Prevention and Control
In Africa – where 90 percent of the world’s malaria-related deaths occur – the major challenge facing malaria control operations is ensuring that effective malaria control services are widely available to those populations at greatest risk from malaria illness.
Insecticide-Treated Mosquito Nets
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Source: Chris Thomas/USAID |
The methods employed include the first goal of “universal coverage” with insecticide-treated mosquito nets (ITNs), especially the long-lasting insecticide-treated mosquito nets (LLINs). Through the PMI, more than 6 million ITNs have been distributed throughout the 15 focus countries, the majority of which are provided free of charge to local residents. In addition, the President's Malaria Initiative (PMI) has helped coordinate other support from other groups for improving access to LLINs, including from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, UNICEF, and private sector coalitions such as Malaria No More.
USAID, through the NetMark project, pioneered public-private partnerships with commercial ITN manufacturers and distributors to grow a sustainable market for increasing access to ITNs through large parts of Africa. NetMark set the standards for consumer and user-based formative research to develop communications and information plans for ITN acquisition and appropriate use; NetMark expanded the innovative use of targeted subsidies through discount vouchers, enabling access to a choice of low-cost LLINs through collaboration between local health posts and surrounding retail outlets. NetMark was also at the forefront of helping countries develop national policies to improve access to ITNs, especially the removal of taxes and tariffs, which was a significant barrier to affordability in many countries.
As NetMark expanded access to LLINs through sustainable market systems, USAID and the PMI have also made significant investments through the individual country programs to deliver free LLINs to those most in need through campaign-style distributions (e.g., in conjunction with vaccination and vitamin A campaigns); nongovernmental organizations, including those providing home-based care for persons living with HIV/AIDS; routine distributions; and antenatal clinics and other public sector outlets.
Integrated Vector Management
Vector control is implemented through the framework of Integrated Vector Management (IVM), which is defined as “a rational decision-making process for the optimal use of resources for vector control” that includes the following key elements: advocacy, social mobilization and legislation, cross-sector collaboration, integrating methods, evidence-based decisionmaking, and capacity building. USAID has been the key partner working with the World Health Organization (WHO) to develop the global strategy for IVM and its implementation through the Integrated Vector Management Project, a successor to the earlier Environmental Health Project. In addition to the global strategy development, the IVM project supports capacity building for vector control specialists and for a number of operational research and early implementation activities for larval source management in specific ecological situations, such as peri-urban areas, where it can contribute to an overall vector management program. Through other projects, USAID and the PMI provide significant direct support for the procurement, implementation, management, and evaluation of ITNs and indoor residual spraying.
Indoor Residual Spraying
The second major vector control intervention is indoor residual spraying (IRS) – the organized, timely spraying of a WHO-approved insecticide on the inside walls of houses or dwellings. This is currently being implemented primarily through a central mechanism with field support from the individual country programs. Here, support is being provided for the environmental assessment of, planning, training of, implementation of, supervision of, and monitoring and evaluation for IRS operations in 15 countries, providing protection to approximately 17 million people.
Included as part of the IRS programs is a large effort to improve pesticide management for the safe and judicious use of pesticides according to the standards and regulations of the national regulatory authorities, the U.S. Government, and international treaties (in particular the Stockholm Convention) in those countries where, under the treaty, malaria control programs continue the use of DDT.
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