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

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Progress in Reaching GMAP targets in India
National Vector Borne Disease Control
ProgrammeIndia
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• 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 2012
• 50 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)

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• Country Profile
• Population 1065 Million
• (95 of Countrys Population lives in Malaria
  Transmission Risk Areas)
• States UTs 35
• Districts 628
• PHCs 22669
• Microscopy Centres 22669
• Sub-centres 144988
• MPW (M) 65511
• MPW (F)149695
• ASHAs 481308

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Malaria Disease Burden

• 1953 - Estimated Malaria - 75 Million
• Estimated Deaths Due to Malaria 0.8
  Million
• Launching of NMCP
• 1958 - Launching of NMEP
• 1966 - Cases Reduced to 0.1 Million
• Early 70s - Resurgence of Malaria
• 1976 -Malaria Cases 6.46 Million and 59 Deaths
• 1977 - Modified Plan of Operations Introduced
• 1984 - Annual Malaria Incidence Reduced to 2.2.
  Million Cases

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MALARIA ENDEMIC AREAS
PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS (Compared to the country total) PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS (Compared to the country total) PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS (Compared to the country total) PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS (Compared to the country total) PERCENTAGE CONTRIBUTION OF POPULATION, MALARIA CASES, PF CASES AND DEATHS (Compared to the country total)
States Population Malaria cases Pf cases Death
N.E. States 4 13 17 46
Other high endemic states 42 67 77 43
Other 54 20 6 11
API
Andhra, Chhattisgarh, Gujarat, Jharkhand, MP,
Maharashtra, Orissa, Rajasthan
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Distribution of Districts by API
API Districts Nos. Population 000
Less than 0.5 279 531051 50.0
0.5 1 111 219943 20.7
1 2 72 123918 11.7
2 5 79 110015 10.4
More than 5 86 77580 7.3
Total 628 1062508 100.0
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• India - Malaria Control Strategies
• The three pronged strategy for prevention and
  control of malaria is
• Early Diagnosis and Prompt Treatment
• Disease Surveillance through MPWs ASHAs
• b. Case Detection management
• c. Epidemic Preparedness and Response

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

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• Malaria Control Strategies Contd
• 3. Supportive interventions
• 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

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• Early Diagnosis and Prompt Treatment
• a. Disease Surveillance
• Conducted through
• 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

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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

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RDT Supply vs. Need

• 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

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Scaling up RDTs

• Introduced in 2003-04 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

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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 2nd line treatment for treatment of
  Pf cases in CQ resistant areas in 1982.
• 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.

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ACT Supply vs. Need

• 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

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Scaling up ACT
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• Integrated Vector Control
• Indoor Residual Spray
• 1953 entire country uniformly sprayed
• 1977 - MPO adopted (areas with API gt 2 covered
  with IRS)
• Currently high risk areas API gt 3 covered with
  IRS during the transmission season
• 90 Million of Countrys population targeted
  annually and coverage is 80
• Insecticide used DDT, Malathion, Synthetic
  Pyrethroids

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• 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

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ITNs Actual vs. Need
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Scaling up ITNs
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GIS Mapping Based identification of High Risk
Areas Eg. Problematic Villages Identified
through GIS for Focus Intervention in District
Nalbari, Assam (2006)
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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 112.6 million
• LARVIVOROUS FISH
• Cost effective environment friendly method
• Emphasis on perennial water bodies as hatcheries
• Over 2191 district level 19023 Block/ PHC level
  hatcheries established
• No of water bodies seeded are 192,781

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Improving Access to Use of Malaria Prevention
and control Services

• WORLD BANK PROJECT TARGETS
• gt 80 of population in high-risk project areas
  protected by ITNs or IRS
• gt 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

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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

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RBM Partnerships 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.
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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.
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• Indias Progress
• The programme adopted universal coverage during
  1960s 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 countrys population under
  sustained control

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THANK YOU
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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.
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• 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 175-250 million cases
  and 500,000 deaths annually from malaria.

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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 85-125 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.
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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.
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Scaling up ACT
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Plan for Scaling Up For Impact