MEDP Mandla conceptualized a study to assess the needs of the ASHAs for achieving malaria elimination in Balaghat district of Madhya Pradesh. Alongside, an IEC/BCC KAP assessment for the community members of this district was planned. This month, MEDP completed the data collection for these two studies in collaboration with the Chief Medical and Health Officer and District Malaria Officer of Balaghat District.

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This month, four more manuscripts were published as part of the MEDP thematic series in the Malaria Journal. The titles of the manuscripts are as follows (Figure 1): 1) Assessment of ASHA for knowledge, diagnosis and treatment on malaria in Mandla district of Madhya Pradesh as part of the Malaria Elimination Demonstration Project 2) A comprehensive mobile application tool for disease surveillance, workforce management and supply chain management for Malaria Elimination Demonstration Project 3) A model for malaria elimination based on learnings from the Malaria Elimination Demonstration Project, Mandla district, Madhya Pradesh 4) Improvement of Indoor Residual Spraying and Long?Lasting Insecticidal Net services through structured monitoring and supervision as part of the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh Online access link to the collection: https://www.biomedcentral.com/collections/mandlaelimination

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MEDP Mandla completed the first phase of one-on-one trainings of 260 ASHAs of Mandla District. The Malaria Field Coordinators visited the ASHAs of Mandla and provided them hands-on training on malaria diagnosis and treatment along with a key training points of all the health programmes running in Mandla District. Additionally, a printed pocket-size job-aid was also provided to the ASHAs for quick reference.

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The fifth manuscript titled “Significance of training, monitoring and assessment of malaria workers in achieving malaria elimination goal of Malaria Elimination Demonstration Project” as part of the eleven-paper thematic series of the Malaria Elimination Demonstration Project was published in the Malaria Journal. Three more manuscripts titled: 1) A model for malaria elimination based on learnings from the Malaria Elimination Demonstration Project, Mandla district, Madhya Pradesh; 2) Assessment of ASHA for knowledge, diagnosis and treatment on malaria in Mandla district of Madhya; and 3) A comprehensive mobile application tool for disease surveillance, workforce management and supply chain management for Malaria Elimination Demonstration Project have been accepted for publication. Online access link: https://www.biomedcentral.com/collections/mandlaelimination

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MEDP Mandla has started collection of end-line data to assess the effectiveness of Information, Education, Communication and Behavior Change Communication strategy of the project. The interim data collection results have been submitted for publication in the Malaria Journal. In the upcoming month, over a thousand community members of Mandla including residents, teachers, and school students will be administered with a comprehensive assessment tool to determine the effect of IEC/BCC strategy of MEDP.

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The fourth manuscript titled “Socio-economic determinants of malaria in tribal dominated Mandla district enrolled in Malaria Elimination Demonstration Project in Madhya Pradesh” as part of the eleven-paper thematic series of the Malaria Elimination Demonstration Project was published in the Malaria Journal (Figure 1). The fifth manuscript titled “Significance of training, monitoring and assessment of malaria workers in achieving malaria elimination goal of Malaria Elimination Demonstration Project” has been accepted for publication and is in-press. Online access link: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-020-03540-x

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On December 30, 2020, a virtual reorientation training for Malaria Field Coordinators on IEC/ BCC strategy adopted in MEDP was done to discuss the findings of the IEC/BCC assessment study and to strengthen the capacity of Malaria Field Coordinators of MEDP Mandla.

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Two manuscripts from the MEDP thematic series have been published in the Malaria Journal. "Study design and operational framework for a community-based Malaria Elimination Demonstration Project (MEDP) in 1233 villages of district Mandla, Madhya Pradesh". Online access link: https://bit.ly/3gxfA32 (Figure 1) "A study of malaria vector surveillance as part of the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh". Online access link: https://bit.ly/3m4t7jF (Figure 2) Two more manuscripts titled “Significance of training, monitoring and assessment of malaria workers in achieving malaria elimination goal of Malaria Elimination Demonstration Project” and “Socio-economic determinants of malaria in tribal dominated Mandla district enrolled in Malaria Elimination Demonstration Project in Madhya Pradesh” have been accepted for publication.

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This month, MEDP has re-initiated the data collection for the ASHA needs assessment study. The baseline assessment was done in the year 2017 and findings have been submitted for publication as part of the MEDP thematic series in the Malaria Journal. This end-line assessment is being done following the training of ASHAs, the job-aids distributed to them, and regular capacity building exercises performed by MEDP in the last three years.

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This month, FDEC India released its CSR progress report 2018-20 featuring its flagship initiative – Malaria Elimination Demonstration Project.

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This month, distribution of 1,30,000 LLINs in 319 villages was initiated by the District Malaria Office to replace the same number of LLINs distributed in the year 2016-17. MEDP actively supported the distribution by organizing on-spot IEC/BCC campaigns for usage and storage of bed nets. MEDP will initiate a post-distribution usage survey in the coming months.

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On September 17 2020, MEDP published its first paper as part of the thematic series in Malaria Journal. The paper titled "Demonstration of indigenous malaria elimination through Track-Test-Treat-Track (T4) strategy in a Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh" was published. Online access link: https://rdcu.be/b7pvJ

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The second round of Indoor Residual Spray in 26 high-risk villages was initiated by the District Malaria Office from September 1, 2020. MEDP participated in the planning of the IRS in these villages and communicated the spray dates and plans in-advance to the community members. Supportive supervision is being provided by MEDP using the IRS monitoring tool developed by the project. Special emphasis is being placed on strict adherence to COVID-19 social distancing and infection control protocols.

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This month we witnessed an increase in cryptic cases all over the district. To rule out any asymptomatic reservoirs, we conducted aggressive ring-type MSAT around all the cryptic cases. A total of 18 MSAT rounds were conducted this month. We tested 5,452 individuals, diagnosed and treated four positive cases. The average coverage of the target population was 94%.

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From July 14 to 17, 2020, team from ICMR NIRTH led by Dr A K Mishra arrived at Mandla to conduct their periodic entomological assessment as part of MEDP. Resting collections, cone-bioassays, IRS monitoring, night collections etc. were performed by the team.

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From July 1 to 15, 2020, MEDP was asked by the state to support the 'Kill Corona' initiative in Mandla district. During this campaign, special active fever screenings were conducted throughout Mandla district by teams of ASHAs, ANMs, MPWs, Village Malaria Workers (VMW-MEDP), and Malaria Field Coordinators (MFC-MEDP). The planning was done strategically to prevent disruption of the existing malaria surveillance in the high-risk monsoon season. Fever patients were also tested on-the-spot using RDTs by MEDP Mandla. We diagnosed and treated six malaria positive cases during this campaign.

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From July 8 to 10, 2020, 14 new Village Malaria Workers were trained for induction to MEDP by the District Malaria Office and FDEC India. Pre and post-training assessments were done for the candidates. They have been cleared for active duty by the Chief Medical and Health Officer (CMHO), Mandla.

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The first round of Indoor Residual Spray in 26 high-risk villages was initiated by the District Malaria Office from June 16, 2020 to July 31, 2020. MEDP participated in the planning of IRS in these villages and communicated the spray dates and plans in-advance to the community members. Supportive supervision is being provided by MEDP using the IRS monitoring tool developed by the project. Special emphasis is being placed on strict adherence to COVID-19 social distancing and infection control protocols

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Similar to every year, the month of June was observed as the malaria prevention month in Mandla district in collaboration with the District Malaria Office, Government of MP. A malaria rath was flagged off by CMHO Mandla on June 1, 2020. This vehicle consists of audio-visual IEC/BCC messages on malaria prevention. MEDP participated in these awareness activities throughout the month. Owing to COVID-19 restriction, events such as community markets, school sessions, rallies etc. were cancelled. However, Inter-Personal Communication was used as the preferred method of malaria awareness messages while following appropriate social distancing protocols.

