What Did Maharashtra Do?

Maharashtra and other states throughout India launched the first National Filaria Control Program (NFCP) in 1955. Most other states discontinued the program in 1960, but Maharashtra continued implementing it under the state health budget. In 2004, as part of India’s revitalization of its commitment to eliminate LF, the country designed the Elimination of Lymphatic Filariasis (ELF) program and launched it in all endemic states with funding from the National Health Mission. Maharashtra started the implementation of the ELF, while continuing with the efforts of the previous program, the NFCP. The activities undertaken by both NFCP and ELF created synergies across both programs that contributed to Maharashtra’s success toward eliminating lymphatic filariasis (LF).

Launched in 1955 with the objective of undertaking control measures in endemic areas, NFCP has continued to be an important component of Maharashtra’s LF response to date. These control measures, carried out through survey units, control units, and night clinics, included mass diethylcarbamazine (DEC) administration, antilarval measures in urban areas, and indoor residual spraying in rural areas. Maharashtra benefited from control measures such as studying the endemicity across its implementation units (IUs), identifying hotspots, identifying cases and treating them at hospitals, and conducting vector management activities like spraying insecticides and clearing stagnant water. Findings from NFCP informed Maharashtra on the progress of the ELF program and provided significant input to assess district endemicity.

Launched in 2004, the ELF program aimed to accelerate the path to LF elimination through two main pillars: preventive chemotherapy via mass drug administration (MDA) and alleviation of chronic illness through morbidity management and disability prevention (MMDP). While MDA focuses on interrupting community transmission through supervised administration of drugs, MMDP focuses on alleviating the suffering of affected populations through surgery and home-based treatment. In this section we describe key activities that Maharashtra undertook as part of MDA.

Until 2010, Maharashtra used a single-drug therapy with DEC as part of MDA. Over time, the double-drug therapy of DEC and albendazole proved to be more effective in eliminating LF and therefore the IUs adopted it. In 2018, the state introduced triple-drug therapy using ivermectin, DEC, and albendazole, the impact of which has yet to be documented.

Since 2004, Maharashtra has conducted MDA through collaboration with multiple stakeholders at the national, state, division, district, block, and community levels, as represented in Figures 2 and 3.

The state and IUs established clear roles and responsibilities for each stakeholder to ensure the implementation of MDA as planned, as shown in Figure 3. The sections below describe the key steps that these stakeholders implemented throughout the MDA campaign cycle.

MDA is a six-step process with activities that fall broadly in three stages:

• Pre-MDA—planning, drug procurement, training, and social mobilization. Preparation for the actual MDA campaign and the most critical stage for building momentum across stakeholders to ensure successful program implementation.
• MDA administration—drug administration, the annual administration of drugs to the entire population as well as the supervision and reporting of drug administration.
• Post-MDA—monitoring and evaluation after MDA surveys and reporting to the state along with along with third-party MDA assessments for tracking drug coverage and addressing gaps of the campaign.