Progress in Reaching GMAP targets in India National Vector Borne Disease Control Programme India

Objectives Prevention of deaths due to malaria Prevention of morbidity due to malaria Maintenance of ongoing socioeconomic development Specific Objectives API 1.3 or less by % reduction of morbidity and mortality due to malaria by 2010 (National Health Policy- 2002) To halt and reverse the incidence of malaria by 2015 (MDGs) GMAP Targets Reduce global malaria cases from 2000 levels by 50% in 2010 and by 75% in 2015 (GMAP) Reduce global malaria deaths from 2000 levels by 50% in 2010 and to near zero preventable deaths in 2015 (GMAP)

Country Profile Population: 1065 Million (95% of Country’s Population lives in Malaria Transmission Risk Areas) States & UTs: 35 Districts: 628 PHCs: Microscopy Centres: Sub-centres: MPW (M): MPW (F): ASHAs:

Malaria Disease Burden Estimated Malaria - 75 Million Estimated Deaths Due to Malaria – 0.8 Million Launching of NMCP Launching of NMEP Cases Reduced to 0.1 Million Early 70’s - Resurgence of Malaria Malaria Cases 6.46 Million and 59 Deaths Modified Plan of Operations Introduced Annual Malaria Incidence Reduced to 2.2. Million Cases

MALARIA ENDEMIC AREAS API PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS (Compared to the country total) States % Popul ation % Malaria cases % Pf cases % Death N.E. States Other high endemic states* Other *Andhra, Chhattisgarh, Gujarat, Jharkhand, MP, Maharashtra, Orissa, Rajasthan

Distribution of Districts by API APIDistricts Nos.Population ‘000 % Less than – – – More than Total

India - Malaria Control Strategies The three pronged strategy for prevention and control of malaria is: 1.Early Diagnosis and Prompt Treatment a. Disease Surveillance – through MPWs & ASHAs b. Case Detection & management c. Epidemic Preparedness and Response

Malaria Control Strategies Cont… 2. Integrated Vector Control a.Indoor Residual Spray b. Insecticide treated Bednets (ITNs) & Long Lasting Insecticide Treated Nets (LLINs) c. Source Reduction

Malaria Control Strategies Contd… 3. Supportive interventions a.Training & Capacity Building b. Behaviour Change Communication c. Intersectoral Collaboration d. Community Participation d. Public Private Partnership (eg. NGO/ CBOs/ IMA etc.) e. Monitoring, Evaluation & Supportive Supervision f. Legislation

Early Diagnosis and Prompt Treatment a. Disease Surveillance Conducted through: A.Passive and active surveillance for case Detection B. Sentinel Surveillance for severe cases and deaths b. Malaria Diagnosis Microscopy Rapid Diagnostic Tests c. Microscopy Slides collected by MPWs Slides examined in microscopy centers in PHCs 95 million slides were examined in 2007 d. Rapid Diagnostic Tests MPWs/ ANMs /ASHAs trained on RDTs Test in remote inaccessible areas endemic for P.falciparum

Scaling up of Service Delivery Engaging 9655 contractual MPWs against vacancies for surveillance Vacancies of LTs: 6822 (Sanctioned – 23236) Engaging LTs against vacancies under Global Fund, WB Project and also through NRHM 117 thousand ASHAs trained with special focus on use of RDTs for diagnosis and ACT for treatment

At Present 100 million slides collected Pf Specific RDT in Use 50% of cases are Pf Pf cases are mostly confined to 250 million population 40 % of Pf cases are in remote areas RDT Supply vs. Need

Scaling up RDTs Introduced in and gradually scaled up Used in inaccessible and remote areas At Present monovalent RDTs ( only for PF) are being used Training of community volunteers in RDT and drug delivery

Treatment of Cases Chloroquine was the Drug of Choice for both Pv & Pf till emergence of resistance in Pf Pf Monitoring (Parasite Sensitivity of anti-malarials) started in 1977 SP adopted as 2 nd line treatment for treatment of Pf cases in CQ resistant areas in Combination therapy of Artesunate plus SP adopted in 2004 for treatment of Pf cases in CQ resistant areas. Use of ACT extended to cluster of blocks and 7 pilot districts under the programme since 2007 According to Revised Drug Policy (2008) ACT is 1st line drug for Pf in all high endemic areas in addition to CQ resistant and surrounding blocks.

