Malaria Fighter: Jean-Pierre Rucakibungo

Kigali, Rwanda

Jean-Pierre Rucakibungo, Senior Finance and Administration Manager, oversees all the financial, accounting, and compliance aspects for PMI VectorLink Rwanda. Born and raised in Rwanda’s capital city of Kigali, Rucakibungo is fluent in English, French, Swahili and Kinyarwanda and holds a Bachelor of Science from the National University of Rwanda and an MBA from the University of Roehampton, London. In his spare time, he enjoys studying the history and culture of Rwanda in his mother language (Kinyarwanda). Recently, Rucakibungo took time to talk to us about his work.

VL: How did you get started working with malaria?

JPR: After the genocide, we had a lack of people who were qualified in finance. There were many NGOs, so I started with Médecins sans Frontières in finance. I continued working with projects in finance, and in 2011, I started working with the PMI Africa Indoor Residual Spraying (AIRS) Project. I ensure that the office management, budgeting, operations, procurement, financial, subcontracting, and human resources systems are compliant with USAID rules and regulations.

VL: Do you have any personal experience with malaria?

JPR: When I was a child, we all used to have malaria. Anytime someone wasn’t well, we would think it was malaria. Our mother used to give us Nivaquine, which is a preventative medicine that my siblings and I had to take it daily. It was very bitter, so we had to take it in front of her. When we used it, we tended not to get malaria. If someone had a fever and tested positive for malaria, then he/she was treated with a more effective drug. The last time I had malaria was in 2001. When I’m traveling to those districts with high malaria, I’m afraid to see mosquitoes. It’s a bad illness. After you have it, you have to build up your strength. Everybody should sleep under a mosquito net to protect themselves from contracting it.

VL: What has surprised you most about working with PMI VectorLink (or AIRS)?

JPR: When IRS first came to Kigali, I was not aware that malaria was an illness that could be eliminated. I knew people were doing research on mosquitoes but I didn’t know it was to reduce malaria. It’s a disease that can be controlled, but it’s very costly. Elimination will require coordination with Burundi and the DRC to sustain the gains we are making in Rwanda.

VL: What do you find most challenging about your job?

JPR: The most challenging aspect is eliminating mistakes from the field, such as ensuring that the mobile phone numbers we collect for mobile money payments are registered to the corresponding seasonal workers. In the past, there have been discrepancies and it resulted in delayed payments. After every campaign we look at the challenges we faced and develop a strategy to ensure we don’t make mistakes. Most of the time, the budget is 96-98 percent on target. I use the budget tracker and can manage activities not planned. For instance, the Government of Rwanda has sought our assistance in protecting Mahama Refugee Camp with IRS. While not in the initial work plan budget, we were able to make this happen in 2018 and 2019 by covering operational costs while the government provided the insecticide.

In 2018, we moved to mobile payments for seasonal workers. We had the training for a week. I was excited to know that these things could happen. At the time, I had finished my MBA and I had worked on eMoney with businesses in Kigali. I had the knowledge of how things work. When I was asked to implement online payments for the project, I really understood them well.

By paying our accounts and staff with mobile money I was able to move around the country and follow training for seasonal staff, which helped me to better understand what was happening in the field. As I managed the budget over the years, I’ve learned a lot about IRS and entomology outside of finance, such as when we rehabilitated an entomology laboratory and managed entomological monitoring sentinel sites.

VL: What kind of impact have you seen on malaria in Rwanda from IRS?

JPR: In 2010, the district with the most burden was Nyagatare with 45% of the country’s cases. We’ve sprayed Nyagatare since the beginning of AIRS in 2011. With epidemiological data, the impact is very visible. They now have few cases. Ngoma District was first sprayed in 2019 by the Government of Rwanda. They saw right away the impact of IRS. So when PMI VectorLink sprayed there this year, everyone wanted their homes sprayed. We were impressed to see how much the people liked IRS because they understand the impact.

VL: What do you wish other people knew about the project?

