National Strategic Plan for Malaria Elimination, Democratic state needs a democratic civil society and vice versa Current Affairs 20th July, 2017DEVENDRA VISHWAKARMA
National Strategic Plan for Malaria Elimination
The government has recently released a national strategic plan for the elimination of malaria, and pledged to eradicate the vector-borne disease by 2027.
How bad the situation is when it comes to vector- borne diseases?
- In New Delhi, which was the epicentre of a chikungunya outbreak last year and a dengue outbreak the year before, at least 50 new cases of malaria have been reported in the past week alone, taking the total number of cases since January to 225, according to the city’s municipal corporations.
- Across the country, in Kerala, there have been more than 10,300 new dengue infections and the disease has claimed 21 lives this year.
- Tamil Nadu has reported 4,400 cases, followed by Karnataka with more than 2,100 cases.
- Swine flu is also on the rise: More than 600 people have already died and another 12,460 people have been infected this year. In comparison, there were only 1,786 infections and 265 swine flu deaths all of last year.
- Similarly, chikungunya, which reappeared in this country a little more than a decade ago, has shown no signs of abating. In just three years between 2014 and 2016, there has been a 300-400% increase in the incidence of chikungunya, according to data analysed by the Centre for Science and Environment (CSE).
- India has the third highest malaria burden in the world.
National Strategic Plan (NSP) for Malaria Elimination (2017-22):
The NSP is a year-wise roadmap for malaria elimination across the country based on last year’s National Framework for Malaria Elimination.
The NSP divides the country into four categories, from 0 to 3.
- Zero category: It has 75 districts that have not reported any case of malaria for the last three years.
- Category 1: has 448 districts, in which the annual parasite incidence (API, or the number of positive slides for the parasite in a year) is less than one per 1,000 population.
- Category 2: has 48 districts, the API is one and above, but less than two per 1,000 population.
- Category 3: has 107 districts, reporting an API of two and above per 1,000 population.
The plan is to eliminate malaria (zero indigenous cases) by 2022 in all Category 1 and 2 districts. The remaining districts are to be brought under a pre-elimination and elimination programme.
The NSP also aims to maintain a malaria-free status for areas where transmission has been interrupted. It seeks to achieve universal case detection and treatment services in endemic districts to ensure 100% diagnosis of all suspected cases, and full treatment of all confirmed cases.
Components of the plan:
The plan has four components, based on WHO recommendations: diagnosis and case management; surveillance and epidemic response; prevention — integrated vector management; ‘cross-cutting’ interventions, which include advocacy, communication, research and development, and other initiatives.
Salient features of the NSP :
- Containment of breeding.
- Strengthening malaria surveillance
- Establishing a mechanism for early detection and prevention of outbreaks of malaria.
- Promoting the prevention of malaria by the use of Long Lasting Impregnated Nets (LLINs).
- Effective indoor residual spray.
- Augmenting the manpower and capacities for effective implementation for the next five years.
- Achieving the lofty goal will depend on effective implementation and sustained commitment to the project.
- The government will also need to tackle the root causes of the problem, such as genetic changes in pathogens, insecticide and drug resistance, the challenges of poor urban planning.
- Another area of concern is funding. Last year, the Central government released only 68% of budgeted funds under the national vector-borne disease control programme, and an even smaller percentage of that was actually utilized, according to the CSE’s State Of India’s Environment 2017.
- The lack of adequate healthcare workers who can carry out a prevention programme on a war footing is also a challenge. This includes not just field workers but also entomologists who can research all aspects of vector populations and recommend how these can be kept below the “critical mass”.
- The prospects for vaccines against vector-borne diseases seem to be poor. In India, the International Centre for Genetic Engineering and Biotechnology has been working on a malaria vaccine for at least a decade but it is not ready for clinical trials yet. A dengue vaccine that is being used in about a dozen other countries is not yet allowed in India.
- Other problems include access to conflict-affected tribal areas, and to areas with a high malaria endemicity and insecticide resistance. High endemicity states include those in the Northeast, which share borders with neighbouring countries like Bangladesh, where the prevalence of malaria is high.
Fighting vector-borne diseases is not easy:
- Least of all in a place like India that is a breeding ground for at least six major vector-borne diseases—malaria, dengue, chikungunya, filariasis, Japanese encephalitis and visceral leishmaniasis. As pathogens travel across continents and new strains continue to emerge, the fight against vector-borne diseases has, once again, become a global public health challenge.
- From the 17th through the early 20th century, vector-borne diseases such as malaria, dengue, yellow fever, plague and typhus routinely wreak havoc on entire populations. Since the 1970s, many of the diseases have resurfaced, with even greater intensity in recent decades.
What has resulted into resurgence of vector-borne diseases: