NSP MALARIA INDIA DELHI NEW DELHI 110001

NSP MALARIA INDIA DELHI NEW DELHI 110001

1. 1
NATIONAL STRATEGIC PLAN FOR
MALARIA ELIMINATION-
CURRENT STATUS AND
PROGRESS SO FAR

Presenter: Dr Radhikaa
Facilitator: Dr Nidhi
Moderator: Dr Kriti Vaish

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Introduction and Burden of Disease

Plan of Presentation
Epidemiology of Malaria

Evolution of Malaria Control in India

National Strategic Plan 2023-27
1
2
3
4
6
5 Progress So Far and Current Status (As of July 2025)
References

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INTRODUCTION
●Malaria: Plasmodium spps
●Transmitted by: bite of infected female Anopheles
species, blood transfusions, infected needles, or
transplacentally.
●Symptoms: from mild to severe illness, and death.

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BURDEN OF DISEASE
In 2023, 90% cases globally from WHO African region.
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India: 0.8% cases globally, 55% in WHO SEARO region.
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From 2015 to 2023, 80.5% reduction in malaria cases and
78.3% decrease in deaths in India.
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2015: India reported total 11.7L cases, with 384 deaths.
2024: India reported total 2.5L cases, with 86 deaths.
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3
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1. World Health Organization. World Malaria Report 2024 [Internet]. Geneva: WHO; 2024 [cited 2025 Jul 27]. Available from:
www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2024
2.National Centre for Vector Borne Disease Control. Annual Report 2024: Malaria [Internet]. New Delhi: Ministry of Health and Family Welfare,
Government of India; 2024 [cited 2025 Jul 27]. Available from: ncvbdc.mohfw.gov.in/Doc/Malaria-Annual-Report-2024.pdf

5. Source: WHO Malaria Report 2024
0.8%

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BURDEN OF DISEASE
Approximately 44% of reported cases and 43% deaths from
37 tribal-dominated and hard-to-reach districts (5% of the
country's population).
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High burden states: Jharkhand, Chhattisgarh, Odisha and 7
north eastern states (Assam, Meghalaya, Manipur, Mizoram,
Nagaland, Arunachal Pradesh, Tripura).
4
1
2
3. National Centre for Vector Borne Disease Control. Malaria Situation in India [Internet]. New Delhi: Ministry of Health and Family Welfare,
Government of India; 2023 [cited 2025 Jul 27]. Available from: nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=564&lid=3867
4. Directorate of National Vector Borne Disease Control Programme. National framework for malaria elimination in India 2016–2030 [Internet]. New
Delhi: Ministry of Health and Family Welfare, Government of India; 2016 [cited 2025 Jul 27]. Available from:
ncvbdc.mohfw.gov.in/National-framework-for-malaria-elimination-in-India-2016%E2%80%932030.pdf

7. 7Figure: Distribution of districts according to annual parasite index (API) in 2022

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EPIDEMIOLOGY OF DISEASE
Factors affecting disease:
●Environmental factors
●Parasite virulence factors
●Entomological factors
●Host susceptibility factors
Source: Encyclopedia of Epidemiology

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HOST SUSCEPTIBILITY FACTORS
●Gender
●Pregnancy
●Chronic infections/comorbidities
●Age
●Immunity
●Occupational and behavioural factors
●Genetic polymorphism

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ENVIRONMENT FACTORS
●Temperature
●Altitude
●Precipitation
●Urbanization
●Socioeconomic development
Climate change
●Health systems preparedness

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Figure: Distribution of anopheline species in India
(Source: National Strategic Plan: Malaria Elimination 2023-27)

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PARASITE VIRULENCE FACTORS
●P. falciparum: ~60% cases, ↑ complications, fatality
●P. vivax: more benign, with risk of relapse
●5 species of Plasmodium, 2 common in India
●Antigenic variations (↑ in falciparum) → drug resistance
●Immune evasion by hypnozoites in vivax
●Vector specificity
●Pyrogenic threshold

