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

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

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

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

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

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

Zambia

Mohamed Bayoh has served as Entomology Technical Manager for the U.S. President’s Malaria Initiative (PMI) VectorLink Project in Zambia since 2018. Originally from Sierra Leone, Mohamed holds a PhD in Medical Entomology from Durham University, England, UK, and a Master of Applied Science in Experimental Parasitology from University of Glasgow, Scotland, UK. As a child, Mohamed frequently contracted malaria, so often he said that missing school seemed normal. Recently, Mohamed shared his experience as an entomologist across Africa and how he is working to build local capacity in Zambia.

 Can you tell us a little about your role as an Entomology Technician Manager and your work experience?

I am responsible for PMI VectorLink Zambia’s entomological monitoring to determine the impact of the project’s indoor residual spraying (IRS) and insecticide-treated nets (ITN) campaigns in Zambia. I also provide technical assistance to the Zambia National Malaria Elimination Program (NMEP) on vector control and entomological monitoring. Recent activities include drafting standard operating procedures for entomological monitoring for use by the NMEP. Two important achievements include the training of district-based government health officers in entomological monitoring and the establishment of a PMI-funded laboratory space at the NMEP premises for advanced analysis of mosquito samples.

Before I started with VectorLink, I was a Public Health Specialist and Senior Technical Advisor with the US Embassy/Kenya Centers for Disease Control and Prevention (CDC), based in Kisumu, Kenya, after serving as the Head of Entomology at the Kenya Medical Research Institute/CDC Public Health Collaboration Program in Kisumu. During both periods I worked very closely with the Kenya National Malaria Control Program for 12 years as a resource person in malaria programmatic activities and operational research, the development of malaria vector control strategies, operational guidelines, and program monitoring and evaluation. I contributed to several evidence- based programmatic decision-making processes, for example, the shift from pyrethroid insecticides to non-pyrethroids for IRS, developing technical specification and guidelines for selection of ITNs for national campaigns and other distribution mechanisms.

What changes have you seen in your work and vector control since the VectorLink Zambia project began?

I’ve seen a change in the increased motivation of the Zambia national program in the use of data for decision making as more reliable and robust data has become available. Each decision must be linked to data evidence such that the program is currently developing a national entomological database to guarantee quality data availability and access.

 How has the project strengthened entomology at the local or community level?

PMI VectorLink engages community members in mosquito collection activities. Community members are trained to do the collections themselves. This has helped a lot with the community’s understanding and acceptance of vector control interventions and the link between IRS and ITN activities and a reduction in mosquito bites.

How does the project invest in local partners to lead malaria programs?

The project provides training for malaria control officers in different parts of Zambia on entomological monitoring so that there is human capacity to implement such activities in the districts. The project supports a fully-fledged insectary where a susceptible mosquito strain is reared and a molecular laboratory for mosquito analysis. The PMI-supported insectary and molecular laboratory are available for use by local partners, including university students to learn or do research.

Also, entomological monitoring sentinel sites have been established in many districts, making it easier for the national program to continue such activities in these districts. PMI VectorLink has provided hands-on training and provided equipment, such as vector collection traps and entomological supplies, to the NMEP in areas where PMI isn’t funding activities. Ideally, every district should be able to conduct surveillance. One way we can further assist is to ensure that the training we’ve provided is used in other districts that we don’t work in by providing basic equipment and materials to those districts.

How does the project ensure malaria services, including entomological activities, are resilient against pandemics and other shocks? The project adopted standard World Health Organization and PMI- approved protocols, quickly applying what has been learned from other countries and from what has been tried and tested in data handling and reporting. The project’s commitment to innovation and ways of ensuring the work continues with safety of staff and the public paramount. In 2020, VectorLink Zambia replaced mouth aspirators with battery-operated aspirators as a Covid-19 mitigation measure. (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. To continue measuring efficacy while maintaining safety precautions, PMI VectorLink used handheld, battery-operated aspirators to conduct the cone assays, which would allow staff to keep their protective face coverings on while conducting the tests.)

How does the project share entomological data with local partners? The Zambian Ministry of Health actively participates in the selection of PMI VectorLink-supported sentinel sites, the training of mosquito collectors and the supervision of data collectors during entomological monitoring. The data collected by PMI VectorLink is being used to make vector control programming decisions. This is done through regular vector control technical working group meetings and written reports shared with the NMEP. The most important consumer of this data is the NMEP. Recommendations on the insecticides available for IRS and the type of ITNs and where they can be deployed is based on insecticide resistance data, the environment, and type of mosquito species. The data collected is synthesized into a visualization model which helps the NMEP determine which insecticide to use and where to use them. (PMI VectorLink collaborated with the key partners to compile the entomological data and produce a series of integrated visualizations, incorporating over 600 data points on vector composition and insecticide resistance from 2000-2019. This was the first time that these datasets had been combined and viewed at the same time, and together they painted a comprehensive picture of insecticide resistance and species predominance across the country.)

How does the project ensure that we are reaching the unreached with our entomological activities? In the districts in which we work, we monitor entomological parameters in IRS sites as well as sites where IRS is not being implemented. These sites are usually far to reach areas or communities with scattered households over a large terrain.

What is your hope for the project’s future?  

My hope is that our hard work can continue and that the changes we have recommended based on current data from the various countries are implemented.

 

 

 

 

 

Across the globe, scientists, health professionals, and governments struggle to secure adequate funding to study and fight infectious diseases. While COVID-19 remains one of our greatest disease threats, the World Health Organization (WHO) has called on the global health community to maintain malaria prevention services to protect the most vulnerable from this vector-borne disease. According to the WHO World Malaria Report 2021, malaria killed more than 627,000 people in 2020 (up from 558,000 in 2019) and sickened more than 241 million people. Most of those deaths and illnesses were among pregnant women and children under the age of five in sub-Saharan Africa, where malaria is endemic, and resources and health systems can be severely strained. An estimated 49,000 of those deaths were attributed to a disruption of malaria services during the COVID-19 pandemic.

Fortunately, the increase was far lower than WHO’s prediction that deaths would double if malaria services were discontinued during the pandemic. The success goes to country governments and their communities who have raised awareness about malaria and built capacity to carry out services at local levels. The U.S. President’s Malaria Initiative (PMI) partners with countries to prevent, detect, and respond to malaria and to support vector control. PMI funding provides equipment, knowledge, implementation, and training in entomological monitoring and vector control interventions, such as indoor residual spraying and insecticide-treated nets.

Malaria control requires a deep understanding and knowledge of the mosquitoes carrying the parasite that causes the disease. PMI supports governments and local research institutes and universities to study mosquito behavior and determine key entomological indices including vector density, Plasmodium sporozoite infection rates, and vector lifespan, with a comprehensive plan for insecticide resistance monitoring, so that vector control stakeholders can make evidence-based decisions on how to fight disease.

Trained entomologists are critical to ensuring the necessary monitoring is conducted and applied to crucial decision making in the deployment of mosquito control interventions. In many countries, PMI has helped to establish modern entomological laboratories to identify malaria-carrying mosquitoes and monitor the efficacy of vector control interventions. Local laboratories offer opportunities to further train students in advanced entomological techniques and reduce the costs and time in analyzing collected samples for vector species identification, insecticide resistance mechanism and determination of sporozoite infection, allowing for near real-time data for quick decision making.

For example, in Niger, PMI rehabilitated, equipped, and made functional the Center for Medical and Health Research (CERMES) insectary, a public institution that is part of the Institut Pasteur International Network and functions within the Ministry of Health. For the first time, CERMES is now able to rear the susceptible Anopheles gambiae Kisumu strain locally. PMI also trained 18 CERMES technicians in entomological field techniques and laboratory analysis, such as testing mosquito samples for the malaria parasite.

