The Roll Back Malaria (RBM) Partnership to End Malaria is the global platform for coordinated action against malaria. RBM is comprised of more than 500 partners committed to combatting the disease, including malaria endemic countries and their governments, the private sector, and nongovernmental and community-based organizations.
Since 2017, The President’s Malaria Initiative (PMI) PMI VectorLink Project has supported the RBM Partnership through its co-chair position on the Vector Control Working Group (VCWG) and through hosting the Partnership’s premier resource hub and online community platform, the Vector LearningXchange.
Key staff from the PMI VectorLink Project travelled to Geneva to present new developments and key results on insecticide rotation, data and decision making in IRS, and data collection.
See below for presentations from the conference. These presentations have also been made available on the Vector LearningXchange.
In 2018, Victor Kasuzweni joined the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Malawi as Environmental Compliance Officer (ECO). With a Bachelor of Environmental Science from the University of Malawi and a Master of Environmental Engineering from Suzhou University of Science & Technology in China, Kasuzweni committed himself to protecting the environment long ago. Growing up in Chikwawa, one of Malawi’s low-lying southern districts, he developed a passion for nature at a young age. Recently, Kasuzweni talked about his experience with the project.
How did you get involved in the field of environmental compliance and safety?
I used to watch nature channels on TV from a young age. My motivation to work in the environment came about when I started to hear about pollution and environmental problems, and how we can make the world a safe place. This motivated me to pursue a career in environmental sciences. I have worked for a number of organizations in the area of climate change, emergency response, environmental management and protection over the years. In 2010, I joined the Government’s Environmental Affairs Department, and I was posted to work in Nkhotakota District as an Environmental Officer responsible for the coordination of all the natural resources and environmental management activities at the district level. While working in the district, I was introduced to indoor residual spraying (IRS) which aims to reduce the malaria disease burden. I actively participated in the planning and implementation of IRS activities. The field of environmental compliance and safety in IRS is exciting and fulfilling because it ensures the safety of residents and workers from insecticide exposure and the protection of the general environment from chemical spills while ensuring substantial reduction of malaria disease burden among the communities.
I feel motivated and work hard to deal with demanding and challenging issues more particularly when I see that the initiative I am involved in, such as IRS, is impacting positively on people’s lives. I also feel good to receive feedback from the residents that benefitted from IRS and various stakeholders for the work I am doing. This provides important information for reviewing and reflecting on approaches and strategies to continuously improve on the project’s implementation.
Can you talk about your work with the PMI VectorLink Project?
I joined PMI VectorLink in 2018 and my key responsibility is to ensure the project is environmentally compliant and implemented in accordance with the IRS Best Management Practices and local guidelines. This involves the development of a number of documents to guide the project’s work. I am involved in the planning and implementation of a number of activities that minimize or eliminate potential risks to human health and ecological systems. For instance, I work in close collaboration with the PMI VectorLink project team, government counterparts and local leadership to identify appropriate areas for establishing operational sites needed for the project. I am also involved in the planning and delivery of environmental trainings for various cadres working in IRS, including conducting IRS spray supervision during and after implementation to ensure adherence to safety standards.
What kind of initiatives has the project taken on to protect the environment?
The project conducted EC trainings for stakeholders on various aspects, such as use of personal protective equipment, handling of insecticide exposures, spills, and construction of wash areas and soak pits to deal with effluents to ensure safe disposal. The project has outlined emergency response procedures to deal with adverse effects in times of emergencies and also developed memorandums of understanding (MOUs) with local recycling companies working with paper and plastics. The MOUs lay out guidelines for the proper handling of particular IRS wastes to protect human health and the environment. For instance, the MOUs state that any recycling waste from IRS will not result in the manufacturing of food packaging products or any products that will come in contact with food.
What kind of impact have you seen from the project?
The project is having a big impact on people’s lives especially through the reduction of malaria disease burden. Malaria has been an issue and remains a leading cause of morbidity and mortality in the district. The feedback we are getting from the residents is quite encouraging. They welcome IRS and are seeing immediate changes to mosquito density in their homes. Furthermore, the project has significant implications on socio-economic development. For instance, the project has been a source of employment and brought about economic empowerment in the process. The project design also gave women a chance to actively engage in IRS implementation at various levels. The communities really appreciate this initiative because it empowers women to work on various leadership positions. IRS is one of the most effective malaria control strategies. We encourage people to accept IRS and use it alongside other strategies such as using mosquito nets and keeping surroundings clean and with no stagnant water. Because there hasn’t been IRS in the area for six years the district also benefitted from the project trainings and capacity building sessions. It is envisaged that the knowledge and skills gained will go a long way in making IRS implementation more effective.
