The National Health Policy, 2017 envisages “the attainment of the highest possible level of health and wellbeing for all at all ages, through a preventive and promotive health care orientation in all developmental policies, and universal access to good quality health care services without anyone having to face financial hardship as a consequence”. The aim of the National Health Mission (NHM) is to ensure progress towards the goals and targets set out in the National Health Policy, 2017 for ensuring “universal access to equitable, affordable and quality health care services, accountable and responsive to people’s needs”. This would also enable the country to advance towards meeting Sustainable Development Goal (SDG) 3, i.e. “Ensure healthy lives and promote well-being for all at all ages”, including Universal Health Coverage.The National Center for Vector Borne Diseases Control (NCVBDC), under the overarching umbrella of National Health Mission (NHM), deals with six vector borne diseases i.e. Malaria, Dengue, Chikungunya, Japanese Encephalitis, Kala – Azar and Lymphatic Filariasis.
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Malaria is a potentially life threatening parasitic disease caused by parasite Plasmodium having five known species namely, Plasmodium vivax (P. vivax), Plasmodium falciparum (P. falciparum), Plasmodium malariae (P. malariae), Plasmodium ovale (P. ovale) and Plasmodium knowlesi (P. knowlesi). It is transmitted by the infective bite of female Anopheles mosquito. Two species of the parasite, P. vivax and P. falciparum are commonly reported from India. P. falciparum is the cause for complications and leads to death, if not treated immediately. Malaria is a significant public health concern in India, though its burden has been reduced significantly in recent years due to sustained control efforts.Malaria is endemic in several states, with higher prevalence in rural, tribal, and forested regions. States like Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, and parts of the Northeast are particularly affected. Malaria is transmitted in India through the bite of infected female Anopheles mosquitoes, mainly by Anopheles culicifacies (in rural areas) and Anopheles stephensi (urban areas). These mosquitos breed in ponds, lakes and marshlands in rural areas and overhead tanks, unused wells, and cisterns in urban areas. P. vivax is more prevalent in the plains while P. falciparum predominates in forested and peripheral areas.
The journey for anti-malaria activities started after Dr. Leveran discovered the malaria parasite (MP) in 1880 and Dr. Ronald Ross discovered transmission of malaria by female anopheline mosquito in 1897. The goals of National Malaria Eradication Programme (NMEP) are to interrupt local transmission, therefore, achieve zero indigenous case throughout the country by 2027 and provide an enabling environment to prevent re-establishment of malaria. Malaria free Status is granted to a country by WHO after a country has demonstrated, using rigorous, credible evidence, that the chain of indigenous malaria transmission by Anopheles mosquitoes has been disrupted nationwide for at least three consecutive years. That means a country that has achieved at least three consecutive years of zero indigenous cases. Till date, WHO has awarded the ‘malaria-free’ certification to 43 countries and 1 territory in the world. Even in South East Asian Region, WHO certified Maldives (in 2015) and Sri Lanka (in 2016) as malaria free. Through “National Framework for Malaria Elimination” (NFME), 2016-2030, India wants to achieve zero indigenous cases of Malaria in the country by 2027 and get ‘malaria free’ certification by 2030. India has made remarkable progress in the fight against malaria. India has set the goal of achieving malaria elimination by 2030, as outlined in the National Framework for Malaria Elimination (NFME) 2016-2030 in sync with Sustainable Development Goals (2016-2030). Under Intensified Malaria Elimination Project-3 (IMEP-3) from April 2024 to March 2027 (3 years), Global Fund has been providing financial assistance to Government of India to fight against malaria in 12 states (i.e. 7 North-Eastern States (Arunachal Pradesh, Assam, Meghalaya, Mizoram, Nagaland, Manipur & Tripura), Odisha, Jharkhand, Chhattisgarh, Maharashtra for support from NGO & others and Madhya Pradesh for LLIN only covering total 159 districts. India has made substantial progress in reducing malaria burden. In 1947, there were an estimated 75 million (7.5 crores) cases and 0.8 million (8 lakh) deaths in India. Cases have declined significantly from 6.46 million in 1976 to 0.176 million (1.76 lakh) in 2022.The country has achieved a reduction of 80.5% in malaria morbidity and 78.4% in malaria mortality between 2015 and 2023. This significant achievement is largely due to a combination of preventive measures, effective treatments and community engagement. ln 2023, National API is 0.16 per 1000 population and total 34 States/UTs have achieved API less than 1 except 2 States Tripura (5.69) and Mizoram (14.23).In 2023, a total 122 districts in the country have reported ‘zero malaria cases’.
