Malaria is the leading cause of morbidity and mortality in Uganda. Accounting for 30 – 50 percent of outpatient visits and 15 – 20 percent of hospital admissions, malaria places a huge burden on the Ugandan health system. Recent PMI-supported activities include IRS in high burden eastern and east-central districts with persistently high malaria prevalence rates; ITN distribution via ANC/EPI clinics and school outlets as well as social marketing of nets at a subsidized price; training and supervision of health workers in integrated management of malaria including malaria in pregnancy; a collection of surveillance data; management and monitoring of insecticide resistance; and behavior change communication activities that reach millions of Ugandans with key malaria messages.
In 2019, the PMI VectorLink Uganda project, conducted IRS in 15 districts, targeting 1,369,305 structures using Actellic® 300CS in 13 districts and SumiShield® 50WG in two districts from March 18-June 26, 2019. A total of 1,291,569 structures were sprayed out of 1,393,562 structures found by spray operators in the targeted districts, resulting in a spray coverage rate of 92.7 percent.
In its third year of implementation, the project will conduct IRS in eight Phase I districts (Budaka, Bugiri, Butaleja, Butebo, Kibuku, Namutumba, Pallisa, and Tororo) from March 2, 2020–April 4, 2020, and eight Phase II districts (Alebtong, Amolatar, Dokolo, Kaberamaido, Kalaki, Lira, Otuke, and Serere) from April 20–May 23, 2020. Six districts (Alebtong, Amolatar, Dokolo, Kaberamaido, Kalaki, and Otuke) out of the 16 target districts are funded by DFID while the other 10 are funded by PMI. The project will continue to conduct entomological monitoring and will provide capacity-building support to the national and district governments to plan and implement quality IRS in the future.
In 2020, the PMI VectorLink Uganda project will work with the Ministry of Health (MoH)/National Malaria Control Division (NMCD) and district, sub-county stakeholders to target 1,393,562 eligible structures in 16 districts (10 PMI districts and six DFID) using Fludora Fusion and the balance of Actellic 300CS and SumiShield 50WG from the 2019 spray campaign. Actellic 300CS (71,794 bottles) will be used in 14 of 16 districts, while SumiShield (28,161 sachets) will be used in Dokolo and Lira districts. Fludora Fusion will be used once the balance of old insecticide stock is exhausted in the first week of IRS. The project’s primary objective is to reach a minimum coverage of 85 percent of the structures found in each district by implementing high-quality IRS operations.
In addition to IRS, the project will carry out the following activities:
- Build capacity at the national, regional, district, and local levels to manage IRS operations, including planning, spraying, resource allocation, and monitoring and evaluation (M&E).
- Collaborate with districts on prioritizing implementation of activities in their IRS exit/sustainability plans. The PMI VectorLink project so far has held discussions with USAID/ Regional Health Integration to Enhance Services (RHITES) North-Lango, RHITES East, RHITES East Central, and Sustaining Uganda’s Response to Malaria (SURMa) projects which are the major implementing partners (IPs) of sustainability activities. It has been noted that there is a need for PMI VectorLink to provide leadership to the other IPs in the project target districts to coordinate streamlining of key activities for the sustainability of gains from IRS and other malaria interventions. This will require having activities beyond the IRS campaign period, such as technical support to social and behavior change (SBC) and long-lasting insecticidal net (LLIN) distribution as well as bi-monthly review meetings with stakeholders.
- Prepare an exit strategy in collaboration with key stakeholders and other IPs working on malaria prevention and control given DFID’s plan to withdraw funding for IRS beginning in 2021.
- Conduct training with a focus on IRS supervision and spray techniques to improve the overall quality of spraying.
- Conduct regular M&E of project activities to ensure alignment with set targets and objectives.
- Mainstream gender equality and female empowerment by ensuring women’s participation in all project activities.
- Involve youth in spray activities in the target districts. The project will recruit youth as parish mobilizers and also sensitize youth groups in churches and encourage them to sensitize the community in turn about IRS. The project will also recruit youth over 18 years of age as spray team members, and encourage them to sensitize the community in their villages in partnership with the local council ones (LCIs; village leaders) during spraying.
- Carry out a logistics assessment in all districts, and arrange all procurement, shipping, delivery, and storage of IRS commodities.
- Strengthen the IRS logistics and warehousing system through enhanced training and supervision.
- Coordinate community mobilization activities in collaboration with stakeholders to raise awareness of IRS and encourage beneficiary and stakeholder ownership.
- Conduct insecticide resistance, wall bioassay, vector density monitoring, and vector behavioral studies.
- Collaborate with other IPs in the 16 districts to complement each other’s work and ensure no duplication of efforts.
- Ensure safe and correct insecticide application, thus minimizing human and environmental exposure to IRS insecticides, in compliance with the Pesticide Evaluation Report and Safer Use Action Plan and Supplemental Environmental Assessment (SEA).
- Finalize and share a new nationwide SEA for 2020 to 2025 in view of the expiration of the current SEA in November 2019.
- Evaluate the extent to which the 2019 National Environmental Management Authority (NEMA) Audit and Environmental and Social Impact Assessment (ESIA) recommendations are implemented.
Success stories from PMI VectorLink Uganda: