India left WHO's HBHI group in 2024. Assess what still stands in the way of meeting the NFME target of eliminating malaria by 2030.

Between 2015 and 2023, India cut malaria cases by 80.5% and deaths by 78.3%, and in 2024 it left WHO's High Burden to High Impact (HBHI) group [1]. The National Framework for Malaria Elimination (NFME) asks for more: zero indigenous cases by 2030 [2]. The tools to cut cases are in place. What remains hard is finding and stopping the last hidden infections.

Progress so far

• 122 districts reported zero cases in 2023, and the national vision is malaria-free status by 2027 [1].
• Integrated Vector Management (indoor residual spraying, long-lasting insecticidal nets) and the "test, treat, track" approach have driven these gains [4].

What still stands in the way

• Cases the state cannot see: private doctors do not report malaria cases to the government database [3]. The 80.5% fall therefore measures reported cases. Elimination means proving zero, which cannot be done with incomplete surveillance.
• Concentration in tribal and forest areas: Odisha and the north-eastern tribal states carry most of India's cases [3]. Forest-based work and sleeping outdoors keep people exposed to mosquitoes, and clinics are far away, so diagnosis comes late [3].
• Urban malaria: the invasive Anopheles stephensi breeds in city water storage and needs its own targeted control [4]. Rural methods such as drainage do not reach it.
• Uneven state capacity: NFME sets targets for states according to how much transmission they have [2]. This means the weakest high-burden states set the real national deadline.
• Keeping vector control effective: spraying and nets underpin the gains [4]. If complacency follows the HBHI exit, or insecticides lose effectiveness, the gains could reverse.

Assessment and way forward

• The main barriers now are about reach and visibility, not a lack of tools.
• Make private-sector notification mandatory and link it to the national database.
• Take active, ASHA-led testing into forest and tribal hamlets.
• Use municipal building bylaws and water-tank inspections against urban breeding.
• Monitor insecticide resistance routinely, in line with WHO's Global Technical Strategy 2016–2030 [2].

Leaving HBHI shows that India can bring malaria down at scale. Meeting the 2030 target now depends on finding the last, hidden cases. With universal reporting, outreach focused on tribal areas and urban vector control, elimination is achievable. It would fulfil SDG 3.3 and the right to health under Article 21.