Some key strategies that contributed to this success include:
- Transforming Malaria surveillance as a core intervention for malaria elimination
- Ensuring universal access to malaria diagnosis and treatment by enhancing and optimizing case management -“testing, treating and tracking”
- Ensuring universal access to malaria prevention by enhancing and optimizing vector control through distribution of insecticide-treated mosquito nets and indoor residual spraying
- Accelerating efforts towards elimination and attainment of malaria-free status (zero indigenous case by 2027 and WHO certification of Malaria free status by 2030)
- Promoting research and innovation for malaria elimination
There has been a substantial reduction in the High burden districts from 155 in 2015 to 33 in 2023. Also, 94 districts reported zero Indigenous malaria cases consecutively for three years from 2021 to 2023. The progress of the country against the disease based on the Annual Parasite Incidence (Number of confirmed malaria cases per 1000 population per year) is depicted below:
The progress of the Malaria indicators during 2015-2023 is given below:
| Sl. No. | Subject | 2015 | 2023 | Achievements |
| 1 | Reduction in Malaria cases (Morbidity) | 1169261 | 227564 | 80.5 reduction in 9 years |
| 2 | Reduction in deaths due to Malaria (Mortality) | 384 | 83 | 78.3% reduction in 9 years |
| 3
|
#Annual Parasite Incidence (API) | 0.92 | 0.16 | 82% reduction in 9 years |
| 4 | **Annual Blood Examination Rate (ABER) | 9.58 | 11.62 | 21% increase in 9 years |
| 5 | Districts reporting zero Malaria cases | 30 | 128 | 98 more districts reporting zero cases in 9 years |
#Annual Parasite Index (API) – The number of new confirmed malaria cases per 1,000 population per year.
**Annual Blood Examination Rate (ABER) – The number of blood smears examined or Rapid Diagnostic Test (RDT) for malaria per 100 people in a population per year.
However, malaria remains a significant public health issue in India, especially in rural and remote areas. There are some challenges for malaria elimination like drug and insecticide resistance, hard-to-reach populations in tribal and forested areas, health infrastructure limitations in remote regions of India and climate change, which can alter mosquito-breeding patterns.
Notably, India contributed only 0.8% of global malaria cases and 0.6% of malaria-related deaths in 2023. Sub-Saharan Africa accounts for approximately 90% of global malaria cases and deaths. India’s efforts have been recognized globally, and the country has exited the WHO’s High Burden to High Impact (HBHI) group in 2024 which is considered as a turning point in India’s fight against malaria.The World Malaria Report (WMR) 2024, released by the World Health Organization (WHO) on December 11, 2024, underscores India’s significant achievements towards malaria elimination. This report is a comprehensive review of global malaria trends, recognizing India’s sustained efforts in this endeavour. All these achievements depict the nation’s robust public health system/interventions and its vision to achieve malaria-free status by 2030.
Malaria elimination in India requires a multi-dimensional, coordinated approach involving improved surveillance, vector control, treatment strategies, healthcare infrastructure, and community engagement. Ensuring equity in access to services, strong political commitment, and adequate funding will be essential to achieving the goal of malaria-free India.India remains committed in its goal of becoming malaria-free by 2030 by focusing on strategically leveraging emerging technology and scientific advancements, enhanced capacities, community engagement, and sustained investments to further reduce the incidence and burden of Malaria.
*Dr Sudarsan Mandal is now Sr. Chief Medical Officer, NCVBDC and formerly DDG (TB/NCD/Leprosy)
