1. RTI International RTI International is a trade name of Research Triangle Institute. www.rti.org SUPPORTING MALARIA VECTOR CONTROL IN AFRICA: Country level opportunities and lessons from RTI experiences Jacob Williams CAMA Members Meeting 4 Oct 2011

2. RTI International 2  Malaria control goals  Resource investments  Impact  Challenges to vector control  Experiences and Lessons from RTI’s work  Opportunities for joint action Content

3. RTI International 3 2010 Targets  > 80% at risk protected by LLIN, IRS, Environmental Management  > 80% patients diagnosed at treated with effective anti-malarials  100% coverage of pregnant women in high transmission areas  50% burden reduced compared to 2000 (500k deaths/yr and 175m-250m cases/year) 2015 Targets  Universal coverage with effective interventions.  Global and national mortality near zero  75% reduction in global incidence from 2000 levels  The malaria-related MDG is achieved: halt & begin to reverse incidence  > 8 –10 countries currently in elimination stage achieve zero incidence of locally transmitted infection Global Malaria Control Objectives: GMAP

4. RTI International 4 Funding Sources Global Fund = 70% PMI = 15% World bank = 8% Other countries & bilaterals = 7% Internal investment by endemic countries still remain very low Global Malaria Funding Levels and Need $m Yr Source: RBM Yr  Significant rise: Peaked $1.6 b/yr  25% of total need of $4-6b/yr  80% of funds utilized in first yr  90% of total global funding for Malaria goes to Africa [highest burden] Prevention = 42% Treatment = 33% Health Systems = 14% Program Support = 13%

5. RTI International 5 Progress in Impact: Saving lives  Significant lives saved - about 1.1 million from 2000 - 2010  8% of reduction in 2010 [485 children]  In spite of the progress, mortality & morbidity still unacceptably high Source: RBM

6. RTI International 6 6 Malaria prevalence of malaria has dropped to less than 1% of the population Prevalence of Malaria Zanzibar Progress in Impact: Saving lives

7. RTI International 7 Increases in ITN Ownership

8. RTI International 8 Reduction in prevalence and anemia

9. RTI International 9 SCOPE OF CHALLENGE TO MALARIA VETOR CONTROL  Inadequate policy and institutional frameworks  Inadequate trained personnel and lack of critical specialties  Absence/inadequate critical infrastructure  Changing vector population dynamics and transmission profiles  Inadequate joint action by stakeholders (intersectoral collaboration  Challenges to field effectiveness of major interventions

10. RTI International 10 Pesticide selection & management Vector resistance management Increasing insecticide resistance Challenge: Diminishing arsenal of insecticides…

11. RTI International 11 Challenge: The Collapse of Efficacy… Efficacy X Access X Targeting Accuracy X Provider Compliance X Consumer Adherence = Effectiveness 80% X 80% X 75% =29% X 80% Efficacy x Coverage = Effectiveness Health System Factors

12. RTI International 12 Human Risk level changes Vector Environment e.g. precipitation, temp changes Challenge: Changing local disease eco-epidemiology Outcome: Change in Disease burden behavioural genotypic population dynamics (e.g. specie succession) parasite

13. RTI International 13 RTI CONTRIBUTION TO MALARIA CONTROL IN AFRICA Facilitating impact through USG investments

14. RTI International 14 To establish the most efficient, cost-effective and sustainable program that is responsive to changing local disease eco-epidemiology and maximizes impact on disease Goal of National Malaria Vector Control

15. RTI International 15 Country Capacity consideration 1. Policies/strategies 2. Program management 3. Human resource priorities  Staffing requirement by levels and competency area  Geographical and structural distribution of competencies  Training opportunities, major skill areas and numbers trained  Efficiency in staff deployment and utilization success  Staff retention and carrier pathways 4. competency requirement -mobilizing country level sectors/ stakeholders EpidemiologyVector ecology EntomologyAnthropology Program managementHealth economy Procurement & logisticsCommunication & public education Data managementpesticide management Monitoring &Evaluation Financial management Capacity buildingTools specific field skills 5. Infrastructure (insectaries/ento labs)

16. RTI International 16  Expertise and demonstrated competencies in all areas of Malaria control [prevention, control, health systems]  Strong country level presence  Demonstrated competencies  Innovative technologies and schemes (e.g. cell phone technology, environmental and human health safety)  A primary player for global action and standards setting - a primary collaborator with WHO, RBM, UNEP RTI COMPETENCIES IN MALARIA

