18-Jul-2017: Five-year plan to eliminate malaria

According to the World Malaria Report 2016, India contributed 89% of the incidence of malaria in the South-East Asia region. As per the provisional epidemiological report 2016, there were over 10 lakh positive cases in India’s 36 states and UTs, which caused 331 deaths. The Indian record stands in sharp contrast to some of its neighbours — the Maldives was certified malaria-free in 2015, and Sri Lanka followed last year.

The Health Ministry has now released its vision for ridding the country of malaria by 2027, and of eliminating the disease by 2030. To be declared malaria-free, a country has to report zero incidence for at least three years. The ambitious National Strategic Plan (NSP) for Malaria Elimination (2017-22) was launched last week in New Delhi by Health Minister J P Nadda. The NSP, a year-wise roadmap for malaria elimination across the country, is based on last year’s National Framework for Malaria Elimination, which was, in turn, spurred by World Health Organization's Global Technical Strategy for Malaria, 2016-2030.

What is this plan to eradicate malaria?

The NSP divides the country into four categories, from 0 to 3. Zero, the first category, 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. In Category 2, which 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.

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. There are 660 reporting districts, which, along with another 18 reporting units, make up a total of 678 reporting units.

Which states have the highest incidence of malaria?

In India, malaria is caused by the parasites Plasmodium falciparum (Pf) and Plasmodium Vivax (Pv). Pf is found more in the forest areas, whereas Pv is more common in the plains. The disease is mainly concentrated in the tribal and remote areas of the country. The majority of reporting districts are in the country’s eastern and central parts — the largest number of cases are found in Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, and the Northeastern states of Tripura, Mizoram and Meghalaya.

What kind of challenges is the NSP likely to face?

One of the biggest challenges is the shortage of manpower. According to the Health Ministry, there are only about 40,000 multipurpose health workers (MPWs) against the approximately 80,000 sanctioned posts in the 1,50,000 subcentres in the country. 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.

How will the NSP be funded?

The resources required for the elimination of malaria would be to the tune of Rs 10,653.16 crore over a period of five years (2017-2022). According to the NSP, the finances would be managed from government sources, international donors, and the corporate sector as part of companies’ corporate social responsibility. Of the total sum required, Rs 4,381.23 crore will be spent on intervention, Rs 6,223.05 crore to meet programme costs, and Rs 48.88 crore on governance and other heads.

Why is this plan significant?

For the first time, the union Health Ministry has come up with a roadmap for elimination of malaria in the country. Before this, the effort was to “control” malaria under the National Vector Borne Disease Control Programme. The NSP is a detailed strategy with operational guidelines for Programme Officers of all states towards set targets. It has also given a detailed breakdown of annual budgetary requirements over five years.

28-Jul-2017: Operational Guidelines for Planning and Implementation of Family Participatory Care

Ministry of Health and Family Welfare recently released Operational Guidelines for Planning and Implementation of Family Participatory Care (FPC) for improving newborn health. The guidelines will serve as a guiding document for those intending to introduce FPC in their facility as an integral part of facility based newborn care. The document also provides details of infrastructure, training, role of health care providers and steps in the operationalization of FPC in the newborn care unit. The operational guidelines of FPC are for all stakeholders involved in the process of planning and delivering newborn care.

The guidelines also addresses various aspects of attitudes, infrastructural modifications and practice that will help in establishing FPC at Special Newborn Care Units (SNCU) such as sensitization of State and District Managers on FPC, prioritization of SNCUs for initiating FPC, making required infrastructural enhancement in SNCU, creating family participatory care environment in SNCU, ensuring availability of supplies for parents-attendants, training of SNCU staff for SNCU, role of healthcare providers for FPC implementation and institutional support for FPC.

Under FPC, the capacities of parents-attendants are built in newborn care through a structured training programme (audio -visual module and a training guide). The staff at newborn care unit will provide continuous supervision and support. Provisions for infrastructure and logistics strengthening required for implementing FPC are ensured in the annual state Program Implementation Plan (PIP). The guidelines will be shared with the States for implementation and it is expected that these guidelines when implemented by States would further improve the quality of care being provided in the SNCUs across the country.

Sick and newborn are highly vulnerable and require careful nurturing in order to survive the neonatal period and first year of life. Under National Health Mission, more than 700 state of the art Special Newborn Care Units (SNCU) have been established across the country to provide 24 X 7 comprehensive care to the newborns by dedicated trained staff.

In the recent years, it is realized that if parents are trained, during the stay of their babies in the hospital, to provide supportive care to their sick and newborns, it will help in not only improving survival of the babies after discharge but will also provide for psycho-social and developmental needs of the newborn. In this regard, Family Participatory Care has emerged as an important concept of health care which provides for partnership between health care staff and families in care of sick newborns admitted in the SNCU.