Niger Puts Mosquitoes to the Test

PMI VectorLink Builds Niger’s Capacity for Evidence-Based Decision Making in Vector Control

In the West African country of Niger, 94 percent of the population is at risk of contracting malaria[1]. As evidenced throughout sub-Saharan Africa over the past 15 years, gains in reducing morbidity and mortality from malaria depends on the use of effective insecticides in vector control measures, such as insecticide-treated nets (ITNs) and indoor residual spraying (IRS). As insecticide resistance grows in malaria vector populations, testing the bioefficacy of insecticides used to kill mosquitoes is increasingly important to reducing the malaria burden. To support Niger in malaria vector entomological monitoring and contribute to quality data collection for decision making, the U.S. President’s Malaria Initiative (PMI) has invested in Niger since 2018 to build capacity and improve entomological data collection in several sites across the country.

Niger’s new, fully-functional insectary enables the country to conduct insecticide resistance testing.

Until recently, Niger lacked an up-to-date insectary to test vector control interventions. While there was adequate space for an insectary, Niger did not have the proper and standardized mosquito rearing conditions in place nor the equipment needed to breed and maintain a susceptible mosquito colony. As a result, Niger’s Medical and Health Research Center (CERMES) was unable to conduct certain types of tests, including the assessment of the bioefficacy of vector control tools and determine how long an insecticide remains effective on a treated tool, such as on ITNs.

In its efforts to build capacity of national institutions, the PMI VectorLink Project, rehabilitated the space being used by CERMES into a fully functional insectary in July 2020 and provided equipment for it. PMI VectorLink is also in the process of importing mosquito eggs of Anopheles gambiae Kisumu, a susceptible strain from Liverpool, England, for rearing and testing, and will provide robust training to the designated insectary technicians. As the only internationally-recognized research institution within Niger’s Ministry of Public Health, CERMES will now be able to draw on scientific evidence on the bioefficacy of the insecticides used to support the National Malaria Control Program (NMCP) in vector control decision making.

According to Dr. Boube Hamani, Head of Entomology for the Vector Control Unit of Niger’s NMCP, the insecticide bioefficacy testing has been a huge challenge for years as the country has had to call on external expertise in the West African Region to carry out bioefficacy tests.

“The rehabilitated and equipped insectary will enable the country to support insecticide bioefficacy tests at the country level,” said Dr. Hamani.

He also noted that the PMI VectorLink Project has contributed to building capacity of the NMCP and CERMES technicians in entomological monitoring and data collection, both in the field and in the laboratory. He added that this increased capacity has enabled the NMCP to have good quality entomological data that will be used for vector control strategic decision making in efforts to eliminate malaria.

This year, PMI VectorLink will be rolling out the use of VectorLink Collect, the integrated database for entomological and IRS data. The goal is to establish a functional work flow for entomologic data within the field office teams, with the purpose of entering timely, high-quality data. In line with that, CERMES will be contracted to manage all data management responsibilities as well as providing monthly data interpretation instruction to support the NMCP entomology unit to understand the impact and implications of vector control tools and better plan their elimination strategy.

[1] World Health Organization

The PMI VectorLink Podcast – Managing Malaria in the Midst of COVID-19

In the second episode of the PMI VectorLink Podcast, our technical experts discuss the challenges of implementing malaria prevention interventions during the global pandemic. Our experts also share some of the adaptions the project has made to continue operations safely and efficiently.

Be sure to check out The PMI VectorLink Podcast on Soundcloud: https://soundcloud.com/pmi-vectorlink

Faith Leaders Promote Uptake of IRS amidst COVID-19

PMI works with a wide range of partners including faith-based organizations for desired health outcomes

In Northern Uganda’s Otuke District, faith leaders are heeding the call to fight malaria. Reverend (Rev.) Jimmy Max Ajon of St. Paul’s Church of Uganda is committed to ensuring that no woman, child or community member loses his or her life to malaria amidst the COVID-19 pandemic and lockdown challenges. In response to pockets of resistance to indoor residual spraying (IRS) among some communities in Otuke District and other regions, the United States President’s Malaria Initiative (PMI) VectorLink Project in Uganda has engaged religious leaders to improve acceptance of IRS and other malaria control interventions, such as the use of insecticide-treated mosquito nets (ITNs).