With that training, CERMES technicians have conducted WHO cone and tunnel tests on durability of insecticide-treated nets. This entomological monitoring data was used by Niger’s National Malaria Control Program to prioritize the distribution of next generation nets for the 2022 campaign.

Similarly, in Burkina Faso, PMI partners with the Research Institute of Health Sciences (IRSS) to conduct entomological monitoring. This partnership has been particularly important this year as increased insecurity in country combined with heavy rains have limited travel to the entomological sites. The government, along with donors like PMI and partners like IRSS, needed data on next generation nets for crucial decision making and to enhance acceptance and use of the nets. To access these hard-to-reach sites and continue with critical net durability monitoring, IRSS worked with local communities, including, local health units, law enforcement officials, and local village chiefs to secure the field investigators to collect net samples and survey households about net use.

IRSS also continued with mosquito collection in two inaccessible areas with the collaboration of community-based mosquito collectors, who received advanced training and support from the PMI-funded IRSS team. The training enabled the collectors to carry out human landing catch and pyrethrum spray catch to measure biting rates, indoor resting density, and malaria transmission.

Local partnerships at the national, district and local levels are critical to fighting malaria. Community health workers, local entomology technicians, and vector control decision makers are among key players in the global strategy to combat malaria.

The detection of the Asian malaria vector Anopheles stephensi in the Horn of Africa (HOA) more than 10 years ago has caused growing concern among malaria stakeholders about the invasive vector’s potential to spread malaria and the effect the vector could have on sustaining gains in malaria control in the region. In 2019, the World Health Organization identified An. stephensi as a “major potential threat” in the progress to control malaria and called for enhance surveillance in Africa. 

A new study published in Parasites & Vectors, provides insight on the vector’s movement patterns and feeding preferences in Ethiopia. The authors’ findings, which analyzed the genetic variations in An. stephensi populations in Ethiopia, offer vector control decision makers crucial information on how far the vector has spread, where it is migrating, and what the vector prefers to feed on in the region. 

In the new study, Genetic diversity of Anopheles stephensi in Ethiopia provides insight into patterns of spread, the authors note, “Since the identification of An. stephensi in Ethiopia, this vector has been detected in 10 additional sites in eastern Ethiopia as far north as Semera and as far south as Godey [13]. Pastoralism is a common livelihood in Ethiopia and involves moving cattle, goats, sheep, and camels hundreds of kilometers every season [19]. Movement may be driven by several factors including limited natural resources, conflicts, recurrent severe droughts, and extreme weather [20, 21].

Resource depletion in recent years has led to movement of livestock over longer distances in search of grazing areas and water [22, 23].”

The authors conclude that “future studies with expanded genomic analysis will further inform our understanding of migration rates and the role of local adaption on the spread of An. stephensi into and throughout the HOA. Collaboration across countries where this mosquito is well established and countries where it is emerging can facilitate a complete understanding of the spread of An. stephensi into Africa.”

The authors’ evidence shows both zoophagic (feeding on common livestock species such as cattle) and anthropophagic (feeding on humans) behaviors of the vector, supporting the need for additional studies into the potential for livestock movement to play a role in the vector’s spread in this region.

As early as 2018, the U.S. President’s Malaria Initiative (PMI) VectorLink Project began collecting mosquito samples of the species in Ethiopia during routine entomological monitoring to study more about the mosquito’s patterns and behavior. PMI provided the mosquito samples for the new study, which was conducted by Baylor University in partnership with Ethiopia’s Jigjiga University and Dire Dawa University. 

PMI has also studied the potential impact of the vector’s establishment on the transmission of Plasmodium falciparum in Ethiopia, estimating that annual P. falciparum malaria cases could increase by 50% (95% CI 14-90) if no additional interventions are implemented. Read more here. To learn more about PMI’s findings on An. stephensi’s distribution, bionomics, insecticide susceptibility, and transmission potential, read here. 