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I. FIRST NOTIFICATION: On May 26 2020, CMHO Mandla informed us that a 20 yrs old Plasmodium falciparum (Pf) positive patient named Pahal Singh from Lutiya village of Nakawal sub-center in Bichhiya block has Left Against Medical Advice (LAMA) from District Hospital on May 24 (same day of admission). MEDP was given the task of tracking and treating the patient. II. TRACKING: MEDP immediately mobilized its resources and Malaria Field Coordinator (MFC) Nandkumar Bajpai with his Village Malaria Worker (VMW) visited the village and interacted with the patient’s family members. They informed that patient had not returned home for the past two days. Following this, we made contact with patient’s brother, who informed us that they are staying with a relative in Bhurkhatola of Rasaiyyadouna village of the same block and is now undergoing treatment from Nirmala missionary hospital. III. PATIENT IS MALARIA NEGATIVE? INVESTIGATED FURTHER: The local VMW Nischal Shriwas tracked them, checked the private lab’s pathology report which showed the patient as malaria negative. He immediately informed us and re-tested him (Pahal Singh) using a RDT. Result was Pf malaria positive (Figure 1). IV. RE-TESTED. MALARIA POSITIVE AMIDST THE COVID-19 SITUATION: Meanwhile, the local ASHA came to the spot and handed over the ACT anti-malarial and warned the patient and his brother to return to their homes immediately and stay put amidst the COVID-19 pandemic. Both of them were scared and confused. V. PATIENT NOT COOPERATING. WHAT TO DO?: The VMW informed us that the patient is refusing to take the anti-malarial, is suffering from high-grade fever, and arguing because they have been asked to leave the village. VI. MEDP’s DISTRICT OFFICE STEPS IN: With the nearest MFC 40 Kms away and tense situation, the District Officer of MEDP Mr. Sekh Nisar visited at patient at 8 PM on the same day. After rigorous counselling and efforts, the patient was fed, and the first day treatment was administered under direct observation by us. The LLIN was installed and he was made to sleep inside it. The local ASHA was counselled and asked to cooperate with the patient. Both VMW and ASHA were also asked to follow-up on the radical treatment. Few packets of ORS were handed over to the patient. VII. REWIND. EVENTS LEADING TO LAMA.: On May 24, 2020, the patient experienced fever for the first time and underwent treatment from an un-registered medical practitioner, who administered the treatment. On May 25, 2020, he had a repeat episode of high-grade fever with severe headache. They contacted the local ASHA, but was advised to visit the District Hospital, as he was a COVID-19 suspect. The same day patient was admitted in the District Hospital, Mandla. The blood sample was collected and supportive treatment was started. The patient did not feel comfortable and left the premises (LAMA) before the lab results came in. After L.A.M.A., they went to the Nirmala Hospital, where the patient was administered I.V. saline with oral paracetamols. He was discharged in the evening citing malaria negative case. The hospital has only day-care-facility. VIII. COMPLETION OF RADICAL TREATMENT AND MOVING FORWARD: On May 29, 2020, the patient was administered his last dose of ACT anti-malarial by MEDP under direct observation. He is feeling much better and is on the road to full recovery. Moving forward, the patient has been advised to sleep under LLIN and will be followed-up closely by our active surveillance.

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Malaria does not wait to disrupt lives, which is why timely detection & treatment is essential. Our Malaria Elimination Demonstration Project team is working with determination to safeguard lives from this scourge. But the fight against #malaria requires each of us to take up responsibility. #WorldMalariaDay World Health Organization

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On the occasion of World Malaria Day, a leading local newspaper of Mandla district published a story on the status of Malaria in Mandla district.

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Our Malaria Elimination Demonstration Project conducts fortnightly door-to-door Track, Test, Treat, and Track of the entire population of Mandla district in MP to ensure complete follow-up of radical treatment for #malaria. Here is a story of a beneficiary. #WorldMalariaDay Foundation for Disease Elimination and Control of India - FDEC India

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On the occasion of World Malaria Day, testimonial from Dr Srinath Singh, CMHO Mandla

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As the global community struggles with the COVID-19 pandemic, India is working to tackle the disease with prompt and effective public health strategies. MEDP has been granted permissions to work under ‘essential services’ during the lockdown. We have pledged our support to the Government of Madhya Pradesh and are helping the district administration of Mandla in tracking and isolation of suspected COVID-19 patients along with its malaria surveillance and case management activities in the district. The Advance Tour Plans (ATPs) of the field staff have been revised to suit the ongoing lockdown and all necessary infection control protocols are being practiced.

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MEDP is committed in the fight against COVID-19 pandemic. We are helping the district administration of Mandla in tracking and isolation of suspected COVID-19 patients along with its malaria surveillance and case management activities in the district. Recently, we got facemasks hand-stitched by inmates of Mandla jail and distributed them to our entire staff of 270+ for personal protection. The field staff has been stationed to screen all in/out populations at district borders.

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From March 2 to 12 2020, more than 650 residents of Mandla district returned home from states of Andhra Pradesh, Maharashtra, Chhattisgarh, Telangana, and Jharkhand for the festival of Holi. Everyone was tracked using the active village-level migratory population list maintained by the Village Malaria Workers (VMWs). The population was intercepted at bus stops (Figure 1) and symptomatic patients were tested on-the-spot. Asymptomatic cases traveling from malaria-endemic areas were also tested. Surveillance deployed on Sundays and festival days also led to discovery of malaria infections in this population. A total of 21 malaria positive cases were diagnosed, all of whom were administered the treatment under direct observation.

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From February 29 to March 2 2020, the 64th Annual National Conference of Indian Public Health Association (IPHACON 2020) was hosted at AIIMS New Delhi. Malaria Elimination Demonstration Project was invited to present a scientific poster at the national conference and was represented by Dr Harsh Rajvanshi, Program Officer, MEDP Mandla.

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This month MEDP participated in the annual tribal festival of Mandla known as Aadimahotsav. The project installed its IEC BCC/T4 booth as part of the health camp at the festival and provided free-of-cost malaria diagnostic, treatment, and prevention services. Hon'ble Vice President of India Sh. Venkaiah Naidu graced the event.

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On January 22, 2020, MEDP sent four of its field and office staff for a one-day refresher training on staining and fixing of blood slides at ICMR NIRTH, Jabalpur (Figure 2). MEDP regularly collects blood slides and filter paper samples for every tenth febrile case and for every malaria positive case. Samples are also collected for the entire population screened as part of Mass Screening and Treatment (MSAT).

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This month MEDP's Village Malaria Workers helped the Government of MP in achieving total coverage during the periodic pulse-polio immunization campaign in Mandla. MEDP has been helping the government in their various public health initiatives such pulse-polio, dengue drives, rotary camps, etc. since its inception in 2017.

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This month, MEDP planned and completed the data collection for the post-distribution usage survey of LLINs distributed in 2019 by the Government of Madhya Pradesh. The survey was conducted in a randomly selected sample of 2000 households consisting of around 5000 LLINs. The checklist included inspection of the condition of the LLINs, user habits and perceptions, information about side-effects, availability of nets, etc. The data is under analysis and will be published as part of the MEDP research paper on vector control.

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On December 31 2019, MEDP has its mid-year review meeting at the Indian International Centre, New Delhi (Figure 4). The review was attended by the following participants: I. Dr Amit Sharma, Director, ICMR NIMR New Delhi II. Dr Altaf Lal, Director MEDP and Board member FDEC India III. Dr Azadar Khan, Board member FDEC India IV. Dr Suman Wattal, Dy. Director, NVBDCP New Delhi V. Dr Ashwani Kumar, Director, VCRC Puducherry VI. Dr Manju Rahi, Scientist F, ICMR HQs New Delhi VII. Dr Anup Anvikar, Scientist F, ICMR NIMR New Delhi VIII. Dr Abhinav Sinha, Scientist E, ICMR NIMR New Delhi IX. Dr Praveen Bharti, Scientist E, ICMR NIRTH Jabalpur X. Dr Satyendra Pandey, Consultant Entomologist, DHS Bhopal (nominated by Dr Himanshu Jayswar SPO DHS Bhopal) XI. Mr Ramji Balavi, DMO Balaghat XII. Dr Harsh Rajvanshi, Program Officer, MEDP Mandla XIII. Mr Sekh Nisar, District Officer, MEDP Mandla Key action points were discussed and identified as follows: I. Fourth Malaria Elimination Advisory Group meeting in April 2020 – Dr Amit Sharma kindly accepted request for hosting this meeting at NIMR similar to last year. II. Hemex at MEDP Mandla – Drs. Lal, Anvikar, and Bharti to facilitate introduction of ‘Hemex’ device in Mandla. Preferably, this should be tested in small geographical area for efficacy, cost-benefit analysis etc. before escalating to pan-district. III. Improvement in district level coordination – Dr Satyendra Pandey assured support in improving coordinating with the state government at district level. IV. Mass Drug Administration – Further discussions at the upcoming MEAG meeting to lay down the groundwork for MSAT followed by MDA in Mandla or neighbouring districts.