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ENTOMOLOGICAL FACTORS
●Insecticide resistance
●Feeding preferences (anthropophilic/zoophilic;
endophagic/exophagic)
●Vectorial capacity
●Resting behaviour (endophilic/exophilic)
●Breeding habitats
Where,
m = ratio of mosquitoes to humans;
a = biting rate;
p = mosquito survival probability;
n = extrinsic incubation period●Genetic resistance
●Behavioural resistance

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Feature Species Programmatic Implication
AnthropophilicAn. stephensi,
fluviatilis, baimaii
More likely to cause human malaria
outbreaks
Zoophilic
(partial)
An. culicifacies Reduced human transmission, varies
by region
Endophilic (rest
indoors)
An. stephensi,
minimus
Good targets for IRS and LLINs
Exophilic (rest
outdoors)
An. fluviatilis, baimaiiRequire outdoor vector control
Urban breedingAn. stephensi Rising risk in cities – water storage
management needed
Forest breedingAn. dirus, fluviatilis Tribal/forest malaria – needs focused
interventions

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Important Definitions
Malaria control: Reducing disease burden to a level at which it is no longer a
public health problem. (Continued measures required for control.)

Malaria elimination: Interruption of local mosquito-borne malaria
transmission; reduction to zero of the incidence of infection caused by human
malaria parasites in a defined geographical areas a result of deliberate efforts.
(Continued measures required to prevent re-establishment of transmission.)

Malaria eradication: Permanent reduction to zero of the worldwide incidence
of malaria infection by a particular species. (Intervention measures no longer
required.)

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EVOLUTION OF MALARIA CONTROL IN INDIA
Malaria Survey of India
Focused on research and epidemiology
1911-1927
DDT Introduced into country
~75 million cases and 0.8 million deaths / year.
1947-1953
National Malaria Eradication Programme
Plan: to attack, consolidate and maintain zero
transmission at district level
1958-1977
National Malaria Control Programme
Used DDT for IRS, surveillance and treatment
Cases ↓ from 75 million (1951) to 50 K (1961).



1953-1958
6.47 million cases in 1976
Highest no. since 1958

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EVOLUTION OF MALARIA CONTROL IN INDIA
Modified Plans of Operations
Early diagnosis and prompt treatment; vector
control; IEC/BCC with community participation
1978: Therapeutic efficacy study started
1982: National antimalarial drug policy
1995: Global Malaria Action Plan (WHO)
1977-1997
Urban Malaria Scheme
AIMS: 1. To prevent deaths due to malaria and; 2.
Reduction in transmission and morbidity.
Towns with population>50K, API>2 and bylaw
implementation

1971
Initiated in 23
towns;
Now 131 towns
and cities.
1996: 3.3 million
cases, 2.8k deaths
1977: P. Falciparum
Containment
Programme

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EVOLUTION OF MALARIA CONTROL IN INDIA
2005-10: Intensified Malaria Control Project with GFATM
2010-15: IMCP-2




National Anti-Malaria Programme
1997-2005: Enhanced Malaria Control Project with
World Bank focused on 8 endemic states
1997-2002
National Vector Borne Disease Control
Programme
2003
2004: Integrated
Vector
Management
National Strategic Plan-I : 2012-17
Mixed success
New hotspots emerged

2012

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EVOLUTION OF MALARIA CONTROL IN INDIA
National Framework to Eliminate Malaria
Blueprint for zero indigenous cases by 2030
Elimination by 2027, maintenance thereafter
Stratification of districts
●Programme phasing
●District as the unit of planning and implementation
●Focus on high transmission areas
●Special strategies for P. vivax elimination


2016
National Strategic Plan-II 2017-22


2017
2018 High Burden to High Impact Group established
●122 districts with zero transmission (<10 in 2016)
●High burden states showed steep decline
-COVID-19 disruption
-Urban malaria
resurgence
Guiding principles:
Diagnosis and case management
Surveillance and epidemic response
Integrated Vector Management
Cross cutting interventions

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HIGH BURDEN TO HIGH IMPACT
●Flagship initiative of World Health Organisation.
●Targeted 11 countries- 10 in sub-Saharan Africa, and India, responsible
for 75% cases
●Country-owned, country-led
●Focused on high-burden settings
●Intensified approach to ↓ mortality while reducing malaria cases;
●Packages of malaria interventions, including a strong foundation of
primary health care.

