Malaria paradigms in India and control strategies.

The paper gives a brief history of malaria control in India through the National Malaria Control Programme (NMCP), National Malaria Eradication Programme (NMEP), implementation of the Modified Plan of Operation (MPO), strengthening of malaria control by launching P. falciparum Containment Programme (PfCP) and the Urban Malaria Scheme (UMS). Making reference to various evaluations of the NMEP, the paper analyses the present malaria situation and brings out reasons demanding change in the strategy of malaria control in consonance with the global malaria control strategy of the World Health Organization (WHO). The epidemiological analysis has revealed that the present adverse malaria situation concentrates mostly under the following five epidemiological paradigms viz. (i) tribal malaria, (ii) rural malaria, (iii) urban malaria, (iv) industrial malaria, and (v) border malaria. Malaria control requires specific approaches and control strategies for each paradigm. We have suggested changes/augmentation in the organizational set-up beginning from NMEP Directorate to the most peripheral health units. The primary responsibility of malaria prevention and control including cost in developmental projects should be shared by the corporate sectors through intersectoral coordination. Residual problems during maintenance phase of the project would come under the general health services. International and bilateral cooperation increases resources availability. The available tools and their rational use for malaria control in different epidemiological paradigms has been discussed with emphasis on integrated control, selective use of chemical insecticides and adoption of cost-effective and sustainable malaria control methods. In this context, intersectoral collaboration, community participation, training, operational research and health education have been discussed as the vital components for effective malaria control.