 

 

 

Senegal

In 2012, Sokhna Tall joined the U.S. President Malaria Initiative (PMI) Africa Indoor Residual Spraying Project in Senegal. While working as an Assistant Accountant, she became interested in indoor residual spraying (IRS) technical work and began participating in various project training courses for IRS operations, including training of trainers, spray operators, team leaders, pump technicians, washers, and guards. In 2014, she was promoted to District Coordinator and has continued in that role with the PMI VectorLink Project. As a District Coordinator, Sokhna ensures the coordination of all IRS activities in Koungheul District, including logistics management, advocacy with the authorities, training of seasonal workers, monitoring of environment compliance and supervision of IRS operations. When not planning or carrying out IRS, she oversees supply logistics and distribution of insecticide-treated nets (ITNs) with the project. Recently, Sokhna took time to talk about her role in fighting malaria.

Do you have any personal experience with malaria?

Growing up in Dakar, Senegal, I had multiple experiences with malaria. The experience that really affected me was in August 2009 during the peak of malaria transmission in Senegal. My son, who was just one and a half years old at the time, fell sick with malaria. When I took him to the hospital, I was shocked by the high number of children suffering from malaria, some of them under IV treatment for severe malaria. The number of beds available was not sufficient for all the children. Some mothers were just seated on the floor with their children. This experience contributed to my decision to apply and work for a malaria prevention project as I was convinced that malaria was a real burden for mothers like me. Today, more than 10 years later, situations like this are no longer observed in Dakar and in many regions in Senegal as the incidence of malaria has decreased significantly due to the extensive use of ITNs and IRS in some districts.

Can you talk about how the project has worked to provide malaria services during the COVID-19 pandemic?

At the beginning of the pandemic, the project developed a contingency plan for IRS in the COVID context. This contingency plan follows Ministry of Health and PMI guidelines, which includes ensuring barrier and prevention methods for spread of the disease in all IRS activities. The project also includes COVID prevention measures in IRS workshops and trainings to ensure all participants are compliant with the guidelines. The project successfully carried out the IRS campaigns in 2020 and 2021, protecting approximately 571,600 people each year from malaria.

What impact has your job had on malaria in Senegal?

I can proudly say that the PMI VectorLink Project is contributing to the decreased density of malaria vectors in all sprayed areas of the district. Malaria incidence has reduced from 8.1 to 7.7 per 1000 from 2019 to 2020 in the Kaffrine Region, which includes Koungheul District where I supervise IRS. We have received lots of gratitude from communities who have let us know that they are sleeping quietly with no mosquito noise around. Medical professionals from the district have also reported a decrease of malaria cases in children specifically.

What changes have you seen in IRS implementation since the project began?

Many changes have been introduced since the beginning of the project but the most ones are related to the introduction and use of new information technologies, such as the use of smartphones for data collection and the introduction of mobile payments for seasonal workers. Previously, we used a paper-based data collection system, which was a source of constant headache, long working hours, and multiple discussions within the district team. Under the PMI VectorLink Project, data collection in Senegal is done through a smartphone and is a real relief for my work as a District Coordinator.

How does the project invest in local partners to lead malaria programs?
The project builds the skills of national partners like the National Malaria Control Program (NMCP), regional medical teams, district health teams, National Service of Hygiene, and environment officers to carry out IRS. For example, in 2021, the project conducted a Master Training workshop which trained national partners in the process of IRS planning, implementation, monitoring and all aspects of a campaign at the national and local levels. In addition, every year the project trains local leaders in IRS, from training of trainers to insecticide management, procurement, and so on. Local partners are the key to the success of the activities, and the partners are involved in all IRS implementation steps. All activities are conducted in collaboration with the local partners to ensure malaria prevention services can be sustained.

