The document discusses India's national health programmes and measures taken since independence to improve public health. It outlines various vector-borne disease control programmes implemented across states to prevent and control communicable diseases such as malaria, filariasis, Japanese encephalitis, dengue, chikungunya, and kala-azar. It provides details on the National Vector Borne Disease Control Programme's strategies, categorization of states and districts based on disease burden, and progress and challenges in eliminating malaria in India.

1. Dr. Mukesh Kumar
Tutor, PSM
PJMC, Dumka

2. Since India became independent, several measures have been
undertaken by the National Government to improve the
health of the people.
Prominent among these measures are the NATIONAL HEALTH
PROGRAMMES, which have been launched by the Central
Government for the control/ eradication of the communicable
diseases, improvement of environmental sanitation, raising
the standard of nutrition, control of population and improving
rural health.
Various international agencies like WHO, UNICEF, UNFPA,
World Bank, as also a number of foreign agencies like SIDA,
DANIDA, NORAD and USAID have been providing technical
and material assistance in the implementation of these
programmes.

3. • The National Vector Borne Disease Control Programme(NVBDCP) is implemented in the
State/UT's for prevention and control of vector borne diseases namely Malaria,
Filariasis, Kala-azar, Japanese Encephalitis (JE), Dengue and Chikungunya.
• The Directorate of NVBDCP is the nodal agency for planning, policy making and technical
guidance and monitoring and evaluation of programme implementation in respect of
prevention and control of these vector borne diseases under the overall umbrella of
NRHM.
• The States are responsible for planning, implementation and supervision of the
programme. The vector borne diseases are major public health problems in
India.Chikungunya fever which has, re-emerged as epidemic outbreaks after more than
three decades has added to the problem.
• The prevention and control of vector borne diseases is complex; as their transmission
depends on interaction of numerous ecological, biological, social and economic factors
including migration.
• Out of the six vector borne diseases, malaria, filariasis, japanese encephalitis, dengue
and chikungunya are transmitted by different kind of vector mosquitoes, while kala-azar
is transmitted by sand flies.
• The transmission of vector borne diseases in any area is dependent on frequency of
man-vector contact, which is further, influenced by various factors including vector
density, biting time, etc.Mosquito density is directly related with water collection, clean
or polluted, in which the mosquitoes breed.

4. Under NVBDCP, the three pronged strategy for
prevention and control of VBDs
• (i) Disease management including early case detection and complete
treatment, strengthening of referral services, epidemic preparedness and
rapid response;
• (ii) Integrated vector management (IVM) for transmission risk reduction
including indoor residual spraying in selected high-risk areas, use of
insecticide treated bed-nets, use of larvivorous fish, anti-larval measures in
urban areas, source reduction and minor environmental engineering; and
• (ili)Supportive interventions including behaviour change communication
(BCC), public private partnership and inter-sectoral convergence, human
resource development through capacity building, operational research
including studies on drug resistance and insecticide susceptibility,
monitoring and evaluation through periodic reviews/field visits, web based
management information system, vaccination against JE and annual mass
drug administration against lymphatic filariasis

5. YearPrior to 1953Estimated malaria cases in India - 75 million;Deaths due to malaria - 0.8
million.
1953 Launching of National Malaria Control Programme (NMCP).
1958NMCP was changed to National Malaria Eradication Programme.
1965 Cases reduced to 0.1 million.
Early 1970's Resurgence of malaria.
1976 Malaria cases - 6.46 million.
1977 Modified Plan of Operations implemented.
1997World Bank assisted Enhanced Malaria Control Project (EMCP) launched.
1999Renaming of programme to National Anti Malaria Programme (NAMP).
2002Renaming of NAMP to National Vector Borne Disease Control Programme.
2005Global Fund assisted Intensified Malaria Control Project (IMCP) launched.
2005 - NVBDCP became integral part of NRHM.
2005- Introduction of RDT in the programme.
2006 - ACT introduced in areas showing chloroquine resistance in falciparum malaria-

6. 2008 - ACT extended to high Pf predominant districts covering about
95% Pf cases.
2008 - World Bank supported National Malaria Control Project
launched.
2009 - Introduction of LLINs. New drug policy 2010.Introduction of
bivalent RDT.
2013 - New drug policy 2013.
2016 - National Framework for Malaria Elimination in India launched.
2017 - National Strategic Plan for Malaria Elimination in India 2017-
2022 launched.