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As per NVBDCP’s National Strategic Plan for Malaria Elimination 2017-22, Indoor Residual Spray in the form of focal spray must be done in and around 50 houses of the malaria case where API is less than one and no vector control interventions like IRS or LLINs have been done. Till date, this was not being done in Mandla district. After extensive discussions with NVBDCP and GoMP, FDEC India took the responsibility of these focal sprays in the district. This month spray was completed in all the target villages

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From December 5 to 7 2019, MEDP was showcased by ICMR NIRTH as one of its flagship projects at the Chutka Health and Wellness festival in Mandla organized by the Ministry of AYUSH, Government of India. Participants were taught about malaria using the latest IEC BCC tools developed by the project following interactions of project field staff with community leaders and officers.

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The MSAT exercise started in November 2019 around cryptic or gametocyte positive cases were continued this month to cover all such cases for this year. This month, the target population was 1479 individuals, a coverage of 82.4% (1219) was achieved and no positive cases were found.

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MEDP Mandla was awarded with First Prize in poster-presentation at the 6th National Summit on Good and Replicable Practices and Innovations in Public Healthcare Systems in India in Gandhinagar, Gujarat by the Ministry of Health and Family Welfare, Government of India (Figure 3-4).

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The project presented its achievements and strategies in the poster presentation competition. It was appreciated by the judges as a unique PPP initiative to have demonstrated excellent results within a short span of time. In the All India-level competition, Madhya Pradesh state was awarded for MEDP Mandla.

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Rotary’s Active Hands Are Touching (RAHAT) provides free medical examination, dental procedures, and surgeries to the areas with limited access to healthcare since 2010. Once again, this year 2019, the large-scale camp will be organized by RAHAT in Mandla district catering to a population of more than 12 lac people. MEDP Mandla supported RAHAT in its initiative from November 7 to 14 2019. MEDP participated in two phases: A. Screening: Preceding the camp, MEDP participated in mass screenings of patients to be selected for treatment at the camp. In all nine blocks of Mandla, under the supervision of respective Block Medical Officers, the field staff participated in the coordination and conduction of these screenings (Figure 1). B. Diagnosis and treatment: MEDP was tasked as the single point of contact for diagnosis and treatment for malaria of all the fever patients visiting the camp. The project was allotted space in the General Medicine section of the camp. The duty hours were from 9 AM to 5 PM. Two teams were allotted in pre-lunch and post-lunch. Lunch was provided by the camp organizers. The MEDP booth consisted of three VMWs and one MFC supervised by the IEC/BCC officer. All diagnoses and treatment modalities along with IEC BCC material was present in the camp. The staff also participated in the coordination of camp activities with the organizers (Figure 2). MEDP tested a total of 509 patients in the 7-day camp. No malaria positive case was diagnosed. The patients who were tested at the camp for malaria represented all blocks of Mandla district i.e. the entire area covered by MEDP as part of the project’s objectives. All patients were malaria negative. This is a good secondary indicator for assessing our performance all over the district.

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On October 28, 2019, MEDP was invited for a long talk at the Malaria Elimination – Gains & Challenges session in the Melbourne conference 2019 at the Walter and Eliza Hall Institute in Melbourne, Australia. Speakers from around the world shared their experiences, learnings and strategies for malaria elimination in various domains from molecular biology to field implementation to programmatic management. In addition to talk from MEDP on malaria elimination in Mandla, Dr Audrey Odom John from the Washington University School of Medicine spoke about the novel inexpensive and accurate malaria diagnosis tool using a breath-test being developed by their team, Dr Ngor Pengby from Cambodia showcased their plans for malaria elimination using a mobile application surveillance tool very similar to what MEDP Mandla has introduced in the district. The talk was well-received and the strategy of MEDP with special focus on operational excellence and accountability were lauded by the audience.

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From October 23 to 25 2019, as per the operational plan, ICMR NIRTH completed its quarterly entomological investigation in Mandla district. The team headed by Dr. A K Mishra studied the quality of Indoor Residual Spray, performed night collections, resting mosquito collections, cone bioassays, insecticide susceptibility tests, etc. in the target villages.

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Rotary’s Active Hands Are Touching (RAHAT) provide free medical examination, dental procedures, and surgeries to the areas with limited access to healthcare since 2010. Once again, this year 2019, the large-scale camp will be organized by RAHAT in Mandla district catering to a population of more than 12 lac people. MEDP Mandla is supporting RAHAT in its glorious initiative and is participating is patient screening for the upcoming camp all over the district.

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Round 2 of Indoor Residual Spray was started on September 1, 2019, and was completed by October 15, 2019, in the district. As per the operational plan, MEDP Mandla provided supportive supervision to the spray teams along with the implementation of the monitoring tool for the IRS.

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On the occasion of the 150th Birth Anniversary of Mahatma Gandhi, FDEC India was awarded with the prestigious Mahatma Gandhi Award for Social Good at a glittering ceremony at the Hotel Crown Plaza in Gurgaon, Delhi NCR. The Mahatma Awards were constituted in the United States to raise global awareness around the positive impact brands, agencies and non-profits have at society. The awards are organized by Liveweek USA and sponsored by the Aditya Birla group, they are presented annually to individuals and organizations in acknowledgment of their impactful work.

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From September 26 to 28 2019, MEDP was invited to speak at the 30th National Congress of Parasitology and Global Summit for Malaria Elimination organized in the memory of Late Dr. Neeru Singh by Special Centre for Molecular Medicine and the Indian Society of Parasitology at JNU New Delhi. The project presented the overview and key achievement of Malaria Elimination Demonstration Project and the indigenously developed mobile application surveillance, human resource management, and supply chain management tool - SOCH (SOlutions for Community Healthworkers).

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A glimpse of our incredible journey so far!

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Testimonial from Nirmala Janghela.

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Business India is a fortnightly business news magazine founded in 1978 and is published out of Mumbai. The magazine planned a special CSR supplement to celebrate 41 years of its successful run (Figure 2). Since MEDP is a public private partnership project between Government of Madhya Pradesh, Indian Council of Medical Research, and the Foundation for Disease Elimination and Control of India, which is a CSR initiative of Sun Pharmaceutical Industries Ltd. MEDP was featured as a full-page article in the magazine’s August 12-25 2019 issue.

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Following up to the needs-assessment of ASHAs in malaria, all the ASHAs of the district were trained by MEDP. It was requested at the 3rd Malaria Elimination Advisory Group meeting at ICMR-NIMR in New Delhi that a comprehensive ASHA training module should be prepared by the project. Hence, a training module for ASHAs in malaria has been prepared by MEDP and approved by National Vector Borne Disease Control Programme, Ministry of Health and Family Welfare, New Delhi. The module contains relevant course material along with methodology of training including pre/post training assessments based upon the learnings of MEDP Mandla. It is available in English and Hindi and will soon be uploaded on www.fdeci.org

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As per routine vector control activities in Mandla district, the 45-day round one of Indoor Residual Spray was done in 18 selected villages. MEDP performed supportive supervision of the spray teams and also filled the IRS monitoring checklists in each village. Preliminary results show significant improvement as compared to last year’s spray operations. Detailed analysis is in progress.

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From July 26 to 31, ICMR NIRTH conducted its quarterly entomological investigation in Mandla district. The team studied the quality of Indoor Residual Spray, performed night collections, resting mosquito collections, cone bioassays, insecticide susceptibility tests etc. in the target villages.

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From July 4 to 9 2019, MEDP conducted mid-year refresher trainings for the entire field staff of the project including 235 Village Malaria Workers and 25 Malaria Field Coordinators. The training included refreshers on all operational components of the project including disease surveillance and case management, vector control, capacity building, and IEC/BCC. Pre and post training tests were administered to all the candidates.

