While Malaria cases have declined globally, it still is a disease of concern and continues to have severe implications on public health. The Honourable Prime Minister, Narendra Modi, pledged at the East Asia Summit in 2015 to make our country Malaria-free by 2030. This clarion call set India’s health machinery into motion and ever since we have shown tremendous progress in controlling the disease. However, Malaria still continues to be a significant public health issue for India – putting around 1.3 billion people at risk. According to the World Malaria Report 2022, India accounted for about 79% of all Malaria cases; and 83% of deaths in South-East Asia region. Additionally, our country has the largest burden of P. vivax Malaria cases globally with over 3.6 million cases. If we are to achieve our ambition of elimination – each and every case needs to be diagnosed and treated.
According to data from the National Sample Survey on health conducted in 2017-18, close to 70% of the population gets diagnosed and treated in the private sector, making the role of private sector health facilities crucial in tackling diseases. The private sector comprises of a mix of formal and informal healthcare providers, and for-profit and not-for-profit facilities. To achieve the goal of Malaria elimination by 2030, we must have zero cases by 2027 and sustain such incidence for 3 years to receive the official certification of elimination by the WHO. With a large population dependent upon the private sector for treatments, the private sector needs to be strongly integrated though a public-private partnership and intersectoral coordination to estimate the actual disease burden. The HIV, TB, and most recently, the COVID-19 responses have shown us how public-private integration can help assess and address the burden of issues of public health concern. We must replicate such efforts for Malaria as well.
WHO, in their World Malaria Report 2021, estimated cases between 2.7 million and 5.9 million in India in 2020, whereas our official data showed only around 187,000 cases of Malaria. A likely cause of this discrepancy can be the proportion of Malaria burden treated in the private sector. Furthermore, in 2016, India reported 10.09 lakhs Malaria cases while the sales of anti-Malaria drugs were worth INR 626.10 crore, accounting for cases vastly higher than the officially reported figures.
Malaria is a notifiable in 31 states/union territories. As a notifiable disease, it is enforceable that every case diagnosed by healthcare providers, public as well as private, is notified to the authorities to help identify the true Malaria burden. However, there are serious challenges to the enforcement of this notification. A major obstacle in consolidation of reporting systems is that case reporting data is captured in a disjointed manner by multiple stakeholders, often in complete silos. In addition, the data is not reported in near real-time. The multiplicity of Malaria data resources limits interoperability. Timely reporting of cases by the private sector will not only help us understand the true burden of Malaria in India but also help create strategies to navigate the barriers to it. The integration with private sector will strengthen surveillance, give an opportunity to implement standard treatment guidelines, improve access to quality care and pharmacovigilance with sharing and scaling up of the best practices.
As India enters the last leg of its Malaria elimination strategy, accurate reporting will be crucial. Inaccurate reporting of Malaria cases poses as a threat to achieving elimination as it fails to show the true status of Malaria, thus adding pressure on the public health infrastructure. Strict notifications of the disease across India and ensuring accurate reporting from the public and private sectors will be definite steps towards addressing Malaria and achieving our elimination priorities. Strategies that provide effective incentives and disincentives for reporting Malaria should be put to work.
WHO estimates India’s socio-economic burden due to Malaria at around USD 2 billion. This highlights the intensity of the disease and the urgent need to eliminate it. With the private healthcare sector engaging with a large proportion of Malaria cases, its active involvement in the national Malaria elimination program will be key. With near real-time case-based reporting of Malaria, adoption of technology, implementation of strategies developed from global best practices and the use of innovative tools, India will be successful in controlling the spread of Malaria and in eventually eliminating the disease within the ambitious timeline.
