In India, 225 million preschool and school-age children are estimated to be at risk of infection from worms. India accounts for 65% of soil-transmitted helminth (parasitic worms) cases in South East Asia, and 27% of cases globally.

In recent years, India has scaled up its national deworming programme, through which almost 250 million children are dewormed twice a year in February and August. This is the largest school-based deworming programme globally, and CIFF is working with Evidence Action to support the programme. Our three core objectives in India are to:

• Institutionalise National Deworming Day (NDD) across the country

• Build the capacity of State Governments to execute and assess programme impact through coverage and prevalence survey

• Work with Government to develop the road map for transmission break (stopping the transmission of disease from person-to-person)

The programme started with a pilot in 2015 in three states. The programme has now been scaled-up to national level, working in 33 states to benefit children both in and out of school.

Following the programme scale-up in 2018, the focus is now directed towards improvements to programme quality and coverage. The prevalence surveys conducted in Chhattisgarh in August 2018 have shown dramatic reduction in worm prevalence. The results of this survey will be shared with National and State Governments along with national and international experts to understand the reasons of this dramatic reduction and inform future work.

The Government of India has formed a high-level scientific committee to develop a road map towards transmission break. It is through this committee that global evidence is being studied and at the same time programmatic information is being evaluated, so the programme can develop effectively and continue to deliver extremely positive results.

In 2019, CIFF will support multiple initiatives in the state of Chhattisgarh for creating a model for breaking the transmission of worms. This will include:

• National Deworming Day conducted in all the states of India as soil-transmitted helminths are present in all the states.
• Coordination between Mass Drug Administration programmes for both deworming and Lymphatic Filariasis (LF). LF is a disease which is endemic in almost 17 states in India. The control programme for both the diseases uses Mass Drug Administration (MDA) as a strategy. There is considerable overlap between MDA for LF and MDA of NDD. The target population for NDD is 1-19 years and for LF >2 years. The drug, Albendazole, is used in both the programmes. Coordination between the two programmes would ensure timely target setting, drug procurement, community messaging, accurate reporting and cost efficiency.
• Improving monitoring and verification. We will pilot a simplified coverage evaluation survey with finger marking in the state. Finger marking was used as an effective tool in India’s polio programme, the lessons from which will be applied to the national deworming programme.
• WASH (water, sanitation and hygiene) in schools. Global evidence suggests that WASH in schools has a significant positive impact in decreasing worm prevalence. The Government of India’s ‘Clean India: Clean Schools’ campaign has already created huge momentum towards building a WASH infrastructure in schools. CIFF will support and increase the sustained maintenance of this infrastructure, along with continuing to create behaviour change in districts identified as high-prevalence for worms.
• CIFF will conduct annual prevalence surveys with robust designs to track the decrease in prevalence as a result of the above initiatives.

CIFF and partners will work closely with all the stakeholders to demonstrate the operational model of the transmission break programme in Chhattisgarh, which will provide a clear motivation to ensure deworming is maintained, its application is efficient, and the behaviour change across the country leads to the long-term success of creating a healthy and flourishing environment for children.