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June 26 to 28 2019 – MEDP conducted the induction trainings for the newly recruited 20 Village Malaria Workers. As routine practice, the selected candidates are attached to their respective Malaria Field Coordinators for ‘shadowing’. Once the candidates have seen their working area, understood the process and given consent for the posting – the induction trainings are initiated. This leads in increased compliance at the job post-training. The training was conducted in collaboration with the District Malaria Office of Mandla. In the post-training assessment, all 20 Village Malaria Workers qualified the exam which has a 70% qualifying threshold . All the candidates scored more than 85% marks with 11 of them scored 100%. The batch has been cleared for active duty.

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This is a testimonial from one of our units enrolled in the Sentinel Surveillance Strategy (SSS) network where we have enrolled more than 500 private practitioners all across Mandla district.

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As per the routine operational guidelines, the state of Madhya Pradesh has planned the round 1 of Indoor Residual Spray (IRS) in 18 villages of Mandla district. The exercise is scheduled from June 15, 2019, to July 31, 2019. Similar to the previous year, MEDP is providing supportive supervision to the spray teams during the IRS. Last year, there was significant improvement in all parameters of IRS including solution preparation, spray quality, personal protection techniques, etc.

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As per the operational plan of MEDP and recommendations from the 3rd Malaria Elimination Advisory Group (MEAG) meeting held in New Delhi, the mass screening and treatment (MSAT) exercise in two blocks of Mandla was initiated as per the approved MSAT protocol of ICMR NIRTH Jabalpur. Technicians from NIRTH visited Mandla and supported the exercise on-ground. The coverage of target population was at 97.8% against the desired target of >80%. From each tested individual (11454), all three samples (RDT, Blood Slide, Filter Paper) were attempted. We have been able to collect all three samples from more than 98% individuals. Zero positive cases found in low API category (Narayanganj) and 7 positive cases found in high API category (Mawai). Amongst the 7 cases, 6 were asymptomatic, 4 were Pf, 3 were Pv. In terms of migration, 4 were introduced cases, 3 were indigenous in origin. The MSAT data is maintained separately and is not included in the regular surveillance reports

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The state government of Madhya Pradesh observes ‘malaria month’ in June every year. Similar to the previous year, District Malaria Office and MEDP kick started the malaria month celebrations in Mandla district. The 'malaria rath' was flagged off by the CMHO Mandla followed by an awareness rally. Ahead of the monsoon season, this month we put extra focus on disseminating IEC BCC messages for malaria prevention, diagnosis, and treatment along with screening camps all across the district.

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March 13 to 16 2019 – MEDP was invited to the Meeting on High Burden to High Impact (HBHI) approach on malaria and program review of Vector Borne Diseases being held at Courtyard by Marriott in Bhopal. The meeting was organized by NVBDCP and WHO Country Office for India. States having high burden of malaria presented their challenges and plans to tackle the disease using HBHI approached. MEDP presented a session on solutions for these challenges using their learnings from Mandla. The session was very well received and state programmes were advised to replicate learnings from MEDP wherever possible.

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An awards ceremony was conducted for outstanding performance by field staff in various categories on May 11 2019 at Kingfisher Hotel in Mandla. A total of 4 awards for Malaria Field Coordinators, 10 awards for Village Malaria Workers, and one Best Cluster Award were announced in categories ranging from monitoring and supervision, attendance, efforts in T4 surveillance, efforts in IEC/BCC practices, team management skills, efforts in hardship areas, use of software tools etc.

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As part of the operational plan of MEDP, the seventh entomological visit by ICMR NIRTH was successfully concluded from May 1 to 6 2019 by a team led by Dr. A K Mishra, Scientist E. Resting indoor hand catches, pyrethrum spray catches, light trap catches and human landing collections were performed during this visit.

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On April 25 2019, MEDP collaborated with the District Malaria Office Mandla and participated in the malaria awareness rallies and camps conducted throughout the district. This year’s theme was ‘Zero Malaria Starts with Me’. The local population was given information about the signs and symptoms of malaria and prevention methods ahead of the rainy season in the district. MEDP was also invited to participate in the World Malaria Day celebrations at National Centre for Disease Control in New Delhi. The event was jointly organized by National Vector Borne Disease Control Programme (NVBDCP), National Centre for Disease Control (NCDC), Indian Council for Medical Research (ICMR), and World Health Organization (WHO) Country Office for India. The meeting highlighted the current needs for malaria elimination in the country and encouraged the sharing of best practices by different states and projects with the programme so that the same can be replicated all across the country.

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On April 16 2019, MEDP participated in the discussion meeting on Cost Estimation and Investment Case for Malaria Elimination Leading to Eradication in India hosted by ICMR at National Institute of Medical Statistics (NIMS). MEDP shared its experiences from Mandla which would be helpful in laying down the path for this study. MEDP was also invited to participate as a key discussant in during the launch of first ever Malaria Elimination Research Alliance (MERA) India on April 24 2019 at ICMR HQs in New Delhi.

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A two-day meeting was held at the ICMR-National Institute of Malaria Research (NIMR), New Delhi to review the progress of the Malaria Elimination Demonstration Project (MEDP). The briefing document, including the detailed progress report was sent to the members one week in advance of the meeting. The meeting consisted of 12 exhaustive sessions highlighted the progress of the project in various domains such as surveillance and case management, epidemiological aspects, capacity building, IEC BCC, data reporting etc. A live demo of the indigenously developed mobile application surveillance, workforce and supply chain management tool – SOCH (SOlutions for Community Healthworkers) was also arranged.

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Within 15 months of operation, there was a significant reduction in malaria cases in Mandla.

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In the month of February 2019, the Madhya Pradesh government started the distribution of 250250 Long Lasting Insecticidal Bed Nets (LLINs) in 460 selected villages of Mandla district based upon 2015 epidemiological data. Areas having API more than one were selected for distribution of the LLINs. After last year’s distribution of LLINs, MEDP carried out post-distribution monitoring and presented its report on the same. Keeping in mind the gaps observed, the main focus areas were identified as IEC/BCC and microplanning of the distribution along with an effective communication system. MEDP participated in helping with the distribution plan of the bed nets along with providing its Village Malaria Workers for IEC/BCC activities during the distribution. The Malaria Field Coordinators were also stationed at their respective areas on the days of distribution of bed nets. A live WhatsApp group was created consisting of SPO (Bhopal), CMHO, DMO, DVBDC, BMOs, MTSs, MIs, and MEDP staff. Everyday latest information about the LLIN distribution is posted on the group by the respective personnel and troubleshooting is done. The deadline for exercise was February 25, 2019; which has been extended to March 15, 2019.

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January 28, 2019 – The team from ICMR NIRTH led by Dr. A K Mishra – Scientist E, arrived at Mandla to conduct their sixth quarterly entomological visit as part of MEDP Mandla. The team will be performing mosquito collections, cone bio assays, susceptibility tests etc. as part of the visit. Pre-selected villages based on API, IRS and LLIN criteria were targeted by the team. The exercise was completed by February 1, 2019.

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A briefing about the upcoming LLIN distribution was held in the office of the District Magistrate of Mandla – Sh. Jagdish Chandra Jatiya. MEDP has offered full support in planning and IEC/BCC campaigns for the upcoming exercise. The distribution is expected to start from first week of February in all blocks of the district.

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An IEC/BCC KAP assessment has been planned to assess the current status of knowledge, attitude and perceptions of the general population of Mandla about malaria and to review the project activities in the domain. After exhaustive consultations with ICMR NIRTH, a comprehensive KAP assessment tool has been developed targeting the household members, middle school students and teachers of Mandla. Phase 1 of the activity (Households) started on January 24 and is expected to be completed by February 1 2019. Following this, phase 2 will consists of school students and teachers. Findings from this KAP assessment will enable us to understand the knowledge gaps of the district and customize our interventions accordingly.