Malaria is still the leading cause of morbidity in Uganda and is responsible for most outpatient visits, hospital admissions and deaths. The PMI VectorLink Project, in collaboration with the Ministry of Health’s (MOH) National Malaria Control Division, conducts IRS in 16 districts in Uganda.

Recognizing that religious leaders have the potential to promote and sustain positive change in the community through their well-established outreach and community programs, the project organized community dialogues and sensitization meetings with key religious, cultural and opinion leaders. The project trained the leaders on the benefits of IRS and ITNs, community mobilization and advocacy techniques, and also enlisted their support in promoting IRS and supervising its implementation in their respective communities.

“Religious leaders have a role to play – to not only preach the word of God but also to ensure our people are safe from any form of illness for the betterment of the Kingdom of God,” said Rev. Ajon.

Rev. Ajon shared what he learned with his fellow parish priests and a total of 102 faith leaders, who subsequently promoted lifesaving integrated malaria messages and COVID-19 prevention measures. He and other local leaders joined the project supervision teams to mobilize, monitor and supervise the spray activities in various sites in Otuke District. Rev. Ajon also participated in scheduled radio talk shows and called upon every community member to open their house for spraying and support the spray teams in controlling malaria. Through door-to-door mobilization, he personally reached out to communities, particularly those individuals who were resisting IRS, successfully convincing them to allow their houses to be sprayed.

“Fighting malaria and COVID-19 is not the role of the health workers alone. We need everybody’s contribution, and the first contribution is personal responsibility for your safety and that of your loved ones so that we can protect the communities from both malaria and COVID-19.”

– Rev. Jimmy Max Ajon

 “Before IRS was introduced, many community members, including my family used to frequently visit the health facilities due to malaria. Now the malaria episodes have reduced in my household,” he said. “Many communities in Otuke have directly benefited from the intervention, and there is a reduction in the numbers of people who line up at the health facilities.”

The project noted increased IRS acceptance in the communities with the demand for IRS greatly increased as well, thanks to the involvement of religious and community leaders like Rev. Ajon. For example, in Otuke District, the project surpassed the spray target by 12% and protected 20,000 more people than planned with no cases of COVID-19 transmission reported during the campaign. The project protected approximately 5 million people from malaria overall.

Rev. Ajon has pledged to continue speaking at funerals, church services and other faith community outreach meetings about the benefits of spraying houses and sleeping under mosquito nets to ensure that the burden of malaria is drastically reduced. He also pledged to remind communities to go to the health centres for testing and treatment if they have signs and symptoms of malaria and also participate in clearing any stagnant pools of water in order to eradicate malaria out of Otuke District.

 

Entomologists Take Testing Matters into Their Own Hands

PMI VectorLink Adapts Entomological Tool to Ensure Insecticide Residual Efficacy Testing Continues during COVID-19

When COVID-19 began to ripple across the globe, the Government of Zambia quickly put in place strict lockdown measures to prevent the spread of the virus. In response, the U.S. President’s Malaria Initiative (PMI) VectorLink Project rapidly adapted core malaria vector control interventions, namely indoor residual spraying (IRS) and distribution of insecticide-treated nets (ITNs), following PMI and global guidelines, to minimize the risk of COVID-19 infection while continuing to protect communities from malaria and prevent further strain on health systems during the pandemic.

Field assessments to measure the impact of these interventions, however, were interrupted due to the increased risk of transmission of the coronavirus. Impact assessments are critical to generating timely information to inform decisions on optimal vector control approaches and rational use of resources. PMI VectorLink conducts wall cone bioassays to assess how long the insecticide sprayed on walls during IRS remains effective. The longer the insecticide lasts, the longer household members are protected from potential malaria vectors. The traditional method of conducting wall cone bioassays involves the use of mouth aspirators to transfer mosquitoes from holding cups to cones attached on sprayed walls and back to holding cups after the insecticide exposure period. Because staff cannot keep their face coverings on and perform mouth aspiration at the same time, this step was temporarily suspended in Zambia and other PMI VectorLink country entomology programs.

