The PMI Vectorlink Kenya End of Spray Report 2020

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KENYA END OF SPRAY REPORT 2020 SPRAY CAMPAIGN: FEBRUARY 10 - MARCH 21, 2020

Recommended Citation: The PMI VectorLink Project Kenya. May 2020. Kenya End of Spray Report 2020: Spray Campaign: February 10 – March 21, 2020. Rockville, MD, USA: The PMI VectorLink Project, Abt Associates Inc. Contract: AID-OAA-I-17-00008 Task Order: AID-OAA-TO-17-00027 Submitted to: United States Agency for International Development (USAID)/President’s Malaria Initiative (PMI) Submitted on: May 5, 2020 Approved on: June 10, 2020

The views expressed in this document do not necessarily reflect the views of the United States Agency for International Development or the United States Government

CONTENTS Acronyms ...... iii Executive Summary ...... iv 1. Country Background ...... 1 2. IRS Implementation Activities ...... 3 2.1 IRS Planning and Partner Collaboration ...... 3 2.2 Spray Operations and Supervision ...... 5 2.3 Insecticide Procurement and Inventory ...... 9 2.4 IEC/SBC Activities and Outcomes ...... 10 2.5 Capacity Building ...... 12 2.6 Gender Mainstreaming...... 12 2.7 Overview and Results of Cost and Operational Efficiency Strategies ...... 13 3. Entomology ...... 15 3.1 IRS Residual Efficacy and Mosquito Insecticide Susceptibility ...... 15 3.2 Residual Efficacy ...... 15 4. Environmental Compliance ...... 18 4.1 IRS Campaign Assessments ...... 18 4.2 Incident Reports ...... 19 4.3 Demobilization and Waste Management ...... 19 5. Monitoring And Evaluation ...... 21 5.1 Data Collection, Entry, and Quality Assurance ...... 21 5.2 mHealth ...... 23 5.3 Results ...... 24 6. Challenges, Lessons Learned, And Recommendations ...... 28 6.1 Challenges ...... 28 6.2 Lessons Learned ...... 29 6.3 Recommendations ...... 30 Annex A: Environmental Mitigation and Monitoring Report (EMMR) ...... 31 Annex B: Monitoring and Evaluation Indicator Matrix ...... 39

LIST OF TABLES Table 1: Summary of 2020 IRS Campaign Results ...... v Table 2: Number of Seasonal Staff Trained ...... 4 Table 3a: Number of Seasonal Staff Hired, Homa Bay County ...... 5 Table 3b: Number of Seasonal Staff Hired, Migori County ...... 6 Table 4: Operations Sites: Number, Location, and Ownership of Operations Sites ...... 7 Table 5: 2020 IRS Insecticide Usage Summary ...... 9 Table 6: Channels of Communication, Frequency of Use, and Estimated Number of People Reached ...... 11 Table 7: Number of An. gambiae Kisumu Strain Exposed to Walls Sprayed with Actellic® 300CS and Percentage Mortality 24 Hours after Exposure ...... 16 Table 8: 2020 Incident Reports ...... 19 Table 9: Solid Waste Quantification and Disposal ...... 20 Table 10: Mass Mobilization Data Collection Tools ...... 21 Table 11: Spray Data Collection Tools ...... 21 Table 12: Spray Coverage by Sub-County ...... 25 Table 13: Insecticide Burn Rate and SOP Performance by Sub-County ...... 26

LIST OF FIGURES Figure 1: Map of Kenya Showing IRS Intervention Counties ...... 1 Figure 2: Susceptibility of An. gambiae s.l. and An. funestus to Pirimiphos-Methyl in Kenya in 2019 ...... 15 Figure 3. Mean Monthly Mortality (24h) of Susceptible An. gambiae Kisumu Following Cone Bioassay on Walls Sprayed with Actellic® 300CS in 2020 ...... 16 Figure 4: Reasons for Non-Spray Homa Bay County ...... 26 Figure 5: Reasons for Non-Spray Migori County ...... 26 Figure 6: Malaria Cases Based on Epidemiological Data from Migori and Homa Bay Counties, 2010–2020 .. 27

ACRONYMS BCC Behavior Change Communication BMP Best Management Practice CFV Control Flow Valve CMMF Community Mass Mobilization Form CMMP Community Mass Mobilization Progress CoE Committee of Experts DCV Data Collection Verification DHIS 2 District Health Information Software 2 DNMP Division of National Malaria Programme DOS Directly Observed Spraying ECCL Environmental & Combustion Consultants Limited EMMR Environmental Mitigation and Monitoring Report IEC Information, Education and Communication IRS Indoor Residual Spraying ITN Insecticide-Treated Nets KEMRI Kenya Medical Research Institute KEMSA Kenya Medical Supplies Authority KMS Kenya Malaria Strategy M&E Monitoring and Evaluation MMRL Mass Mobilization Roll Call MOH Ministry of Health NEMA National Environment Management Authority NMCP National Malaria Control Program ODK Open Data Kit PMI President’s Malaria Initiative PMT Performance Monitoring Tracker PPE Personal Protective Equipment PSECA Pre-season Environmental Compliance Assessment SBC Social and Behavior Change SCMCC Sub-County Malaria Control Coordinator SCMOH Sub-county Medical Officer of Health SEA Supplemental Environmental Assessment SMEOR Surveillance, Monitoring and Evaluation, Operations Research SOP Spray Operator SOP Standard Operating Procedure SPTS Spray Performance Tracking Sheet ToT Training of Trainers VC Vector Control WHO World Health Organization WMP Waste Management Plan

