Three Diseases- Malaria, Filaria & Kala-Azar-are under Elimination Programmes

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The Government is implementing 3 (three) disease eradication programmes namely, National Vector Borne Diseases Control Programme (NVBDCP), National Leprosy Eradication Programme (NLEP) and the national TB Elimination programme (NTEP).

Under National Vector Borne Diseases Control Programme (NVBDCP), 3 diseases namely Malaria, Filaria & Kala-Azar are under the elimination programme.  These diseases are targeted for elimination, and not for eradication.

Eradication of the disease is the permanent reduction to zero of the worldwide incidences of infection caused by the specific agent as a result of deliberate efforts; and when intervention measures are no longer needed. However, Vector-borne diseases (VBDs) are caused by vector and vector is climate-sensitive and ecological driven. Vector is affected by temperature, humidity, rainfall etc, and, therefore, it is not possible to eradicate the VBDs completely from the world.

The details of the diseases targeted for elimination are as follows:-

1. Malaria:  The goal is to achieve zero indigenous cases of Malaria in the country by 2030.
2. Lymphatic Filariasis: The definition of Elimination of Lymphatic Filariasis (LF) is to achieve <1% microfilaria rate (Mf rate) in the endemic areas. The global target for Lymphatic Filariasis is the elimination of the disease as a public health problem by 2030.
3. Kala-azar: The definition for kala-azar elimination as a public health problem is to achieve an annual incidence of less than one case per 10,000 population at the block level. All efforts are being made to achieve the annual incidence of less than one case per 10000 population in all the 633 endemic blocks across 54 districts in 4 states by the end of 2021.  Once achieved, the elimination is to be sustained for 3 years for KA elimination certification.
4. Leprosy can only be eliminated as a Public Health problem, and not eradicated because of the extra human sources (reservoirs) of the Mycobacterium leprae (M. leprae), the agent responsible for causing leprosy. However, the Government of India is committed towards achieving a leprosy free India by breaking the chain of transmission of the disease at the community level. The definition of leprosy elimination as a Public Health Problem is to have less than 1 case per 10,000 populations. India has already achieved this target at the national level in 2005.
5. Tuberculosis: The Government is implementing the National TB Elimination programme(NTEP) with the goal of ending TB by 2025. Eradication of tuberculosis is not possible due to the ongoing transmission of the disease. The programme is aiming at its elimination. The National Strategic Plan (2017-25) is being implemented for ending TB in the country by 2025.

The Union Government has chalked out disease elimination strategies. The details of the plan and steps being taken by the Government to achieve the target are as follows: –

National Vector Borne Diseases Control Programme (NVBDCP)

1. Malaria:

The Government has launched the National Framework for Malaria Elimination (NFME), 2016-2030 to eliminate malaria in India in a phased manner. The goal is to achieve zero indigenous cases of Malaria in the country by 2027 and to sustain elimination by 2030.

As per NFME, the States/UTs of the country are divided into three categories for malaria elimination.

1. 15 low burden states (category 1)
2. 11 moderate burden states (category 2)
3. 10 high burden states (category 3)

Major Interventions are as follows:

• Early diagnosis and radical treatment: Use of Rapid Diagnostic Test Kits, ASHA incentives for diagnosis & ensuring complete treatment.
• Case-based surveillance and rapid response
• Integrated vector management (IVM)
• Indoor residual spray (IRS)- 2 rounds of IRS for vector control in areas with Annual Parasite Incidence >2.
• Long-lasting insecticidal nets (LLINs) / Insecticide-treated bed nets (ITNs): LLINs are being used in the programme to cover sub-centres with Annual Parasite Incidence >1.
• Larval source management (LSM)
• Epidemic preparedness and early response
• Behaviour Change Communication and community mobilization

1. Lymphatic Filariasis:

• Mass Drug Administration (MDA) for disease transmission control. To accelerate disease elimination, an Accelerated Plan for Elimination of Lymphatic filariasis (APELF) 2018, triple Drug Therapy (Ivermectin + Diethylcarbamazine (DEC) + Albendazole) has been implemented in 30 districts and is being further scaled up.

• Morbidity Management & Disability Prevention (MMDP) targets 100% coverage for hydrocele surgery and home-based morbidity management services for lymphoedema cases.
• The achievement of <1% Microfilaria rate is validated by Transmission Assessment Survey (TAS).

1. Kala-Azar:

• Single Dose Liposomal Amphotericin B (LAMB) for treatment.
• Use of synthetic pyrethroid in place of DDT for IRS.
• Introduction of hand compression pumps in place of stirrup pumps for convenience and quality of IRS
• Revised incentives to PKDL patients from Rs. 2,000/- to 4,000/- and to ASHA from Rs.300/- to 500/- in 2018.
• Pucca houses in KA affected villages have been constructed under PMAY-G – Total 25,955 houses in 2017-18 (1371 houses in Bihar & 24584 in Jharkhand).

National Leprosy Eradication Programme (NLEP)

• A well laid out Operational strategy for Active Case Detection and Regular Surveillance has been put in place, both in rural and urban areas, through ASHAs and Frontline Workers in order to ensure detection of leprosy cases on regular basis and at an early stage in order to prevent grade II disabilities.
• Leprosy screening has been integrated with Rashtriya Bal Swasthya Karyakram (RBSK) and Rashtriya Kishore Swasthya Karyakram (RKSK) for screening of children (0-18 years)
• Leprosy screening has been integrated with the activities of Comprehensive Primary Health Care under Ayushman Bharat – Health and Wellness Centre (AB-HWC) for screening of people above 30 years of age.
• Contact tracing is done and Post Exposure Prophylaxis (PEP) is administered to the eligible contacts of Index case (Person diagnosed with leprosy) in order to interrupt the chain of transmission at the community level.
• Various services are being provided under the programme for Disability Prevention and Medical Rehabilitation (DPMR) i.e., reaction management, provision of Microcellular Rubber (MCR) footwear, Aids & Appliances, self-care kits etc.
• Reconstructive Surgeries (RCS) are conducted at District Hospitals/Medical Colleges/ Central Leprosy Institutes, and welfare allowance @ Rs 8000 is paid to each patient undergoing RCS.

Progress made in the last five years is as under: –

Other indicators showing consistent improvement in leprosy cases has been tabulated below :-

National TB Elimination programme(NTEP)

The key focus areas are:

• Early diagnosis of all the TB patients, prompt treatment with quality-assured drugs and treatment regimens along with suitable patient support systems to promote adherence.
• Engaging with the patients seeking care in the private sector.
• Prevention strategies including active case finding and contact tracing in high risk / vulnerable population
• Airborne infection control.
• Multi-sectoral response for addressing social determinants.

The Government has targeted to end TB by 2025, 5 years ahead of the global targets of Sustainable Development Goals (SDGs) of 2030. The SDG targets with regard to TB are:

• 80% reduction in incidence and
• 90% reduction in mortality (baseline 2015).

Health and hospitals being a State subject, all the programmes are implemented by the respective States/UTs. The government of India, under these programmes, provides guidelines, technical guidance, and financial support to the States/UTs as per the approved annual Programme Implementation Plan (PIP). States/UTs involve local administration i.e., District Collectors, PRI members, block-level officials etc. in these programmes as per the need of the programme. A few States also involve NGOs occasionally in these programmes if there are specific requirements or special challenges under the programme which cannot be addressed solely through Government intervention.

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