JPR: Most people know there is a project spraying houses to fight malaria. I often explain the impact the spray can have. We explain that we are not eliminating all mosquitoes rather mosquitoes that carry the malaria parasite. I’m often explaining the impact of IRS and why we spray the walls and ceilings of every house. When the insecticide we had been using previously was shown to have reduced efficacy, we changed to a bendiocarb insecticide. People were happy because they could see it was working. Later, when we started spraying with the organophosphate Actellic, the population could see it was killing the mosquitoes and other insects. Before people used to tell stories that the pyrethroid insecticide brought fleas into the house, but now they do not. They don’t hear mosquitoes in the house at night, so they can sleep. With the new insecticide, people like it more. When people aren’t experiencing malaria, they don’t understand why we are still spraying. So we often have to explain why we need to continue with IRS in order to maintain control.

VL: What is your hope from the project?

JPR: As we start the third year of the project, I see that we have a well-equipped laboratory, so the entomology is going well. But we don’t have enough entomologists and continued efforts are needed to build local capacity. With project trainings and time, we will be better able to fight malaria. One thing I’ve seen is the increased use of mosquito nets. We are moving more toward using nets for fighting malaria. The Government of Rwanda is now distributing nets across the country. We are combining IRS with nets, and in the three years, we will see where we will be.

VL: What could other countries learn from Rwanda?

JPR: The one number one thing is how we implement IRS as a team. Since we started, our entire operations staff is involved in all aspects of the project. While our environmental compliance officer conducts environmental assessments, she’s not the only person who knows how to do the job. We work as a team, so when I’m in the field I can support the team. Or if we’re spraying in two districts at the same time, we can support each other. The teamwork makes IRS in Rwanda successful.

PMI VectorLink Study Published in Scientific Reports

Impact of indoor residual spraying with pirimiphos-methyl (Actellic 300CS) on entomological indicators of transmission and malaria case burden in Migori County, western Kenya

A study conducted by the U.S. President’s Malaria Initiative VectorLink Project (the follow-on project to the PMI Africa Indoor Residual Spraying Project) in western Kenya shows that IRS with pirimiphos-methyl was highly effective for the control of indoor biting and indoor resting, pyrethroid-resistant An. funestus mosquitoes and resulted in substantially reduced numbers of this primary vector species coupled with reduced malaria cases. The study found that due to the long residual effect of pirimiphos-methyl, it was possible to achieve year-round protection with a single round of IRS. Sustaining these gains is a priority for the Kenya National Malaria Control Program and development partners. The authors of the study say that IRS should continue to be implemented to sustain the impact on An. funestus. Because there was less of an impact of spraying on An. arabiensis populations, likely due to their exophilic (outdoor-biting and resting) nature, additional control measures are needed to control outdoor biting and resting An. arabiensis. The peer-reviewed Scientific Reports is the 11th most cited journal in the world, with more than 300,000 citations in 2018*, and receives widespread attention in policy documents and the media. 

*2019 Journal Citation Reports® Science Edition (Clarivate Analytics, 2019)

 

https://rdcu.be/b2Pdr 

 

PMI Assists Ethiopia along Journey to Self-Reliance in IRS

PMI Support Goes beyond Targeted-Districts

In 2017, more than 1.5 million cases of malaria were reported in Ethiopia with an additional 1 million cases estimated to have occurred, according to the World Health Organization World Malaria Report 2019. Although Ethiopia’s malaria incidence is significantly lower than much of sub-Saharan Africa, the country’s government is committed to further reducing the risks of infection. To protect its population from this deadly disease, the Government of Ethiopia (GOE) conducts indoor residual spraying (IRS), one of the most-effective strategies proven to reduce the burden of malaria and envisaged to eliminate the disease by 2030.

The U.S. President’s Malaria Initiative (PMI) has supported Ethiopia’s Federal Ministry of Health (FMOH) National Malaria Control Program (NMCP) in conducting IRS since 2008. Working with the FMOH, the Benishangul-Gumuz, Gambela, and Oromia regional health bureaus (RHBs) and the district health offices, the PMI VectorLink Project sprayed 487,746 structures in 2019, across 44 districts, protecting more than 1.3 million people.

Ethiopia’s NMCP also implements IRS in hundreds of other districts without PMI support. The FMOH reports that more than 5 million structures are sprayed and more than 15 million people are protected every year under the national IRS program. In 2019, PMI continued its technical support to 60 additional districts the GOE sprays while also extending its reach to share IRS best practices to five additional regions of the country, including Amhara, Afar, Somali, Tigray and Southern Nations, Nationalities, and People’s Region (SNNPR).

In 2018, VectorLink Ethiopia, in collaboration with the NMCP, observed that the RHBs) had insufficient capacity to carry out IRS while ensuring adherence to PMI best practices. The team identified challenges around spray quality and environmental and safety compliance (EC) in non-PMI-supported districts, primarily due to a shortage of skilled personnel and inadequate operational budget at the district level.

To increase the GOE’s ability to implement safe and effective IRS on its own, the PMI VectorLink Project held a five-day training in November 2019 for 129 participants from the five additional regions. The training introduced participants to basic IRS techniques and EC procedures to ensure PMI Best Management Practices are followed. Previously, for example, participants from non-PMI districts were reported to lack the knowledge and skills around formal rinsing procedures in IRS. Such procedures protect both the spray operators and the environment from exposure to the insecticide. During the training, the participants also learned how to construct a cost-effective and permanent soak pit that allows operations to meet EC standards. The two constructed soak pits acted as model soak pits in the training and will be used as centers of excellence during future trainings. In addition, the concept of field simulation was introduced and participants took part in homeowner preparation in the field.

PMI VectorLink held a five-day training to help the Government of Ethiopia implement IRS safe and effectively across the country. Photo: PMI VectorLink Ethiopia

NMCP Team Leader Mebrahtom Haile Zeweli described the training as a ‘game changer’ as it was going to ensure quality IRS is implemented in non-PMI-supported districts. The NMCP Team Leader was optimistic that the participants will use all the techniques learned to implement safe and quality IRS in their respective districts. Mebrahtom also asked the project to extend this training to more districts as it was key to ensuring safe and effective IRS as well as the sustainability of IRS since it is implemented at the district level.

Abebech Asres, a training participant and the Malaria Focal Point Person from Amhara Region, South Gondar Zone, said that the skills and knowledge acquired on soak pit construction and rinsing procedures will be used to implement safe IRS by protecting IRS actors, residents and the environment from contamination.

The soak pit constructed for training purposes will be used as center of excellence in future trainings for the non-PMI districts. Photo: VectorLink Ethiopia

Better Data, Better Results

Field-Based Mobile Data Collection in Burkina Faso Helps Improve Spray Coverage

Team leaders comparing tablet data to paper form data with SOPs.

Indoor residual spraying (IRS), proven to reduce the burden of malaria, entails spraying the interior walls and ceilings with an insecticide that kills malaria-carrying mosquitoes. IRS requires high-quality data to plan, implement, and track progress during a spray campaign. Having real-time data readily available and accessible facilitates reporting and decision-making on the ground without delay, and more quickly mitigates operational challenges. Until recently, field teams relied on paper data collection forms, which required an additional step of manually entering data into an electronic system, delaying the time between collection and the data being processed for use in decision making. That all changed when the PMI VectorLink Project piloted its mobile data collection strategy in Burkina Faso during the 2019 spray campaign.

Traditionally, spray operators serve as the primary point of data collection. Once they’ve sprayed a house, they record the home on their data collection form. If a home could not be sprayed (e.g. the head of the household was not home to accept IRS), the spray operator would note that on the data collection form. At the end of each day, spray operators would return their data collection forms at the operation site where data clerks then entered the information into a computer. The data is then cleaned, analyzed, processed, and sent to a global server where the information can be accessed from a real-time database.

Screenshot of the data collection form on the mobile data tablet.

Now, with mobile data collection, the need to manually enter data is removed – along with potential data entry errors that can skew the data overall and influence results. During the pilot, 547 spray operators across all three spray districts (Kongoussi, Solenzo, and Kampti) collected their household data using mobile tablets, each set up with the Open Data Kit (ODK) application. The ODK application was configured specifically for household-level data based on the standard, the paper form that spray operators were familiar with and formatted to reduce data entry error. Once collected via the mobile tablets, data is then synced to the project’s DHIS 2-based VectorLink Collect server on a daily basis for analysis and reporting.

IRS can require thousands of people to work together in a short period of time to reach a set of targets. Improving processes and procedures to increase efficiency and save costs is essential for sustainability. Field-based mobile data collection speeds up the team’s ability to identify and respond to problems, allowing the team to better serve the community by protecting them more effectively from malaria.