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EVOLUTION OF MALARIA CONTROL IN INDIA
Malaria Programme Review
●Midterm checkpoint for NFME
●8 themes


2022
National Strategic Plan-III 2023-27
Vision: Malaria Free India
Mission: Malaria elimination in India by 2030
2023
India exits HBHI group2024

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NATIONAL STRATEGIC PLAN 2023-27
Goals:
●to interrupt local transmission
●achieve zero indigenous cases by 2027
●provide an enabling environment to prevent
re-establishment of malaria.

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MILESTONES UNDER NSP 2023-27
Year Milestone for malaria elimination
2024 Category 1 States/UTs (28) should reach Category 0; Category 2 States/UTs (6) should reach
Category ; 1 Category 3 States/UTs (2) should reach Category 2
2025 Category 0 States/UTs maintain the status; Category 1 States/UTs will make the efforts to
move to Category 0; Category 2 States/UTs will make intensified efforts to move towards
Category 1
2026 Category 0 States/UTs (34) maintain the status Category 1 States/UTs will make intensified
efforts to move towards Category 0
2027 All the States/UTs should reach Category 0, i.e., zero indigenous cases
2030 The re-establishment of local transmission prevented in areas where malaria has been
eliminated The malaria-free status maintained throughout the nation.

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CATEGORIES DEFINED FOR ELIMINATION
CATEGORYSTATE DISTRICT
Category
0
Transmission of malaria
interrupted and Zero
Indigenous Cases
Zero indigenous cases
Category 1 API < 1 case/1000 population
in all districts
API <1 per 1000 population
Category 2API < 1 case/ 1000 population
but some districts having API
>1
API 1 and above but less than 2
per 1000 population
Category 3API >1 case/ 1000 populationAPI 2 and above per 1000
population

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NATIONAL STRATEGIC PLAN 2023-27
5 strategies outlined:
1.Transforming malaria surveillance as a core intervention for malaria
elimination
2.Ensuring universal access to malaria diagnosis and treatment by enhancing
and optimizing case management - “testing, treating and tracking”
3.Ensuring universal access to malaria prevention by enhancing and optimizing
vector control.
4.Accelerating efforts towards elimination and attainment of malaria free status
5.Promoting research and innovation for malaria elimination and prevention of
re-establishment of malaria transmission

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NATIONAL STRATEGIC PLAN 2023-27
1.Transforming malaria surveillance as a core intervention for malaria
elimination.

●Surveillance in high and low transmission settings: ACD, PCD and proactive
& reactive case detection.
●Surveillance in the area with zero indigenous case: prevention of
reintroduction (POR) with immediate notification of imported cases.
●Case notification investigation systems according to the “1–3–7 days”
approach.

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Surveillance activities carried out as routine (active, & passive), sentinel-based,
mass surveillance, case and foci-based surveillance.
●API = (confirmed cases during the year/population under surveillance) × 100
●ABER = (the number of smears collected in the year/populations under
surveillance) × 100
●SPR = (number of smears found positive during a given time period/ total
smears collected in the time period) × 100
●Rapid Fever Survey in case of outbreaks

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NATIONAL STRATEGIC PLAN 2023-27
2. Ensuring universal access to malaria diagnosis & treatment by
enhancing and optimizing case management - “testing, treating and
tracking”

●Universal diagnostic testing of all suspected malaria cases
●Universal access to malaria treatment
●Safety and therapeutic efficacy of anti-malarial medicines

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NATIONAL STRATEGIC PLAN 2023-27
3. Ensuring universal access to malaria prevention by enhancing and
optimizing vector control

●Knowledge and understanding of vector bionomics,
●Surveillance of vector species,
●Incrimination of vector species,
●Community awareness and implementation of effective control measures

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NATIONAL STRATEGIC PLAN 2023-27
Category 0 and 1 states Category 2 and 3 states
• Potential breeding sites (RS-GIS)
• Regular adult vector monitoring
• Environmental management and
modification
• Biological control
• Foci-based adult vector control
interventions in and around 50 houses
of positive cases.
• Focal IRS
• Universal coverage with LLINs if API>1
• In sub-centres with API>1, two regular
rounds of supervised IRS
• LLIN usage to be ensured in above
• In outbreak situations, additional
round of IRS
• Anti-larval measures in urban areas
with main focus in slums.