VL Zambia Insectary technician Justine Nzowa uses the handheld aspirator. Photo: Mohamed Bayoh

To continue measuring efficacy while maintaining safety precautions, PMI VectorLink ordered handheld, battery-operated aspirators to conduct the cone assays, which would allow staff to keep their protective face coverings on while conducting the tests. The design of the aspirators, however, made it difficult to release mosquitoes from the collection vial inside the unit into the cone on the wall or the holding paper cups. The team responded quickly, modifying the aspirator to improve the mosquito release function, and then deploying them after training for field staff was conducted on their proper use. The field teams are now using the modified aspirators for wall cone bioassays to monitor the insecticide’s residual efficacy on walls while safely wearing their protective face coverings and maintaining social distance. This adaptation is also being replicated in other VectorLink country programs.

As of June 2020, the cone bioassays have shown positive results, with residual efficacy of eight months. This means that the insecticides used during IRS (Fludora Fusion and SumiShield) last throughout the malaria transmission season, providing longer protection to the communities than the previous insecticide used. Without the aspirator innovation, testing during COVID-19 would not have been possible. Knowing that the insecticide lasts longer allows the National Malaria Elimination Program (NMEP) and PMI to begin IRS earlier next year before the rainy season begins, ensuring hard-to-reach areas are protected and that people do not have to bring their belongings out of the house and into the rain during spraying.

“The VectorLink Zambia team’s coordinated effort to ensure continuity in residual efficacy monitoring by successful modification and testing of handheld aspirators for deployment in the field was much appreciated,” said Dr. Emmanuel Kooma, Head of Vector Control, at the NMEP. “I am particularly satisfied that the method can safely be used as a replacement to the conventional mouth aspirators for the wall bioassay tests, a needed intervention during this pandemic.”

 

 

Moving forward with IRS during Uganda COVID-19 Lockdown

PMI Continues Malaria Control Interventions in Uganda during COVID-19 to prevent further strain on health systems

Around the world, countries are grappling with the COVID-19 pandemic while also trying to maintain health services to protect people from life-threatening diseases, such as malaria. In Uganda, where malaria is endemic, the government put in place strict lockdown measures to slow down the COVID-19 pandemic. Measures included a shutdown of public transportation, a limit on the number of people in private vehicles, a nightly curfew and a limit on the number of people gathering together. While these measures aid in the prevention of the spread of the novel coronavirus, there was also a temporary halt to critical malaria prevention services, such as indoor residual spraying (IRS).

To reduce the burden of malaria in Uganda, the United States President’s Malaria Initiative (PMI) VectorLink Project in collaboration with Uganda Ministry of Health (MOH) National Malaria Control Division (NMCD) implements IRS to kill mosquitoes that transmit the disease in 16 high-burden districts to protect approximately 4.7 million people. In April 2020, the nationwide lockdown delayed the start of the project’s second phase of IRS in eight districts (Serere, Kaberamaido, Kalaki, Amolatar, Dokolo, Lira, Alebtong and Otuke). The project completed its first phase before the lockdown, protecting 2.9 million people.

To ensure continuity of malaria prevention measures, the project worked closely with the MOH, NMCD, partners and stakeholders and received clearance from government of Uganda leadership to continue implementing IRS amid the lockdown with strict protocols in place. The project worked closely with local government leaders through the District COVID-19 taskforce and District IRS taskforce to implement quality IRS. The project leveraged the coordination of both taskforces, including community mobilization platforms already in place for COVID-19 at district, sub county and village levels. The Local Council Chairpersons served as key IRS mobilizers while holding security/ coordination responsibilities as the COVID-19 focal points at the village level.

IRS Training, Kyere Subcounty, Serere District. Photo: Daniel Eninu, PMI VectorLink Uganda, May 2020

In addition to the standard personal protective equipment provided to spray operators, the project provided face masks for all training participants and facilitators, portable handwashing facilities at entrances to all training rooms, and hand sanitizers at operational sites, all while observing the recommended number of people per gathering to embrace social distancing. Training was conducted in small teams of 10 participants in large halls or classrooms with facilitation from the District Health teams and trainers from other districts.