For instance, the VectorLink team was able to make quick and informed decisions in regards to the improvement of spray performance, by immediately intensifying mobilization activities in response to high refusals in certain areas with specific and adapted messages. The project plans to scale mobile data collection in 2020 IRS campaigns in Benin, Cote d’Ivoire, Mali, and Senegal as well as continue its use in Burkina Faso.

While conducting this pilot, VectorLink Burkina Faso sprayed more than 200,000 structures, protecting more than 580,000 people, including 92,000 children under five years of age and 11,000 pregnant women.

 

Exploring the Contribution of 3rd Generation IRS Products with NgenIRS

The NgenIRS partnership led by IVCC and funded by Unitaid with support from The U.S. President’s Malaria Initiative, The Global Fund, PATH, and Abt Associates is establishing a sustainable, competitive and growing market for effective 3GIRS products at affordable prices.

NgenIRS is making the most effective, long-lasting insecticides available to malaria programs and implementation partners to support insecticide resistance management strategies. In an upcoming webinar hosted by The Vector LearningXchange, representatives from the NgenIRS partnership will discuss the role of 3rd generation IRS products in reducing malaria in light of increasing pyrethroid resistance.

Register here: https://www.vectorlearningxchange.com/register/

2019 World Malaria Report

The World Health Organization has just released its 2019 World Malaria Report. The report provides a comprehensive update on global and regional malaria data and trends. The report tracks investments in malaria programs and research as well as progress across all intervention areas. The 2019 report is based on information collected from over 80 countries and areas with ongoing malaria transmission. 

Check out the report here: 2019 World Malaria Report

 

PMI VectorLink @ 2019 Global Digital Health Forum

The PMI VectorLink Project joins the Global Digital Health Network in celebrating innovation and supporting proven practices at scale. This event seeks to balance the need for evidence-based scaling of proven systems with the urgent need to determine how emerging technologies and approaches can improve health outcomes. 

The 2019 forum will host 600-700 attendees with engaging sessions to connect government stakeholders, digital health technologists, researches, donors, implementers and field experts from across the globe. 

To RSVP and for more information visit: https://gdhf2019.dryfta.com/ 

December 9 – 11, 2019
Bethesda North Marriott Hotel & Conference Center
5701 Marinelli Rd
Rockville, MD

Image Credit

Sprayers

PMI VectorLink at ASTMH 2019

The 2019 Annual Meeting of the American Society of Tropical Medicine & Hygiene (ASTMH).

Wednesday, November 20, 2019 – Sunday, November 24, 2019

The ASTMH Annual Meeting draws tropical medicine and global health professionals representing academia, government, non-profits, philanthropy, NGOs, industry, military, and private practice. The meeting is designed for researchers, professors, government and public health officials, military personnel, travel clinic physicians, practicing physicians in tropical medicine, students and all health care providers working in the fields of tropical medicine, hygiene and global health. The Annual Meeting is a five-day educational conference that includes four pre-meeting courses and draws approximately 4,800 attendees.

The PMI VectorLink Project is at the forefront of innovative prevention and surveillance methods that protect vulnerable communities in sub-Saharan Africa from the burden of malaria.

Click the image below to see our full list of ASTMH Presentations:

Gaylord National Resort and Convention Center
201 Waterfront Street
National HarborMD 20745
United States

Engaging Women in Vector Control

Engaging Women in Vector Control – Virtual Keystone Symposia.

On October 1, 2019, The PMI VectorLink Project participated in a live virtual event in partnership with the Bill & Melinda Gates Foundation, covering the topic of Engaging Women in Vector Control. The event highlighted the Accelerate to Equal Initiative, which strives to understand and overcome the barriers to women’s engagement in public health efforts.

Two of our local gender focal points, Zeddy C. Bore– PMI VectorLink, Kenya and Helen Amegbletor – PMI VectorLink, Ghana, participated in the session and shared their experience leveraging women’s roles as leaders within their families and communities to more effectively and sustainably fight against malaria. Here is a snapshot of the session:

What strategies are used to secure women’s positions at PMI after taking maternity leave? 

ZB & HA: The PMI VectorLink Project has a well-documented policy regarding women due for maternity leave. While away on maternity leave, their positions are only temporarily filled by another staff member on the project. She will return to take up her role after her leave period is over. Should it become necessary for her to travel outside the work station for an overnight stay, she is allowed to go along with a nanny who can take care of her child while she is out in the field undertaking the activity. The nanny and baby-related travel and lodging costs are paid for by the project. This is to help encourage the breastfeeding of children up to 24 months and mother-child bonding is not affected.

