India may have cut its malaria burden by nearly 80% over the past decade, but the disease is proving harder to eliminate in its last-mile pockets, with 33 high-burden districts across nine states and UTs accounting for nearly two-thirds of all malaria cases and more than half of deaths reported in 2025.
With the 2030 malaria-elimination target approaching, the Union Health Ministry has now called for a sharper, district-specific strategy, stronger surveillance and faster diagnosis and treatment in areas where transmission continues.
The government said the number of high-burden districts has fallen dramatically from 155 in 2015 to 33 in 2025. Even more significantly, 160 districts reported zero indigenous malaria cases between 2022 and 2025, indicating that local transmission has been successfully interrupted in several parts of the country.
But the remaining burden is concentrated. The 33 high-burden districts reviewed by the health ministry accounted for 64% of malaria cases and 54% of malaria deaths in 2025, making them critical to India's efforts to achieve elimination by 2030.
“Focused, area-specific strategies and strengthened surveillance are essential to accelerate India’s progress towards malaria elimination by 2030,” said Aradhana Patnaik, Additional Secretary and Mission Director, National Health Mission, Union Health Ministry.
Patnaik chaired a high-level review meeting with senior health ministry officials, the National Centre for Vector Borne Diseases Control (NCVBDC), mission directors of national health missions and district officials from the affected states and districts.
The review covered Mizoram, Odisha, Tripura, Assam, Andhra Pradesh, Andaman and Nicobar Islands, Chhattisgarh, Jharkhand and Maharashtra.
The latest figures present a mixed picture of India's malaria fight. On one hand, the nearly 80% reduction in cases and deaths between 2015 and 2025 reflects sustained investments in surveillance, vector control, diagnosis and treatment.
On the other, the concentration of cases and deaths in a relatively small number of districts shows why a uniform national approach may no longer be enough.
The Ministry has called for District Action Plans in all 33 high-burden districts and Village Action Plans in high-burden villages. The idea is to tailor interventions to local epidemiological and geographical conditions rather than relying on a one-size-fits-all approach.
This assumes significance because malaria transmission is influenced by local factors, including mosquito breeding sites, rainfall, waterlogging, forested and difficult-to-reach areas, population movement and access to healthcare.
Early diagnosis and complete treatment remain at the heart of the elimination strategy. The review emphasised strengthening the Test, Treat and Track approach, with delays in diagnosis and treatment identified as critical contributors to malaria deaths.
States have been asked to strengthen active surveillance and ensure uninterrupted supplies of diagnostic kits and anti-malarial medicines, particularly in remote and vulnerable areas.
The challenge is not merely finding cases. In areas where malaria transmission has fallen sharply, surveillance becomes even more important because a relatively small number of undetected infections can sustain transmission.
The government therefore wants fever cases to be detected quickly, tested and followed through treatment.
The ministry has also turned its attention to the quality of malaria surveillance data. States were advised to examine unusually high Annual Blood Examination Rates (ABER), which can indicate duplicate testing, repeated entries or the inclusion of asymptomatic screening.
The Ministry stressed that asymptomatic cases detected through mass screening should be reported separately and excluded from API and ABER calculations. This, it said, would ensure a more accurate assessment of malaria transmission and programme performance.
Better data, officials stressed, is essential for identifying where transmission persists and directing resources accordingly.
The review also highlighted a factor that has often complicated malaria-control efforts: mosquito breeding is not confined to the boundaries of the health department, said an official from the Ministry.
Waterlogging, poor drainage, stagnant water and inadequate environmental management can create conditions conducive to transmission.
Patnaik therefore stressed the need for intersectoral convergence, calling for stronger coordination with the Rural Development and Urban Development departments as well as Panchayati Raj institutions.
The official said malaria elimination will require more than medicines and mosquito-control measures. Preventing mosquito breeding at the source has to become part of local development and sanitation planning.
The government is also looking to strengthen community participation, he pointed out.
Self-help groups, community volunteers and Panchayati Raj representatives have been encouraged to participate in early reporting of fever cases, identification of waterlogging and mosquito-breeding sites and source-reduction activities.
Such local involvement could prove particularly important in remote areas, where people may delay seeking medical attention or face difficulties reaching health facilities.
The fact that 160 districts recorded zero indigenous cases for four consecutive years from 2022 to 2025 offers considerable encouragement. It also raises the stakes for protecting those gains and preventing reintroduction, pointed out the official.
With the 2030 deadline less than four years away, the focus is increasingly shifting from broad national reduction to precision elimination, said the official.