Community health workers are an important link because all activities are carried out at the community level. They know the field better, and are often the messengers, supervisors, and sometimes operators in IRS activities. Community health workers are strongly encouraged to apply to all positions of IRS activities. Once they are recruited, the project trains them and hires those who meet the criteria to be involved in IRS.

How does VL tailor its approach to ensure it fits Senegal’s needs?
PMI VectorLink adapts to the realities of the country, taking into consideration the concerns of the country’s health systems. The project’s work is aligned to the National Malaria Strategic Plan developed by NMCP. All activities (planning, operational activities, etc.) are discussed and done in concert with national and local partners.

The NMCP and the Vector Control Steering Committee choose which districts receive IRS services. These districts are in rural areas where access to care is not always easy. The project provides protection for everyone in these districts, particularly those most vulnerable to the malaria.

 

 

Mozambique

Duartina Francisco serves as Country Operations Director and Gender Focal Person for the U.S. President’s Malaria Initiative (PMI) VectorLink (VL) Project in Mozambique. She began working in vector control with the PMI Africa Indoor Residual Spraying (IRS) Project in 2012. Duartina holds an MBA in Management of Integrated Systems, Quality Environment and Safety from Mozambique’s Higher Institute of Science and Technology and a Bachelor in Environment Management, Planning and Community Development. She’s a trained nurse in maternal and infant health and previously worked as a field officer and trainer on a project that focused on orphans and people living with HIV. Recently, Duartina took time out of her busy day to talk about her work.

What do you find most challenging about your job?

Convincing and mobilizing targeted populations to accept having their houses sprayed is the most challenging aspect (IRS involves spraying the inside walls and ceilings with an insecticide that kills the malaria parasite-carrying mosquitoes). There are lots of myths about IRS that make it challenging for people to accept IRS. The most recent widespread myth was that IRS spray operators were vampires and that mobilizers were marking houses to easily identify which households would have their blood sucked. This caused many households to remove all mobilization stickers and to wipe off any markings that mobilizers left on their houses as part of the house-to-house mobilization. IRS requires the entire community’s acceptance and efforts (The World Health Organization recommends higher than 85 percent coverage for IRS to be successful).

In Mozambique, community leaders are also political leaders and play a critical role in IRS. They are responsible for encouraging their community to stay at home and not to leave to farm on spray days so that they can have their houses sprayed. By involving local leaders before the IRS campaign began, we were able to dispel this myth.

Another challenge has been the impact of natural disasters, such as heavy rains and cyclones. While malaria incidence has decreased thanks to the project’s vector control interventions, the flooding and rains provide additional breeding grounds for mosquitoes, which results in higher abundance of mosquitoes and increased risk of malaria transmission.

What changes have you seen in IRS implementation since the PMI VectorLink Project began?

There has been an increase in the engagement of political leaders at all levels in malaria matters, especially for IRS. We have many political parties in country. In the past, it was difficult for a member of the opposition party to accept IRS because they saw it as political issue and not a health issue. This resulted in many refusals for spray in communities that were known to be affiliated with the opposition party. The project began having separate, focused meetings at both the provincial and local levels within the community structure to ensure that all political party leaders are involved in IRS. There used to be one central level meeting where leaders of the opposition political parties were not invited or represented. Once the meeting moved to different levels, it improved participation from all leaders.

How does the project reach the most vulnerable, particularly those not previously protected with vector control? Our target populations include those living in very remote places where it is difficult for them to reach basic health care services in time if they contract malaria and where there is little access to buy products to protect their houses against mosquitoes. We prioritize these areas for IRS first to ensure we reach them before it rains, when it becomes more difficult to travel. With the introduction of the IRS mobile soak pit, our work in remote areas is easier.