To read more and to view the session recording, visit: Extending the Conversation | Engaging Women in Vector Control.

 

Building Capacity One Insectary at a Time

The PMI VectorLink Project Helps Establish Sierra Leone’s First Vector-Borne Disease Insectary and Laboratory.

In the West African country of Sierra Leone, 100 percent of the population is at risk of contracting malaria. Despite the country’s incredible progress in reducing the number of deaths related to malaria in recent years, the disease still contributes to an estimated 2,240,000 outpatient hospital visits every year. One million of those patients are under the age of five[1].

Lab technician at work in Sierra Leone’s VBDIL.

To protect people from malaria, Sierra Leone uses both insecticide-treated nets (ITNs) and indoor residual spraying (IRS). However, the emergence and spread of insecticide resistance pose major challenges for the way the country currently conducts its vector control interventions. In efforts to help stakeholders and Sierra Leone’s government make strategic plans on where to conduct specific malaria control interventions, the U.S. President’s Malaria Initiative (PMI) worked in collaboration with Sierra Leone’s National Malaria Control Program (NMCP) and the Neglected Tropical Diseases Program to establish the country’s very first, fully-functional Vector-Borne Disease Insectary and Laboratory (VBDIL) to support entomological monitoring for malaria, and research for other vector-borne diseases. 

A key defense to fighting the infectious disease is understanding the enemy. The more scientists know about the Anopheles vector – the mosquito that carries the malaria parasite – the better equipped they will be in making vector control decisions. The VBDIL will allow the country’s entomologists to test the resistance of Anopheles mosquitoes to malaria vector control products. Being able to assess the effectiveness of potential vector control interventions will help the country make strategic decisions for vector control programming. To protect people from malaria, Sierra Leone currently uses insecticide-treated nets and plans to use indoor residual spraying.

“We have no doubt that the collaboration and partnership with PMI VectorLink will contribute immensely to the fight against malaria in Sierra Leone.” – Dr. Samuel Juana Smith, NMCP Program Manager

With the VBDIL in place, Sierra Leone will be able to undertake most of the entomological activities themselves without having to rely on data from other countries. Since the VBDIL was established, entomologists have reared mosquitoes of the An. gambiae s.s Kisumu strain – the primary mosquito vector responsible for the transmission of malaria in most of sub-Saharan Africa – making it the first time Sierra Leone can rely on quality vector control tools in-country. The insectary and laboratory offer the required conditions to rear mosquitoes from larvae collected at nearby sentinel sites. Trained entomologists then use the reared mosquitoes and assess their susceptibility to the insecticides used in IRS and ITNs. Based on data collected and the results gathered from these susceptibility tests conducted in the VBDIL, the NMCP has advocated for the procurement and 100 percent use of piperonyl butoxide (PBO) nets, for Sierra Leone’s next insecticide-treated net mass campaign set to take place in 2020. PBO nets have been shown to significantly reduce malaria infection in areas with high rates of insecticide resistance.[2] Dr. Samuel Juana Smith, NMCP Program Manager says that they “have no doubt that the collaboration and partnership with PMI VectorLink will contribute immensely to the fight against malaria in Sierra Leone.”

U.S. Ambassador to Sierra Leone, Maria E. Brewer, visits the VBDIL during its Grand Opening in Makeni.

To build human resource capacity and ensure country ownership, PMI VectorLink trained members from Sierra Leone’s NMCP, District Health Office, and Ministry of Health (MOH) on mosquito sampling and identification, insecticide resistance monitoring, and cone bioassay tests. Now, trained staff from the MOH and district offices support the monthly entomological monitoring in four sentinel districts: Bombali, Bo, Kono, and Western Rural area. The insectary and entomology laboratory will also be used by research and academic institutions and will serve as an avenue for building further local capacity in country.

[1]National Malaria Strategic Plan 2016-2020, National Malaria Control Program. Ministry of Health & Sanitation. 2015.
[2] Katherine Gleave et al. “Piperonyl butoxide (PBO) combined with pyrethroids in insecticide‐treated nets to prevent malaria in Africa” Cochrane Database Syst Rev. 2018 Nov; doi: 10.1002/14651858.CD012776.pub2