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RBM Partnership interviews Dr Madan Pradhan - Public Health Officer, Government of Odisha. Odisha has registered significant progress in the reduction of malaria cases this year and has been recognized in the World Malaria Report 2018 of the World Health Organization. Interview - https://www.youtube.com/watch?v=yUcIlDkI1IA&feature=youtu.be

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January 15-17, 2019 – In order to further strengthen the IEC/BCC practices by the project – experts from ICMR NIRTH conducted a re-orientation training for the entire staff of 235 Village Malaria Workers and 25 Malaria Field Coordinators. Drs. Kalyan B. Saha – Scientist F and Arvind Verma – STO from ICMR NIRTH performed troubleshooting in IEC/BCC activities by personally interacting with the entire staff during block-level sessions in the district. Half-yearly reviews of IEC/BCC activities have been proposed by ICMR NIRTH and accepted by the project.

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January 17, 2019 – MEDP was called upon by the H’ble Chief Minister of Madhya Pradesh – Sh. Kamal Nath followed by an in-depth review by PS Health – Dr. Pallavi Govil. The key highlights of the project with the reduction in malaria cases, capacity building, entomology, IEC/BCC findings etc. were noted. Following this, MEDP has been asked to prepare and present a model for malaria elimination based upon the findings of the project. The same model will be used to replicate the project in other parts of Madhya Pradesh. The project was represented by Dr. Azadar Khan, Senior Vice President - Sun Pharma and Board Member – FDEC India, Dr. Altaf Lal, Senior Advisor – Sun Pharma, Project Director – MEDP & Board Member – FDEC India.

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As part of its IEC/BCC campaign, MEDP produces calendars with malaria awareness messages. These calendars ensure year-round compliance by the general population. This year, 2000 such calendars were produced and hung all over the district at schools, anganwadis, sub-centers etc.

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January 10, 2019 – Dr. Altaf Lal delivered a plenary session at the ‘Dr. Neeru Singh Memorial Lecture’ at 14th ICVVBD in Bhubaneshwar. The session was organized in the memory of Late Dr Neeru Singh – Past Director ICMR NIRTH to honor her exceptional contributions in the field of tribal health. MEDP was her brainchild and operational plan was developed with her guidance.

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On December 14/15, 2018 – MEDP was invited as plenary speaker for ‘Best practices in IEC/BCC’ at the National IEC/BCC Consultation Workshop by NVBDCP & Malaria No More at Radisson Blue Hotel in Guwahati. The project was represented by Dr. Harsh Rajvanshi – Program Officer. The meeting consisted of State Program Officers, Regional Directors, IEC/BCC consultants and NGOs working in high malaria burden states of the nation. The IEC/BCC strategy of the project along with the original material developed by the project was demonstrated in the workshop. The material including calendars, flex, posters, flip books etc. was offered to all the participants for use in their respective states free-of-cost without any copyright issues. Following which, we have received the requests from SPOs of Madhya Pradesh and Manipur – all the material along with source files has been shared with them.

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On December 13, 2018 – MEDP participated in the ‘Eat Right India’ movement by Food Safety and Standards Authority of India (FSSAI) along with the district administration of Mandla. The project participated in the cycle rally organized by CMHO Mandla and several extra-curricular activities to raise the awareness about healthy eating and importance of exercise. In recognition to our efforts, we were awarded ‘first prize’ by the Mandla district administration.

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As mentioned in the last report, we have been noticing malaria cases with significant migration history to Kanha National Park. Since the tiger reserve is out-of-bounds for the regular surveillance done as part of MEDP, a decision was taken to perform mass screening of the entire Kanha National Park field staff and residents. Special permission was sought from the Field Director of Kanha National Park and intensified mass screening was done by the Malaria Field Coordinators under direct supervision of District HQs. The exercise started on October 31 and was completed by November 10, 2018 covering all seven ranges of the tiger reserve including those in the adjoining district of Balaghat. Total 8 malaria cases were diagnosed during this exercise inside the national park. All of these cases were provided prompt radical treatment and were followed up till completion of the same. We are still diagnosing cases in the buffer zones of the park and surveillance has been strengthened in these areas.

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The project recruited 20 new Village Malaria Workers out of the 150 candidates who appeared for interviews in the months of September and October. Written test and interviews were used as form of screening methods for the candidates. From October 22 to 24, 2018, a three day intensive training was organized for the new recruits. The District Vector Borne Disease Consultant from the District Malaria Office also participated in the trainings. Pre and post training assessments were conducted for all the participants keeping 70% marks as the qualifying threshold. One candidate could not clear the post-training assessment and was let go. Remaining 19 candidates were inducted and posted in the vacant positions. Key observation – We had two groups of candidates. Before the trainings, one group was exposed to the field by shadowing their MFCs and other group was trained without pre-exposure to the field. We noted that the group with prior field exposure performed better in the post training assessment.

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As part of the operational plan, the fifth quarterly entomological investigation was concluded at Mandla from 9th to 14th October, 2018. The team was led by Dr A K Mishra – Scientist E from ICMR NIRTH. The team performed indoor resting mosquito collection, cone bioassays and monitoring of indoor residual spray.

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On October 5, 2018, MEDP was awarded with Best Public Health Initiative (Gold) Award by ACEF Asian Leadership Awards at Westin Hotel in Mumbai. The ceremony was graced by dignitaries of leaders in public health, digital marketing, CSR and social work. The MEDP team was represented by Dr A H Khan – Director FDEC India, Dr Himanshu Jayswar – Deputy Director (Health) Government of MP, Mr. Brajesh Choudhary – GM CSR Sun Pharma and Dr Harsh Rajvanshi – Program Officer of MEDP.

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As part of the operational plan, MEDP started the Cluster Combination Approach (CCA) exercise in select areas to assess the asymptomatic malarial case load and to determine the most cost effective model for malaria elimination. The planning of the exercise was done with ICMR NIRTH. The clusters for mass screening were selected on the basis of APIs and hard to reach areas. The Government of MP’s 2017 epidemiological data was used to determine the test sites. The six day exercise started on September 17, 2018 as the first round. It ended on September 24, 2018. Each day, up-to 150 Village Malaria Workers were deployed in four teams to the target clusters. The first round yielded a total coverage of 63.2% of the total target population with 34 Pf cases. Following this, the mop-up was planned using the updated household data in the mobile application system – SOCH and the daily household visit registers of the local VMWs. The mop-up of mass screening started on September 29, 2018 and ended on October 5, 2018 yielding a total coverage of 74.3%. Detailed analysis of the exercise is in-progress.

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During a recent board meeting of FDEC India, it was suggested that a monitoring and evaluation checklist should be put in place for the field staff. This should be filled by the immediate supervisory staff during regular field visits. MEDP is introducing a 30-point checklist for the Village Malaria Workers (VMWs) – to be filled by the Malaria Field Coordinators (MFCs). This will help in systematic performance and systems review of the project.

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On August 4, 2018 – MEDP was invited by the CMHO Mandla to participate in the Mukhyamantri Yuwa Swarojgar Yojna (MMYSY) event organized on behalf of the H’ble Chief Minister of Madhya Pradesh in Mandla. This event was organized to promote the small and medium scale industries. MEDP installed its IEC/BCC booth in the event to spread awareness amongst the visitors in the event. We experienced a large number of visitors who came to the booth and learned about malaria symptoms, treatment and prevention

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On July 31st, 2018 – The round 1 of the Indoor Residual Spray was completed. MEDP participated in this exercise by providing supportive supervision to the spray teams through its 25 Malaria Field Coordinators (MFCs) and assistance in information dissemination about the spray to the villagers through its network of 220+ Village Malaria Workers (VMWs). FDEC India also observed this round and recorded the findings in its monitoring checklist. The data entry has been completed and is under analysis.

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Following up to the minutes of the second Malaria Elimination Advisory Group (MEAG) meeting on 23/24 March 2018 at ICMR NIRTH, Jabalpur – A mid year review meeting was planned at the Mandla office to track the progress of the project with respect to the recommendations made by the MEAG members. Each participant was given a briefing packet which had the agenda for the meeting, handout of the presentation slide deck, monthly and weekly reports of the project from January to June 2018 and the village-level surveillance data from September 2017 to June 2018. The agenda and slide deck for the meeting was circulated with all the participants 3 days in-advance. The meeting started at 10 AM and concluded by 5 PM. The minutes of the meeting with action points were prepared and shared with all the participants. The participants were as follows: 1. Dr Suman Lata Wattal – Deputy Director, NVBDCP New Delhi 2. Dr Altaf Lal – Senior Advisor, Sun Pharma 3. Dr Aparup Das – Director, ICMR NIRTH Jabalpur 4. Dr Himanshu Jayswar – SPO, Directorate of Health Services Bhopal 5. Dr Praveen Bharti – Scientist D, ICMR NIRTH Jabalpur 6. Dr Srinath Singh – CMHO Mandla 7. Mr Ram Shankar Sahu – DMO Mandla 8. Dr Harsh Rajvanshi – Program Officer MEDP Mandla 9. Mr. Rajesh Verma – DVBDC Mandla 10. Mr. Sekh Nisar – District Officer Mandla Following the meeting, a short introductory session was organized with the Village Malaria Workers and Malaria Field Coordinators with the group to learn about the actual field dynamics of Mandla. Alongside, a short demo of the mobile application surveillance tool – SOCH and IEC/BCC material was also organized for the group.

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From July 9th to 14th, the mobile application surveillance tool – SOCH (Solutions for Community Health workers) developed by Sun Pharma IT and Swaas Systems was launched in Mandla. Entire staff of 270+ was trained during this exercise. This tool was developed to digitize all paper-based reporting systems including surveillance data, attendance, tour plans and stock management. The pilot of this app was conducted in two blocks – Mandla and Bicchiya in April 2018 followed by the pan-Mandla roll-out in July 2018. The trainers included Mrs. Nidhi Kaintura from Sun Pharma IT Mumbai, Mr. Raja C. and Mr. Sachin Saxena from Swaas Systems Chennai and Mr. Vinay Telasey from FDEC India. As part of the Operational plan, MEDP has started collecting blood slides and filter paper samples for every 10th febrile case. The training for blood slides for microscopic examination and filter paper samples for PCR was conducted by Dr. Praveen Bharti, Scientist D and Mr. Shashikant Tiwari, Technician from ICMR NIRTH. The trainings were conducted parallel to the mobile app training for the entire field staff from July 9th to 14th. The blood samples are transported from the ground to MEDP district office on a weekly basis. The blood slides are stained and fixed along with cluster-wise compilation of both slides and filter papers. Following this, the samples are transported to ICMR NIRTH for examination.

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As per the operational plan, IEC/BCC is an integral component of the project. The project is currently employing two major IEC/BCC strategies – Haat bazaar (T4 booth) and School-level activities. This month we started our school activities. The target classes chosen for these activities is from 6th to 8th as the most appropriate age group for knowledge gathering and dissemination amongst their peers. The activity involves addressing the morning school assembly, which is done by the Malaria Field Coordinators (MFCs) and assisted by their Village Malaria Workers (VMWs). Following the school assembly, focus group IEC is done using flip books that have been developed by FDEC India. The entire field staff follows a roster with an advanced tour plan under the direct supervision of the Capacity Building Officer.

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The field staff of MEDP follows an Advance Tour Plan (ATP) for their weekly door-to-door visits to the households in villages. To further plan this ATP, we have divided the day into three sections - morning, afternoon and evening. The visit of field staff is further divided into tolaas, mohallas etc. of the village. This helps in better monitoring of the staff and villagers are better informed upon the time and date when they can expect a Village Malaria Worker (VMW) for Track, Test and Treat of malaria. Hence, now known as a micro-ATP. This exercise involved the entire district – 1233 villages and 235 VMWs, the ATPs have now been frozen and shared with all the relevant stakeholders including Directorate of National Vector Borne Disease Control Programme New Delhi and Government of Madhya Pradesh at both state and district levels.

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On June 3, Honorable Chief Minister of Madhya Pradesh – Sh. Shivraj Singh Chouhan visited Anjania. MEDP participated in the event by installing a Track, Test and Treat cum IEC/BCC booth in the event. The team worked on increasing awareness about malaria along with testing and treating any fever case who visited the booth during the event. On June 23, the District Magistrate visited Maniksara village of Bijadandi block as part of the Vishesh Jan Sunvai. The DM interacted with our team during this visit and also visited the T3/IEC BCC booth. She appreciated and encouraged the team

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As per the routine vector control measures initiated by the state, Indoor Residual Spray (IRS) round one was initiated in 111 villages from June 16. As per the operational plan, MEDP observed the IRS last year and offered their support in assisting the IRS this year. Following this, all the Malaria Field Coordinators of the respective regions were officiated as supporting supervisors by the GoMP along with the existing Malaria Technical Supervisors and Malaria Inspectors. The staff received training by the state in the presence of spray teams and are supervising those teams throughout the duration of the spray.

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Upon the request of the CMHO Mandla, MEDP has initiated a fever case load estimation study in the District Hospital. The purpose of the study is to get an estimation of fever case load at the hospital and to test each fever case for malaria before he/she is sent to the physician. The exercise is done every week on Monday – the busiest day of the OPD. Three trained Village Malaria Workers are stationed in the OPD to capture and test each fever patient for malaria. The initial duration of the study is from June 2018 to September 2018, which can be extended, if required.

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June 2018 is observed as malaria month by the state. It focusses on raising awareness for prevention and treatment of malaria with the help of sound IEC/BCC and advocacy efforts all over the district. On June 1 2018, a rally was flagged off from the District Hospital by CMHO Mandla. The team rallied all over Mandla city with slogans and posters of malaria awareness including a ‘malaria rath’ which showcased information about prevention and treatment of malaria. All the stakeholders including FDEC India involved in malaria control activities in Mandla joined hands with the District Malaria Office and participated in advocacy and awareness efforts throughout the month.

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As part of the operational plan, a team from ICMR NIRTH under the guidance of Dr. A K Mishra, Scientist E conducted the third round of entomological survey in Mandla from May 28th to June 1st 2018. Last two surveys were done in October 2017 and February 2018, respectively. The team visited villages with different API categories and performed mosquito catching, cone-bio assays etc.

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Government of MP organized block-wise trainings of all the ASHAs of Mandla under the Ayushmaan bharat programme. FDEC India was invited to participate in these trainings. Out of the 9 blocks, 8 blocks were covered in the month of May 2018 and we participated in all the trainings. We also distributed job-aids to all the ASHAs. These pocket-size booklets contain the basics on malariology, RDT procedures, tips on LLIN and IRS, complete drug regimens for all types of malaria infections as per the GoMP guidelines etc. Hands-on sessions for the correct procedure of performing a Rapid Diagnostic Test (RDTs) were also conducted. Feedback was recorded for all the sessions and shared with the Chief Medical and Health Officer (CMHO) of Mandla.

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The project maintains strict quality adherence protocols and strives to achieve maximum potential. To help us with the same, Sun Pharmaceuticals sent experienced professionals from Vadodara and Mumbai to help us optimize our processes. Mr. Brajesh Choudhury, GM-CSR visited Mandla from Vadodara on 16th and 17th May, 2018 and evaluated the project as part of CSR initiatives by Sun Pharmaceuticals. Mr. Arun Dhuriya, Manager – Marketing Services visited Mandla from Mumbai from 21st to 24th May, 2018 and helped us optimizing the processes and reporting of workflow management.

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One of the objectives of MEDP is to demonstrate the collateral benefits on other vector borne diseases like Dengue. Keeping this objective in mind, MEDP celebrated the National Dengue Day 2018 by conducting various IEC/BCC camps all around the district. The field staff used the IEC/BCC booths for dissemination of key-dengue prevention messages in the district. The activity was well received by the community of Mandla.