1.8 Million Total Malaria Cases 50 % Pf Proportion ACT rolled out as first line treatment of Pf cases in 117 districts Eventually will cover 95% of Pf cases ACT Supply vs. Need

Scaling up ACT

Integrated Vector Control a.Indoor Residual Spray 1953 – entire country uniformly sprayed MPO adopted (areas with API > 2 covered with IRS) Currently high risk areas API > 3 covered with IRS during the transmission season 90 Million of Country’s population targeted annually and coverage is 80% Insecticide used: DDT, Malathion, Synthetic Pyrethroids

b. Insecticide treated Bednets (ITNs) & Long Lasting Insecticide Treated Nets (LLINs) Introduced in high risk areas in 2001 Plain Bed-nets procured so far are mainly used in - GFATM Project - WB Project Efforts are on to introduce LLIN Use guided by epidemiological and entomological parameters or IRS operational difficulty

ITNs Actual vs. Need

Scaling up ITNs

GIS Mapping Based identification of High Risk Areas Eg. Problematic Villages Identified through GIS for Focus Intervention in District Nalbari, Assam (2006)

Other Vector Control Methods LARVICIDING & ADULT CONTROL Undertaken in urban set up with temephos, pirimiphos methyle & Biological larvicide (Bti) & pyrethrum extract 2% as adulticide 131 major towns are covered Target population is million LARVIVOROUS FISH Cost effective & environment friendly method Emphasis on perennial water bodies as hatcheries Over 2191 district level & Block/ PHC level hatcheries established No of water bodies seeded are 192,781

Improving Access to & Use of Malaria Prevention and control Services WORLD BANK PROJECT TARGETS > 80% of population in high-risk project areas protected by ITNs or IRS > 80% of RDT positive cases among adults receiving ACT no later than the day after the first contact To be adopted in all high endemic areas

Meeting the Gaps Additional inputs provided through Global fund & World Bank Projects A. HUMAN RESOURCE PMUs at National, State Level District Level – DVBDC Consultant, MTS B. COMMODITIES ITNs/ LLIns Synthetic pyrethroids RDT ACT

RBM Partnership’s vision Substantial and sustained reduction in the burden of malaria in the near and mid-term, and the eventual global eradication of malaria in the Long term, when new tools make eradication possible.

Targets of the GMAP : Achieve universal coverage, for all populations at risk with locally appropriate interventions for prevention and case management by 2010 and sustain universal coverage until Local field research suggests that coverage can gradually be targeted to high risk areas and seasons only, without risk of a generalized resurgence; Reduce global malaria cases from 2000 Levels by 50% in 2010 and by 75% in 2015; Reduce global malaria deaths from 2000 Levels by 50% in 2010 and to near zero preventable deaths in 2015; Eliminate malaria in 8-10 countries by 2015 and afterwards in all countries in the pre-elimination phase today; and In the long term, eradicate malaria world-wide by reducing the global incidence to zero through progressive elimination in countries.

India’s Progress The programme adopted universal coverage during 1960’s when eradication was contemplated. Subsequent resurgence in certain areas resulted in adoption of targeted approach in high risk areas Country on track for SUFI & Universal Coverage of control interventions in these areas Partnerships forged with WHO, Global Fund, World Bank & Private Partners 28% reduction in Malaria Morbidity from baseline of 2000 Around 70% of country’s population under sustained control

THANK YOU

GMAP Vision Vision is of a world free from the burden of malaria. By 2015: the malaria-specific MDG is achieved, and malaria is no longer a major cause of mortality and no longer a barrier to social and economic development and growth any where in the world. Beyond 2015: all countries and partners sustain their political and financial commitment to malaria control efforts. The burden of malaria never rises above the 2015 level, ensuring that malaria does not re-emerge as a global threat. In the long term: global malaria eradication is achieved. There is no malaria infection in any country. Malaria control efforts can be stopped.

Targets By 2010, through targeting universal coverage: 80% of people at risk from malaria are using locally appropriate vector control methods such as long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS) and, in some settings, other environmental and biological measures 80% of malaria patients are diagnosed and treated with effective anti- malarial treatments; in areas of high transmission, 100% of pregnant women receive intermittent preventive treatment (IPTp); and the global malaria burden is reduced by 50% from 2000 levels: to less than million cases and 500,000 deaths annually from malaria.

By 2015: − universal coverage continues with effective interventions; − global and national mortality is near zero for all preventable deaths; − global incidence is reduced by 75% from 2000 levels: to less than million cases per year; − the malaria-related Millennium Development Goal is achieved: halting and beginning to reverse the incidence of malaria by 2015; and − at least 8-10 countries currently in the elimination stage will have achieved zero incidence of locally transmitted infection.

Beyond 2015: − global and national mortality stays near zero for all preventable deaths; − universal coverage (which translates to ~80% utilization) is maintained for all populations at risk until local field research suggests that coverage can gradually be targeted to high risk areas and seasons only, without risk of a generalized resurgence; and − countries currently in the pre-elimination stage will achieve elimination.

Scaling up ACT

Plan for Scaling Up For Impact UNIVERSAL COVERAGE (100%) GF / WB Domestic Budget Timeline for SUFI MAX PROG CAPACITY (19 Million) SUFI Gap lag in SUFI 80% COVERAGE