Combating Malaria in Zambia Through Rapid Scale-Up of the Indoor Residual Spraying Program
June 5, 2008
An IRS spray operator is trained on uniform spray coverage technique
Malaria is a major public health challenge in Zambia. It is endemic, perennial, and a major cause of illness and death, especially among children and pregnant women. It is estimated to account for more than 45 percent of all clinic consultations and a quarter of childhood deaths, with 4.3 million suspected cases and 50,000 deaths annually.
Having identified the control of malaria as a national health priority, the Government of Zambia developed a National Malaria Strategic Plan (NMSP) in 2006 with the goal of reducing malaria morbidity and mortality by 75 percent within 5 years. The plan provides a framework for malaria control that includes interventions by public/private partnerships and the collaboration of national and international stakeholders.
The 15 districts in Zambia where Abt Associates and the IRS program currently operate
Through the Health Services & Systems Program (HSSP), funded by USAID and led by Abt Associates, and as part of the President's Malaria Initiative, we are providing substantial technical and management support for the strengthening, capacity building and scale-up of the national Indoor Residual Spraying (IRS) program to combat Malaria. The primary objective of the IRS operation is to achieve the coverage target of 85 percent of eligible structures in the 15 districts in which it is now active, meaning at least 85 percent of those household structures targeted for spraying are covered by annual IRS campaigns. Between them these 15 target districts contain 34 percent of Zambia's population. Spraying begins in late September, and is typically conducted in an operational period of 60 days, before the heavy seasonal rains. With Abt Associates' support, the IRS program has rapidly expanded its reach into the 15 target districts, nearly doubling the number of houses sprayed from the first to second spray season, and maintaining a coverage rate above 80 percent for the two years. In the 2007-2008 spray campaign, 657,695 households were covered; achieving a highly effective average coverage rate of 93 percent of the targeted 700,000 and protecting 3,286,514 people.
IRS spray operators being trained for district campaigns
HSSP works in partnership with the Zambian Ministry of Health at all levels to support increased access to quality health services and to strengthen health systems. HSSP partners include JHPIEGO, the International Science & Technology Institute, and Save the Children. Among its many activities HSSP provides significant assistance to the National Malaria Control Center (NMCC), a Department of the Ministry of Health's Directorate of Public Health and Research. NMCC developed its first annual national action plan for 2006, key elements of which are the introduction of insecticide-treated bed nets, indoor residual spraying (IRS), effective case management, and malaria prevention in pregnant women — all interventions that have been scientifically proven to be effective at reducing the disease burden and mortality.
The NMCC's IRS program is part of the Integrated Vector Management (IVM) strategy to prevent malaria. It sprays insecticides such as pyrethroids and organochlorides on indoor walls and ceiling surfaces of houses of vulnerable population groups in urban and peri-urban communities. Residual insecticide deposits on those surfaces act to reduce vector density and disease transmission potential by killing vector mosquitoes, which rest in houses before or after biting and consuming the blood of people who may or may not be infected with malaria. NMCC has also planned to carry out limited control of mosquito larvae in selected localities in these IRS areas to complement the vector reduction efforts under IVM programs.
A GPS enumerator at work, interacting with the community
HSSP has focused considerable efforts on the strengthening national level capacities within the NMCC to quantify, procure and plan IRS operational needs and design implementation plans to achieve targeted coverage and scale up IRS activities in the districts where the IRS program is operational. Support involves technical, managerial, and administrative assistance, and includes providing key human resource staff to support IRS operations. These Abt Associates staff positions include the IRS Program Officer, Senior Logistics Officer, Senior Resident Advisor, Operations Research/Information Management Officer, and a number of other support staff. HSSP has also provided support to the MOH and NMCC in the development of the Global Fund to Fight AIDS, Tuberculosis and Malaria's Round 7 malaria proposal.
The goal of HSSP IRS activities is to provide support that will strengthen the capacity of personnel and improve systems at the NMCC and district level to effectively plan, implement, and monitor the IRS program. HSSP provides support in national strategy development — its technical assistance has been instrumental in the introduction and adoption of guidelines, training manuals, planning formats, data recording/reporting forms and databases (including GPS database geo-coding and mapping of all sprayed structures), monitoring and supervision check lists and evaluation studies for IRS operations.
HSSP also provides assistance in:
Quantification and procurement of insecticides, equipment, and spares for IRS operations,
Pesticide safe storage and handling
Training and supervision of district managers and spray operators
Implementation of IRS activities, and
Monitoring, information management and applied research for IRS.
The NMCC is planning to expand its IRS coverage from 15 to 36 of the nation's 72 districts, and the intention in all districts is to consolidate operations, upgrade environmental safeguard practices, and improve ownership of IRS programs by the districts themselves. Abt Associates will continue to provide technical and operational support to this important national program.