What is your hope from the project?
I have a great hope that the project will have made substantial reduction of malaria burden by 2022. Through the effective planning and implementation of IRS among stakeholders in the district, there will be a number of best practices to inform learning and programming and share with other partners working on IRS in Malawi.
PMI Collaborates with Malawi Government to Combat Malaria
The numbers were going the wrong way. After a six-year absence of indoor residual spraying (IRS) in Malawi, the number of people falling ill from malaria was steadily rising, with confirmed malaria cases more than doubling since 2012.
“Mortality is 19.8 per 100,000 people. That’s 10 deaths a day – 3,650 a year from malaria alone. That’s too many,” said Dr. Michael Kayanga, Vector Control Program Manager for Malawi’s National Malaria Control Program (NMCP). “We were the only country in the region not implementing IRS.”
IRS involves spraying an insecticide on the walls and ceilings where mosquitoes carrying the malaria parasite tend to rest. Eager to reverse the deadly upwards trend, the NMCP collaborated with the U.S. President’s Malaria Initiative (PMI) VectorLink Project to bring IRS back to Nkhotakota District – one of the country’s most vulnerable areas and a district that PMI last sprayed in 2012.
If the partnership continues the way it started, we should be very successful and each child under five can be free of malaria. With the PMI VectorLink Project, I hope we have reduced malaria by more than 50 percent of the current status in the next two years.
– Shadreck Mulenga Deputy Vector Control Program Manager, NMCP
In October and November 2018, PMI VectorLink successfully sprayed 112,264 structures during a 32-day campaign, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five, who are at the highest risk of dying from the disease. In addition to implementing IRS, PMI VectorLink provided training at district and national levels of government in spray quality, supervision, planning, logistics and environmental compliance and safety, including how to handle insecticide and dispose of IRS waste.
Peter Kamuloni, Nkhotakota District Environmental Health Officer, said, “Before, we were just learning in school, but not on the ground. The project training took it to the practical level and what we learned can be applied to dealing with other chemicals. The inventory tracking training was also key. IRS storekeepers learned enough that they can work for big companies now.”
While PMI conducted the IRS campaign, the government played a key role in the recruitment of seasonal workers, community mobilization, and donated the space for data collection centers.
“Most projects fail because of poor planning,” Kamuloni added. “PMI VectorLink had good leadership. Everyone was 100 percent committed. The incentive for us was that the NMCP was part and parcel of the project. We were respected and were not treated as if we were outside the project; and the project was in line with our goals as a district – to reduce malaria.”
PMI VectorLink is also helping the NMCP to develop a roadmap for its Insecticide Resistance Management Plan to ensure the long-term efficacy of IRS.
“We’ve collaborated well and we really own the project,” said Dr. Kayanga. “We’re quite happy. Since we sprayed, there’s already been a huge difference in the reduction of mosquitoes. People even called to tell us thank you.”
PMI VectorLink Ensures Successful IRS Campaign during Caterpillar Harvest
When the rainy season arrives in the south-central Africa country of Zambia, families both rejoice and worry. The wet months bring an onslaught of mopane worms, locally known as caterpillars. These insects are a healthy source of protein and revenue, particularly for rural communities who depend on the harvesting season for added income. A cup of caterpillars sells for the equivalence of US$4. During the hunting season, which spans about four weeks, an average household can make approximately $80. In Zambia, where 60 percent of the population lives below the poverty line, the added income during rainy season can provide much needed security.
But with those rains comes another insect that can wreak havoc on a family’s health and economic well-being: the malaria-carrying mosquito. Malaria accounted for 13.5 percent of Zambia’s annual hospital admissions in 2017 with children and pregnant women at highest risk of infection. To reduce the spread of the disease, the US President’s Malaria Initiative (PMI) VectorLink Project supports the Zambia government to implement indoor residual spraying (IRS). IRS involves spraying long-acting insecticides on the walls and ceilings of people’s homes to kill the mosquitoes. In 2018, the PMI VectorLink Project supported IRS campaigns in 29 districts in four provinces – Luapula, Muchinga, Northern and Eastern.
