Transcript Zimbabwe’s Emergency Indoor Residual Spraying (IRS) Program

Zimbabwe’s Emergency
Indoor Residual
Spraying (IRS)
Program
Allison Belemvire, Program Officer
BACKGROUND
• 2 million people get malaria annually
• 2nd leading cause of death in Zimbabwe
• 50% of pop = mainly rural & malaria endemic areas
• Cholera situation: realized a malaria epidemic could
potentially occur in the near future
Incidence
rate/1000
Malaria Incidence Rates
160
140
120
100
80
60
40
20
0
2000
2001
2002
2003
2004
Year
2005
2006
2007
2010
WHY IRS?
• IRS = Pillar of Zimbabwe’s Malaria Control Program
• IRS = Application of long-acting chemical insecticides on the
walls and roofs of all houses and domestic animal shelters in a
given area, in order to kill the adult vector mosquitoes that
land and rest on these surfaces1
– to reduce the life span of vector mosquitoes
– to reduce the density of the vector mosquitoes
1Indoor
Residual Spraying: Use of indoor residual spraying for scaling up global
malaria control and elimination. WHO Position Paper, 2006
EMERGENCY IRS
OBJECTIVES: FEB-MAR 09
• To reduce the rate of malaria
transmission & prevent malaria
epidemics in the 20 districts
most affected by malaria in
Zimbabwe
• To achieve, by March 31, 2009, at
least 85% room & population
coverage of IRS in targeted
malaria endemic areas
Malaria Stratification (2002)
20 Emergency IRS Districts (Feb-Mar 2009)
EMERGENCY IRS PARTNERS
• NMCP = Overall Coordination
• USAID & USAID|DELIVER PROJECT = $200k
– Equipment Procurement: 250 Hudson X-Pert Sprayers, 25 Spares Kits, 200 Hardened
Stainless Steel Nozzles, 190 Nozzle Body Caps
– PLAN Subcontract: National Assurance Coordinator
– 2 Month STTA
•
Monitoring & Supportive Supervision Field Visits
• DfID & Crown Agents = £ 200k
–
–
–
–
Payment of Spray Teams ($3/day; $1 for food)
District & Provincial Incentives
Fuel coupons, vehicle rentals and repairs
Food provisions
EMERGENCY IRS PARTNERS
• PLAN Zimbabwe
• WHO
• Zimbabwe Defense Forces (ZDF)
• Local communities and NGOs:
– District Development Fund (DDF)
– World Vision
– Save the Children
– IOM
RESULTS:
NMCP FORMAT
Week 1-8 Coverage %
Target
Rooms
Mudzi
10
76586
68508
58202
58541
76.0%
85.5%
Murewa
10
41564
42968
30038
42119
72.3%
98.0%
UMP
11
68967
92585
66931
86192
97.0%
93.1%
Binga
21
52386
128665
45234
68442
86.3%
53.2%
Hwange
18
34000
142014
31653
51185
93.1%
36.0%
Lupane
18
43000
105785
35131
62957
81.7%
59.5%
Gokwe N
10
28046
45828
25871
42581
92.2%
92.9%
Gokwe S
5
42039
64992
25230
38514
60.0%
59.3%
Hurungwe
12
21829
27422
18933
21115
86.7%
77.0%
Kadoma
12
19325
22260
16957
22037
87.7%
99.0%
Centenary
11
41831
66075
35603
59139
85.1%
89.5%
4
16313
24338
15564
22486
95.4%
92.4%
Mt Darwin
11
35000
58330
31306
49497
89.4%
84.9%
Rushinga
19
53543
71320
47668
64371
89.0%
90.3%
Mbire
11
35273
50978
28176
43497
79.9%
85.3%
Masvingo
Bikita
7
29380
44070
28079
44736
95.6%
101.5%
Manicaland
Chimanimani
10
40254
53745
31116
42004
77.3%
78.2%
Nyanga
15
51566
70707
46221
62744
89.6%
88.7%
Beitbridge
12
19806
41862
15649
25567
79.0%
61.1%
7
25233
29130
17778
21876
70.5%
75.1%
775941
1251582
651340
929600
83.9%
74.3%
Mash East
(as of mid-April 09)
Mat North
Midlands
Mash West
Mash Central
District
Guruve
= Achieved 85% target
= Awaiting final update
Mat South
Gwanda
TOTAL
234
Target
Pop
Week 1-8 Totals
Target
Wards
Province
Rooms
Pop
Rooms
Pop
RESULTS: PMI FORMAT (as of mid-April 09)
Total rooms
refused
Total rooms
locked
Mash East
155171
11501
10426
177098
40893
87.6%
Mat North
112018
7664
9214
128896
9975
86.9%
Midlands
51101
2404
2735
56240
5122
90.9%
Mash West
35890
3373
3635
42898
13479
83.7%
Province
Mash Central
158317
No data
No data
No data
Manicaland
77337
No data
No data
No data
No data
No data
Mat South
33427
No data
No data
No data
No data
No data
25474
26791
29392
No data
28079
651340
781
No data
% Rooms
sprayed
Masvingo
Total
532
Total eligible rooms
encountered
Other
structures
sprayed
Total rooms
sprayed
434524
4170
73639
95.5%
88.9%
= Awaiting final update
FIELD MONITORING ACTIVITIES
IRS Teams
• Supervise & provide on the job training of spray operators (Observation of spray
operators, and insecticide management)
• Troubleshoot & provide recommendations; follow up on previously noted
challenges
IRS Reporting
• To review the record keeping of IRS teams (Spray Operator Record Book, Team
Leader Daily Worksheet, and Camp Guard Record Book)
• To facilitate the collection of IRS data and timely submission to the NMCP
• To review the stock records for insecticide, fuel & inventory of equipment
Case Management
• To collect current data on malaria trends at the district level
• To confirm ACTs and RDTs consumption rates, stocks & expiry dates
• To assess the progress of the training rollout for RDTs and ACTs
• To facilitate the re-distribution of RDTs and ACTs, where necessary
• Assess progress of drug efficacy monitoring in sentinel sites, if applicable
