Equity in Vector Control: Engaging Hard-to-Reach Populations with Indoor Residual Spraying (IRS)

The PMI VectorLink project works with country governments to implement indoor residual spraying (IRS) to prevent malaria. While IRS is designed to have far-reaching coverage, there are some populations left behind in IRS planning and implementation.

PMI VectorLink strives to identify these populations, ensuring that disadvantaged, minority, and geographically hard-to-reach populations are protected from malaria and tailoring strategies to increase IRS acceptance and access. Across country teams, PMI VectorLink is collaborating with community organizations, governments, and village leaders to reach certain populations including people with disabilities in Ghana, people in prisons, the military, and police in Rwanda, and ethnic groups in Côte d’Ivoire.

In Ghana, PMI VectorLink works with the Ghana Federation of Disability to engage people with disabilities and ensure that IRS strategies and messaging are inclusive of their needs. The team uses the Association’s regular meetings as a platform to provide community education on IRS before each year’s campaign and invites Association leaders to participate in district-level stakeholder meetings and national IRS campaign launch events. PMI VectorLink Ghana disseminates messaging asking households and communities to support their neighbors who are elderly, ill, or disabled to adequately prepare their households before the arrival of spray teams, which involves moving items out of the home. Including people with disabilities in community IRS events provides a platform for an often-disadvantaged group to have a voice in IRS mobilization and planning efforts.

Working with the Ministry of Health, PMI VectorLink Rwanda collaborates with government agencies including the District Authorities and Rwanda Correctional Services (RCS)to reach prisons, military and police quarters with IRS. The Government of Rwanda is a champion in this work, requesting that these structures receive IRS more than ten years ago. In 2021, IRS acceptance in selected prisons, military and police quarters was 100% because the District Authorities are committed to these activities, liaising closely with RCS and with military and police leadership. This high spray coverage demonstrates the impact that government leadership can have when they prioritize equity in health promotion interventions.

In Côte d’Ivoire, PMI VectorLink identified a community, predominantly comprised of the Lobi ethnic group, that had lower-than typical acceptance of IRS. Married Lobi women typically live separate from their husbands in small homes where they sleep and store all their household items and harvested food. The accumulation of household items signifies wealth in the Lobi community, so many women have an abundance of goods, thus were hesitant to move their household items outside of their dwellings due to the inconvenience and sensitivity around publicly displaying their wealth. PMI VectorLink Côte d’Ivoire engaged community leaders to better understand these barriers and worked to emphasize the benefits of spraying. Messaging was tailored to promote not only the health benefits, but also the opportunity for Lobi women to conduct a deep cleaning of items stored in their homes. Now, the annual IRS campaign is also an annual cleaning.

These efforts demonstrate close collaboration with national, regional, and community counterparts to ensure that implementation is informed by local priorities, data, and information. Cross-country peer learning exchanges within the PMI VectorLink project have provided a valuable platform for country teams to share successes and challenges as well as spread innovative ideas about effective strategies to reach disadvantaged populations. For example, PMI VectorLink Zambia is supporting the government to expand spray coverage to prisons in 2022 based on the successes learned in Rwanda. In the coming months, PMI VectorLink country teams plan to expand their equity work by systematically identifying populations that are not currently reached by vector control and collaboratively developing tailored strategies to reach those groups.