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On May 10th and 11th, 2018 – MEDP was visited by the Directorate of NVBDCP, New Delhi and Directorate of Health Services, Bhopal. Team consisted of Dr. P K Sen, Director – NVBDCP; Dr. Avadhesh Kumar, Addl. Director – NVBDCP; Dr. Himanshu Jayswar, SPO – Directorate of Health Services; Dr. K B Saha, Scientist E – ICMR NIRTH; Dr. M M Maholia, State Entomologist - Directorate of Health Services, Dr. Nikhilesh Chandra, Regional Director; Dr. R K Vyas, CMO (NFSG) – ROHFW Bhopal; Mr. Ram Shankar Sahu – DMO; Dr. Harsh Rajvanshi – Program Officer, MEDP; and Mr. Rajesh Verma – Consultant VBD, Mandla. A short presentation was conducted on the state of the project in the MEDP Mandla office following which the team visited PHC Anjania of Bicchiya block and were met by the medical officer along with a lab technician, MTS, 3 VMWs and one MFC of MEDP. Following this, the team visited CHC Ghughari and met the CBMO of the CHC along with the lab technician, MTS, two MFCs and 5 VMWs of MEDP. Then, the team also visited a Sub Centre in Mohgaon where they were met by the ASHA, ANM, MI and MFC with 2 VMWs of MEDP. Lastly, a nearby village was visited to witness the chopaal IEC/BCC of EMBED project by Godrej. Discussions were held later that day and the subsequent morning about the overall functioning of the project and inter-sectorial coordination with the Government of MP.

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On May 10 2018, MEDP was featured in the CSR supplement of leading daily English newspaper – Hitavada. The half-page feature talked about the malaria statistics of India, signing of the three party agreement between Government of Madhya Pradesh, Indian Council for Medical Research and Foundation for Disease Elimination and Control of India which was established by Sun Pharma as a non-profit entity. The article also featured on the project progress in the past year including statistics on the tracking, testing and treating of malaria in the Mandla district. A brief introduction on the upcoming mobile application – SOCH (Solutions for Community Healthworkers) was also featured.

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A study titled “Assessment of ASHA for knowledge, diagnosis and treatment on malaria in Mandla district of Madhya Pradesh” was completed by MEDP. This was undertaken as a part of our commitment to the state of Madhya Pradesh. On April 30th, 2018; the report was officially submitted to the state with recommendations. We concluded that there is strong need for fresh training on RDTs and treatment regimen for Pv and Pf. We propose to conduct group and/or one-on-one training as we visit the villages. It is also suggested that similar study may be undertaken in other districts of MP, so that training and capacity needs for ASHAs can be determined. Since ASHAs are situated and live in their respective villages, they will make excellent champions, lead workers and communicating operators for malaria elimination.

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We celebrated the World Malaria Day 2018 with this year’s theme by the World Health Organization (WHO) - ‘Ready to beat malaria’. This theme underscores the collective energy and commitment of the global malaria community in uniting around the common goal of a world free of malaria. Keeping the global and national commitments in mind, the National Vector Borne Disease Control Programme (NVBDCP) suggested the organization of IEC/BCC campaigns on this malaria year’s day. MEDP celebrated this day by organizing its unique Information, Education and Communication/Behavior Change Communication (IEC/BCC) campaign at the National Panchayati Raj Day 2018 inaugurated by the Honorable Prime Minister of India – Sh. Narendra Modi in Mandla on April 24, 2018. Thousands of people interacted with our team and learned about malaria. Eight such booths with the field staff team were placed all over the Panchayati Raj festival. The project was also featured in the ‘success stories’ of the district during this festival. MEDP has developed its original IEC/BCC material including the artwork and has claimed no copyrights on the same. We encourage the stakeholders and partners to use this material extensively for the benefit of the community. Additionally, on April 25, 2018, MEDP launched the pilot phase of its mobile application surveillance tool – Solution for Community Health workers (SOCH) developed with Sun IT Mumbai and Swaas Systems Chennai. The application will enable us to digitize all paper-based reporting systems, GPS tracking, attendance management, stock and inventory management along with recording and generation of accurate surveillance data.

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The mobile application – SOCH, which was formally deployed in two blocks of Mandla (Bicchiya and Mandla) as a pilot exercise had its training for the 60 VMWs and 6 MFCs of these blocks from April 10 to 13, 2018. Trainers and developers from Sun IT Mumbai and Swaas Systems Chennai came to Mandla for this 4-day training exercise. It included hands-on training of the district-level staff and field staff for the mobile app and web-interface. Following the feedback received on the pilot run of the mobile application, a full-fledged roll out will be conducted for pan-Mandla coverage in the upcoming months.

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Nineteen new Village Malaria Workers (VMWs) were recruited in the month of march. To better orient them with their core deliverables and the workplace, they were attached provisionally with their Malaria Field Coordinators (MFCs) for 15 days to observe and assist, but not to Track, Test & Treat. Following this, they were called for the formal induction training at the MEDP office from April 2nd to 4th, 2018. The new VMWs have received their Track, Test and Treat certificate from the CMHO Mandla and are actively deployed in their work areas.

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A two-day meeting was held at the National Institute for Research in Tribal Health (NIRTH) to review the progress of the Malaria Elimination Demonstration Project (MEDP). MEAG members, stakeholders and observers from all around the country were present for the meeting. Presentations by PATH, CHAI, Malaria No More, Tata Trust and Godrej in their respective work in malaria were made. Day 1 included presentations on state of M-MEDP-MEDP structure, project timeline, staffing update, communication, collaborations, training and assessment of Field Workers, summary of first MEAG with follow up, demo and training of IEC/BCC, roll-out of Track, Test and Treat (T3), surveillance and case management, troubleshooting, inter-sectorial coordination, real-time reporting and data sharing along with a demo of the mobile application surveillance tool “SOCH” Day 2 began with presentations on proposed research questions by scientists from ICMR NIRTH followed by ASHA needs assessment, LLIN monitoring and entomological studies done by the project. The meeting concluded with a discussion on solutions for observed challenges. A sub-committee was formed to address the issues and the report was submitted on the same day.

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During our interactions at the second MEAG meeting, we realized that most high-level stakeholders do not have enough time to read the detailed reports generated by the project. We were also requested by the DM and CMHO to advise them on strategies to better prepare the district from Dengue and Diarrheal diseases in-advance this year. To address this, a WhatsApp group was created which has stakeholders like Director NVBDCP, Director ICMR NIRTH, Board of FDEC India, Scientists of ICMR NIRTH, SPO DHS Bhopal, DM CMHO DMO Mandla etc. We post short updates in bullets with photographs in this group for quick review and reference

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On March 9, 2018 FDEC India was requested by the Government of Madhya Pradesh for support in a pulse-polio round in Mandla. FDEC India deployed its entire field staff of 260 individuals (235 VMWs and 25 MFCs) to aid the polio vaccination drive for the entire duration (March 11 to 13 2018) The field staff received trainings from the respective Block medical officers of all the blocks on March 10 2018 as polio booth supervisors.

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MEDP developed its own IEC/BCC material for use in the community outreach activities. These material have been developed based upon our regular feedback from the field – which included the field staff and the community of Mandla. The artwork used in the material has been developed by us and we do not claim any copyrights to the material and encourage the government and organizations to make use of the same.

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A new progress-mapping tool has been introduced in the office. Due to growing amount of incoming data, we have introduced a Data Entry Roster. This roster contains the names of the Data Entry Operators (DEOs) along with their daily targets. The roster also contains additional notes and instructions, which act as a guide for resolving confusions during data entry. At the end of each week, each DEO is evaluated based on his/her daily performance and target achieved – the best performing DEO is awarded as ‘DEO of the week’ along with a certificate.

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As part of the operational plan, a second round of entomological investigation was carried out from 21st to 25th February, 2018 by ICMR-NIRTH under the supervision of Dr. A K Mishra – Scientist E. The team performed indoor resting collections in 9 villages of different category and observed that the vector density is higher in IRS villages which was comparatively lower in October visit, may be due to 2nd round IRS was just over at that time. However, as per discussion with few villagers during survey, the team felt that IEC is very much needed among the villagers, at least for the use of LLINs. Most of the villagers are presently not using nets as observed by NIRTH team may be due to winter, however, in October visit, LLIN usage by the villagers was comparatively good. The team was accompanied by District Officer – MEDP.

