Malaria is still a serious problem in rural and tribal dominated areas of India. India reported an estimated 0.33 million cases, with almost equal proportions of P. falciparum and P. vivax in 2019 [1]. The tribal community represents 8.6% of the country’s total population which contributed to 46% of total malaria cases and 47% malarial deaths in the country [2].
The utilization of health services is poor among them and they have their orthodox health beliefs. Person infected with malaria initially approaches the traditional healer and unlicensed medical practitioner (UMP) that delays in the correct malaria diagnosis and treatment that leads to continuous spread of infection and antimalarials drug resistance [3]. Therefore, training of UMP’s for malaria diagnosis as per the national program would add taste in the flavour. However, Auxiliary Nurse Midwife (ANM) was envisaged for midwifery care in rural and tribal India, but they were later realised as multi-purpose workers, hence, their curriculum and trainings also were modified to fit a multi-purpose worker profile.
At present, malaria mostly remains in rural and tribal regions where preventive measures are hindered by poor healthcare systems with insufficient human resources [4]. Thus, including local residents as malaria volunteer & socially vulnerable groups such as ethnic minorities and proper training to healthcare staff at village and district level could be helpful in malaria control. The network of malaria services expanded dramatically with the involvement of village-level female health volunteers, the Accredited Social Health Activists (ASHAs), in the provision of early case detection and complete treatment (EDCT) in malaria-endemic areas. They form an essential link between the community and health care delivery system. The ASHA is usually a woman with basic school level certification from the village, chosen by the community. They are sometimes overburdened by the other healthcare task but their presence in the village helps in the management of malaria cases [5]. ASHAs go door to door visiting the poorest and most vulnerable, to diagnose malaria, treat and report their activities to the sub-centre using the standard forms of the National Vector Borne Diseases Control Program. ASHAs were equipped with rapid diagnostic tests (RDTs) and anti-malarial drugs in line with the National Treatment Guidelines [6]. Peoples suffering from fever were encouraged to seek malaria diagnosis and treatment from ASHA’s. They also create awareness about the various health-related services available to people, and encourage them to use those services.
Digital Healthcare tools hold tremendous opportunities in the form of mobile healthcare, remote diagnostics. Digitisation in malaria healthcare services, including surveillance, diagnosis, and treatment, may be helpful in malaria control [7]. The quantum shift from paper-based work to digital work and involvement of digital tools in the elimination program may change the mode of healthcare delivery in remote areas. This can be done by enabling the use of mobile application for surveillance and maintaining the track record of patients that can be made possible by giving periodical training to district health officials of community health centre in every district. This has been made possible by a series of efforts made by ASHA worker in their community.
Attaining and maintaining high coverage of the affected population with multiple measures poses serious challenges to the over-stretched health system to the most resource-constrained districts of Indian states [4]. These rural and tribal communities faced multiple barriers in timely access to malaria treatment resulting in a high, though under-reported malaria burden that fuelled the persistent transmission of the disease. Efforts of healthcare workers in the villages with their cooperation in the Malaria elimination program playing a vital role to achieve ‘malaria-free India’.
References:
[1] World Malaria Report 2020 n.d. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2020 (accessed December 9, 2020).
[2] Sharma RK, Thakor HG, Saha KB, Sonal GS, Dhariwal AC, Singh N. Malaria situation in India with special reference to tribal areas. Indian J Med Res 2015;141:537–45. https://doi.org/10.4103/0971-5916.159510.
[3] Singh MP, Chand SK, Saha KB, Singh N, Dhiman RC, Sabin LL. Unlicensed medical practitioners in tribal dominated rural areas of central India: bottleneck in malaria elimination. Malar J 2020;19:18. https://doi.org/10.1186/s12936-020-3109-z.
[4] Nema S, Ghanghoria P, Bharti PK. Malaria Elimination in India: Bridging the Gap Between Control and Elimination. Indian Pediatr 2020;57:613–7. https://doi.org/10.1007/s13312-020-1888-5.
[5] Nema S, Verma AK, Bharti PK. Strengthening diagnosis is key to eliminating malaria in India. Lancet Infect Dis 2019;19:1277–8. https://doi.org/10.1016/S1473-3099(19)30544-4.
[6] Singh Y, Jackson D, Bhardwaj S, Titus N, Goga A. National surveillance using mobile systems for health monitoring: complexity, functionality and feasibility. BMC Infect Dis 2019;19:786. https://doi.org/10.1186/s12879-019-4338-z.
[7] Nema S, Verma AK, Tiwari A, Bharti PK. Digital Health Care Services to Control and Eliminate Malaria in India. Trends Parasitol 2021;37:96–9. https://doi.org/10.1016/j.pt.2020.11.002.
