National Malaria Elimination Programme (NMEP)
India’s response to malaria has evolved from controlling it to aiming for complete elimination by 2030.
The NMEP, implemented under the Ministry of Health and Family Welfare, is the national strategy for
achieving this goal. It operates under the larger framework of the National Vector Borne Disease Control
Programme (NVBDCP).
I. OBJECTIVES OF THE NATIONAL MALARIA ELIMINATION
PROGRAMME
The NMEP outlines specific short-term, medium-term, and long-term objectives to combat malaria in
India:
A. Short-Term Objectives
1. Early Detection and Complete Treatment of Malaria Cases
Rapid and accurate detection using RDTs and microscopy ensures patients are treated before
complications arise. Treatment is provided free of cost through government health infrastructure.
2. Prevention of Deaths Due to Malaria
One of the central goals is to minimize malaria-related mortality, especially in high-risk
populations such as children under five, pregnant women, and people in tribal areas.
3. Reduction in Morbidity and Transmission
By interrupting the chain of transmission through vector control, the overall incidence of malaria
can be significantly reduced.
B. Medium-Term Objectives
1. Achieving Pre-Elimination Targets in Low Transmission Areas
Districts with low malaria transmission are expected to reach pre-elimination status by
intensifying surveillance and treatment coverage.
2. Building Robust Surveillance Systems
A reliable malaria surveillance system that detects every case is critical for both elimination and
preventing resurgence.
C. Long-Term Objectives
1. Elimination of Malaria in India by 2030
Defined as having zero indigenous cases, and ensuring no re-establishment of local transmission.
2. Sustaining Malaria-Free Status in Eliminated Areas
Regular surveillance and vigilance are necessary even after elimination to prevent reintroduction.
3. Strengthening Human Resource Capacity
Continuous training and capacity building of health staff across the country are key to sustained
success.
4. Intersectoral and International Coordination
Working with urban development, education, defense, and neighboring countries to manage
cross-border transmission.
II. COMPONENTS OF THE NATIONAL MALARIA
ELIMINATION PROGRAMME
The success of the NMEP lies in the effective implementation of its core components, which function
synergistically:
1. Case Management: Diagnosis and Treatment
● Diagnosis:
○ Use of Rapid Diagnostic Tests (RDTs) for field detection.
○ Microscopy remains the gold standard for confirmation.
○ Mobile health units and fever surveillance workers are deployed in rural/tribal areas.
● Treatment:
○ Treatment protocols follow WHO guidelines.
○ Plasmodium falciparum infections are treated using ACT (Artemisinin-based
Combination Therapy).
○ Plasmodium vivax is treated with chloroquine and primaquine.
○ Directly Observed Treatment (DOT) ensures compliance.
2. Integrated Vector Management (IVM)
This is a key preventive component of the programme and includes:
● Indoor Residual Spraying (IRS): Two rounds of insecticide spraying annually in high-endemic
villages. Targets the resting places of mosquitoes on walls and ceilings.
● Distribution of Long-Lasting Insecticidal Nets (LLINs): Free distribution to households in
high-risk areas. Lasts up to 3 years and effective even after multiple washes.
● Larval Source Management (LSM): Elimination of breeding sites such as stagnant water bodies.
Introduction of biological agents like Gambusia fish which eat larvae.
● Use of Chemical Larvicides: Application in urban settings like construction sites, drains, and
water tanks.
3. Surveillance, Monitoring & Evaluation
● Case-Based Surveillance: Each malaria case is traced, recorded, and followed up until cure.
Geotagging and line listing are used to identify hotspots.
● Entomological Surveillance: Vector density, mosquito species identification, and insecticide
resistance tracking.
● Digital Health Tools: Use of web-based applications like the Malaria Dashboard and DHIS2 for
real-time data sharing. Integration with the Integrated Disease Surveillance Programme (IDSP).
4. Behavior Change Communication (BCC) and IEC
● Community Engagement: Door-to-door awareness campaigns by ASHAs and ANMs. Emphasis
on use of bed nets, early diagnosis, and completion of treatment.
● Mass Media Campaigns: Use of TV, radio, folk performances, street plays, posters, and mobile
vans.
● IEC Materials: Posters, handouts, and audio-visuals in regional languages distributed in schools,
workplaces, and public areas.
5. Capacity Building
● Training of Medical Officers, Lab Technicians, and Field Workers: Regular upskilling on new
diagnosis and treatment guidelines. Emphasis on entomology training and vector control skills.
● Development of Training Modules: In collaboration with WHO and other partners.
● Supportive Supervision: Mentoring at the ground level to ensure quality service delivery.
6. Epidemic Preparedness and Outbreak Response
● Formation of Rapid Response Teams (RRTs).
● Pre-positioning of logistics – medicines, RDTs, insecticides in vulnerable districts.
● Special focus during monsoon and post-flood conditions where vector breeding increases.
7. Intersectoral Collaboration and International Cooperation
● Ministries like Urban Development, Rural Development, Environment, Defense, Education, and
Transport are involved.
● Collaboration with neighboring countries such as Bhutan, Bangladesh, Myanmar, and Nepal
under cross-border malaria elimination initiatives.
