By: Amrit Sangma

New Delhi: Barphulin Sangma was getting ready for the Good Friday service when an 18 year old sick man was brought to her. He had been ill for the last four days.

Sangma who is working as a community health volunteer (CHV) under intensified malaria control project immediately tested the man and found out that he was suffering from malaria. However she could not start the treatment immediately as she had ran out of medicine meant for adults.

Despite her best efforts, she could get the required medicine only the next day. She had to collect the medicine herself from a place far away from her village. She eventually managed to administer a timely treatment to the patient. In the pursuit of saving a life, Barphulin and another colleague had missed their Good Friday prayer, which they believed their religion truly teaches – spirit of serving people in need.

Here is an anecdote that fits the context like a glove. Once a little girl walking on the sea shore was seen pausing so often to pick up an object and then throwing it into the sea.  An old man who was observing her from a distance approached her and called out, “Good morning!  May I ask what it is that you are doing?”

“Throwing starfish back into the ocean before the sun dries them up’, came the reply.

“I’m afraid you won’t really be able to make much of a difference”, replied the man looking at thousands of starfishes that lay on the shore.

The girl bent down, picked up yet another starfish and threw it as far as she could into the ocean. Then she turned, smiled and said, “It made a difference to that one!”

India in alignment to Sustainable development goal 3 (SDG) of ensuring healthy lives and promoting well-being, has committed to eliminate malaria by 2030. The country has a diverse geography and population. Chasing this target will be not be easy but not chasing it is not an option. What then should be India’s strategy in this mission?

Although malaria is not among the fatal diseases, it causes 19,500 to 20,000 deaths annually in India according to WHO . Most often than not, these deaths occur in the absence of timely treatment, aggravated by epidemic outbreak.

India has realized that the mission to eliminate malaria will be far from complete without people’s participation. That is why, Caritas India’s intensified malaria control project-3 (IMCP-3) in support to the government health system, has trained health volunteers in selected project villages of malaria prone India. In the last one year, 1,454 such community health volunteers (CHVs) and ASHAs were trained.

They are trained to bring behaviour change and communication (BCC) practices for preventing and controlling the disease. Other trainings include early diagnosis and treatment, medicine and stock management, monitoring and evaluation and coordination towards health systems and community systems strengthening.

CHVs are the first port of call for promoting preventive malaria interventions including use of medicated mosquito nets (LLNs) and extending to early diagnosis and treatment.

The IMCP-3 aims for universal coverage by effective interventions thereby catalyzing decline in malaria related mortality and morbidity and contributing to achievement of national goals and Sustainable Development Goals (SDGs).  The goal of IMCP-3 is to reduce malaria related mortality by at least 50% and morbidity by at least 50% in project areas (in eight states) by 2017 as compared to 2012.  The objectives are:

  • To achieve near universal coverage (80%) by 2017 by effective preventive intervention (LLIN) for population living in high risk project areas.
  • To achieve near universal coverage (80%) of fever cases by correct, affordable and appropriate parasitological diagnosis; and prompt, effective treatment according to the national drug policy in project areas by 2017.
  • To achieve 100% coverage in project areas by appropriate BCC activities to improve knowledge, awareness and responsive behaviour regarding effective preventive and curative malaria control interventions by 2017.
  • To strengthen surveillance and M&E, program planning and management, and coordination and partnership development to improve service delivery in project areas by 2017.
  • To strengthen health systems, community systems through capacity building (training) to improve service delivery in project areas by 2017.

 

Caritas India consortium is covering approximately four million people in 46 districts (out of 119 districts of northeast states and Odisha). The target group/beneficiaries include marginalized groups, tribal population, and women and children and other key affected population such as, Jhum cultivators (shifting cultivators); forest workers; miners; migrant and mobile populations (especially in border areas). These groups face an increased burden and or vulnerability due to a combination of biological, socioeconomic, and structural factors combined with lower access to services. 

Many experience inequality, prejudice, marginalization and limits on social, cultural and other rights such as, socio-economic disadvantage.  Many malaria cases and deaths occur among these key populations, as malaria transmission is intense in areas inhabited/frequented by them. 

The Caritas India Consortium now has 16 FBOs, NGOs, (as Sub-recipients-SRs and Sub-Sub-recipients-SSR, who are implementing entities) & National Institute of Malaria Research, as partners.  Under IMCP-3, the civil society partners include: Voluntary Health Association of India (VHAI) and their state chapter in Tripura, Itanagar Diocesan Empowerment Association (IDEA), Seva Kendra, JirsongAsong, Diocesan Social Service Society (DSSS) Imphal, Bakdil, Development Association of Nagaland (DAN), Jana Unnayan Samiti Tripura (JUST), Sambalpur Social Service Society, Lepra Society, ZoramEntu Pawl, Centre for Peace and Development, North East India Committee on Relief and Development (NEICORD), Jaintia Hills Development Society and Nongstoin Social Service Society. In addition, community networks, Village Health Sanitation and Nutrition Committees, Self Help Groups etc. are also partners for supporting specific interventions at community level.

The output indicators achievement given SDG 3 reflects   achievement of the period April 2016 to February 2017.  Report from SR/Partners is received by Caritas India quarterly; on 15th day after the end of the quarter, hence Jan-Mar’16 quarter report reflects data received until February 2017.

Overall, the IMCP-3 is progressing well and has gained momentum despite somewhat prolonged process of identification of villages (62% new geo. scope in 2015) with commensurate delays in selection of new SRs in new geo. scope, recruitment and capacity building, sensitization at state and district levels in 2015.  Most activities stand accelerated in the right direction and are expected to influence the trend of the disease. 

Over the past decade, India has made significant strides in controlling malaria. Reduction of 45% in malaria morbidity & 69% in malaria mortality were achieved between 2000-2015 (Source: NVBDCP, GoI). A National Framework for Malaria Elimination 2016-2030 has since been launched by the NVBDCP in 2016 with a vision of malaria free India.