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1. Strategic Action Plan for Malaria - National Framework 2016-2030, 4-category state classification, time-bound targets (2022-2030), IVM strategies, NSP 2017-2022, special P. vivax strategy
2. Telemedicine - Definition, types (synchronous/asynchronous/RPM), eSanjeevani, India's 2020 Telemedicine Practice Guidelines, advantages and applications in preventive medicine
3. Integrated Vector Control (IVM) - Environmental, biological, chemical, personal protection methods combined; MDA for filariasis; principles from WHO/Park's
4. NIKSHAY - Launched May 2012, meaning (NI+KSHAY = eradication of TB), all 11 functional components, 99 DOTS, DBT-Aadhar linkage, automated reports
5. Vatsayan Kendra / ICTC - HIV counselling and testing centre, 3 types (Standalone, Facility-integrated, Mobile ICTC), 15,000+ centres, functions, community-based HIV screening
6. PPTCT - Started 2002, evolution from SD-NVP to Option B+, all 11 essential service components, Family-Centric approach, Early Infant Diagnosis at 6 weeks
7. IPV - Killed Salk vaccine, 2 fractional intradermal doses at 6 and 14 weeks, role after bOPV switch, OPV vs IPV comparison
8. NPCDCS - Launched 2010, 2 components (Cancer + DCS), 5 objectives, services at all health levels, TCC/SCI funding, 3-cancer screening programme
9. National Tobacco Control Programme - Launched 2007-08, COTPA 2003 provisions, 3-tier structure, TCCs, Quitline (1800-11-2356), mCessation, TB-Tobacco collaboration
10. IDSP - Launched November 2004 (World Bank funded), S-P-L weekly format, CSU/SSU/DSU structure, RRTs, diseases covered, IHIP 2019 upgrade
11. End TB Strategy - WHO 2014 strategy, India's NSP 2020-2025 (target 2025), DETECT-TREAT-PREVENT-BUILD pillars, NTEP (renamed from RNTCP in 2020), key initiatives (Nikshay Poshan Yojana, 99 DOTS, CBNAAT, Bedaquiline)

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Strategic Action Plan for Malaria Control in India

(From Park's Textbook of Preventive and Social Medicine)

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Historical Background - Milestones

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Three-Pronged Strategy of NVBDCP

1. Disease management - early case detection, complete treatment, strengthening referral services, epidemic preparedness and rapid response
2. Integrated Vector Management (IVM) - Indoor Residual Spraying (IRS) in high-risk areas, insecticide-treated bed nets (ITNs), larvivorous fish, anti-larval measures, source reduction, environmental engineering
3. Supportive interventions - Behaviour Change Communication (BCC), public-private partnership, inter-sectoral convergence, human resource development, operational research, monitoring and evaluation, web-based MIS, vaccination against JE, annual MDA against lymphatic filariasis

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National Framework for Malaria Elimination in India (2016-2030)

Goals

1. Eliminate malaria (zero indigenous cases) throughout the entire country by 2030
2. Maintain malaria-free status in areas where transmission has been interrupted and prevent re-introduction

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Time-Bound Objectives

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Programme Phasing - Classification of States/UTs (2014)

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District-Level Stratification (District as Unit of Planning)

1. Zero cases
2. API > 0 to < 1
3. API 1 to < 2
4. API 2 to < 5
5. API ≥ 5

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Broad Strategies of the Malaria Elimination Framework

1. Early diagnosis and radical treatment
2. Case-based surveillance and rapid response
3. Integrated Vector Management (IVM):
   • Indoor Residual Spray (IRS)
   • Long-Lasting Insecticidal Nets (LLINs) / ITNs
   • Larval Source Management (LSM)
4. Epidemic preparedness and early response
5. Monitoring and evaluation
6. Advocacy, coordination and partnerships
7. Behaviour Change Communication (BCC) and community mobilization
8. Programme planning and management

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Category-Specific Interventions

Category 3 - Intensified Control Phase (API ≥ 1)

1. Massive scaling up of disease management and preventive approaches
2. Screening of all fever cases suspected for malaria
3. Classification of areas by local malaria epidemiology; tailored interventions
4. Strengthening intersectoral collaboration; special interventions for tribal populations and hard-to-reach/conflict-affected areas
5. One-stop centres or mobile clinics on fixed days in tribal areas for malaria diagnosis and treatment
6. Timely referral and treatment of severe malaria to reduce mortality
7. Strengthening district/sub-district hospitals as per Indian Public Health Standards for severe malaria management
8. Robust supply chain management system
9. Optimum surveillance using microscopy and RDTs
10. Equipping all health institutions with microscopy, RDTs, and injectable artemisinin derivatives for severe malaria

Category 2 - Pre-Elimination Phase (API < 1, some districts API ≥ 1)

• Setting up elimination surveillance system
• Initiating elimination phase activities in districts where API has been reduced below 1
• Planning based on epidemiological investigation and classification of each case and focus

Category 1 - Elimination Phase (API < 1 in all districts)

1. All efforts directed at interrupting local transmission in all active foci
2. Mandatory notification of each malaria case from private sector and all other health facilities
3. Adequate case-based surveillance and complete case management
4. Investigation and classification of all malaria foci
5. Total coverage of all active foci by effective vector control measures
6. Early detection and treatment using Active Case Detection (ACD) and Passive Case Detection (PCD)
7. State and national level malaria elimination database established
8. Interventions for mobile and migrant populations screening
9. Effective epidemic forecasting and response system
10. Quality assurance of all medicines and diagnostics
11. Establishment of State Reference Laboratory - all positive slides sent for confirmation; 100% notification to laboratory after elimination achieved; immediate SMS/e-mail alert for each positive case with name, gender, address, date, parasite type

Category 0 - Prevention of Re-establishment

1. Detect any re-introduced case
2. Immediately notify all detected cases
3. Determine causes of resumed local transmission
4. Apply rapid curative and preventive measures
5. Prevent re-introduction of malaria
6. Maintain malaria-free status

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Surveillance System

• Active Case Detection (ACD): Blood smears collected by MPWs/ANMs during fortnightly house visits in rural areas
• Passive Case Detection (PCD): Fever cases reporting to peripheral health volunteers/ASHAs, sub-centres, malaria clinics, CHCs, secondary/tertiary hospitals
• ABER (Annual Blood Examination Rate): Maintained at ~10% nationally; much higher in high-endemic areas
• About 100 million blood slides collected from fever cases annually; ~1.5 million malaria cases detected
• RDTs deployed at ASHA level for point-of-care diagnosis
• Programme plans to supply RDT kits to private providers in exchange for data

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Special Strategy for P. vivax Elimination

1. Hypnozoites prolong parasite lifespan and are difficult to detect
2. RDTs for P. vivax are less sensitive than those for P. falciparum
3. Radical treatment requires 14 days of primaquine (vs. only 3 days for P. falciparum ACT)
4. P. vivax has a longer incubation period

• Expanding bivalent RDTs and quality microscopy to detect all P. vivax infections
• Ensuring compliance with 14-day radical primaquine treatment
• Tackling urban malaria by targeting An. stephensi by antilarval measures

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Focus on High-Endemic Areas and Tribal Population

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Key Indicators for Monitoring

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Drug Policy Highlights

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Source: Park's Textbook of Preventive and Social Medicine, 26th Edition, Chapter on Vector-Borne Diseases (NVBDCP) and National Framework for Malaria Elimination, pp. 469-473.