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Vector Control Equity: Engaging Hard-to-Reach Populations with Indoor Residual Spraying

The Abt-led President’s Malaria Initiative (PMI) VectorLink project works with country governments to implement indoor residual spraying (IRS) to prevent malaria. While IRS is designed to have far-reaching coverage, IRS planning and implementation leaves some populations behind such as those in remote,  difficult-to-reach areas, living in structures ineligible for spraying, or outside of government systems.

PMI VectorLink strives to identify these populations to protect them from malaria and tailor strategies to increase IRS acceptance and access. PMI VectorLink country teams collaborate with community organizations, governments, and village leaders to reach certain populations, including people with disabilities in Ghana; people in prisons, the military, and police in Rwanda; and ethnic groups in Côte d’Ivoire.

In Ghana, PMI VectorLink works with the Ghana Federation of Disability to engage people with disabilities and ensure that IRS strategies and messaging address their needs. The team uses the association’s regular meetings as a platform to provide community education on IRS before each year’s campaign and invites association leaders to participate in district-level stakeholder meetings and national IRS campaign launch events. PMI VectorLink Ghana disseminates messaging asking households and communities to help their neighbors who are elderly, ill, or have disabilities prepare their households before the arrival of spray teams. That involves moving items out of the home. Including people with disabilities in community IRS events provides a platform for an often-disadvantaged group to have a voice in IRS mobilization and planning efforts.

Working with the Ministry of Health, PMI VectorLink Rwanda collaborates with government agencies including the district authorities and Rwanda Correctional Services (RCS) to reach prisons  with IRS. The Government of Rwanda pioneered this work, requesting that these structures receive IRS more than 10 years ago. In 2021, IRS acceptance in selected prisons was 100%. The reason: district authorities are committed to these activities and work closely with RCS. The high spray coverage demonstrates the impact that government can have when leaders prioritize equity in health-promotion interventions.

In Côte d’Ivoire, PMI VectorLink identified a community, predominantly composed of the Lobi ethnic group, that had lower-than-typical IRS acceptance. Married Lobi women typically live separately from their husbands in small homes where they sleep and store all their household items and harvested food. The accumulation of household items signifies wealth in the Lobi community, so many women have an abundance of goods. They were hesitant to move their household items outside of their dwellings due to the inconvenience and sensitivity around publicly displaying their wealth. PMI VectorLink Côte d’Ivoire engaged community leaders to  understand these barriers and worked to emphasize the benefits of spraying. The team tailored messaging to promote not only the health benefits, but also the opportunity for Lobi women to conduct a deep cleaning of items stored in their homes. Now, the annual IRS campaign is also an annual cleaning.

These efforts demonstrate collaboration with national, regional, and community counterparts to ensure that local priorities, data, and information inform spray implementation. Cross-country peer learning exchanges within the PMI VectorLink Project have provided a valuable platform for country teams to share successes and challenges and spread innovative ideas about effective strategies to reach disadvantaged populations. For example, PMI VectorLink Zambia is supporting government efforts to expand spray coverage to prisons in 2022 based on the successes in Rwanda. In the coming months, PMI VectorLink country teams plan to expand their equity work by systematically identifying populations that are not currently reached by vector control. The teams will collaborate to develop tailored strategies to reach those groups.

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