HR: RECRUITMENT & TRAINING
• Recruitment of experienced spray operators
– Diverse, gender sensitive
– General hands from hospitals & air force members
• 3 day crash training (typical training is 10 days)
• Emphasis on practical work
• 1:3 Supervisor to operator
ratio
• Provincial teams
• Insufficient training
manuals printed
ACCOMODATION
• Primary schools & Clinics
• District Development Fund (DDF) buildings
• Tents & Stretcher Beds: Leaking & inadequate tents;
broken stretcher beds
• LLINs provided for only a couple of spray teams
EQUIPMENT & PPC
• Inadequate PPC
– Lack of face masks & gloves
– Only 1 pair of work suit
– Shortage of shoe sizes
• Equipment
– Cholera spraying damaged brass
fittings & nozzles
– Shortage of equipment for
sprayers in some districts
– Quality of water = blockages in
nozzles
– Poor service history for spray
pumps; compromise quality of
spray swath
TRANSPORTATION & FUEL
• District vehicles: 1 functioning vehicle; constant
breakdowns, cholera use
• Hired lorries (7-9 ton lorries) too large for small
village paths; missing parts (starters)
• Rain: washed out bridges, inaccessible roads, mud
• Expired fuel coupons: difficult to get both
coupons & fuel @ service stations
INSECTICIDE
MANAGEMENT
Pyrethroids: DeltaGuard &
ICON; NMCP Procured
• Min/Average = 8 sachets/day
• Camp guard records: control
of empty sachets to minimize
leakage
• “Excess” insecticide:
– Variation of recording
structures like chicken
houses and latrines
– Disposal of insecticide
FOOD ALLOCATIONS
• $1/day for food hamper
– Mealie meal, oil, beans, sugar, salt
• Teams took extra food home after campaign
• Generally appreciated by all
• Some districts/ NGO’s provided meat
• Comments: beans; sugar but no tea
• Transport Challenges:
– Misallocation of food
– Rain spoiled mealie meal
WARNING TEAM
• Teams used bicycles,
motorcycles and by foot
• Inconsistencies:
– Notebook usage
– Data collected
– Setting of daily targets
• Challenges:
– Fuel
– Tires for bikes, motos
IEC & COMMUNITY
MOBILIZATION
• Some teams met w/ village chiefs
Limited comm. participation:
• Inadequate IEC materials
• Materials not delivered before spraying
• Agriculture activities
• Food distribution
Limited district participation:
• Cholera outbreak
• Incentives & resources (per diem, fuel
to supervise etc.)
SPRAY TECHNIQUES
• Good techniques due to experienced operators
• Spray operators sensitized communities before mixing
insecticide & spraying
• Bio-assays: assess quality of insecticide application
• Poor service record for spray pumps; not often calibrated
DATA COLLECTION &
RECORD KEEPING
• District Level
– Communication challenges
– Incomplete & late reporting
• Spray Team Level
– Maps & daily targets available
– Spray operators = good records
• Challenges
– Not enough notebooks
– Inconsistent record keeping for
supervisors
– Revision of target rooms and
population
*ACT & RDT CASE MANAGEMENT
• Shipment
– 1 bulk shipment of 1.6 million ACT
treatments arrived Nov 2007
– Possible over quantification of
commodities
• Training
– Case Mgmt. TOT carried out in
Feb & Oct 2007
– Rollout training began in Nov 2008
* ACT & RDT CASE MANAGEMENT
• Timing
– ACTs/RDTs pushed to districts before trainings (due to
delayed release in GF funds)
• SP & CQ still circulating in provinces
– Short shelf life: ACTs expire in July 2009 & RDTs expire in
Sept 2009
• Information
– No consumption data or information basis for the “push”
– Unaware of current stock status in districts & clinics (i.e.
Gokwe S = overstocked, Binga = stock out)
RECOMMENDATIONS: OVERALL
• Develop clear National IRS policy; support with research
• Start up logistics: central distribution of equipment, food,
supplies & forms
• Strengthen provincial involvement & link b/t districts &
national level
– Increase provincial/district motivation & innovation
• Reports = uniform format & schedule
– Revisit calculation of targets & thresholds
• Improve communication chain
RECOMMENDATIONS: SPRAY TEAMS
• More training for teams; including supervisors
• Emphasize mop up activities for locked rooms
• Insecticide management: use 2 types, not 4 types
• Service spray pumps routinely
• Work contract for spray operators
• Trucks: pay on mileage rate, not daily rate; specify type of
truck needed
• IEC materials for year round awareness
LESSONS LEARNED
• Logistical Challenges
– “Come & Get” Logistics = delayed start
– Cholera spraying damaged pumps
– Communication breakdown (no landlines, mobiles, email)
– Lorries & vehicles to support the program
• Timing of Emergency IRS Activities
– Rains
– Agriculture
– Food Distribution
– Cholera
• Data Collection & Reporting
– Poor adherence to weekly reporting schedule; incomplete
reporting
– Modification of original targets
– Communication breakdown
THANK
YOU!
Acknowledgements: Martin Netsa,
Wilson Chauke and Jasper Pasipamire