17. RTI International 17 Over 12 years experience in prevention and control of vector-borne diseases. Currently implementing the following five IRS projects:  Indoor Residual Spraying, covering 13 countries: 2006 -  Indoor Residual Spraying 2, covering 13 countries: 2010 -  Kenya Indoor Residual Spraying: 2010 -  Malaria Control in Main-land Tanzania and Zanzibar: 2006 -  Tanzania Vector Control Scale-up Project : 2010 -  Integrated Vector Management: 2007 - RTI COMPETENCIES IN MALARIA

18. RTI International 18 Vector- borne disease A Vector- borne disease B A1A2 A3A4B1B2 B3B4 Possible VC interventions [IRS, LLINS, Env. Man etc] Selected VC interventions (single disease) A2A3A4B2B4 Intersectoral collaboration Subsidiarity/Community involvement Technical capacity Conducive policy & legal framework Conducive institutional framework National vector control strategy **Multi-disease intervention (if appropriate) B1 Where, A2 = B2A4 = B4 *Cross-cutting IVM attributes Vector control intervention  Rationalize decision - making  Maximize resource utilization RTI CONTRIBUTION AND EXPERIENCES IN AFRICA Supporting national transition to IVM

19. RTI International 19 Supporting national transition to IVM “A rational decision-making process for the optimal use of resources for vector control” WHO 2008 Desired Outcomes Ecological soundness…Cost-effectiveness….Sustainability Characteristics 1. Advocacy, social mobilisation and legislation 2. Collaboration within health sector and with other sectors 3. Integrated approach (range of interventions, often in combination & synergistically) 4. Evidence-based decision-making (VC Methods based on knowledge of factors influencing local vector biology, disease transmission & morbidity) 5. Empowerment and involvement of local communities and other stakeholders 6. Capacity-building RTI CONTRIBUTION AND EXPERIENCES IN AFRICA

20. RTI International 20 IVM: Ensuring Adequate VC Support Systems Williams et. al. 2006, after Birley 1994 Decentralization

21. RTI International 21 Supporting of country capacity strengthening  Development of appropriate policy/institutional frameworks in endemic countries  Development of strategies: - Overarching IVM, plus specific interventions (IRS, LLINS)  Establishment of critical competencies/capacities - Trained human resources - Critical infrastructure - Generation/management/utilization of local data  Improving efficiencies and sustainability of ongoing programs  Reorienting national vector borne disease control programming & management philosophies to enable full IVM

22. RTI International 22 Supporting of Country Capacity Strengthening Development of critical guidance, manuals and tools

23. RTI International 23 Focus on strengthening  program management capacities  Improving Implementation competencies  Targeted training (entomology, IVM etc)  Establishing infrastructure (insectaries, labs)  Establishing surveillance schemes Supporting of Country Capacity Strengthening

24. RTI International 24 Increased coverage 32+ million population 8 million structures 8 million <5s protected 2 million pregnancies protected IRS personnel trained Facilitating Impact: PMI-supported IRS 2008-2010

25. RTI International 25 Facilitating Impact: PMI-supported IRS 2008-201025 IRS expansions in several countries

26. RTI International 26 IF MALARIA IS A SOCIAL PROBLEM THEN….. MOBILIZING WHOLE COMMUNITY FOR VECTOR CONTROL

27. RTI International 27 IEC/BCC for Vector control Brochure, Benin Country Brochures  Angola128,00  Benin 170,000  Burkina24,910  Ethiopia300,000  Ghana12,000  Kenya212,538  Liberia490  Mali87,000  Mozambique589,342  Rwanda247,371

28. RTI International 28 Partnership (global, regional and country level)  mobilizing various constituencies for joint action.  Work groups on “evidence generation”, “capacity strengthening” & “advocacy and communication”) Concentrate initially on high impact small steps (low hanging fruits) for early successes, then on high impact major steps which may require some lead time  Guidance, manuals and evaluation toolkits [ Handbooks Policy Documents, M&E for IVM]  Increased opportunities/access to training: Training materials & institutionalize harmonized IVM training course Mobilizing global resources

29. RTI International 29 VECTOR CONTROL CHALLENGE – OPPORTUNITY FOR JOINT ACTION  Country level capacity priority technical areas (IVM & specific subareas like entomology, LLINs, IRS, RDTs, IEC/BCC etc)  Establishing critical infrastructure (insectary/laboratories) and supporting monitoring/surveillance schemes  Corporate investment in workplace and CSRs  IRS/LLIN delivery  End use trials of new products (quantifying programmatic input/requirements in scaled-up utilization)  Providing technical oversight/quality assurance to delivery  Assisting the impact evaluations

30. RTI International 30 Thank you