Dte. National Vector Borne Diseases Control Programme (NVBDCP), MOHFW Intensified Malaria Elimination Project (IMEP) Jan’18 - Mar’21 GFATM Supported Dr Avdhesh Kumar Additional Director Dte. National Vector Borne Diseases Control Programme (NVBDCP), MOHFW

Introduction Global Fund is supporting the country Malaria programme. IMCP-II, Round IX: covered 7NE states for 5 years (Oct. 2010 – Sep. 2015). IMCP-3, New Funding Model: 27 months (Oct. 2015 – Dec. 2017). IMEP: 39 months (Jan. 2018 – Mar. 2021). Together, 7 NE states comprise a population of approx. 45 Million in 91 districts. Target group/beneficiaries include marginalized groups, tribal population, women and children & other key population like Jhum cultivators, forest workers, migrants & mobile population (esp. in border areas).

IMEP: Introduction Signing of GF Grant: 27th April 2018 IMEP implemented in project states since Jan 2018 Coverage: 7 NE states & Madhya Pradesh Principal Recipient: Dte. NVBDCP, MoHFW Govt. Sub-Recipients: 8 State Govts. (Arunachal, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Tripura, Madhya Pradesh) NGO Sub-Recipients: Bakdil, Meghalaya & Centre for Peace & Development, Mizoram Goal: To reduce malaria related morbidity and mortality by at least 70% in project areas by 2020.

Objectives Achieve universal coverage of population at risk of malaria with an appropriate vector control intervention (LLIN). Achieve universal coverage of case detection and treatment services at all levels in project areas to ensure 100% parasitological diagnosis of all suspected malaria cases and complete treatment of all confirmed cases. Strengthen the surveillance to detect, notify, investigate, classify and respond to all cases and foci in all districts (in project areas) to move towards malaria elimination. Achieve universal coverage in project areas by appropriate BCC activities to improve knowledge, awareness and responsive behaviour regarding effective preventive and curative interventions. Ensure effective programme management and coordination to deliver a combination of interventions for malaria elimination.

IMEP: Geographical Coverage States: 8 Districts: 147 Popn.: 127 million

NVBDCP Strategies for Malaria Elimination Major Strategies Ensuring daily usage of Long Lasting Insecticidal Nets Early diagnosis with Microscopy /Rapid Diagnostic Tests Complete Treatment as per National Malaria Treatment Policy Community awareness & intersectoral collaboration on malaria Better Monitoring & Supervision Additional HR & Capacity Building Trained ASHAs for Malaria diagnosis & treatment at Community level Quality IRS in high risk areas & other vector control measures Daily LLIN Usage Malaria Microscopy Capacity Building of ASHAs Community Awareness

Performance Indicators: Target & Achievement Impact Indicators Baseline 2015 (7NE + MP) Target 2018 (7 NE + MP) Achievement Confirmed Malaria Cases 2,32,706 94,515 42,179 Malaria I-2.1: Confirmed malaria cases (microscopy or RDT): rate per 1000 persons per year 1.83 0.72 0.325 Malaria I-3.1(M): Inpatient malaria deaths per year: rate per 100,000 persons per year 0.128 0.041 0.011 Malaria I-4: Malaria test positivity rate (%) 1.53 0.62 0.389

Amount in USD (million) IMEP Budget (Jan 2018 - Mar 2021) Approved Funding (PR incl. SRs) Amount in USD (million) Amount in INR (crore) Dte. NVBDCP (PR incl Govt. SRs) 63.46 412.48 Local NGOs (NGO SRs) -Meghalaya & Mizoram 1.55 10.06 Total 65.01 422.54 (Y1- Rs 7.64; Y2- Rs. 227.23; Y3- Rs. 127.93 & Y4- Rs. 59.74) Prioritized Above Allocation Request Amount USD (million) Amount in INR (crore) PAAR (LLINs for Odisha in 2020; and Implementation of HMIS) 49.40 321.10

