Cross-border Collaboration for Malaria Elimination …india-ccm.in/wp-content/uploads/2018/04/Cross-border...Elimination National Framework for Malaria Elimination in India (NFME),

Cross-border Collaboration for

Malaria Elimination in SE Asia

Dr. Avdhesh Kumar

Additional Director

National Vector Borne Diseases Control Programme,

Ministry of Health & Family Welfare, Govt. of India

India: Demographic & Health Profile

• Population: 1.31 billion; rural: 67%

• Area: 3.29 million sq km; forest area: 21%

• Bordering countries: 8

• 36 States/ UTs with average popn. 36 million

• 678 Districts with average popn. 1.86 million

• 25,308 PHCs with average popn. of 52,000

• 153,655 Sub-centres with average popn. of

8500

• Village worker (ASHA) 700,000 with average

1000 popn.

Background• India, Bangladesh & Myanmar: high endemic; Nepal:

medium endemic; Bhutan: low endemic

• Malaria elimination target: B’desh - 2030; Bhutan - 2020; Myanmar - 2030; Nepal - 2025

• Border areas are high malaria endemic with:

– difficult areas;

– poor health infra-structure;

– Highly mobile and tribal population;

– Sometimes political insurgency;

– Problem of drug resistance

• Cross-cutting interventions: Cross-border collaboration is critical

• International borders - Bangladesh, Bhutan, India Myanmar, Nepal - significant for malaria elimination

Total malaria cases declined by 58.6%; Pf cases by 49%; deaths by 88.8%in 2017 compared to 2000.

487

290

162113

119

222

135

76

190

100

200

300

400

500

600

0

50000

100000

150000

200000

250000

2009 2010 2011 2012 2013 2014 2015 2016 2017*

Total Cases PF Cases Deaths

De

ath

s

Cas

es

*Provisional

Epidemiological Situation, NE States, India, 2009-2017*

Total malaria cases declined by 84.3% & 72.2%; Pf cases by 82.7 & 72.1%;and deaths by 96% & 75% in 2017 compared to 2009 & 2015, respectively.

CATEGORISATION OF STATES BASED ON MALARIA BURDEN (API)

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

TELANGANA

CHHATTISGARH

ANDHRA PRADESH

PUNJAB

JHARKHAND

WEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEP

N

EW

S

Malaria Elimination StatesCatetory-I (15)

Category-II (11)

Category-III (10)

• Chandigarh, Daman & Diu, Delhi, Goa, Haryana, Himachal Pradesh, J & K, Kerala, Lakshwadeep, Manipur, Puducherry, Punjab, Rajasthan, Sikkim, Uttarakhand

Category 1

(15)

• Andhra Pradesh, Assam, Bihar, Gujarat, Karnataka, Maharashtra, Nagaland, Tamil Nadu, Telangana, Uttar Pradesh, West Bengal

Category 2

(11)

• A & N Islands, Arunachal Pradesh, Chhatisgarh, Dadra & Nagar Haveli, Jharkhand, Madhya Pradesh, Meghalaya, Mizoram, Odisha, Tripura

Category 3

(10)

STATES WITH MAJOR BURDEN OF MALARIA -2016

Name of the

State/UTs

Pop. in

(000's)B.S.E. Pf Cases

%

CONTRIBUTION

TO Pf.

Total

Malaria

Cases

%

CONTRIBUTION

TO TOTAL

MALARIA

Deaths

Odisha 43905 7188885 389332 54 449697 41 77

Chhattisgarh 27930 4830145 121503 17 148220 14 61

Jharkhand 36893 2959427 83232 12 141414 13 15

Meghalaya 3285 468254 31867 4 35147 3 45

Tripura 3940 351392 9545 1 10546 1 14

Mizoram 1172 267747 5907 1 7583 1 9

TOTAL OF

ABOVE STATES117125 16065850 641386 90 792607 73 221

ALL INDIA 1281912 124920962 716166109067

7331

LLINs Distribution and Usage

40 million LLINs distributed in 7 NE States, Odisha, Jharkhand & Chhattisgarh; 11 other States; 9.3 million LLINs in pipeline

National Policies and Guidelines for Malaria

Elimination

National Framework for Malaria

Elimination in India (NFME), 2016-30

Launched by Hon’ble Health & Family Welfare

Minister on February 11, 2016

Operational Manual for Malaria

Elimination in India- Version 1

Launched by Director General of

Health Services (DGHS) on World

Malaria Day- April 25, 2016

Category Definition No. (%)

Cat 0: Prevention of re-Establishment phase

Districts historically without localtransmission; reported no case for 3 yrs.

75 (11.0)

Cat 1: Elimination phase Districts having API < 1 per 1000 popn. 448 (66.1)

Cat 2: Pre-elimination phase Districts having API 1-2 per 1000 popn. 46 (6.8)

Cat 3: Intensified control phase Districts having API >2 per 1000 popn. 109 (16.1)

Cat 3 districts: Odisha (22); Chhattisgarh (17); Jharkhand (17); MP (10); Arunachal (10); Mizoram (7); Meghalaya (6); Tripura (6); Assam (5)

National Strategic Plan, 2017-22Districts as operational units; stratified in 4 categories based on API 2014-16.

Goal:

• Eliminate malaria in Category 1 districts (API <1) by 2020;

• Eliminate malaria in Category 2 districts (API 1–2) by 2022;

• Reduce transmission in Cat 3 districts (API>2) to stabilize API at <1 by 2022.

