A two-day meeting on cross-border collaboration on malaria elimination along the India-Bhutan border was organized in Guwahati, Assam, India, on 4–5 November 2019 in collaboration with the WHO Country Office for India. The meeting was a step forward to translate various recommendations from previous meetings/consultations and to operationalize the 2017 Ministerial Declaration on Accelerating and Sustaining Malaria Elimination in South-East Asia to a mutually agreeable strategic “roadmap” with special emphasis on a border-relevant package of interventions at the subnational (district) level. The meeting was also aligned with the Regional Action Plan 2017–2030 “Towards 0. Malaria-Free South-East Asia Region”, as well as India’s Framework for Malaria Elimination (2016–2030) and National Strategic Plan for Malaria Elimination (2017–2022) and Bhutan’s National Strategic Plan for Malaria Elimination (2020–2023).
Bhutan aims to achieve elimination by 2023; whereas efforts are ongoing in India to reduce the malaria burden and at the same time prevent local transmission of malaria in areas where it has been eliminated, as part of a phased elimination strategy, and achieve national malaria-free status by 2030. Bhutan faces a distinct threat of missing the set elimination target and reintroduction of malaria in hitherto malaria-free areas due to cross-border issues.
General objective
To strengthen cross-border collaboration between India and Bhutan to achieve malaria elimination.
Specific objectives
- To review and share updates on malaria elimination with special focus on border districts of Bhutan and India; and
- To develop a roadmap for cross-border collaboration in malaria elimination in the districts of India and Bhutan sharing a border for the next three years.
The participants included: Joint Secretary, MoH&FW; Director and Deputy Director from National Vector Borne Disease Control Programme (NVBDCP) of the Government of India (GoI) and Directors concerned, Regional Office for Health & Family Welfare (RoH&FW) of the Government of India; state and district teams from Arunachal Pradesh, Assam, Sikkim and West Bengal, all bordering Bhutan; representatives from the Bodoland Territorial Area (BTA) districts; as well as the Bhutan Vector-borne Disease Control Programme (VDCP) and teams from Bhutanese districts bordering India; besides WHO (Country Office for India, the South-East Asia Regional Office, and headquarters). The total number of participants was 42, including 10 participants from Bhutan.
During the opening session, delegates from the MoH&FW and NVBDCP, GoI, and VDCP, Royal Government of Bhutan, and WHO addressed the participants and emphasized comprehensive interventions within national boundaries along the international border and the criticality of effective cross-border collaboration for complementary responses through district-wise microplans tailored to the context. Micro-stratification and analyses of data at local level was emphasized. Best practices from the Greater Mekong Subregion (GMS) were also shared. The criticality of regular follow-up was stressed. It was underscored that the WHO support has been commendable and should continue.
The technical sessions started with presentations and discussions relating to key messages from recent cross-border meetings and the WHO operational framework for cross-border collaboration to accelerate malaria elimination in the WHO South-East Asia (SEA) Region. This was followed by country presentation by India on malaria situation and progress to elimination with special emphasis on actions taken along the international border. The Indian states and districts bordering Bhutan presented the overall profile, health systems profile and malaria situation over recent years, especially with reference to malaria along border areas and possible actions at local levels towards malaria elimination along the Indo-Bhutan border. Thereafter, Bhutan presented the overall country situation report followed by detailed district-wise profile and malaria information along the India border.
Salient recommendations were as under:
1. For countries:
- Sharing of malaria data at district-to-district level through identified focal points: [real time (within 24/48 hours)] including complete case history that would commence with such platforms/modes as – Whatsapp, Dropbox, e-mails, phone, etc.
- District-to-district coordination meetings (quarterly) for joint review and planning.
- Synchronized implementation of interventions like LLIN distribution, IRS by districts on both sides of the border as much as possible.
- Diagnosis and treatment irrespective of nationality and follow up of treatment compliance.
- Strengthening of surveillance and M&E adjusted to burden reduction & elimination settings.
- Initiation of case/focus investigation, classification & response especially in border districts of India reporting relatively few cases.
- Screening of population coupled with IEC/BCC in identified locations (“marketplaces” on certain designated days) jointly by India and Bhutan.
- Ensuring reporting from private sector to HMIS by India.
- Involvement of local school students, teachers, self-help groups, community leaders for early diagnosis and complete treatment (EDCT), IEC/BCC etc. in remote and difficult-to-reach areas as alternate mechanisms of service delivery in India.
- Epidemiological analysis of each border district periodically.
- Optimal cooperation and coordination between Bodoland Territorial Council (BTC)/BTAD and state NVBDCP in Assam.
2. For WHO:
- Create, facilitate and support the digital platforms for malaria data sharing between India-Bhutan border districts.
- Facilitate review of district-to-district cross-border coordination annually.
- Strengthen capacity at state, district and sub-district levels especially on epidemiological analysis as well as case and focus investigation, etc.
The meeting ended with a vote of thanks to all dignitaries and delegates by Dr Roop Kumari, Technical Officer, Malaria and VBDs, WHO Country Office, India.