Malaria is considered the most important public health problem in Mozambique where it accounts for nearly one-third of all deaths and 42 percent of deaths in children less than five years old. Although malaria prevalence has decreased in all provinces, the country continues to face challenges that have slowed the progress of key malaria prevention and treatment interventions. PMI-supported activities include support for the national Indoor Residual Spraying (IRS) program; free routine Insecticide-treated Bed Net (ITN) distributions to pregnant women and to children; procurement and distribution of rapid diagnostic tests to all levels of the health system; provision of intermittent preventive treatment of pregnant women; and revitalization of the community health worker program.
IRS continues to be a critical component of Mozambique’s National Malaria Control Strategy launched in December 2017 for 2017–through 2022. Through the support of PMI, Mozambique has implemented 14 rounds of IRS since 2007; these include six rounds under the AIRS Project (2011–2017) and three rounds under the PMI VectorLink project (2018–2019).
In 2019, Mozambique did IRS in five provinces: in Maputo, Gaza, and Inhambane provinces, implemented by Tchau Tchau Malaria and funded through a public-private partnership, MOSASWA; in Nampula province, implemented by the NMCP and funded by the Government of Mozambique; and in Zambezia province, implemented by VectorLink Mozambique and funded by PMI/ USAID. The Global Fund provided support to the Ministry of Health (MOH) to procure insecticide for all five provinces. PMI VectorLink Mozambique conducted IRS in five districts in Zambezia province, using both SumiShield® 50WG and Fludora® Fusion, from October 28 to December 14, 2019. The original target was 331,360 structures; in the end, 338,330 structures were sprayed out of 350,172 structures found by spray operators (SOPs), accounting for an IRS coverage rate of 96.6%.
In 2020, Mozambique implemented IRS activities in five provinces: in Maputo, Gaza, and Inhambane provinces, implemented by Tchau Tchau Malaria and funded through a public-private partnership, Mozambique, South African and Swaziland Initiative; in Nampula province, implemented by the NMCP and funded by the Government of Mozambique; and in Zambezia province, implemented by VectorLink Mozambique and funded by PMI/ USAID. The Global Fund provided support to the Ministry of Health (MOH) to procure insecticide for all five provinces. PMI VectorLink Mozambique conducted IRS in five districts in Zambezia province, using both SumiShield® 50WG and Fludora® Fusion, from October 28 to December November 30, 2020. The target was 350,172 structures; in the end, 361,820 structures were sprayed out of 373,094 structures found by spray operators (SOPs), for an IRS coverage rate of 97%.
In year 4 (March 2021 – February 2022), VectorLink worked with the NMCP, Zambezia Provincial Directorate of Health (PDH), Provincial Health Services (SPS), District Services for Health, Women and Social Welfare (SDSMAS), Ministry of Agriculture and Rural Development (MADER), and Ministry of Land and Environment (MITA) to spray 309,547 targeted structures in four districts using pirimiphos-methyl CS in three districts and bendiocarb 80WP-SB in one district. The project’s primary objective is to reach a project contractual minimum coverage of 85% of the structures found in each district and at least 90% of structures per the NMCP target, which was communicated by the NMCP Director on July 12, 2021, during the 2021 national Training of Trainers (TOT)by implementing high-quality IRS operations. In 2021, VectorLink achieved an overall spray coverage of 96.8% and protected 1,408,179 people including 189,408 children under 5 years of age, and 79,410 pregnant women.
To support successful spray campaign, VectorLink Mozambique conducted the following activities:
- Safely undertook all pre-spray, during and post spray campaign including entomological monitoring activities while adhering to COVID-19 mitigation measures.
- Carried out a logistics assessment in all districts and manage all international (other than insecticide) and local procurement, shipping, customs clearance, timely delivery, and storage of sprayer, spare parts, insecticide, and personal protective equipment (PPE).
- Ensured safe and correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides.
- Led community mobilization, education, and communication (IEC) and social behavior change communication (SBCC) sensitization and mobilization activities to increase community awareness and acceptance of IRS.
- Conducted routine entomological monitoring in all spray sites.
In addition to spray preparation and actual campaign, VectorLink Mozambique successfully completed:
- Provided technical assistance to Nampula Province to conduct quality of insecticide application and insecticide decay rates in support of the NMCP IRS campaign.
- Supported entomology activities in Nampula Province, in three districts: Nampula City and Erati were targeted for IRS; Mogovolas was a non-IRS (control) district. Nampula PDH technicians performed the activities under the supervision and guidance of the VectorLink Nampula entomology coordinator. Activities conducted measured entomological indicators, namely, malaria vector species composition, density, biting time and place, blood meal source and human blood index, infection, entomological inoculation rate, and seasonality. The vector sampling methods included pit shelter, Prokopack, and Centers for Diseases Control (CDC) light trap collections. Cone bioassays were also conducted to evaluate quality of spraying and monitor the decay rate of the insecticide after spraying in the two IRS districts.
- Participate in National TOT in Inhambane Province, NMCP led activity; VectorLink Mozambique, specifically its operations manager, supported the NMCP in facilitating sessions on logistics planning and distribution, design, and construction of soak pits, construction of temporary training walls, and data collection
- Mentored for new Zambezia PDH malaria focal person; The mentorship continued begun in 2019 and continues. He has worked closely with the VectorLink operations manager who have mentored him on the planning and implementation of project activities. With the PMI’ intent to enter a G2G agreement with Zambezia, the malaria focal point and his program assistants had weekly meetings for the planning and implementation of all project activities.
- Capacity strengthening of the PDH and /SPS through weekly meetings to discuss all stages of IRS preparations and/implementation based on the operation plan to equip them with capacity for the government-to-government (G2G) implementation in future.
- Mentored the Zambezia PDH malaria focal person; The mentorship continued begun in 2019 and continues. He worked closely with the VectorLink operations manager who have mentored him on the planning and implementation of project activities. With the PMI’s intent to enter into a G2G agreement with Zambezia, the malaria focal point and his program assistants had weekly meetings for the planning and implementation of all project activities.
- Provided financial support for the NMCP’s entomology monitoring field activities in Niassa, Cabo Delgado, Tete, Sofala, and Manica provinces.
- Provided financial support for the senior entomologist seconded to NMCP, three laboratory technicians seconded to INS, and the entomology coordinator seconded to Nampula Province.
- Procured supplies and materials for Nampula insectary and laboratory analysis at INS.