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NATIONAL STRATEGIC PLAN 2023-27
4. Accelerating efforts towards elimination and attainment of
malaria-free status

●State programme implementation with central support
●Advocacy and social behaviour change & communication
(National/State/District Task Force for Malaria Elimination)
●Multi-sectoral collaborations with other ministries and departments
and partnerships
●Procurement and supply chain management

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NATIONAL STRATEGIC PLAN 2023-27
5. Promoting research and innovation for malaria elimination and prevention of
re-establishment of malaria transmission

●Key focus areas:
-Therapeutic efficacy studies (TES)
-Quality assurance of RDTs
-Vector control and insecticide resistance
-Regular GIS mapping
●By ICMR, NCDC, medical colleges and universities in collaboration with SVBDCP

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NSP 2023-27: RECENT UPDATES
1.Integration of IHIP for Malaria reporting
- Piloted as Malaria Monitoring Information System in Odisha and Himachal
Pradesh from 2018-2022
- Currently adapted by 26 states and union territories
- Timely information flow from subcentre to district and national level.
- Drawbacks: Areas under Urban Malaria Scheme not covered appropriately;
Data entry at primary level lagging; Indicators need to be modified

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2. ASHA incentivised for diagnosis and treatment
Malaria–Preparing Blood Slides/complete
treatment
for RDT or radical treatment of positive Pf
cases

Rs. 15 per slide/ Rs. 75 per positive
cases

Confirmed case of Malaria Incentive raised from Rs 75/- to Rs.
200/- per case

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3. Testing pentavalent rapid diagnostic kits
-P. malariae and P. ovale cases going undetected
-P. knowlesi also found in certain areas
-Pentavalent RDKs bought by some states (per NVBDCP specifications)
-Under study at ICMR for cost efficacy

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4. Drug procurement and inventory management
-Drug/ diagnostics/ insecticide procurement used to be centralised
-Currently only ACT/AL, ACT/SP, Artesunate, RDT kits and LLINs are
centralized
-DVDMS (Drug and Vaccine Distribution Management System) being
rolled out (7 states onboarded so far) for states to manage inventory
at sub-district level

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5. Insecticide Resistance Study
-By ICMR Vector Control Research Centre, Puducherry
-Ten districts selected in endemic areas, where high-level resistance to
pyrethroids confirmed in An. culicifacies or An. stephensi.
-Two blocks from each district, one village from each block selected
-Presence, intensity and mechanism of resistance to be analysed

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6. LLIN usage study
-Availability and usage of LLINs
-Sample size: 37,500 households (subcentre based stratified sampling)
-Community perspective about role of LLINs
-KAP regarding malaria prevention
-11 states selected

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7. Therapeutic efficacy study
-As per WHO recommendation
-Initiated by NCVBDC for the first time in 2025 (usually ICMR)
-For AS+SP, ACT-AL, CQ
-One-arm prospective study of clinical and parasitological response
-15 sites with 100 participants each
* iDES: Integrated drug efficacy surveillance: incorporates drug resistance
monitoring as part of routine case-based surveillance and response.

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8. Longitudinal study
-To assess malaria burden and the sociodemographic and behavioural
factors influencing transmission in various geographical contexts
-Clusters of 1000-1500 will be followed up over a year
-To assess prevalence and parasitemia progression, recurrence etc
-12 districts from 10 states covering urban, periurban, rural,
forest-foothill, coastal and cross-border areas.

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9. MERA India (Malaria Elimination Research Alliance)
-Initiated by ICMR in 2019
-Platform to bring stakeholders together to collaborate on research,
training and strategies for malaria elimination
-Research outcomes so far:
●Smartphone-enabled malaria detection device.
●AI-assisted mosquito traps for enhanced surveillance.
●Cost-effectiveness of Mass Testing and Treatment
●Adoption of PCR as a diagnostic tool for malaria during the
elimination phase.

