in 2013 and, the disease killed about
584 000 people.
• As per the World Malaria Report 2015, India
accounts for 70% of the total malaria incidence in
the South-East Asia Region.
• In the year 2014 around 2043 malaria cases were
reported from BIHAR in which 699 cases were
due to P.falciparum.

4. WHO GTS for Malaria 2016-2030
• The WHO Global Technical Strategy for
Malaria 2016-2030 was adopted by the World
Health Assembly in May 2015.
• The strategy provides comprehensive
technical guidance to countries and
development partners for the next 15 years.

5. • The timeline of 2016–2030 is aligned with the
2030 Agenda for Sustainable Development.
• Under the SDG umbrella, two strategies will
guide malaria control and elimination efforts –
the Global Technical Strategy for Malaria
(GTS) 2016-2030 and the Action and
Investment to Defeat Malaria (AIM) 2016-
2030 – for a malaria-free world.

6. • It provides a technical framework for all
malaria-endemic countries working towards
malaria control and elimination.
• It also highlights the urgent need to increase
investments across all interventions: including
preventive measures, diagnostic testing,
treatment and disease surveillance, as well as
in harnessing innovation and expanding
research.

7. Vision – A World Free of Malaria

9. Strategic Framework
Pillar 1. Ensure universal access to malaria prevention,
diagnosis and treatment
(1) Prevention strategies based on vector control, and
administration of chemoprevention.
(2) Universal diagnosis and treatment of malaria in
public and private health facilities

10. Pillar 2. Accelerate efforts towards elimination and
attainment of malaria-free status
1. By active case detection and case investigations
as part of a malaria surveillance and response
programme.
2. Use of medicines for prophylaxis, or other
possible new approaches to remove the
infectious reservoir.
3. Innovative solutions to respond to the spread of
insecticide resistance, residual transmission, and
to target the hypnozoite reservoirs of P. vivax.

11. Pillar 3. Transform malaria surveillance into a core
intervention.
1. All endemic countries and those susceptible
to the re-establishment of malaria should
have an effective health management and
information system.
2. To identify gaps in national programme
coverage, detect outbreaks, and assess the
impact of interventions in order to guide
changes in programme orientation.

12. with two supporting elements:
1.Harnessing innovation and expanding
research
• By increasingly engage in basic, clinical and
implementation research.
• Basic research is essential for a better
understanding of the parasites and the
vectors, and to develop more effective
diagnostics and medicines,
• improved and innovative vector control
methods, and other tools such as vaccines.

13. 2.Strengthening the enabling environment
• By Strong political commitment, robust
financing and increased multisectoral
collaboration.
• use and timely replacement of long-lasting
insecticidal nets or, application of indoor
residual spraying.

14. National Framework for Malaria
Elimination in India (2016–2030)
• It is in line with the WHO Global Technical
Strategy for Malaria 2016–2030 (GTS) and the
Asia Pacific Leaders Malaria Alliance (APLMA)
Malaria Elimination Roadmap for the Asia Pacific.
• Implementation of the Tribal Malaria Action Plan
(TMAP) for intensification of malaria prevention
and control activities in tribal and ethnic
population groups spread across different
states/Uts.

15. VISION
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.

16. • .

17. 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 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.

18. Implementation
• This Framework will be implemented by the
Directorate of (NVBDCP) which is the umbrella
programme for prevention and control
of malaria and five other vector borne
diseases.
• A Malaria Elimination Committee and a
Malaria Elimination Taskforce will be
constituted at the state as well as district
levels.

19. Methods of implementation
1. Surveillance and case management
• Case detection (passive and active)
• Early diagnosis and complete treatment
• Sentinel surveillance
2. Integrated vector management
• Indoor residual spraying
• Insecticide treated bed nets (ITNs)/Long-lasting
insecticidal nets (LLINs)
• Anti-larval measures including source reduction

20. 3. Epidemic preparedness and early response
4. Supportive interventions
• Capacity building
• Behaviour change communication
• Intersectoral collaboration
• Monitoring and evaluation (M&E)
• Operational and applied field research

21. Need
• In 2012, it was estimated that the total
economic burden of malaria in India was
around US$ 1940 million, with 75% from lost
earnings and 25% from treatment costs borne
by households.
• Besides saving lives, eliminating malaria in
India would also avert these socioeconomic
losses.

22. • To strengthen health systems, address emerging multi-
drug and insecticide resistance, and intensify national,
cross-border and regional efforts to scale up malaria
responses to protect everyone at risk.
• To assess Coverage and quality of interventions;
measuring operational and epidemiological indicators
to ensure that programme activities are yielding
desired results in achieving milestones, targets and
objectives.
• Documenting progress towards malaria elimination;
and advising on revisions in policies and strategies
when needed.

23. Challenges
1. Population movements, often uncontrolled
across states/UTs, and sharing of large
international borders with neighbouring
malaria endemic countries.
2. Shortage of skilled human resources:
• Shortage of qualified entomologists in the
country leading to poor vector surveillance
• About 40 000 multipurpose health workers
(MPWs) against 80 000 sanctioned posts.

24. 3. Insecticide resistance:
• Among the six primary vectors of malaria in
India, resistance to DDT has been widespread
in An. culicifacies (district level), but malathion
resistance is localized