A model for malaria elimination based on learnings from the Malaria Elimination Demonstration Project, Mandla district, Madhya Pradesh

Abstract

Background: Malaria Elimination Demonstration Project (MEDP) was started as a Public-Private-Partnership between the Indian Council of Medical Research through National Institute of Research in Tribal Health, Govt. of Madhya Pradesh and Foundation of Disease Elimination and Control of India, which is a Corporate Social Responsibility (CSR) initiative of the Sun Pharmaceutical Industries Limited. The project's goal was to demonstrate that malaria can be eliminated from a high malaria endemic district along with prevention of re-establishment of malaria and to develop a model for malaria elimination using the lessons learned and knowledge acquired from the demonstration project.

Methods: The project employed tested protocols of robust surveillance, case management, vector control, and capacity building through continuous evaluation and training. The model was developed using the learnings from the operational plan, surveillance and case management, monitoring and feedback, entomological investigations and vector control, IEC and capacity building, supply chain management, mobile application (SOCH), and independent reviews of MEDP.

Results: The MEDP has been operational since April 2017 with field operations from August 2017, and has observed: (1) reduction in indigenous cases of malaria by about 91 %; (2) need for training and capacity building of field staff for diagnosis and treatment of malaria; (3) need for improvement insecticide spraying and for distribution and usage of bed-nets; (4) need for robust surveillance system that captures and documents information on febrile cases, RDT positive individuals, and treatments provided; (5) need for effective supervision of field staff based on advance tour plan; (6) accountability and controls from the highest level to field workers; and (7) need for context-specific IEC.

Conclusions: Malaria elimination is a high-priority public health goal of the Indian Government with a committed deadline of 2030. In order to achieve this goal, built-in systems of accountability, ownership, effective management, operational, technical, and financial controls will be crucial components for malaria elimination in India. This manuscript presents a model for malaria elimination with district as an operational unit, which may be considered for malaria elimination in India and other countries with similar geography, topography, climate, endemicity, health infrastructure, and socio-economic characteristics.

Keywords: Malaria elimination; Malaria model; Mandla; National malaria elimination.

Fig. 1

Map of India showing the malaria distribution. States of Odisha, Chattisgarh, Madhya Pradesh, and the north eastern states are most affected by malaria. (Source: NVBDCP)

Fig. 2

Comparative schematic of the malaria surveillance and case reporting system between the state government (right) and FDEC India (left) at district-level. Same color boxes indicate equivalent positions between the two systems

Fig. 3

Two different model showing ANM/MPW and ASHA as the primary unit of surveillance

Fig. 4

SWOT categorization of both ANM/MPW and ASHA-based models

Fig. 5

Real time cases information group in local language. English translation provided in blue colour

Fig. 6

Hardcopy data reporting model at district-level

Fig. 7

Stock request from front line worker through the mobile app. English translation written adjacent to local language text