At operation sites, the project posted posters and flyers indicating signs, symptoms and prevention measures for COVID-19 and incorporated COVID-19 mitigation strategies in all training materials. On May 25th VectorLink Uganda successfully started its second phase of IRS, and by June 20th, the project had sprayed approximately 1.4 million structures over the two spray phases, protecting a population of about 5 million people including 132,089 pregnant mothers and 950,163 children under five years.

Mr. George Edward Onya, the Resident District Coordinator (RDC) of Kaberamaido District during an IRS planning meeting said, “COVID-19 transmission is yet to take hold so let us fight malaria now so that by the time COVID-19 arrives our facilities will not be congested with malaria cases and our frontline workers will have the time and resources to fight COVID-19.” He further noted that PMI VectorLink Uganda was quite exemplary in implementing IRS amidst COVID-19 and achieving high coverage, which will go a long way in preventing malaria transmission in the district.

 

 

 

 

PMI Enhances Evidence-Based Decision Making to Prevent Malaria

PMI Pilots Integrated, Global Database with IRS and Entomological Data to Manage and Guide Timely-Vector Control Decisions

Insecticide resistance is rising across the globe, threatening the massive gains made in the control of malaria over the past 15 years. These gains can be attributed to the increased use of indoor residual spraying (IRS) and insecticide-treated nets (ITNs), which use insecticides to kill or repel mosquitoes that carry the malaria parasite. Timely, evidence-based vector control decision-making is essential to ensuring the most effective insecticides are being used.

The U.S. President’s Malaria Initiative (PMI) VectorLink Project conducts robust entomological monitoring efforts to understand malaria vectors – species that carry malaria – and their geographical and temporal distribution, feeding and resting behaviors, and resistance to insecticides. In 2018, PMI VectorLink developed a comprehensive District Health Information Software (DHIS2)-based data management system, VectorLink Collect, to support routine IRS data needs across project countries. Now, the project is expanding the database to manage entomological data across 17 African countries.

Several remote training sessions on the new programs in VectorLink Collect were cascaded to the entire VectorLink Zambia entomological team, empowering the team to begin data entry and management within the VectorLink Collect system.

This advancement enables PMI-funded IRS and entomological data to be managed in a single system, and supports improved data quality and integrated analytics. VectorLink Collect also allows both internal and external decision-makers, such as National Malaria Control and Elimination Programs (NMCP/NMEP), and PMI/USAID in the U.S. and in country, to access comprehensive data at multiple levels. Furthermore, building VectorLink Collect on DHIS2, a platform that is used by Ministries of Health in every PMI-focus country where VectorLink works, also supports country-level priorities and systems, and aligns with PMI’s goal to support sustainability and the journey to self-reliance.

The project piloted the VectorLink Collect entomology instance in Zambia in February 2020. The Zambia country team had already been using VectorLink Collect for IRS data, and carries out comprehensive entomological activities. The pilot has helped the project to better understand data work flow needs, quality review processes, and general ease of use of this new system for entomological data. The VectorLink Zambia team provided comprehensive feedback and recommendations to inform critical updates to program design and minimize challenges as more countries start using the system. It became apparent that certain field work factors, such as the remoteness of collection sites, needed to be accounted for in determining realistic data entry timeframes. In addition, Zambia introduced a monthly plan to guide data review and data entry processes and expectations. The successful pilot concluded in April 2020, and the project continues to enter ongoing entomological data into VectorLink Collect.

The success of this important pilot and overall positive feedback from the VectorLink Zambia field entomologists and data managers supports the use and expansion of VectorLink Collect for entomological data. It formed the basis for finalizing training approaches for the broader roll out to remaining country teams. This is especially valuable as all trainings will now be conducted remotely. The use of VectorLink Collect for entomological data will allow for an integrated, global database to manage and use timely data to guide malaria control work.

Rabecca Ngwira, VectorLink Zambia entomology field coordinator, said, “We have longed for a system that allows rapid generation of entomological data summaries and graphical representations without a need for elaborate Excel worksheets and complicated use of formulae, and here we have it in the VectorLink Collect.”

 

 

 

Maintaining Malaria Prevention in the Face of COVID-19

While the global community responds to the COVID-19 pandemic brought on by the novel coronavirus, the vector control community continues its commitment to fighting malaria. Although this pandemic may have changed the way that we live and work, our commitment to saving lives remains as strong as ever.

