By Aniruddha Ghosal
Odisha, with just four per cent of India’s land area and three per cent of its population, accounted for over 40 per cent of the country’s total malaria cases in 2016. In the next two years, the caseload decreased by 90 per cent, mortality declined by 83 per cent and the test positivity rate — malaria confirmations per 100 samples tested — dropped to 1.03 in 2018, compared to 6.23 in 2017.
So, what changed? What did the state do differently?
“We realised that the existing guidelines, meant for the entire country, wasn’t suitable for our needs. We had to create a new model. It was an experiment. And, it worked,” explained an official of the National Vector Borne Disease Control Programme (NVBDCP) at Bhubaneswar.
For the state, and the country, the stakes couldn’t be any higher. Consider this: in 2016, India accounted for nearly 90 per cent of the total malaria cases of the Asia-Pacific region and Odisha singlehandedly accounted for nearly a third of the total cases in the region, as per the World Health Organization (WHO). For years, Odisha struggled, as other states saw their malarial incidence go down.
The model was started in 2013 as the ‘Comprehensive Case Management Project’ (CCMP) – which the Indian Council of Medical Research (ICMR) and National Vector Borne Disease Control Programme (NVBDCP) have since said should be replicated across the country. The project used a “quasi-experimental design”. Pairing two blocks — one that served as a control that would see the existing programme, another where interventions would take place. It led to two surprising findings: firstly, that there were villages left entirely untouched by the health machinery where the malarial burden was high, and that there existed a vast population of people who had malaria, but showed no symptoms and acted as ‘reservoirs’ of the disease.
It was in 2008 that Odisha began its anti-malarial programmes in earnest. By 2010, the political will and finances on the ground were buoyed by the presence of a massive network of Accredited Social Health Activists, or ASHA workers — trained community health activists. With India’s anti-malarial strategy hinging on early case detection and complete treatment, officials urged those with a fever to reach out to these health workers. The ASHA activists had been trained to treat malarial infections and were armed with rapid diagnostic tests (RDTs) and anti-malarial drugs.