Indian Districts Bordering with Bhutan, Nepal, Bangladesh & Myanmar (Districts-70/ States -12)

BHUTANARUNACHAL PRADESH

ASSAM

MEGHALAYA

SIKKIM

INDIA

East District

Darjiling

Jalpaiguri

KokrajharChirang Baksa Udalguri

West Kameng

Towang

KokrajharChirang Baksa Udalguri

West Kameng

Towang

Pithoragarh

Champawat

Udhamsingh Nagar

Pilibhit

Kheri

Bahraich

Srawasti

Balrampur

SiddharthnagarMaharajganj

Kushinagar

Champaran West

Champaran EastSitamarhi

MadhubaniSupaul

ArariaKishanganj

Darjiling

West District

North District

UTTAR PRADESH

BIHAR

UTTARAKHAND

WEST BENGAL

TRIPURA

24-Parganas South

Nadia

Murshidabad

24-Parganas North

Maldah

Dakshin Dinajpur

Uttar Dinajpur

Darjiling

Jalpaiguri

Koch Bihar

Dhubri

West Garo Hills

South Garo Hills

West Khasi Hill

East Khasi HillJaintia Hills

Cachar

Karimganj

Tripura North

Tripura West

Tripura South

Dhalai

Tripura North

Mamit

Lunglei

Lawngtlai

Darjiling

BANGLADESH

MIZORAM

Anjaw

Changlong

Tirap

Mon

Tuensang

Kiphire

Phek

Ukhrul

ChandelChurachandpur

Champhai

Serchhip

Lunglei

Saiha

Lawngtlai

INDIA

MYANMAR

MANIPUR

NAGALAND

NEPAL

JHARKHAND

CHHATTISGARH

ORISSA

MADHYA PRADESH

MAHARASHTRA

N

EW

S

•Total Bordering Districts Population-115 million•Total Bordering PHCs Population - 17 Million

Districts bordering with Bangladesh (Districts -25 /States- 5 )

BHUTANARUNACHAL PRADESH

ASSAM

MEGHALAYA

SIKKIM

INDIA

BIHAR

WEST BENGAL

TRIPURA

24-Parganas South

Nadia

Murshidabad

24-Parganas North

Maldah

Dakshin Dinajpur

Uttar Dinajpur

Darjiling

Jalpaiguri

Koch Bihar

Dhubri

West Garo Hills

South Garo Hills

West Khasi HillEast Khasi Hill

Jaintia Hills

Cachar

Karimganj

Tripura North

Tripura West

Tripura South

Dhalai

Tripura North

Mamit

Lunglei

Lawngtlai

Darjiling

BANGLADESH

MIZORAM

N

EW

S

BHUTANARUNACHAL PRADESH

ASSAM

MEGHALAYA

WEST BENGAL

SIKKIM

INDIA

East District

Darjiling

Jalpaiguri

KokrajharChirang Baksa Udalguri

West Kameng

Towang

N

EW

S

Districts of India Bordering with Bhutan (Districts-9/ States-4)

BHUTANARUNACHAL PRADESH

ASSAM

MEGHALAYA

TRIPURA

BANGLADESH

MIZORAM

Anjaw

Changlong

Tirap

Mon

Tuensang

Kiphire

Phek

Ukhrul

ChandelChurachandpur

Champhai

Serchhip

Lunglei

Saiha

Lawngtlai

INDIA

MYANMARMANIPUR

NAGALAND

N

EW

S

Districts of India Bordering with Myanmar(Districts-15/ States-4)

NEPALSIKKIM

Pithoragarh

Champawat

Udhamsingh Nagar

Pilibhit

Kheri

Bahraich

Srawasti

Balrampur

SiddharthnagarMaharajganj

KushinagarChamparan West

Champaran EastSitamarhi

MadhubaniSupaul

ArariaKishanganj

Darjiling

West District

North District

UTTAR PRADESH

BIHAR

UTTARAKHAND

WEST

BENGAL

INDIA

N

EW

S

Districts of India Bordering with Nepal (Districts-21/ States-5)

Strategies for Cross-border

Collaboration• Screening of population;

• Training of security personnel;

• Dx & Tt facilities;

• Data collection and its integration into national MIS;

• Sharing of information & policy guidelines;

• Joint planning & implementation of malaria prevention & control activities;

• Regular Review Meetings

Financial support - CRUCIAL

Regional WHO (Regional Coordination Cell)

National National

State State

District District

Coordination Mechanism for Cross-

border Collaboration

Challenges and Way Forward...3 main Challenges

• Political: Advocacy, Leadership

• Technical: Support through WHO & other agencies

• Financial: GF support; other donor agenciesf

• Joint Action Plan for

➢Reducing importation risk on both sides - Strong

surveillance system required

➢Vector control - help in reducing vector load and

thus reducing risk of transmission on both sides

➢EWS & Rapid Response (Team)

➢Information sharing

Challenges and Way Forward...• Joint Annual Evaluation/Review by bordering

nations

– Mid-term Reviews

– Biennial Evaluations

• Inter-country Meeting of bordering nations: Involve

MOH, MEA, MHA for broader agreement on day-to-

day collaboration

• State/ District level Inter-country Meeting

• GF support for Regional Cross-border

Collaboration Proposal;

• Savings from GF grants utilized

Thank you