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MEDP was invited to the monthly meeting of the health committee of Zilla Panchayat under the chairmanship of Smt. Angoori Jhariya and members Sh. Vijay Sarvate, Smt. Kiran Chandrol, Smt. Anita Tiwari and Sh. Ranjit Kaur. Additional members included Dr. Srinath Singh – CMHO Mandla and Mr. Ram Shankar Sahu –DMO Mandla. MEDP was represented by Dr. Harsh Rajvanshi – Program Officer, Mr. Sekh Nisar – District Officer and Mr. Vikesh Thakre – Capacity Building Officer. A short presentation on the project including the goals, latest surveillance data and request for support from the members at field level was presented. The project was well received and the committee assured their support to the workers. Additionally, a couple of incidents by the members towards improper work by the VMWs were shared – for this, a helpline no. 07642 252483 (Office landline) was circulated to everyone to convey their grievances or any reports about the project.

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On 30th and 31st January 2018, Dr. Himanshu Jayswar – State Programme Officer, DHS, Bhopal visited MEDP in Mandla. The visit included inspections of MEDP office and field operations. The focus of the meeting was on improving the inter-sectorial coordination along with enhancement of the collaborative efforts by GoMP and FDEC India towards achievement of the project objectives. The highly endemic block of Mawai was visited by the team along with interactions with the VMW and MFC of the area. Future plans for passive surveillance and MP state malaria elimination efforts were also discussed.

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As part of the operational plan, the second round of LLIN observation was started on 29th January and completed on 10th February. A refresher training was conducted for the Malaria Field Coordinators in the MEDP office prior to this exercise. As advised by ICMR – National Institute for Research in Tribal Health – 5% sample was selected using random sampling from each village where LLIN was distributed (approximately 6000 LLINs). The activity was supervised by the Program Officer and the District Officer. Data entry has been completed and analysis is in-progress

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The surveillance data reporting system consists of two modes – Electronic and Hard Copies. The electronic mode enables us to obtain real-time data information of positive cases and gives us compilation of surveillance data at regular intervals. The hard copies help us in maintaining physical records, line-list of fever cases along with cross-validation of electronic and physical data. Till now, the physical records were collected during regular supervisory field visits by District-level staff and during monthly meeting of the MFCs. This resulted in an overwhelming amount of data getting dumped in the office and caused confusion amongst the data entry staff in systemizing the same. To resolve this problem – we have introduced reporting of physical forms by public buses on 3 days of the month (8th, 16th and 23rd) and one day by-hand (1st – during monthly meeting). This segregates the data automatically into weekly, fortnightly and monthly intervals. 13 reporting sites have been identified and the forms no. 9 (fever cases) and 9A (positive cases) are sent by the MFCs in the morning bus to the district office.

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A refresher training of all Malaria Field Coordinators was conducted for observation of post-distribution usage of Long-lasting Insecticidal Bed Nets (LLINs). After the initial observations, we discovered several unforeseen challenges during conduction of this exercise in the field. To address these challenges, we will again initiate this exercise of observing the LLINs in Mandla district. The one-day training was conducted in Mandla office with focus on sampling strategy, understanding each field of observation checklist and one-on-one mock interview sessions

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On January 16th, 2018 – The MEDP Mandla office was visited by Mrs. Saraswati Marawi – President, Mr. Shailesh Mishra – Vice President and Ms. Anusuiya Marawi – Member, Zilla Panchayat. The visit included introductions with the project staff followed by extensive discussions on project operations. The delegation from Zilla Panchayat also clicked several photos and recorded a short video of the Program Officer discussing about MEDP. The same was aired on a local news channel in Mandla. The leadership assured their support for the project and appreciated the work-done by MEDP

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In the month of November 2017 – a Training of Trainers (ToT) workshop was conducted by experts from ICMR NIRTH: Dr. Kalyan B. Saha – Scientist E, Dr. Ravendra Sharma – Scientist D, Dr. A Verma – STO and Mrs. Sulochana Rajak – Deputy Media Incharge from the office of CMHO, Government of MP and MEDP Staff. In this training, Capacity Building Officer (CBO) of MEDP was trained as a Master Trainer and all 25 Malaria Field Coordinators (MFCs) were trained as Trainers for the Village Malaria Workers (VMWs). During this month, training sessions were conducted for all the VMWs by the MFCs under direct supervision of the CBO . Few sessions were also monitored by the Program Officer and District Officer (MEDP) and attended by the District Malaria Officer, Consultant Entomology (RHOFW) and Consultant VBD from GoMP . Total 205 VMWs from 8 blocks have been trained, only one block (Ghughari) is remaining with its 23 VMWs and is scheduled for this month. Alongside, material is under development and field deployment of IEC-BCC activities will begin soon.

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Training session for newly recruited 23 Village Malaria Workers (VMWs) and one Malaria Field Coordinator (MFC) (23+1) was conducted from 12th to 14th December, 2017. The session was tutored by the Representative from the District Malaria Office – GoMP, District Officer – MEDP Mandla and Capacity Building Officer – MEDP Mandla. Pre and post training tests were administered, a total of 19+1 trainees cleared the post-training test with 70% passing threshold. A re-training was conducted for the remaining 4 trainees, out of which, one candidate quit the training mid-way and one was let go due to poor performance in the post-test even after re-training. A total of 21+1 candidates were cleared for active duty. These new recruits were certified to Track, Test and Treat (T3) Malaria in Mandla by the Chief Medical and Health Officer (CMHO), Mandla – GoMP as well.

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The MEDP was invited to Directorate of Health Services, Bhopal on December 12, 2017 for a progress update. The meeting with attended by Dr. Himanshu Jayswar – SPO, Dr. Praveen K Bharti – Scientist D NIRTH, Mr. Ram Shankar Sahu – DMO Mandla, Dr. Harsh Rajvanshi - PO MEDP, Mr. Rajesh Verma – Consultant VBD Mandla and Mr. Satyendra Pandey – Consultant Entomology Bhopal. The progress and conduct of the project with inter-sectorial coordination between District Malaria Office and MEDP was discussed in-length.

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As part of our commitment to the Government of Madhya Pradesh, a needs assessment for Accredited Social Health Activists (ASHAs) was carried out with the help of ICMR-NIRTH, Jabalpur. Officials from NIRTH included Dr. M M Shukla – Scientist F, Dr. Nishant Saxena – Scientist B and Dr. A Verma – STO. The objective was to assess the knowledge, practices, and attitude of Accredited Social Health Activists (ASHAs) related to malaria. Out of total 1300 ASHAs of Mandla district, 220 were selected randomly for interviews by NIRTH and MEDP Staff in the months of June and July 2017. The analysis for the same was completed in December 2017. A formal report to communicate the detailed findings to the Government of Madhya Pradesh is in-process. 62% ASHAs provide no/inadequate Primaquine in cases of Pv

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Information, Education and Communication with Behavior Change Communication is an integral part of the project. A two-day training session for the Malaria Field Coordinators (MFCs) was conducted on 9th and 10th November, 2017 at Satkar Celebrations, Mandla. These trainers were trained by experts from ICMR-NIRTH: Dr. Kalyan B. Saha – Scientist E, Dr. Ravendra Sharma – Scientist D, Dr. A Verma – STO and Mrs. Sulochana Rajak – Deputy Media Incharge from the office of CMHO, Government of MP. The training included basics of IEC/BCC, tools of communication, techniques of IEC/BCC followed by a live demonstration by a group of performers from Dindori, Mandla. This group was earlier trained by NIRTH scientists and worked on an IEC based study on Malaria in Dindori. On the second day, the participants also prepared and demonstrated the taught techniques in forms of slogans, skits and ventriloquism using hand puppets. These trainers then drafted a schedule to train their Village Malaria Workers (VMWs) to conduct the two initial activities– Haat Bazaars and School Camps in their respective sub-center areas.

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A two-day PILOT was conducted for Track, Test and Treat to identify real-time challenges in the field. Following this, a pan-Mandla rollout for T3 was designed to enable hands-on experience for field workers . The purpose was to expose the entire workforce of 254 field staff to their core deliverables under strict supervision of MEDP Officers and NIRTH Scientists. This helped them in learning the right way to do the things in their first attempt.

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A five-day intensive training workshop for all Malaria Field Coordinators (MFC) (25) and Village Malaria Workers (VMW) (229), who were selected through exams and/or interviews, was conducted by the MEDP Staff, District Malaria Officer, NVBDCP Consultant, and NIRTH staff. The training also included a one-day Ethics and Personality Development session delivered by an expert from Mumbai

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