While offering life-saving protection, the 2018 spray campaign coincided with the period when households migrate to the forests to hunt for caterpillars. This activity would ordinarily have posed a major challenge for the 2018 IRS program since householders lock up their homes during the hunting exercise, thereby making access impossible for the spray teams. Furthermore, IRS requires beneficiary communities to remove their household items from their homes so that the indoor walls and ceilings can be sprayed.
The PMI VectorLink Project in collaboration with the National Malaria Elimination Program (NMEP) engaged authorities in 15 of the districts that hunt for caterpillars as well as the traditional leadership in these communities. PMI VectorLink tailored the IRS campaign to accommodate the movement of the communities. In some districts, the campaign was suspended for a few days to allow the migrating communities to return from their forest camp sites and have their homes sprayed. These accommodations ensured that the caterpillar hunting exercise could go on concurrently with the IRS campaign thereby creating a win-win situation for the community: they generated sizable incomes from the caterpillar harvesting while also being protected from malaria-carrying mosquitoes.
Dr. Emmanuel Kooma, Head of Vector Control at the NMEP, said, “Engaging the district and traditional leadership yielded very positive results with regards to the caterpillar harvesting situation in the communities.”
During the 2018 IRS campaign, PMI VectorLink sprayed 559,137 homes, surpassing its 85 percent coverage target and protecting more than 2,722,414 people, including 87,163 pregnant women and 397,483 children under five.
PMI VectorLink Increases Women’s Participation in IRS by Removing Barriers
Malaria remains the leading cause of morbidity in Uganda, accounting for 4% of all estimated malaria cases in 2017, according to the World Malaria Report 2018. To reduce the burden of malaria in Uganda, the President’s Malaria Initiative (PMI) VectorLink Project implements indoor residual spraying (IRS) to kill the mosquitoes that transmit the disease. PMI VectorLink works with Uganda’s Ministry of Health in planning and implementing IRS in 15 districts, strengthening the country’s capacity to manage IRS.
Because an important part of increasing capacity is ensuring the participation of women in IRS, the project encouraged women who were already working in the district health offices and the National Malaria Control Program (NMCP) to attend the training.
“Our aim is to strengthen the capacity of districts in all the malaria high-burden districts in Uganda so that they are able to plan and implement quality IRS and reduce malaria in their districts as one of core responsibilities. This is the responsibility of each person. I really appreciate the fact that the project has taken steps to increase female participation in IRS,” said Dr. Jimmy Opigo, Program Manager for NMCP Uganda. He added that the only way to defeat malaria is to involve every member of society affected by malaria, and women play a critical role in these efforts.
In the past, women’s participation in IRS has been significantly lower than that of men due partly to gender-based barriers that can constrain women’s participation. Mothers of young children can find it difficult to attend required trainings to qualify for IRS jobs. To increase women’s participation in IRS, and more specifically, to build a cadre of women in supervisory roles, the project provided meals and accommodations during trainings for participants and their babysitters. This allow for the full participation of mothers of young children during a recent five-day “boot camp” training held December 3-7, 2018. Nineteen women were trained on the implementation of IRS, supervision and gender inclusion, a 12 percent increase from last year.
Beatrice Apong, Health Inspector for Lira District, attended the training with her three-month-old baby. “I was really honored to be part of the IRS boot camp training,” she said. “I am grateful to the project for the support accorded to my baby helper which gave me ample time to be part of the training.” She added that she will work to ensure that more women are recruited and participate actively in IRS as a member of the district health team.
World Health Organization. (2018). World Malaria Report 2018. World Health Organization. http://www.who.int/iris/handle/10665/275867.
PMI VectorLink Boosts Women’s Roles in IRS, Promoting Gender Equity
For Agbethia Malenga, there is no job a woman can’t do. With a certificate in automobile mechanics, this 29-year-old is not your stereotypical woman. But it’s women like Malenga who are helping to challenge gender roles and making a difference doing it. Recently, Malenga played a key leadership role in helping the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Malawi to successfully carry out the country’s first Indoor Residual Spraying (IRS) campaign since 2012. IRS kills mosquitoes that transmit malaria by spraying insecticide on the walls and ceilings where mosquitoes prefer to rest. PMI returned to Malawi in 2018 to help reduce the burden of malaria in one of the country’s hardest hit areas: Nkhotakota District.