7. National StrategicPlan for MalariaElimination
• The main activities of the programme are :
• 1. Formulating policies and guidelines.
• 2. Technical guidance.
• 3. Planning.
• 4. Logistics.
• 5. Monitoring and evaluation.
• 6. Coordination of activities through the States/Union Territories and in consultation with national
organizations such as National Centre for Disease Control (NCDC),National Institute of Malaria
Research (NIMR).
• 7. Collaboration with international organizations like theWHO, World Bank, GFATM and other
donor agencies.
• 8. Training.
• 9. Facilitating research through NCDC, NIMR, Regional Medical Research Centres etc.
• 10. Coordinating control activities in the inter-state and inter-country border areas.

8. S.N. VBDs Description
1 Malaria Parasitic diseases
and targeted for
Elimination.
2 Kala-azar
3 Lymphatic Filariasis
4 Dengue Arboviral diseases
and outbreak prone
5 Chikungunya
6 Japanese
Encephalitis
National Vector Borne Disease Control Programme
Technical and Financial Support is provided by NVBDCP/NHM to
States/UTs for prevention & control of 6 Vector Borne Diseases (VBDs):

9. LIFE CYCLE OF MALARIA PARASITE
TYPES OF MALARIA PARASITE
Plasmodium vivax (Pv)- may lead to
chronicity
Plasmodium falciparum (Pf) – leads
to complication death
In India, above 2 are common
Others rarely
Plasmodium malariae
Plasmodium ovale

10. 0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
100.00
0
1000000
2000000
3000000
4000000
5000000
6000000
7000000
Malaria in India
PV Pf Pv% Pf% ABER API SPR SfR
1958
Natiional
Malaria
Eradication
Programme
1965
Zero
Malaria
Deaths
reported
1977 Modified plan of
Operation(MPO)
1982
First national anti-malaria drug
policy
1995
National Anti-
Malaria
Programme
(NAMP)
1997 Enhanced
Malaria control
Project
2005 Intensified
Malaria Control
Project
Supported by the
Global fund and the
National Vector
Borne Disease
Control project
2016
NSP
1971 UMS
WHO 24m WHO 29m WHO 21m WHO 13m

11. 0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
110000
120000
130000
140000
150000
160000
170000
SEASONAL TREND OF MALARIA IN INDIA
2015 2016 2017

12. 0
20000
40000
60000
80000
100000
120000
January February March April May June July August September October November December
SEASONAL TREND OF Pf. MALARIA IN INDIA
2015 2016 2017

13. CATEGORISATION OF STATES BASED ON MALARIA BURDEN (API)
• Chandigarh, Daman & Diu,
Delhi, Goa, Haryana, Himachal
Pradesh, J & K, Kerala,
Lakshwadeep, Manipur,
Puducherry, Punjab, Rajasthan,
Sikkim, Uttarakhand
Category 1
(15 States)
-State/Districts
reporting an API of
less than 1 case per
1000 population
• Andhra Pradesh, Assam, Bihar,
Gujarat, Karnataka,
Maharashtra, Nagaland, Tamil
Nadu, Telangana, Uttar
Pradesh, West Bengal
Category 2
(11 States)
- State < 1 API but
some districts report
API of 1 case per 1000
population
• A & N Islands, Arunachal
Pradesh, Chhatisgarh, Dadra &
Nagar Haveli, Jharkhand,
Madhya Pradesh, Meghalaya,
Mizoram, Odisha, Tripura
Category 3
(10)
- States with API of 1
or more per 1000
population

14. CATEGORISATION OF DISTRICTS/REPORTING UNITS (API based)
Category of districts Definition Number
(%)
Category 0:
Prevention of re-
establishment phase
No local transmission and reporting no case for last 3 years. 75
(11.0)
Category 1:
Elimination phase
Districts/units having API less than 1 per 1000 population 448
(66.1)
Category 2:
Pre-elimination phase
Districts/units having API 1 and above, but less than 2 per
1000 population.
46
(6.8)
Category 3:
Intensified control phase
Districts/units having API 2 and above per 1000 population. 109
(16.1)