MAJOR ANTI-MALARIA PROGRAMMES IN INDIA
India has implemented a series of national programmes since independence to combat malaria. Each
programme evolved based on the epidemiological situation, technological advances, and policy changes.
The following are the major milestones in India’s fight against malaria:
1. National Malaria Control Programme (NMCP) – 1953
Objective: To reduce malaria morbidity and mortality through vector control and early diagnosis.
Key Features:
● First major health programme post-independence.
● Introduced Indoor Residual Spraying (IRS) with DDT as the main vector control method.
● Emphasis on surveillance, detection, and treatment using microscopy.
● Rapid deployment of resources and workforce, especially in rural areas.
Impact:
● Reduced estimated annual cases from 75 million to about 2 million by the early 1960s.
● Dramatic success in several parts of the country prompted the shift towards eradication.
2. National Malaria Eradication Programme (NMEP) – 1958
Objective: To eradicate malaria completely from India.
Key Features:
● Built upon NMCP's achievements.
● Intensive vector control and surveillance to eliminate the parasite reservoir.
● House-to-house surveillance by health workers.
● Case finding through mass blood surveys.
● Introduction of three-phase strategy: Attack, Consolidation, and Maintenance.
Challenges and Decline:
● Emergence of DDT resistance in mosquitoes.
● Parasite resistance to chloroquine.
● Operational and logistical issues, especially in inaccessible tribal areas.
● Funding and workforce attrition led to resurgence in cases during the late 1970s.
3. Modified Plan of Operation (MPO) – 1977
Objective: to contain malaria transmission and reduce deaths, rather than focusing on eradication.
Key Features:
● Categorized areas based on Annual Parasite Incidence (API):
○ High-risk
○ Moderate-risk
○ Low-risk
● Focused vector control and case detection in high endemic zones.
● Introduced Village Health Guides (VHGs) to assist in malaria surveillance and treatment delivery.
● Improved monitoring and supervision of malaria workers.
Impact: Helped stabilize malaria incidence, though complete control remained elusive in certain
states like Odisha, Chhattisgarh, and parts of the Northeast.
4. Enhanced Malaria Control Project (EMCP) – 1997
Objective: To strengthen malaria control in tribal, forested, and high-burden areas using modern
tools and community involvement.
Key Features:
● Funded by the World Bank and implemented in 100+ high-burden districts.
● Emphasized decentralization and community participation.
● Introduced Insecticide-Treated Nets (ITNs) and later Long-Lasting Insecticidal Nets (LLINs).
● Trained ASHA and Community Health Volunteers (CHVs) in diagnosis using RDTs and prompt
treatment.
● Promoted environmental management and biological control using larvivorous fish.
Impact:
● Improved case management and surveillance in tribal belts.
● Boosted community-level health infrastructure and local ownership of malaria control.
5. National Anti-Malaria Programme (NAMP) – 1995 onward
Objective: To continue malaria control activities nationwide with uniform standards and stronger
surveillance.
Key Features:
● Continued from MPO and absorbed the EMCP strategies.
● Reinforced indoor spraying, distribution of nets, and use of RDTs.
● Focused on integration with primary health care delivery systems.
● Expanded data reporting and laboratory capacity.
● Preceded the launch of NVBDCP.
6. National Vector Borne Disease Control Programme (NVBDCP) – 2003
Objective: To provide integrated control of six vector-borne diseases, including malaria.
Diseases Covered:
1. Malaria
2. Dengue
3. Lymphatic Filariasis
4. Kala-azar
5. Chikungunya
6. Japanese Encephalitis
Key Features:
● Single umbrella programme for cost-effective resource utilization.
● Standardization of training, diagnostics, and treatment.
● Use of GIS and computerized reporting systems for surveillance.
● Introduction of mass awareness campaigns, especially in urban settings.
● LLINs and IRS campaigns expanded across the country.
Impact:
● Coordinated efforts led to significant reduction in disease burden.
● Facilitated cross-learning and inter-disease resource sharing.
7. National Framework for Malaria Elimination (NFME) – 2016
Objective: To eliminate malaria in India by 2030 in line with WHO’s Global Technical Strategy.
Strategic Pillars:
1. Universal case detection and treatment.
2. Integrated vector management.
3. Strong surveillance systems.
4. Community mobilization and intersectoral collaboration.
Milestones:
● Elimination (zero indigenous cases) in Category 1 districts by 2020.
● Progressive expansion of elimination goals to remaining districts by 2030.
8. National Strategic Plan for Malaria Elimination (NSP) 2017–2022
Objective: To operationalize NFME through detailed annual targets and district-level
categorization.
District Categories:
● Category 0 – No transmission.
● Category 1 – Sporadic, low transmission.
● Category 2 – Moderate transmission.
● Category 3 – High endemicity.
Key Features:
● District-specific strategies tailored to burden.
● Massive scale-up of LLIN distribution.
● Training health workers in remote regions.
● Use of mobile apps, GPS-based entomological mapping, and online dashboards for monitoring.
Outcomes:
● Significant reduction in malaria morbidity and mortality.
● Some states (e.g., Gujarat, Odisha) showed steep declines in case load.
● India accounted for the largest absolute decline in malaria cases in the Southeast Asia region,
according to WHO reports.