With support from the U.S. President’s Malaria Initiative (PMI), the PMI VectorLink Project continues to deploy life-saving interventions, like insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS), to help reduce the overall strain on health systems by keeping the most vulnerable people malaria-free. Working in close collaboration with country governments, national malaria control programs, and ministries of health, we have been able to adapt our programming to adhere to social distancing guidelines and country-specific practices to continue to reduce the burden of malaria.

While in the field and during campaign launches, we encourage all staff and partners to use face coverings where social distancing is not possible. Zanzibar MRC coordinator and ZAMEP deputy Program Manager during the ITN campaign Launch in Zanzibar.
During our most recent ITN campaign in Zanzibar, we made sure to include hand sanitizer, gloves, and masks with each ITN registration booklet before they were passed out to beneficiaries.
Here we see one of our team members splitting the ITN bales into pieces to allocate among the volunteers to then pass on to beneficiaries. In this campaign alone, we’ve protected over 400,000 people in Zanzibar by providing ITNs.
Hand washing stations like the one pictured here have been introduced at all campaign sites to encourage handwashing among staff whenever possible. Master Training Session in Gambela, Ethiopia.
Where virtual training is not possible, we utilize large rooms and empty classrooms to host in-person training sessions. We make sure that participants are wearing masks and are spaced at least 2 meters apart. Training of Trainers in Gambela, Ethiopia.
Live-action training for spray operators is essential for successful and efficient IRS campaigns. To ensure that operators are well equipped to carry out IRS, we’ve modified or training sessions by reducing the number of operators trained at once. This limits the number of people in one room at once and allows us to maintain appropriate social distance. Gambela, Ethiopia.
At the start of each day during a spray campaign, our field teams conduct morning mobilizations to ensure that spray operators, team leaders, and supervisors are ready for the day ahead. Along with encouraging words to kick start the day, our teams are also reminding to maintain social distance, wear all personal protective equipment at all times, and to wash hands whenever possible. Burkina, Faso.

 

PMI VectorLink Malaria Fighter: Dr. Oliver Lulembo

 Zambia

Dr. Lulembo (front) discusses net distribution with a community in Luapula Province, one of the areas with the highest incidence of malaria.

Dr. Oliver Lulembo has dedicated his life to treating and caring for people’s health. From his days as a pediatrician to his work as a public health practitioner, Dr. Lulembo has seen the rewards treatment and prevention can have in reducing the burden of malaria. He received his Master of Medicine in Pediatrics and his Bachelor of Medicine and Surgery from the University of Zambia in Lusaka and a Master of Public Health from San Diego State University in California. After years as a pediatrician and clinician, he shifted his career to designing, implementing and managing health programs in Zambia, Botswana and Malawi. From 2008-2012, Dr. Lulembo served as PMI Zambia’s Resident Advisor for USAID. In 2012, Dr. Lulembo retired from full-time work so he could spend more time with his four grandchildren. Now he works part-time as Senior Insecticide-Treated Net (ITN) Technical Advisor for the PMI VectorLink Project in Zambia. Recently, Dr. Lulembo took time late in his evening to talk about his current work with the PMI VectorLink Project.

Can you tell me about your role on the PMI VectorLink Project?
In my previous role with PMI, I worked with the Zambia National Malaria Elimination Program (NMEP) on their strategy for vector control interventions to distribute nets, amongst other responsibilities. This was mostly with routine net distribution through antenatal care, the Expanded Programme on Immunizations and supported mass campaigns. Now I am working with the NMEP and the Ministry of Health to help build their capacity to plan, implement, monitor and evaluate the upcoming ITN mass distribution campaign. It’s a very exciting assignment. PMI plans to procure an estimated 2.1 million ITNs for the 2020 campaign targeting Eastern, Luapula, Northern, and Muchinga Provinces.

What is your experience with malaria?

I have experience from many perspectives. One, of course, is as a patient of malaria. Several times. As you grow older, the attacks get less severe because you develop a bit of immunity. So I don’t get many attacks now. Also, I live in Lusaka, which is an urban area. The incidence of malaria here is quite low.

My first born also had malaria, and it was quite a big deal as he became very, very sick. That’s quite typical of malaria. You never know how patients fare in a short period of time, especially if they have not yet developed any immunity. If you don’t intervene with medical treatment, they die. My youngest son also had very severe malaria, which was quite serious.