Dr. Michael Kayanga, Program Manager for Malawi’s National Malaria Control Program, said that in this district, “Contracting malaria twice in one year is expected but more than once in a month is common for children. When sick so often, children can easily slide into malnutrition. Malaria affects the entire household.”
Mortality from malaria was 19.8 per 100,000 people, according to the 2015-16 Malawi Demographic and Health Survey. “That’s 10 deaths a day – 3,650 a year from malaria alone,” said Dr. Kayanga. “The incidence of malaria is 5.8 million cases or one-third of our population. If you consider that two people care for the ill, that’s affecting the whole population.”
Pregnant women and children under five are the most vulnerable to malaria. As the primary caregivers, women face an additional burden when malaria strikes a family.
Malenga is excited to help bring those numbers down. In 2018, PMI VectorLink sprayed 112,264 structures, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five.
“I love my job. IRS is an area of work that is traditionally for men. Many men told me I couldn’t do it. At first I wasn’t sure I could – not because I’m a woman but because it’s a big job.”
Malenga served as an IRS Site Manager, overseeing 127 people, including Spray Operators, Team Leaders, Washers, Supervisors, Storekeepers, Security Guards, as well as a Monitoring and Evaluation Assistant, a Finance Assistant, and an Information, Education, and Communication Assistant. PMI VectorLink encourages women to apply for all positions on the project and ensures equal opportunity for women in supervisory roles. In PMI VectorLink Malawi’s first year of implementation, 40% of all seasonal staff were women.
Malenga said the project taught her how to work under pressure and gave her the confidence she needed to manage a large site. “PMI VectorLink was very transparent in the hiring process,” she said. “The security and safety precautions on the project were excellent. They ensured women had the right Personal Protective Equipment (PPE) and sufficient training to protect themselves.” The project provided sexual harassment guidelines to all its workers with posters and job aides in the local language Chichewa and regular SMS messages to workers’ phones to reinforce the training. The project also ensures women and men have separate changing areas to ensure privacy.
“One Spray Operator said he couldn’t work for a female Team Leader,” said Malenga. “I told him that if you have a problem with her, then you have a problem with me and that he wouldn’t be able to work on the project. He straightened up quickly.”
“When I walk by, some of the mothers in the community tell their children, ‘Look at her. She’s a woman in an important job. If you work hard, you can do something important, too.’”
– Agbethia Malenga, PMI VectorLink Malawi IRS Site Manager
Promoting the role of women in IRS – an area that has historically been male-dominated – is helping to improve the overall economic power of women.
Spray Operator Bertha Banda said that because the project hires women, it is helping to provide her extra security. “As a mother, the project has given me peace of mind. My son had malaria as a baby in 2015. He had fevers and diarrhea. I couldn’t work. I’m so happy to be a Spray Operator. I’m able to pay my son’s school fees, invest in my clothing business and buy seeds to plant maize. IRS gives us double protection.”
In the southeast African country of Malawi, malaria accounts for 40 percent of hospitalizations in children under five, 30 percent of all outpatient visits and is one of the major causes of morbidity and mortality across all age groups. Transmission is perennial in most areas and peaks during the rainy season from November to April. To help protect people from malaria during this year’s rainy season, the U.S. President’s Malaria Initiative (PMI) conducted an indoor residual spraying (IRS) campaign through the PMI VectorLink Project in October and early November 2018. IRS uses an insecticide that kills the mosquitoes that transmit the disease. PMI VectorLink successfully sprayed 112,264 structures during a 32-day campaign, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five. Recently, we talked to some of the beneficiaries and seasonal workers for the project. Here is their story. Photos by Laura McCarty/Abt Associates
Jessica Katunda, a widow who is living with HIV, was recently protected from malaria through the PMI VectorLink Malawi’s indoor residual spraying campaign. “As a person living with HIV, we suffer a lot. Our immune system is compromised, making it difficult to fight disease. I am thankful for IRS.”
When family members, particularly children, are sick, women are most often the primary caregivers in Malawi. IRS helps protect people from malaria, enabling women like Elizabeth Kwanjiwao to work and earn money through activities such as washing clothes.
Elizabeth Kwanjiwao shows off her IRS card which helps keep track of when her house is sprayed. The card also provides information on how to prepare for spraying. A mother of five, her four-year-old daughter has suffered the most. “She had malaria three times in October. I was very afraid. IRS is a success. Now my children can go to school.”
