High Burden to High Impact (HBHI) Approaches - Country Perspective for Adoption and Adaptation in India

Abstract

In India, a National Framework for Malaria Elimination (NFME) has been developed and launched on 11 February 2016 align with the Global Technical Strategy (GTS) for malaria elimination 2016-2030. Malaria elimination will be carried out in a phased manner. In accordance with the NFME, National Strategy Plan for malaria elimination 2017-2022 has been developed by National Vector Borne Disease (NVBDCP), MoH & FW, Govt. of India in collaboration with WHO Country Office India and launched in July 2017. The country has made significant improvement in the malaria situation in recent years. Reported malaria cases were reduced by 49 % and deaths by 50% in 2018 compared to 2017. However, India and ten countries in Africa contribute approximately 70% of the world’s malaria cases and deaths. These countries adopted the “High Burden to High Impact (HBHI) approach”. HBHI has four response elements: (i) Political will to reduce malaria deaths; (ii) Strategic information to drive impact, (iii) Better guidance, policies and strategies, and (iv) A coordinated national malaria response. India has adopted this approach in May 2019 to further accelerate and sustain the progress in the states with high malaria burden. Initially, HBHI approaches are being adopted by NVBDCP with the support of WHO in four high burden states namely Jharkhand, Chhattisgarh, West Bengal and Madhya Pradesh. During the first phase, an in-depth situation analysis on malaria in these states have been conducted using the tools provided by WHO. Key features of adaptation of HBHI approaches in India and detail analysis of one state Madhya Pradesh are presented in the article.

Outbreak prone communicable diseases of public health importance in the northern districts of West Bengal – Current status & the way forward

“…Bhutan and Nepal, which were among the 21 countries earmarked for elimination of malaria by 2020, reported one and 127 indigenous malaria cases respectively in 2019. West Bengal contributed to 7.5 per cent of the total malaria cases in the country and is one of the four high burden States for malaria in India where the High Burden High Impact (HBHI) approaches are to be implemented under NVBDCP (National Vector Borne Disease Control Programme) 26 . No spurt in the number of cases or outbreaks of malaria was reported from any district of the northern part of West Bengal during 2018-2020.…”

Science of malaria elimination: using knowledge of bottlenecks and enablers from the Malaria Elimination Demonstration Project in Central India for eliminating malaria in the Asia Pacific region

“…However, between 2015 and 2020, indigenous malaria cases decreased significantly from 3,901 to 127. This reduction is attributed to various interventions applicable to similar hard-to-reach areas with poor socioeconomic indicators and indigenous populations ( 2 ). The principal malaria vector species are Anopheles culicifacies (year-round presence) and Anopheles fluviatilis (seasonal presence) ( 3 ).…”

Assessing afebrile malaria and bed-net use in a high-burden region of India: Findings from multiple rounds of mass screening

“…In 2019, the World Health Organization (WHO) launched the high burden to high impact (HBHI) strategy as a country-driven response to have a rapid and sustainable impact on malaria. The HBHI strategy aims to use accessible and affordable frontline services to accelerate progress in countries with the highest disease burden [ 3 ]. Malaria accounted for an estimated 241 million infections and 627000 deaths globally in 2020 [ 1 ].…”

“…Malaria is endemic to Chhattisgarh, India. Chhattisgarh is one of the four high-malaria burden states in India selected for the HBHI initiative [ 3 ]. The state has 44% of its area covered by forests [ 24 ].…”