National Malaria Control Programme (NMCP) was launched in India in April 1953.It was based on indoor residual spraying with DDT (1g per sq. meter of surface area) twice a year in endemic areas where spleen rates were over 10%..The NMCP was in operation for 5 years (1953-58). The results of the programme were highly successful in that the incidence of malaria had declined sharply from 75 million cases in 1953 to 2 million cases in 1958, an estimated 80 percent reduction of the malaria problem. It also paid rich dividends to the country in different fields like agriculture, land projects and industry. Encouraged by these spectacular results Government of India in the Ministry of Health changed the strategy from malaria control to eradiation, and launched the more ambitious National Malaria Eradication Programme (NMEP) in 1958. According to international standards, the programme was divided into preparatory, attack, consolidation and maintenance phases. 

In the beginning, malaria eradication programme was highly successful. But every soon setbacks appeared in t he form of focal outbreaks. The resurgence had grown to epidemic proportions. The annual incidence of malaria cases in India escalated from 50,000 in 1961 to a peak of 6.4 million cases in 1976. 

Revised Strategy: 

Considering the resurgence of malaria as well as the situation in the neighbouring countries, the Government of India in the Ministry of Health appointed several task forces and Expert Committees on malaria to review the situation. Based on their recommendations, a Modified Plan of Operation (MPO) to control malaria was evolved and put into operation from April 1977. 

Modified Plan of Operation (MPO) : 

The Modified Plan of Operation under the NMEP came into force from 1st April 1977 with the following objectives: 

1. To prevent deaths due to malaria

2. To reduce malaria morbidity 

3. To maintain agricultural and industrial production by undertaking intensive antimalarial measures in such areas. 

4. To consolidate the gains so far achieved. 

5. Flexibility in the policies according to the epidemiological situation and local conditions is an essential feature in this programme. 

Malaria Control through Primary Health Care: 

A new approach to malaria control was approved by WHO in 1978, i.e. implementation of malaria control in the context of the primary health care strategy. This is because several anti-malarial activities, including drug distribution, can be carried out by the most peripheral level of primary health care system with community participation, where such system has been developed. Malaria control within the framework of PHC demands national commitment, community participation and inter-sectoral cooperation. Strategies and approaches are being adjusted to control malaria through primary health care. 

The 1994 resurgence of malaria compelled the Government of India to appoint an Expert Committee on Malaria to identify the problem areas and to suggest specific measures against the different paradigms of malaria. Thus Malaria Action Programme (MAP) was evolved and guidelines were distributed to all the states for prediction, early detection and effective response to malaria outbreaks at district level. It necessitated the need to strengthen the health promotion component of the programme by observing “Anti-Malaria Month” before the onset of monsoon i.e. during the month of June to create awareness in the community regarding malaria and its prevention. 

The Expert committee on Malaria has recommended the inclusion of all urban areas with more than 50,000 population and reporting slide positivity rate of 5 percent and above under Urban Malaria Scheme and introduction of active surveillance under this scheme. 

Milestones and Targets 

The following time frame, with milestones and targets, is proposed for implementation of the National Framework for Malaria Elimination in India 2016–2030. 

By 2016

All states/UTs have included malaria elimination in their broader health policies and planning frameworks.

By 2020

1. Transmission of malaria interrupted and zero indigenous cases and deaths due to malaria attained in all 15 states/UTs under Category 1 (elimination phase) in  2014   (base year).

2. 11   states/UTs   under   Category   2   (pre-elimination   phase)   in   2014   enter   into    Category 1 (elimination phase).

3. Five  states/UTs  under  Category  3  (intensified  control  phase)  in  2014  enter  into  Category 2 (pre-elimination phase).

4. Five states/UTs under Category 3 (intensified control phase) in 2014 reduce malaria transmission but continue to remain in Category 3.

5. An estimated reduction in the malaria of 15–20% at the national level compared with 2014. Additionally, progressive states with strong health systems such as Gujarat, Maharashtra, and Karnataka may implement accelerated malaria elimination programmes to achieve the interruption of transmission and demonstrate early elimination followed by the sustenance of zero indigenous cases.

By 2022

1. Transmission of malaria interrupted and zero indigenous cases and deaths due to malaria attained in all 26 states/UTs that were under Categories 1 and 2 in 2014.

2. Five states/UTs which were under Category 3 (intensified control phase) in 2014 enter into the elimination phase.

3. Five states/UTs which were under Category 3 (intensified control phase) in 2014 enter into the pre-elimination phase.

4. An estimated reduction in the malaria of 30–35% at the national level compared with 2014.

By 2024

1. All states/UTs and their respective districts reduce API  to less than 1 case per  1000  population at risk and sustain zero deaths due to malaria while maintaining fully functional malaria surveillance to track, investigate and respond to each case throughout the country. 

2. Transmission of malaria interrupted and zero indigenous cases and deaths due to malaria attained in all 31 states/UTs.

3. Five states/UTs which were under Category 3 (intensified control phase) in 2014 enter into the elimination phase.

By 2027

1. The indigenous transmission of malaria in India interrupted.

By 2030

1. The re-establishment of local transmission prevented in areas where malaria has been eliminated.

2. The malaria-free status is maintained throughout the nation.