A model for malaria elimination based on learnings from the Malaria Elimination Demonstration Project, Mandla district, Madhya Pradesh

Abstract

Background Malaria Elimination Demonstration Project (MEDP) was started as a Public-Private-Partnership between the Indian Council of Medical Research through National Institute of Research in Tribal Health, Govt. of Madhya Pradesh and Foundation of Disease Elimination and Control of India, which is a Corporate Social Responsibility (CSR) initiative of the Sun Pharmaceutical Industries Limited. The project’s goal was to demonstrate that malaria can be eliminated from a high malaria endemic district along with prevention of re-establishment of malaria and to develop a model for malaria elimination using the lessons learned and knowledge acquired from the demonstration project. Methods The project employed tested protocols of robust surveillance, case management, vector control, and capacity building through continuous evaluation and training. The model was developed using the learnings from the operational plan, surveillance and case management, monitoring and feedback, entomological investigations and vector control, IEC and capacity building, supply chain management, mobile application (SOCH), and independent reviews of MEDP. Results The MEDP has been operational since April 2017 with field operations from August 2017, and has observed: (1) reduction in indigenous cases of malaria by about 91 %; (2) need for training and capacity building of field staff for diagnosis and treatment of malaria; (3) need for improvement insecticide spraying and for distribution and usage of bed-nets; (4) need for robust surveillance system that captures and documents information on febrile cases, RDT positive individuals, and treatments provided; (5) need for effective supervision of field staff based on advance tour plan; (6) accountability and controls from the highest level to field workers; and (7) need for context-specific IEC. Conclusions Malaria elimination is a high-priority public health goal of the Indian Government with a committed deadline of 2030. In order to achieve this goal, built-in systems of accountability, ownership, effective management, operational, technical, and financial controls will be crucial components for malaria elimination in India. This manuscript presents a model for malaria elimination with district as an operational unit, which may be considered for malaria elimination in India and other countries with similar geography, topography, climate, endemicity, health infrastructure, and socio-economic characteristics.

Assessing community knowledge, attitude and practices to strengthen communication strategy for Malaria Elimination Demonstration Project in Mandla

“…MEDP was successful in reaching the target population, particularly in the remote areas of the district with its unique tracking, testing, treating, tracking for follow up (T4) services along with communication strategy [ 14 ]. As part of this study, we have previously documented that IEC programmes also benefited the health-workers in making them aware of the principles of surveillance, case management, and vector control [ 15 , 16 ].…”

A qualitative study on community perceptions on quality of healthcare services they received in the Malaria Elimination Demonstration Project in district Mandla, India

“…Alongside the IEC/BCC strategy of MEDP and the continuous follow-up of every malaria-positive case under the T4 strategy helped build faith in the community [ 7 ] is also desirable for frontline workers for malaria elimination to consider. The high levels of satisfaction with the services of MEDP reported in the present study can be attributed to strict adherence to an Advance Tour Plan by the VMWs and MFCs, regular availability of diagnostic and drugs, robust training, monitoring and accountability framework, representation from the local community, and sustainability principles of the project [ 5 , 23 , 26 ]. Similar findings were reported by other studies conducted in Odisha and Madhya Pradesh [ 30 , 33 , 34 ].…”

Monitoring of the Village Malaria Workers to conduct activities of Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

“…These learnings were incorporated in the development of the monitoring tool. A similar strategy was followed while developing the IEC and BCC strategy of the project [ 15 , 18 ]. The systematic process of developing a structured tool to gain high-fidelity work-products has been recommended by Tolley [ 23 ], Baranowski [ 24 ], and Resnicow [ 25 ].…”

“…High scores in adherence to advance tour plans, knowledge of RDT procedures and interpretation, knowledge of anti-malarial drug regiments, submission of daily work-done reports, proper handling of anti-malarial drugs were observed since the beginning of the study. This was because of MEDP’s strong focus on these indicators since the beginning of the field operations [ 15 , 18 ]. Additionally, the mobile application surveillance tool (SOCH) was introduced in July 2018, which further improved the overall accountability, reporting, and supply chain management systems [ 27 ].…”

“…MEDP started its field activities in April 2017. The project developed a Monitoring and Evaluation (M&E) framework in consultation with the ICMR—National Institute of Epidemiology (ICNR-NIE) [ 15 ]. This framework described the key requirements in the monitoring of the elimination project, which gave birth to the monitoring tool.…”