Report of the Special Committee on the Preparation for Entry of the National Malaria Eradication Programme into the Maintenance Phase
The Government of India launched the National Malaria Eradication Programme (NMEP) in the year 1958. It was phased over a period of eight years and was set to operate in four stages: “preparatory, attack, consolidation and maintenance.” On April 10, 1963, the Government of India formed a special committee under the Ministry of Health to formulate a plan for the entry of the NMEP into the ‘maintenance’ phase. An 11-member committee was constituted under the chairmanship of M.S. Chadha – the then Director General of Health Services.
The committee was tasked with reviewing and assessing the requirements necessary for primary health centres to initiate the maintenance phase of the NMEP. It was also asked to formulate a pattern for recruiting staff required for the programme and suggest ways in which the technical and supervisory staff would be deployed after malaria eradication had been achieved in the country. During the 11th session of the committee held between November 5-7, 1963, the interim report was placed before the Central Council of Health.
This 47-page report is divided into six sections: Introduction (Section I); Summary (Section II); Maintenance phase (Section III); Status of N.M.E.P. In India (Section IV); Recommendations (Section V); and Appendices (Section VI).
The report describes maintenance as a state of “continuous vigilance” against the resurgence of malaria cases in the country. The maintenance phase of the National Malaria Eradication Programme should aim for the earliest possible detection of cases and put remedial measures in place, the report states. All medical institutions – public as well as private – should be utilised for this process, irrespective of the system of medicine practised.
Each primary health centre should have a microscope and a laboratory technician to examine blood smears specifically for malaria parasites. A senior laboratory technician should also be recruited to supervise the work of junior technicians.
Noting the inadequacy of medical institutions in rural areas, the report states that there should be facilities for examining blood smears from all suspected cases of malaria and “inadequately explained fever” in these regions. Smears should be collected through domiciliary services and a regularised system of door-to-door visits.
In urban areas, detection of cases at institutional centres should be prioritised. However, areas located on the outskirts would require routine case detection programmes through domiciliary services.
Urban health institutions – which on a daily average see more than 200 outpatients reporting new cases – should have a ‘clinical side-room’ with improved diagnostic facilities. The report suggests that these services be made available to all private medical practitioners in the area as well.
According to the report, the weakest element of the structural set up for the NMEP was at the district-level. Institutions at this level lacked provisions for immediate guidance and supervision. The two supervisory senior officers – the civil surgeon and the district health officer – were overburdened with no time to spare for periodic visits to health units located in the periphery of the district. The report recommends that the district health officer should be assisted by health supervisors appointed as per the ratio of one supervisor per 6 or 7 blocks.
The committee recommended that, a basic unit (at the level of the primary health centres) set up for the control of communicable diseases and provision of preventive healthcare should cater to a maximum of 5,000 people. However, in view of financial and material limitations, such a unit may cover upto 10,000 people.
The report states that the results obtained after the examination of blood smears should be communicated by the examination centres within 24 to 48 hours, and no later than 72 hours. Delay in such communications is stated to be one of the primary reasons for the lack of co-operation between medical practitioners in the country.
Focus and Factoids by Aakanksha.
PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.
Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi
General of Health Services, Ministry of Health and Family Welfare, New Delhi