National Malaria Control Program and Strategy Nepal
-Dr.Sharad H. Gajuryal
MD(Hospital Administration) Resident
Malaria in its various forms has been the cause of
Mortality in Nepal through out the ages.
First documented malaria survey was done by
Major phillips of Indian military service in
Makwanpur and chitwan where out of 889 children
examined 80% had enlarged spleen.
After 1950,during the control of country by King
Trivuwan , various vertical development project
was started including efforts to control malaria.
Nepal began to realize success in controlling
malaria when it launched a large-scale malaria
control project as early as 1954 with financial
assistance from the United States Agency for
International Development (USAID
A National Malaria Eradication Programme
(NMEP) was launched in 1958 to eradicate the
Eradication in 1958-1977 focused primarily on
insecticide spraying, vector control measures and
distribution of anti-malarials.
Extreme geographical conditions and rudimentary
data-collecting systems have always prevented
scientists and health officials obtaining an entirely
accurate picture of the full impact of malaria in
With failure of global malaria effort aimed at
eradication,program changed to Malaria control
program in 1978.
In 1985, more than 42,000 cases of the disease
were reported throughout the country. In the same
year there was a massive epidemic in the western
region of Nepal, with smaller epidemics in the
central region from 1985 to 1988, when the cases
were well above 15,000 annually for successive
Prevailing ecological,epidemiological and socio-
economic suggested changes in malaria control
strategy, as a result malaria control program was
revised in 1992 in accordance with global malaria
control strategy of WHO.
In 1993,Malaria control division was dissolved and
activities were then carried out under
Epidemiological and disease control section.
Malaria control services are provided to approx.
15.6 million people in malaria risk areas of 64
districts of the country.
In Nepal, about 84% (23 million) of the people were at risk of malaria in
2012 with 4% at high risk. One million people live in areas with a
reported incidence of more than one case per 1,000 population per year
However, the scale of preventive interventions appears to have been
limited in Nepal . In recent years, malaria control activities have been
carried out in 65 districts at risk out of 75 administrative districts
In 2010, these 65 districts were further categorized for malaria control
programme interventions. Based on the annual parasite incidence
(API), there were
13 high-risk districts (API ≥1),
18 moderate-risk districts (API=0.5-1),
34 low-risk districts (API=0-0.5) and
ten no-risk districts (API=0) as shown in Figure
. The Global Fund to fight AIDS, tuberculosis and
malaria (GFATM) started supporting a malaria control
programme in high-priority, malaria-risk districts in
Nepal in April 2004 .
Since 2011, The GFATM support is utilized for rapid
diagnostic test (RDT) kits, artemisinin combination
therapy (ACT), long-lasting insecticidal nets (LLINs),
and information, education and
communication/behaviour change communication
(IEC/BCC) for LLIN use. After the introduction of these
interventions, the number of confirmed malaria cases
in Nepal declined substantially
Based on recommendations from the internal and
external evaluation of Nepal’s malaria control
programme in 2010, the country has been
preparing for a pre-elimination phase since 2011.
It has recently adopted a long-term malaria
elimination strategy with the ambitious vision of a
malaria-free Nepal by the year 2026
Early Diagnosis and promote treatment of
uncomplicated malaria cases and development of
referral system of complicated and severe cases.
Development of lab facilities for strengthening
early diagnosis of case in health institution.
Selective application of indoor residual spraying
Promotion of PPM (personal protective measures
Encouragement to community for minor
environmental manipulations facilitating malaria
Promotion of insecticide impregnation bed net
whenever possible as a measure of vector control
and transmission risk reduction
Development of skill of peripheral level health
staffs on different aspect of malaria control.
Development of skill of MO and DHOs in
management of severe and drug resistant malaria
Promote operational field research on malaria on
Vision –Malaria Free Nepal by 2026
Mission _ To provide free, equitable, efficient
accessible and quality malaria intervention to all
people in Nepal.
Goal-By 2016, incidence of locally transmitted
malaria will be reduced by 90% of current level
and and no. of VDC having indigenous malaria will
be reduced by 75% of current level (2010)
To update the stratification of malaria endemic
area and align activities outlined in strategic plan
accordingly in different strata by 2012.
To achieve at least 90% of vector control
coverage of malaria risk population residing in
high and moderate risk area by 2016.
To achieve 90% screening of all suspected malaria
case for all parasitological diagnosis and 100%
effective treatment for all confirmed cases according
to national guidelines by 2016.
To intensify passive malaria surveillance, introduce
weekly reporting including mandatory zero reporting
system, case notification and case based malaria
surveillance and initiate early response of focal
outbreak by 2016.
To ensure that 90% population at malaria risk
adopt at least one malaria preventive measures
by combination of BCC approaches by 2015.
To develop and sustain the required program
management capacity and structure at all level to
effectively and efficiently deliver a combination of
targeted intervention by 2014.