Financial Utilization as on Dec-18 (Rs in Cr) Cost-Category Total Budget (Jan 18 - Mar 21) Budget (Jan-Dec 18) Utilization (Jan-Dec 18) % Human Resource-HR 51.59 18.62 11.51 61.8 Travel Related Cost-TRC 24.04 7.10 2.45 34.6 External Professional Services-EPS 0.43 0.28 - Health Products Non Pharmaceuticals-HPNP 314.25 181.78 144.72 79.6 Procurement & Supply Chain Management Costs-PSCM 12.15 8.03 4.88 60.7 Non-Health Equipment-NHP 5.83 0.17 0.09 52.8 Communication Material & Publications-CMP* (under procurement) 13.38 12.36 0.08 0.6 Program Adm Costs-PA 0.87 0.23 0.01 6.01 Total 422.54 228.56 163.73 71.6

Achievements under IMCP-3 Significant decline in malaria cases & deaths in NE states & Odisha. 7.24 million LLINs distributed in 7 NE states through mass campaign in 2015-2016 for universal coverage of all sub centers with API >1. 11.34 million LLINs distributed in Odisha. 11.27 million LLINs distributed in Jharkhand & Chhattisgarh. 9.65 million LLINs for Madhya Pradesh: under distribution. 95% of ASHAs trained in 7 NE states & Odisha on malaria prevention & control from October 2015-March 2017. 97.5% of total budget for PR1 utilized.

Epidemiological Situation of Malaria, 7 NE States, 2009-2018 2015 vs 2018: Total cases reduced by 79%; Pf cases reduced by 77%; deaths reduced by 84%

Epidemiological Situation of Malaria, Odisha, 2009 - 2018 2015 vs 2018: Total cases reduced by 85%; Pf cases by 85%; deaths by 95%

Malaria decline in GF supported states, 2009 – 2018: the Success Story … Global Fund supporting Malaria programme since 2005. Success story begins from 7 NE states ... Other states following ... INDIA MALARIA SUCCESS STORY MAP 2018 vs. 2016: •48% decline in total malaria cases; •57% decline in malaria deaths 2018 vs. 2015: •79% decline in total malaria cases; •84% decline in malaria deaths 7 NE States Jharkhand Odisha Chhattisgarh Success story moves to Odisha ... Success story moves to Chhattisgarh ... 2018 vs. 2016: •62% decline in total malaria cases; •73% decline in malaria deaths 2018 vs. 2015: •85% decline in total malaria cases; •95% decline in malaria deaths Success story moves to Jharkhand ...

World Malaria Report, 2018: Recognizes India Malaria Program’s Success About 70% of world’s malaria cases in 2017 reported from 10 countries in Sub Saharan Africa and India (10+1). Worldwide cases increased from 217 million (2016) to 219 million (2017). 3.5 million more malaria cases reported in the 10 African countries in 2017 compared to 2016. Only India reported decline (24%) in malaria cases in 2017 compared to 2016.

Major Supplies/ Interventions 50 million LLINs distributed so far… Major supplies/ interventions 7.24 million LLINs distributed in 7 NE states 11.34 million LLINs distributed in Odisha 4.93 million LLINs distributed in Chhattisgarh 10 million LLINs distributed to other states 104 Vehicles to Districts/ States for better programme implementation 351 Motorbikes to enhance monitoring & supervision 1515 Microscopes to improve diagnostic facilities 5 RoHFWs equipped with training microscopes to enhance quality trg 1186 Additional HR for effective programme implementation 9.65 million LLINs supplied to Madhya Pradesh 6.35 million LLINs distributed in Jharkhand Transportation of LLINs to difficult areas Acceptance of LLINs by community Distribution of IEC material Miking activity

LLINs Distribution and Usage 16 16

Challenges & Way Forward... To sustain the gains achieved so far ..... Making malaria a notifiable disease; Enhanced surveillance, monitoring & supervision; Better entomological support; Involving other sectors esp. private sector; Drug resistance & insecticide resistance; Cross border collaboration; GF is exiting from India by 2026 Malaria elimination target is 2030 HR under GFATM gradually shifting to DBS Strong financial support is CRUCIAL

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