Category: Field Notes

This week’s Fist Bump goes to VectorLink Tanzania for their work leading two critical workshops in March 2022 to cap-off a year of successful capacity-strengthening efforts in Zanzibar: A M&E-focused workshop and an IRS Training-of-Trainers (TOT) refresher session.

VL Tanzania has partnered with the Zanzibar Malaria Elimination Programme (ZAMEP) to conduct IRS campaigns the last 7 years. In July 2021, VL Tanzania assumed a Technical Assistance (TA) role to support Zanzibar’s spray activities, with ZAMEP in the driver’s seat to lead the transition from large-scale IRS campaigns to rapid-response IRS efforts in areas experiencing a malaria outbreak. The ZAMEP team highlighted key areas for prioritized TA support, including IRS Operations, Environmental Compliance, and Monitoring and Evaluation (M&E). The VL team helped ZAMEP “race to the starting line” with 3 rapid response IRS efforts over the last 8 months, sometimes with less than 1 week notice before spraying needed to begin.

The M&E team hosted a 2-day workshop for ZAMEP and other local stakeholders to support ongoing TA efforts to strengthen ZAMEP’s information systems and build their capacity to collect, manage, and use rapid-response IRS data. The agenda was packed with fruitful discussions, highlighting the progress ZAMEP has made in incorporating IRS modules into the Malaria Case Notification (MCN) surveillance system and Zanzibar MOH’s DHIS2 database, based on VectorLink-provided data collection tools and IRS module design. The VL Tanzania M&E Team shared best practices for the use of mobile data collection for IRS, as well as standard IRS data visualizations that are key in the daily monitoring and review of IRS campaign data.

Three weeks later, VL Tanzania, with ZAMEP, convened 30 people from four focus areas (Environmental Compliance, Operations, Logistics Management, and M&E) for the IRS rapid response TOT. The objective was to further build a group of IRS experts within ZAMEP, who would have the knowledge and skills to facilitate training for other IRS implementers in districts across Unguja and Pemba Zones. Amongst the participants, there was an average increase of 54.3 percent for Operations and 40.7 percent for Environmental Compliance from the pre- and post-training evaluation tests.

Kudos to the VectorLink Tanzania team for supporting these capacity-strengthening initiatives. We look forward to seeing the skills supported in these workshops put into practice in future campaigns.

Insecticide-susceptible mosquitoes are necessary to test the effectiveness of malaria interventions, but it can be challenging to establish the necessary colonies. This week’s Fist Bump goes to VectorLink Sierra Leone for successfully reestablishing two national insectaries in Makeni and Freetown, used to maintain insecticide-susceptible Anopheles gambiae mosquito colonies. This came after several failed attempts by the team to reestablish the colony.

The dedicated team of insectary technicians, led by Alpha Jalloh and Samuel Conteh, worked day and night to troubleshoot the challenges. The four-day transit period of mosquito eggs supplied by the CDC from the Malaria Research and Reference Reagent Resource Center (MR4) to Sierra Leone meant that several eggs would hatch before arriving at the Freetown insectary. This gave the technicians limited time to grow the few surviving hatched larvae and viable eggs.

After attempting and failing three different times in Freetown, a last-minute decision by the entomology technical team to relocate rearing the last batch shipment to Makeni did the trick. With Alpha Jalloh leading the Makeni team, VectorLink Sierra Leone managed to grow and increase the mosquito numbers until enough were established.

This was instrumental and saw the project achieve one of its key deliverables, ITN effectiveness monitoring, which was over 6-months late due to the absence of a susceptible mosquito colony in the country. This achievement is also great for the Sierra Leone team who could complete the monitoring without the additional cost of shipping the nets outside the country.
The team demonstrated resilience, persistence, and problem-solving abilities to achieve the goal of maintaining national insectaries in collaboration with the National Malaria Control Program (NMCP).

VL Sierra Leone, you are a clear example of perseverance! Excellent work reestablishing the two insectaries.

This week’s Fist Bump goes out to the entire VectorLink Uganda team who recently completed their 2022 IRS campaign on March 26th. VL Uganda has always been our largest IRS program, but this was the first time that the Uganda team sprayed in one phase, instead of the two phased approach – meaning this year’s VL Uganda IRS campaign was our largest ever IRS campaign! Between February 28th and March 26th, VL Uganda aimed to spray 1,125,143 eligible structures across 10 districts, protecting 3,762,780 people from malaria.

This tremendous effort was not without significant challenges. Consolidating what is traditionally a two-phase campaign into one meant resources and personnel had to be planned and strategized differently. The VL Uganda team also had to deal with the logistics of training much larger numbers of spray operators and data center clerks than ever before while also coping with exceptional logistical challenges because of Covid-19 global supply chain impacts. Another major challenge was that the entire team has been impacted by the loss of several team members throughout the COVID-19 pandemic while planning for the 2022 campaign was underway. They also lost Charles Onyait, VL Uganda’s Logistics Coordinator, to a prolonged illness during the campaign. Despite this, the team remained strong and resilient, implementing the PMI VectorLink Project’s largest ever IRS campaign with great efficiency and exceptional results; preliminary results show 98.7% progress, 93.9% coverage, and over one million structures sprayed!