I also have experienced malaria as a pediatrician. I saw babies and young children who tend to get very severe cases of malaria. Sometimes they come for care very late with complications, with severe anemia, and you can lose them. It’s very sad when you’re working with children. The last thing you want is to lose a young life.

Can you talk about the importance of the ITN campaign in the face of COVID?

It’s extremely important, and the good thing is that the government, MOH and partners, such as PMI, are communicating that. We know that COVID-19 and malaria share symptoms, so you get things that are common in both the virus and malaria. Our messaging tries to address that. We cannot afford to let our guard down. We need to maintain our interventions to avoid or abate deaths. That’s been the message consistently. Let’s maintain the prevention control measures, the treatment and other things that make sure we control malaria in this country.

Unfortunately, COVID-19 has diverted part of the workforce from the key interventions related to malaria. It also has changed the way people seek healthcare. So we may not be seeing as many people coming through for care. The international supply chains, including nets, have been delayed slightly. We’ve also seen commodities for testing malaria delayed, so it’s worrisome. But the message has been very clear. We must maintain intervention services.

What has surprised you most about the project?

With the PMI VectorLink Project, the main program has been IRS. Now, it’s working in nets and that’s when I became involved. We are helping the NMEP to implement this huge campaign, which is very different from the previous campaigns that have been implemented before. The past campaign in 2017 was a universal campaign, so it was one net for every 1.8 people. This time around it’s a very special type of campaign. It’s complicated because there will be some communities that receive IRS and some that receive nets. Zambia’s vector control interventions include the use of ITNs, IRS, and, where applicable, larval source management. For the 2020 ITN mass campaign, the NMEP will implement a unique, data-driven approach to the deployment of IRS and distribution of ITNs in a “patchwork” or mosaic configuration.

The ITN campaign will be a door-to-door distribution. We’ve determined quantities of nets for districts and how they flow to the health centers and then to the communities. We’ll have community-based volunteers to register the households and then those volunteers will return to distribute the nets while observing COVID-19 precautions. We had planned this campaign to occur before the rainy season and before the IRS campaign. Because of COVID-19, there’s been a disruption to the supply chain, so it looks like both IRS and ITN campaigns will happen at the same time.

Was this door-to-door approach decided on because of COVID?

This approach came as a lesson from the 2017 campaign, which used fixed distribution points. Communities were primed and sensitized to come to the distribution points to receive their nets. Back in 2013, we did a door-to-door campaign that seemed to work better because the net use-to-access ratio was better. So we’ve gone back to the door-to-door approach.

In this country, malaria incidence is plateauing and we really want to drive down that incidence. Last year’s floods brought an upsurge in malaria incidence and rise in deaths, so that’s worrisome, and we are trying to address that. It has not only affected Zambia but the entire region.

Dr. Lulembo and his wife of 41 years with two of their grandchildren.

Is there anything else you’d like to add?

As a pediatrician, you see patients with malaria come into the hospital. When you treat them and then they go home ok, the feeling is really good. It’s a special feeling you get. It’s out of this world. Then, when you switch over to public health, you are part of planning, implementing, and evaluating strategies that affect not one patient but communities. You are talking in terms of thousands, millions of people who benefit from the work that you are a part of, and that special feeling is magnified so many, many more times. So this work becomes extremely addictive. It’s a privilege and an honor to be part of the work to protect people against malaria. In the malaria world, I think I’m in this for the long, long haul.

 

 

 

PMI VectorLink Photos Place in Abt 2020 Photo Contest

Bezhan Muradi Wins 2nd and 3rd Place

PMI VectorLink Project Operations Analyst Bezhan Muradi won 2nd and 3rd place in the Abt Associates 2020 Photo Contest. With four photos among the top ten finalists, Bezhan was a clear winner and helped to further highlight the wonderful work PMI VectorLink is carrying out every day to reduce the burden of malaria. All four photos come from his trip to Tanzania where VectorLink conducts IRS and supports broad access to ITNs at health facilities and through mass campaigns and school-based distribution. Congratulations to Bezhan!