Ananne Nkhoma, a mother of 8 children, said, “Malaria just passes from one child to the next. When you have illnesses in the family, you don’t have time to do much else but take care of those who are sick. It really affects the family. I can’t earn money. Ever since my house was sprayed, no one in my family has had it. Once the mosquitoes come in the house, they die. I really appreciate the IRS. As we approach the rainy season, I feel ready and secure.”
These kids may be smiling, but they are raising their hands because they’ve all had malaria…this year…multiple times. Six million Malawians – one-third of the country’s population – suffer from malaria every year. The PMI VectorLink Project recently conducted an indoor residual spraying campaign to kill the mosquitoes that carry malaria. These kids are smiling because they said that they know that the people who come into their village “looking like soldiers” to spray their houses are saving their lives. Heroes come in many forms.
These teen girls are out of school because they couldn’t afford school uniforms, which cost approximately US$2. Their parents said that the children are often ill from malaria and would miss school frequently so it was hard to justify spending the family’s minimal earnings on uniforms if they couldn’t go to school. With their homes sprayed these girls are looking forward to going back to school.
Zione Mangani shown here with her husband Matthews Jaya and two of their eight children, said, “Malaria is a big issue here. My six month old had malaria the last week of October. In September my two-year-old had it. When the community health workers came to tell us about IRS, I was very excited. I remember when we last had our homes sprayed six years ago and how it killed the mosquitoes. Without IRS, we’ve really suffered from malaria. Every person in my family has fallen ill because of malaria this year. That’s 10 times of going to the hospital. My brother-in-law and my sister-in-law both died from malaria last year. My mother and my niece died from the disease as well. We are very grateful for IRS.”
The PMI VectorLink Project marks the houses to indicate that they were sprayed.
40 percent of PMI VectorLink Malawi’s seasonal staff were women. Promoting the role of women in IRS – an area that has historically been male-dominated – is helping to improve the overall economic power of women.
PMI VectorLink actively encourages the hiring of women. “It’s important to hire women and show that we can do just as good of a job as men,” said Spray Operator Jen Mwawembe. “I’m so happy to get paid. It’s made me feel secure to care for my family.”
PMI VectorLink provides opportunities for women to serve in supervisory roles.
IRS Site Manager Agbethia Malenga at 29 years old manages 128 people. “At first I wasn’t sure I could manage more than 100 people,” she said. “But my husband encouraged me. I love my job and it’s important to me that this project helps to protect people from malaria, particularly the most vulnerable – pregnant women and children under five. I’ve learned a lot in my job. My team comes from many different cultures and speaks six different languages. I learned how to manage different kinds of people. One spray operator said he couldn’t work for a female team leader. I told him that if you have a problem with her, then you have a problem with me. He straightened up quickly. Some of the mothers in the community will point at me and tell their children, ‘Look at her. She’s a woman and in this important job. If you work hard, you can do something important, too.’”
PMI VectorLink spray operators ensure households know how to prepare their homes for IRS and talk to the community about malaria prevention methods.
Four women fighting malaria: an IRS Site Manager, two spray operators and an IRS Supervisor. The women are using their income to pay for their children’s school fees, improve their homes from mud houses to ones built with cement blocks, buy seeds to plant maize for their family and invest in other income-generating activities.
Dr. Michael Kayanga, Vector Control Program Manager for the National Malaria Control Program, said that PMI brought IRS back to Nkhotakota District because it’s one of the highest malaria-burdened districts in the country. “Children under five are expected to contract malaria twice in one year but more than once a month is common for children in this area. When sick so often, children can easily slide into malnutrition.” PMI VectorLink recently protected 501,324 people from malaria, including 11,066 pregnant women and 90,953 children under five.
PMI VectorLink Builds In-Country Capacity on DHIS 2 Platform
Standardized, reliable health information data is critical to mapping and responding to disease outbreaks, improving disease surveillance, monitoring patient health, and planning targeted health interventions, such as indoor residual spraying (IRS) and distribution of insecticide-treated nets for malaria prevention.
