1. MALARIA CONTROL PROGRAMME Keerti Bhusan Pradhan

2. Malaria Burden- Poverty

3. Global Magnitude of Burden 40% of the world’s population are at risk 300 million acute illness (annually) One million death (annually)

4. Economic Costs of Malaria Malaria is disease of poverty and cause of poverty Major constraint of Economic Development Annual economic growth in countries with high malaria transmission is lower than countries without malaria Severely restrains the economic growth

5. Influence on Social and Economic Decisions Undeveloped tourist industry due to reluctance of travelers to visit Undeveloped markets due to traders unwillingness to invest in malarious areas Preference by individual farmers/households to plant subsistence crops rather than more labour-intensive cash crops because of malaria’s impact on labour during harvest season

6. Role of Private Sector Local and International businesses operating in malarious areas are also learning that support for malaria control not only reduces levels of absenteeism and lost productivity, but also boosts labour, community and government relations In the long term increased productivity will encourage market expansion, boost household spending and change consumption patterns.

7. Ways of Private Participation Contributing Capital to scale-up current programmes or create new ones Assisting in the research and development of new interventions and treatments of malaria Providing management and business expertise to stimulate the market for ITMNs & Antimalarial drugs Using their network of distribution channels to carry life-saving medicines and prevention measures to remote communities Using their marketing and PR expertise to assist public education campaigns WHO/TDR and MMV(Medicines for Malaria Venture)

8. India Magnitude of Burden Two Million cases per year 1000 deaths per year States with major death rate (70%) AP, MS, MP, Rajasthan, Chattishgarh, Gujarat, Jharkhand, Orissa

9. History of Malaria Programme 1946-India started using DDT 1953-NMCP Started 1958-NMCP-NMEP 1959-Vector Resistance detected 1965-Re-emergence of malaria 1976-Peak of malaria cases 1977-India starts MPO 1991-Peak of P. falciparum cases 1994-Large scale epidemics (Eastern India/Western Rajasthan) 2000-NMEP-NAMP

10. Malaria Parasites Plasmodium Vivax-May cause relapsing malaria but seldom death (50-55% of total reported cases) P. falciparum-malignant malaria-death (48-52% of total cases) P.malariae-may cause severe malaria (small numbers found in foothills of Orissa) P. ovale (not found in India)

11. Current Malaria Control Strategies EDPT-Relief and reduce reservoir Selective Vector Control Methods- Insecticide Spray/Larvivorous Fish ITMN IEC-Community Participation & Intersectoral Collaboration Capacity Building of Optimal Utilization of the technical manpower 2002-2003:Rs.203 Crores (2003 million)

12. Economic Loss of Malaria Burden 1990-1993: $630 million (Sharma,1996) 70-80% of the malaria control money is spent on insecticides (Dhingra et al., 1998)

13. Financing Cost sharing between Centre & State (Except 7 N.E. States) Central Govt.-Technical Guidance & Assistance in the form of kind(insecticides, anti malarial drugs,Training,IEC) State Govt.-responsible for programme implementation

14. ITMN AS A STRATEGY 1990-Trials demonstrated the effectiveness of nets treated with pyrethroid Issues Community Financing Affordability by reducing/abolishing taxes and tariffs on insecticides, mosquitonets and other associated materials used

15. Gender and Equity Issues Women with low access to financial resources may delay in seeking the treatment Similarly care for Children falls on mothers Difficulty in financing the treatment for fever during illness

16. Challenges Ecological changes Decrease in Public Financing Centre: State 50:50 ITMN-Availability & Affordability Drugs & Medicines Manpower

17. THANK YOU