VL Tanzania spray operators fist bumping village kids after completion of our spray operations. 2nd Place Winner.

 

A spray operator in Tanzania is leaving the operation site after early morning mobilization. 3rd Place Winner.
A student in Sengerema District of Mwanza region, Tanzania, reads instructions on how to use and clean her bed net after receiving her ITN at school. Top 10 Photo Finalist.
These students show their joy in receiving their ITNs. Top 10 Photo Finalist.

PMI VectorLink Malaria Fighter: Joséphine Tossa

Cotonou, Benin

Joséphine Tossa has spent the past 12 years fighting malaria in Benin on projects supported by the U.S. President’s Malaria Initiative. As a child growing up in southern Benin’s Mono District, Tossa suffered from malaria more than once and saw many others suffer as well.

“After my academic studies,” Tossa said, “I worked in many organizations in the field of community development. It was during this journey that I realized that malaria was not only a disease but also a cause of underdevelopment in underprivileged areas. That’s when I became interested in working in the field of malaria prevention.”

In her career with malaria prevention projects, particularly those managed by Abt Associates, Tossa has served as Finance & Administrative Manager as well as the Gender Focal Point for VectorLink Benin. Tossa shared a few of her insights about her work, the project and malaria in Benin.

VL: What impact has PMI VectorLink had on malaria in your country?

Tossa: Benin has all the environmental conditions for endemic malaria. The burden of malaria was such that health services were almost overwhelmed. With malaria interventions, such as indoor residual spraying (IRS) and insecticide-treated nets (ITNs), some severe forms of malaria have decreased, allowing health services to have time to deal with other diseases. Vector control interventions are implemented in areas that have extensive agriculture. Therefore, malaria prevention activities allow people to stay active and maintain economic growth.

 VL: What changes have you seen in malaria prevention since the project began?

Tossa: Thanks to information, education, and communication activities, populations are increasingly aware of the risk factors for malaria. Increasingly, people are protecting themselves by properly using ITNs, and accepting the spraying of their houses. If these trends continue, Benin can expect a significant reduction in the burden of morbidity and mortality attributable to malaria by the end of this decade.

VL: Can you tell us a bit about your job?

Tossa: As F&A Manager, I ensure finance and administrative requirements are strictly followed. Most of the malaria prevention activities are carried out in campaign mode. Managing financial, administrative, and procurement aspects of thousands of seasonal workers requires a lot of work.

Also, VectorLink Benin is promoting cost-saving initiatives to cope with the increasing prices of new and more effective insecticides. I adopted a systematic approach to cost control, categorizing expenses according to whether they are fixed or variable, direct or indirect to spraying. Cost reduction efforts are now better targeted so they do not impact efficiency in implementation.

VL: Can you tell us about your role as Gender Focal Point on the project?

Tossa: Given the low female participation in malaria prevention, I’ve actively advocated with IRS stakeholders at the national and departmental level for the removal of cultural and social barriers to increase the involvement of women in spraying campaigns. When procuring overalls, boots and other personal protective equipment for IRS campaigns, I always ensure that the gender dimension is taken into account. During spray campaigns, women have easy access to sanitary pads provided by the project, which was not guaranteed two years ago because of cultural barriers. In 2008, around 10% of women were involved in the IRS campaign. Today female participation has almost doubled.

VL: What kind of impact have you seen from the project?

Tossa: The project contributes to a reduction in morbidity due to malaria in rural areas less covered by health services, and provides income opportunities to the local population as seasonal workers, which helps them to improve their living conditions every year.

VL: What has been one thing you’ve learned or loved about working with PMI VectorLink?

Tossa: PMI VectorLink offers safe working conditions and professional development for all its staff. This makes VectorLink a great place to work and have a professional career.

VL: How do you see the country moving forward with malaria prevention or mosquito control?

Tossa: Most vector control interventions take place inside houses. Previously, Benin had lacked interventions that protected people while they are outside. Recently, the country has put a lot of effort in improving the living environment, repairing roads and clearing gutters. Cleaning up the environment to rid it of stagnant water would help to improve protection from malaria. Also, educating and informing the populations on the causes and preventive measures of malaria would enable them to participate and take ownership of the fight against malaria vectors. These activities will optimize the existing interventions, namely ITNs and IRS.