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10. Malaria vaccines
-Mosquirix (RTS,S/AS01): Recombinant protein vaccine
●WHO-recommended, GAVI-funded, rolled out in Africa.
●4 doses (at 5, 6, 7, and 18–24 months)
●Prevents falciparum infection in children, modest efficacy (~45%).
-R21/Matrix-M
●Developed by University of Oxford + Serum Institute of India.
●3 doses + 1 booster
●More affordable than RTS, similar mechanism.
-AdFalcVac (Experimental)
●European & Indian consortium
●Experimental adenovirus vector based vaccine, phase I currently

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NSP 2023-27: PROGRESS SO FAR
Category 2015
scenario
Aim by
2024
Reported at
end of 2023
(HBHI exit)
Current scenario
(2024 annual
report)
Category 0 0 28 3 4
Category 1 15 6 24 22
Category 2 11 2 7 7
Category 3 10 0 2 3
Table showing the targeted vs actual number of states/UTs as per API categories

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Annual
Malaria
Report
2015
Lithograph showing
API of states in year
2015

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Annual
Malaria
Report
2022
Lithograph showing
API of states in year
2022

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Annual
Malaria
Report
2023
Lithograph showing
API of states in year
2023

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Lithograph showing
API of states in year
2024
Annual
Malaria
Report
2024

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District/State API 2023 API 2024 Cases 2023Cases 2024
Kokrajhar (Assam) 0.2 3.59 256 3808
South Garo Hills (Meghalaya) 7.4 2.2 1274 389
Kolkata (West Bengal) 4.7 2.05 17002 10177
Gadchiroli 5.0 5.91 5866 6698
Nicobars (A&N Islands) 0.2 2.32 29 86
Chhattisgarh 1.0 0.98 31706 31373
Jharkhand 0.8 0.96 34087 42352
Odisha 0.9 1.48 41973 68693
Mizoram 14.2 12.88 18077 16899
Tripura 5.7 2.47 22412 10177
Table: Distribution of malaria in selected districts and states in 2023 and 2024.

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Key Takeaway Points
-Reporting and surveillance has been strengthened by IHIP, though full
on-ground implementation will need more time.
-Prevention of re-establishment of infection needs to be strengthened.
-Community engagement must be enhanced to increase preventive
measures.
-Entomological surveillance and cyclical use of insecticides to prevent
resistance.

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REFERENCES
1.World Health Organization. World Malaria Report 2024 [Internet]. Geneva: WHO; 2024 [cited 2025 Jul 27].
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2.National Centre for Vector Borne Disease Control. Annual Report 2024: Malaria [Internet]. New Delhi: Ministry of
Health and Family Welfare, Government of India; 2024 [cited 2025 Jul 27]. Available from:
www.ncvbdc.mohfw.gov.in/Doc/Malaria-Annual-Report-2024.pdf
3.National Centre for Vector Borne Disease Control. Malaria Situation in India [Internet]. New Delhi: Ministry of
Health and Family Welfare, Government of India; 2023 [cited 2025 Jul 27]. Available from:
www.nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=564&lid=3867
4.Directorate of National Vector Borne Disease Control Programme. National framework for malaria elimination in
India 2016–2030 [Internet]. New Delhi: Ministry of Health and Family Welfare, Government of India; 2016 [cited
2025 Jul 27]. Available from:
www.ncvbdc.mohfw.gov.in/National-framework-for-malaria-elimination-in-India-2016%E2%80%932030.pdf
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7.Bhatt RM, Bhatia R, Paliwal JC, Dash AP, Singh V, Singh N, et al. India’s path to malaria elimination: regional
challenges and national solutions. Lancet Reg Health Southeast Asia. 2023;10:100198.
doi:10.1016/j.lansea.2023.100198

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[Internet]. New Delhi: Press Information Bureau; 2024 Dec 25 [cited 2025 Jul 28]. Release No. 2087878. Available from:
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69. THANK
YOU!