Job well done, VL Uganda! It’s great seeing this campaign end on a high note!

This week’s Fist Bump goes to VectorLink Ghana for working with and providing technical assistance to the National Malaria Control Program (NMCP), part of Ghana Health Service (GHS), to successfully complete the country’s mass ITN distribution campaign. These campaigns occur every three years. The goal was to register at least 90% of all households in all regions and to distribute free ITNs to at least 90% of all registered households (1 net per 2 people).

Using the App, NetApp, installed on tablets, a registration assistant from the NMCP/GHS went from house to house and collected information such as the name of the household head, number of people in the household, house number/location, contact number, and ID card number. NetApp would then calculate the number of ITNs to be distributed to each household. A member of the household had to present their previously disclosed information to the distribution point attendant to receive their ITNs.

Insecticide resistance data and combined risks of prevalence, incidence, and mortality determined which nets each region received. In addition to standard and PBO nets, the NMCP/GHS also distributed new generation nets. Households did have an ITN preference and sometimes rejected types they did not want. However, this did not impact the overall campaign.

Social mobilization such as the use of community information centers and phone calls ensured a high number of households received ITNs. This campaign saw improvements such as reduced timeline: the previous campaign lasted almost two years (2017-2018) whereas this one took 14 months. The NMCP/GHS managed to better plan and mobilize resources despite overlaps with other key community-level activities. With VectorLink Ghana’s thorough technical assistance throughout the campaign, the NMCP/GHS exceeded their goal of distributing nets to 90% of registered households, reaching 95.7% instead.

Excellent work, VL Ghana!

This week’s Fist Bump goes to VectorLink Malawi and their IEC Coordinator, Patricia Chirombo, for representing PMI VectorLink in a five-day meeting to develop a new malaria communication strategy for the 2022-2026 period in Malawi with the NMCP and other key stakeholders including Breakthrough ACTION and World Vision.

While the new strategy is a work in progress, its purpose is to provide the framework, guiding principles, and key elements of malaria social and behavior change communication (SBCC) interventions. SBCC is an important strategy to address IRS hesitancy, and reach populations that may not accept IRS to begin with. Using tools such as mass media, print, and radio; community mobilization; and working with District Health Management Teams (DHMTs) who are local policy officials, many of the concerns surrounding IRS can be alleviated through SBCC strategies.

Participants were grouped based on their work such as case management, malaria in Pregnancy-Intermittent Prophylactic Therapy (IPTp), IRS, and ITNs to discuss and develop the relevant sections of the strategy. PMI VectorLink Malawi, World Vision, and other SBCC participants from DHMTs formed the IRS group.

The Malawi Malaria Behavior Survey (MBS) and the Malawi Malaria Indicator Survey (MMIS) for 2021 were used as reference materials. Since these two surveys did not include any IRS-related behaviors as data points, VectorLink Malawi advocated to use the end-of-spray progress reports from the PMI VectorLink and Global Fund districts as additional references to make sure IRS and other vector control interventions are represented in the 2022 – 2026 Malawi Malaria Communication Strategy documents. The NMCP and the rest of the participants agreed. These documents generated a more comprehensive national picture on IRS acceptance and other behavior changes toward IRS.

Excellent work advocating for vector control to be extensively covered in the next Malawi Malaria Communication Strategy, Patricia!

International Women’s Day was this week, giving us the opportunity to recognize and celebrate the accomplishments of women all over the world. This week’s Fist Bump goes to VectorLink Senegal for organizing a round table on gender issues, and the integration of gender in malaria vector control projects.

The event took place on March 7^th, 2022, and VectorLink Senegal, in collaboration with the Home Office, developed a presentation on gender, presented by the Chief of Party Jean Biyik, and Gender Focal Person, Ouleye Dieng.

The presentation covered:

• Sustainable Development Goal (SDG) 5, gender equality,
• Equity in the PMI 2021-2026 strategy,
• Equity at Abt,
• What gender is, why it matters, and what the difference is between equality and equity,
• Compensation measures, and
• Integrating gender dimensions into VectorLink’s work

The main discussion surrounded equality and equity such as the difficulty in changing perceptions strongly influenced by lived experience, and culture and norms of Senegalese society. However, there was consensus that it is necessary to create a favorable professional environment for men and women in particular, especially in the context of this project.

Excellent work engaging all country staff in these important discussions on gender equity, VL Senegal!

This week’s Fist Bump goes to VectorLink Ghana for their work in putting together this video, showcasing how the team reaches the unreached with IRS. 

Great work on this video, VL Ghana!