District Health Information Software 2 (DHIS 2), a free and open source, cloud-based data management platform, has emerged as a globally-accepted standard for health management information systems in low- and middle-income countries and is being used by more than 60 countries and 23 organizations for management and reporting of data. The DHIS 2 software has robust data quality controls and dynamic visualizations to provide end-users with near real-time access to customized information products for decision-making. In 2018, the U.S. President’s Malaria Initiative (PMI) VectorLink Project, through its partner BAO Systems, designed a global, DHIS 2-based data management system to support routine IRS data needs across PMI VectorLink countries. From community mobilization activities to spray team performance, PMI VectorLink’s new system, VectorLink Collect, allows for near real-time program monitoring, quality assurance, and analysis through a variety of core DHIS 2 visualization functionalities. Built to mimic social media posts, allowing for comments and “likes”, the VectorLink Collect DHIS 2 dashboards enable the project to share tailored analytic objects targeted to end-users’ interests, track comment threads in support of real-time data dialogue, and display data in different ways to monitor the progress of an IRS campaign.
The project will have all its IRS countries using the same global DHIS 2 database for data entry and data visualization. In 2018, the project rolled out the use of the platform in Malawi, Zambia, Tanzania, and Kenya. In 2019, PMI VectorLink will bring seven additional countries onto the system and by 2020, all PMI VectorLink countries implementing IRS will be using the VectorLink Collect DHIS 2 system for IRS data. The VectorLink team is currently developing an entomological surveillance module for the DHIS 2 system, including insecticide resistance and susceptibility testing data, to provide a “one-stop data shop” for vector control decision-making.
PMI VectorLink is the first project to have a functional offline, desktop application that syncs with the DHIS 2 server. This means that the reach of the database can be expanded to remote areas with poor connectivity. PMI VectorLink provides training on maintaining and managing the database. To date, the project has trained 254 data entry clerks on basic data entry using DHIS 2 and the country and home office M&E teams are thoroughly trained on the system. The success of the new capacity is already being recognized, and the project plans to hold trainings with in-country government stakeholders to ensure government ownership of spray data for decision-making.
Because all of the PMI-focus countries have some version of a DHIS 2-based system working in their countries, the project is increasing country capacity to manage the core software and improve the monitoring and management of targeted health interventions. In doing so, PMI VectorLink is equipping countries to eventually adopt the system for their own government-led IRS campaigns, if desired.
“I like my job too much,” says Nahimana. “It really motivates me.”
As Operations Manager for the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Malawi, Nahimana said he inherited his work ethic from his mom.
Growing up in Rwanda’s Western Province on the border of DRC in Rusizi District, Nahimana’s home was 100 meters from the school where his uncle was headmaster.
“My mom told me I had to be number one in primary school. She expected it. When we were doing national exams, I was number one at my school. I like studying. It’s part of my passion.”
With a Master’s in Public Health from the National University of Rwanda, a Master’s in Project Management from Jommo Kenyatta University of Agriculture and Technology in Kenya, and a Bachelor in Education and Psychology from the Adventist University of Central Africa, Nahimana took his mom’s wishes to heart and then brought that dedication to his work.
During PMI VectorLink Malawi’s 32-day spray campaign in Nkhotakota District from October 2nd – November 7th 2018, Nahimana often started his work days at 4:30 a.m. and didn’t finish until late at night. The hard work paid off as the project sprayed 112,264 structures, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five in one of highest malaria-burden districts in the country.
Recently, Nahimana carved out time in the early morning before work to talk about his role with PMI VectorLink.
Can you tell us about your work in malaria prevention?
I started working with the PMI-funded IRS Project in Rwanda in 2010 as the M&E Specialist and in 2011 was hired as the M&E Manager. In 2014, I was promoted to Operations Manager and was in that role from 2014-2017. I also supported the PMI-funded IRS project in Mozambique for two months in 2015 in logistics and operations management. Before becoming Operations Manager in Malawi, I also supported the start-up for PMI VectorLink Burkina Faso.
What do you find most challenging about your job?
This job is a big position. It’s lot more than operations. It’s planning and logistics, decision-making and setting direction for the project. If you don’t plan well it will affect implementation. For instance, we have to plan according to how far the structures are away from each other. In Malawi, they are much more scattered than in Rwanda, so we had to adjust our start time with workers leaving very early – by 5:30 or 6 a.m. Fortunately, government stakeholders are always supportive.
What motivates you to work so hard?
I think it started with my education. It also comes with experience. People need to see a change and it pushes you to work hard. There are also expectations from the government. They want to see a change. Malaria is a big issue in this district. We needed to show the impact. In Rwanda, we saw an impact every year after we sprayed. Malaria was reduced drastically. Protecting the community is a motivation on its own.