15. Milestones and Targets for Malaria Elimination
By 2020
• Eliminate malaria from all 15 low transmission states and UTs (Category 1) and
3 additional progressive states and UTs of Category 2
By 2022
• Eliminate malaria from all 8 moderate transmission states and UTs (Category 2)
By 2024
• Reduce the incidence of malaria to less than 1 case per 1000 population in all
states and UTs and their districts
By 2030 and
beyond
• Prevent the re-establishment of local transmission of malaria in areas where it
has been eliminated and maintain national malaria-free status

16. Malaria elimination in phases in India- Stratification
Technical Strategies will need to adapt to this bring this change and maintain it:
HIGH ENDEMIC AREAS CASE DETECTION, TREATMENT, FOLLOW UP, EFFECTIVE VECTOR
CONTROL
MODERATE AREAS INTENSIFY MALARIA REPORTING AND SURVEILLANCE –
early detect, contain and prevent outbreaks
LOW ENDEMIC AREAS CASE BASED SURVEILLANCE AND FOLLOW UP
IN INDIA- WE WILL NEED TO IMPLEMENT THE ABOVE DIFFERENT REGIONS AT SAME TIME
Year Category 0 Category 1 Category 2 Category 3 Total
2015 75 448 46 109 678
2017 106 470 68 34 678
2019 305 233 33 107 678
2020 523 48 15 92 678
2022 571 15 30 62 678

17. National Strategies for Malaria Elimination
▪ Early diagnosis and complete treatment
▪ Case based surveillance and rapid response
▪ Integrated Vector Management
oIndoor Residual Spray (IRS)
oLong Lasting Insecticidal Nets (LLINs)/ Insecticide- treated Nets (ITNs)
oLarval Source Management (LSM)
▪ Epidemic Preparedness and Early Response
▪ Monitoring & Evaluation
▪ Advocacy, Coordination and Partnerships
▪ Behavior Change Communication (BCC) and Community Mobilization
▪ Programme Planning and Management

18. Progress on Malaria Elimination Activities
● Launch of National Framework for Malaria Elimination (NFME) 2016- 2030 in February, 2016
● Dissemination of NFME 2016- 2030 to all States and UTs with instructions to initiate key actions
● Launch of Operational Manual for Malaria Elimination on April, 2016
● Launch of National Strategic Plan (2017-22) for Malaria Elimination document on July,2017
● Formation of a National Malaria Task Force under the Union Health Secretary (July2016) and a
Technical Working Group under the DGHS for oversight of all malaria elimination activities in the
country.
● First National Task Force Meeting under Health Secretary held in Feb2018.
● 14 States have made malaria a notifiable disease

19. Progress on Malaria Elimination Activities (contd)
• 40 million LLINs distributed/being distributed. 11.00 million proposed for the year 2018
• Fourteen states successfully launched their respective plans for malaria elimination, other
states/ UTs are in process of finalizing their action plans for elimination.
• Involvement of private medical sector through trainings, publication of special issue on VBD,
regular SMS to 2.5 lakh medical practitioners under the aegis of Indian Medical Association
(IMA)
• Quality Assurance mechanisms for Rapid diagnostics and malaria microscopy started.
• Rapid Diagnostic Tests: Started in 2009
• Malaria microscopy – up gradation as per international standards initiated in November2016

20. • Financial sustainability
• Uninterrupted supply of materials – procurement and supply uncertainity
• Highly trained and skilled manpower at all levels – hiring and continuation
• Developmental activities creating more malariogenic potential – identification and prevention
• Engagement of private sector
• Drug resistance
• Insecticide resistance
• Research for newer drugs, insecticides
• Real Time reporting from remote and inaccessible areas
Challenges to Malaria Elimination

21. General Strategy for Prevention & Control
 Early diagnosis and complete treatment
(No specific drugs against Dengue, Chikungunya and J.E.)
 Integrated vector Management (IRS, LLIN, larvivorous fish,
chemical and bio-larvicide, source reduction)
 Supportive intervention – (Vaccination only against J.E.)
 Annual MDA using DEC and Albendazole for elimination of
Lymphatic Filariasis
 Behaviour Change Communication