The PMI VectorLink Project utilizes different methods for sharing best practices, providing technical assistance, and engaging stakeholders. This week’s Fist Bump goes to VectorLink Mozambique for their utilization of the IRS technical working group (TWG) to help harmonize and standardize IRS at the national level.

Prior to the creation of the IRS TWG, VectorLink Mozambique, the government of Mozambique, and Tchau Tchau Malaria (Goodbye Malaria) all had different strategies for implementing IRS. The IRS TWG’s creation within the Vector Control Management group in 2019 was a big platform for VectorLink to have better engagement with the NMCP and other partners such as Tchau Tchau Malaria, WHO, PMI/USAID, and the Global Fund.

The IRS TWG meets quarterly and has been able to:

• Harmonize training curricula for all IRS programs in Mozambique.
• Provided guidance on the minimum standards for Personal Protective Equipment
• Drafted (still under review) a national IRS implementation manual, including the latest best management practices for IRS.
• Adopted Vector Link supervisory tools as a standard supervisory tool for IRS
• Successfully conducted national level master trainings.

Since 2021, the supervisory tools were made available at the national level for IRS programs. During the 2021 spray campaign, VL Mozambique observed district level MOH staff using the supervisory tools on tablets, allowing the NMCP to see the progress from all provinces where IRS is being implemented.

Excellent work sharing best practices, VL Mozambique!

Want to learn more about how VL Mozambique provides technical assistance? You can listen to the recording of last week’s webinar, Sustainability in IRS Operations (you’ll also learn about technical assistance in Malawi and Ethiopia), on the Vector LearningXChange: https://www.vectorlearningxchange.com/webinars/

The fight to end malaria requires innovation. This week’s Fist Bump goes out to VectorLink Madagascar for their use of drones to spray rice fields with larvicide.

The objectives of this initiative are to assess larval source management (LSM) as a complementary vector control intervention to ITNs in Madagascar, to see if complementary LSM in combination with ITNS provide more protection from malaria vectors, and to see if LSM decreases malaria transmission.

The larviciding is taking place via drone in two districts with high incidents of malaria, Morombe and Ankazobe, where rice fields are common habitats for mosquito larvae. It will occur twice a month for 5 months. Two different drones were used for this operation: the smaller DJI Phantom 4 Pro drones for the mapping of the intervention areas, and the DJI Agras® T30 drones for the application of larvicide onto the rice fields. The drones for larviciding can carry up to 30L of larvicide, covering two hectares.

Entomological monitoring indicators like the density of adult mosquitos, human biting rates, larval density, and sporozoite rates will determine the effectiveness of LSM along with epidemiological monitoring and logistics and cost-effectiveness surrounding LSM in Madagascar.

The operation was not without its challenges. A cyclone in Madagascar delayed the start of the operation due to inaccessible roads and a collapsed bridge, leading to the field sites. Nevertheless, the team was able to resume its activities, and now they are in the middle of their LSM operation.

Congratulations on utilizing drone technology for malaria prevention, VL Madagascar! Keep up the great work.

This week’s Fist Bump goes to VectorLink Ethiopia for implementing tailored models of indoor residual spraying (IRS) to increase community acceptance and financial sustainability. VL Ethiopia utilizes four different models of IRS: district-based, community-based, cluster-based, and hybrid.

1. District-based IRS model: Implemented at the district level. Each district has on average two centrally located operational sites and one central store. Spray teams stay at the operational sites and require vehicles to travel to villages.
2. Community-based IRS model: Implemented by Kebele (lowest administrative level). Each Kebele has a centrally located operational site, and temporary store. Spray teams can stay at home as they work in their local Kebele. They don’t require vehicles for daily operation activity, which is one of the cost drivers of IRS. Health workers serve as squad leaders in their communities.
3. Cluster-based IRS model: One health center to five Kebeles. Spray teams stay at the health center. Vehicles are required to travel to villages.
4. Hybrid model: Combination of Community-based and Cluster-based models.

 

Along with increasing community acceptance and financial sustainability, different models for IRS are also necessary to improve IRS performance efficiency and allow for alternative implementation plans in case of unforeseen problems. Factors that contribute to the choice of model include accessibility, infrastructure availability within each Kebele, ability of the lowest health system level to implement IRS based on one of the four models, availability of IRS equipment, and unanticipated issues like security concerns. VL Ethiopia utilizes the model that best suits the district.

Community-based and cluster-based IRS models are ways to make IRS more sustainable as they can be implemented with fewer resources, the community is invested and can help with operational costs, there is higher community acceptance of IRS, and better hands-on training is provided for IRS workers as the trainer to trainee ratio is small. However, District-based IRS does have better store management of items like insecticide.

In 2022, VL Ethiopia plans to implement Community-based IRS in 11 districts, District-based in 29 districts, Cluster-based in four districts and Hybrid in four districts. They implemented Cluster-based IRS for the first time in 2019, and Hybrid in 2021, with plans to do a systematic assessment and comparison among the models as well.

Well done, VectorLink Ethiopia!