You also served as the Gender Focal Point for the PMI-funded IRS project in Rwanda. How did you draw on that experience in Malawi?
As the Gender Focal Point in Rwanda, I ensured that the project was gender inclusive, and thus had to fight against norms and attitudes that IRS is a job only for men. We were sure to give equal chance to both men and women. In Rwanda, there’s a big representation of women as Community Health Workers so we had some advantage. When I came to Malawi, we set ground rules to ensure women were given equal opportunity. We strongly encouraged women to apply and gave equal chances to both women and men. As a result, 40 percent of the 2018 seasonal workers were women. NMCP, Nkhotakota District Health Office, and Nkhotakota District Council were part of the recruitment so they played a big role.
How do you encourage and motivate women in their roles when they face gender bias?
First of all, we need to ensure sexual harassment guidelines are posted at each operation site. We trained all seasonal workers on gender issues. Also, during spray operations and morning assemblies gender was part of the messages that were being communicated to seasonal workers through job aid messages.
What is your hope for the project?
Malaria is the leading cause of morbidity and mortality in Nkhotakota district. From my experience in Rwanda, I expect us to see a big reduction of malaria after spraying communities. We should continue spraying Nkhotakota district to keep the burden low. We also need to cover more than one district since malaria is a big threat in Malawi. My dream is to make sure I succeed in what I’m doing and make sure seasonal workers enjoy their jobs and that we see a change in the community.
What do you wish people knew about the project?
People should really know about the impact and the importance of spraying communities. This is an intervention that is generously funded by the U.S. government at no cost to the community. We are using very effective insecticides and we are there to protect them. We want their cooperation.
Do you think Nkhotakota District will ever be malaria-free?
It’s possible. If we spray, and do that effectively, it’s possible.
PMI Brings IRS Back to Malawi, Protecting Country’s Most Vulnerable
In the Southeast African country of Malawi, you would be hard put to meet someone who hasn’t contracted malaria in recent years. In 2017, more than 3,650 Malawians died from the vector-borne disease. Malawi’s Nkhotakota District, situated along the banks of Lake Malawi – one of the African Great Lakes – has one of the highest rates of malaria in the country. According to Dr. Sosten Lankhulani, the Ministry of Health’s Nkhotakota District Health Officer, 45-50% of hospital admissions are due to malaria.
Recently, the U.S. President’s Malaria Initiative (PMI) conducted an indoor residual spraying (IRS) campaign through the PMI VectorLink Project to reduce the burden of malaria. IRS uses an insecticide that kills the mosquitoes that transmit the disease. PMI VectorLink successfully sprayed 112,264 structures during a 32-day campaign, protecting 501,324 people including 11,066 pregnant women and 90,953 children under five.
“Lots of resources are spent on malaria,” said Dr. Lankhulani. “In the past two to three years, we’ve even run out of malaria drugs. IRS helps to reduce malaria. With fewer malaria cases, we will have the treatment supplies and resources to address other diseases, such as TB and acute respiratory diseases.”
Zione Mangani, a mother of eight, is one of many in the district deeply affected by the deadly disease. “My six-month old had malaria the last week of October,” said Mangani. “In September my two-year old had it. My brother-in-law and sister-in-law both died from malaria last year. My mother and my niece died from the disease as well. Every person in my (immediate) family has fallen ill because of malaria this year. That’s 10 times of going to the hospital.”
Shadreck Mulenga, Deputy Program Manager for Malawi’s National Malaria Control Program, said that the last time PMI conducted IRS in this district, there was a 43% reduction in malaria cases. “We expect to see similar results if not better because of the project’s high quality implementation,” he said. “I hope to see malaria reduced by more than 50% of the current status in the next two years.”
The costs associated with malaria go beyond medicine, hospitalization and transportation to the hospital. A reduction in malaria will translate into healthier, more productive lives for Malawians.
Anne Nkhoma, also a mother of eight, said, “Malaria just passes from one child to the next. It’s continuous. When you have illnesses in the family, you don’t have time to do much else but take care of those who are sick. I can’t earn money. Since my house was sprayed (in October 2018), no one in my family has had it. Once the mosquitoes come in the house, they die. I really appreciate IRS. As we approach rainy season, I feel ready and secure.”