In IRS, spray operators rinse liquid waste from spray tanks and protective gear into soak pits that adsorb and safely degrade the traces of insecticide found in the wash-water. In most spray areas, soak pits are permanent installations in a central location that can be accessed at the end of the spray day. However, in some hard-to-reach areas, it is difficult and sometimes impossible for spray teams to return to a soak pit for clean-up purposes. The mobile soak pit, developed under the PMI Africa Indoor Residual Spraying Project, can be carried to a spray location, installed at a wash site in minutes, and used to catch and treat insecticide waste. When spray operations in the area are complete, the soak pit is dug-up and carried away for use at the next location, while the site is restored to its original condition.) We shared this innovation with other provinces, and they are using it, too, which helps us to ensure we don’t leave anyone behind.

Since the project began there has been a decrease in mortality from malaria. The reduction in malaria prevalence in Zambezia Province (where the project implements IRS) went from 68% to 44% between 2015 and 2018 in children under 5 years[1]. At the Zambezia’s 2021 malaria provincial evaluation meeting, the Provincial Health Directorate reported a 9.1% reduction in malaria-related deaths in its eight-month Zambezia malaria progress report in the districts that receive IRS and insecticide-treated nets. 

How does the project invest in local partners to lead malaria programs?

The project engages local partners to lead programs by sharing best practices in managing IRS activities. For instance, PMI VectorLink was the first project in the country to use checklists to supervise IRS activities. This best practice was adopted by the National Malaria Control Program (NMCP) and recommended to all partners to monitor IRS. The project also introduced the best practice of using the mobile soak pit in hard-to-reach areas, which is now being used by the government in three provinces.

Heads of health posts, malaria focal point persons, environmental health officers, among others from the Ministry of Health, have received training from the project. These staff have gone on to train government spray operators who are now capable of supervising spray campaigns. Our project checklists also have been adopted by the Ministry of Health and other partners to manage the entire malaria program, including monitoring malaria indicators at the country level. The VL environmental compliance checklist was adopted and used as foundation for the NMCP, not only for IRS but all malaria strategies implemented in the country. The government’s training of trainers’ curricula was also adjusted based on the project’s curricula. This impact has been very notable as the project is a model for IRS implementation in three regions of the country.

The project also provides entomology support to six provinces, including Zambezia where the project implements IRS. The reported entomological data helps the National Malaria Control Program to make informed vector control decisions for areas where the malaria incidence is increasing.

What progress have you seen in gender equity as Gender Focal Person?

In 2015, when the AIRS Project began to actively promote gender equity and female empowerment at all levels of IRS operations, it seemed like an impossible task to achieve. We started with 7% female participation in IRS. Now we are at 33%. Apart from numbers, I have seen many women apply for different positions (that have traditionally been held by men), such as drivers, spray technicians, site supervisors, and team leaders. At the beginning of the project, women were predominantly working as washers with some working as spray operators. So there has been very good progress, and I am very happy to be part of that.

Can you talk about how the project supports systems to be resilient against the COVID-19 pandemic and other shocks?

Running the vector control activities during the ongoing COVID-19 pandemic has been a challenge. The PMI VectorLink Project works across 26 countries to protect people from malaria. With such a big project, there is diversity of ideas, contexts, and challenges. We learned lessons from other countries that sprayed under the pandemic before Mozambique. As a result, we adjusted our operating procedures, and with Mozambique’s Ministry of Health (MOH) guidance, we developed an action plan to ensure to minimize the spread of COVID-19 among the team. Continuous sharing of information and experiences will contribute to the project being resilient against pandemics and other shocks in the future.

Do you think Mozambique will ever be malaria-free?

Yes, by continuing to implement integrated vector control and management strategies, it can be. There are many interventions taking place at the national level, such as housing improvement, environment sanitization, and massive distribution of bed nets. The integrated vector control management model has shown progress towards elimination in the southern part of the country, which was declared to be in the malaria elimination phase by Southern Africa Development Community in 2020. My hope is that the NMCP continues making efforts in the adaptation/adoption of the tools and best practices used under VL to fight malaria and to expand IRS to other provinces, since the whole country is endemic for malaria.