iii

EXECUTIVE SUMMARY The U.S. President’s Malaria Initiative (PMI) VectorLink Project in Kenya conducted the 2020 indoor residual spraying (IRS) campaign in Homa Bay and Migori counties with a long-lasting organophosphate (Actellic® 300CS). In both counties, the campaign lasted 24 days, from February 10 to March 7 in Homa Bay County and from February 24 to March 21 in Migori County. Following are highlights of the campaign:

• In total, 482,831 structures were found and, of these, 436,472 were sprayed, resulting in 90.4% spray coverage that protected 1,792,495 people. • VectorLink Kenya trained 2,309 people (1,307 in Homa Bay County, 1,000 in Migori County, and 2 national representatives), 957 (41.4%) of whom were women, to deliver IRS in the 2020 IRS campaign. • VectorLink Kenya used 126,700 bottles of Actellic® 300CS with insecticide usage ratios of 3.3 structures per bottle in Homa Bay County and 3.6 structures per bottle in Migori County. • A spray quality assessment conducted in all villages showed 100% mortality of susceptible An. gambiae Kisumu exposed to both mud and cement walls except in Liera village, where mortality was 97% (on both mud and cement walls). One month after spraying, mortality was 100% in all sites. • VectorLink Kenya scaled up the use of smartphones for data collection among spray operators (SOPs) from one operations site in 2019 to five operations sites in 2020, covering a total of 143 SOPs, 23 team leaders, and their 5 spray team supervisors. • Mass mobilization replaced door-to-door mobilization. This new mobilization approach created a new cadre of mobilizers, embedded with the spray team, who worked hand in hand with spray teams in the community and whose job description was revised to include house preparation. • To curb data falsification, VectorLink Kenya implemented a number of measures namely (a) the spray data form was revised to document when a new bottle of insecticide was opened; (b) before the SOP left a village, a village elder would authenticate the data collected (e.g., household owner name, number of households recorded) for accuracy, and (c) every seasonal worker was required to sign an ethic addendum as part of their contracts. • The project successfully implemented the pull system for insecticide distribution by the SOP team leads. The pull system requires that demand for insecticide is driven by number of structures being sprayed at the time. • To institute spray team accountability and make data auditing and verification easier, spray calendars were designed so that spray teams were allocated specific villages to spray. Team leaders were trained to work with mobilizers to allocate structures to individual SOPs each day within a village. This allocation initiative was designed to deter data falsification, especially in light of the chronic problem of not recording unsprayed structures. • SOP daily performance targets were managed to reduce falsification of data. • To identify data quality issues faster in the field, more data collection verifications (DCVs) were conducted in 2020 with a total of 6,548; this was a 65.1% increase from 2019. DCVs were conducted by all levels of supervisors including Ministry of Health (MOH) supervisors. In previous campaigns, this activity was reserved for monitoring and evaluation assistants and VectorLink supervisors only.

TABLE 1: SUMMARY OF 2020 IRS CAMPAIGN RESULTS

Result Homa Bay County Migori County TOTAL Number of sub-counties covered by IRS 8 6 14 Insecticide 72,644 54,056 126,700 Estimated number of structures targeted 218,092 166,547 384,639 Number of structures found 275,989 206,842 482,831 Number of structures sprayed 241,564 194,908 436,472 Spray coverage (number of structures sprayed 87.5% 94.2% 90.4% divided by number of structures found) Population protected 987,449 805,046 1,792,495 Pregnant women protected 20,951 19,776 40,727 Children under five protected 110,783 101,085 211,868 Number of people trained to deliver IRS 1,307 1,000 2,309 * PMI annual indicator for “people trained to deliver IRS” includes team leaders, SOPs, site coordinators, and supervisors (2 Division of National Malaria Programme staff do not fall into any county but are included in the total as supervisors) and excludes clinicians, data clerks, information, education, and communication mobilizers, drivers, washers, porters, pump technicians, and security guards.

v 1. COUNTRY BACKGROUND Since 2006, the U.S. President’s Malaria Initiative (PMI) has protected millions of people in Africa from malaria through indoor residual spraying (IRS), which kills the mosquitoes that transmit malaria by spraying insecticide on the walls, ceilings, and other indoor places where those mosquitoes rest. In September 2017, the United States continued its commitment to tackle this deadly disease, launching the five-year PMI VectorLink Project. Working across 24 countries in sub-Saharan Africa as well as in Cambodia and Latin America, PMI VectorLink equips countries to plan and implement integrated vector control (VC), including safe and cost-effective IRS programs, conducts entomological monitoring activities, and provides support for the deployment of insecticide-treated nets (ITNs). IRS remains one of the key interventions to reduce malaria burden in Kenya and for epidemic response as stipulated in the Kenya Malaria Strategy (KMS) 2019–2023, which was launched in April 2019. Objective one of the KMS calls for protecting 100% of people living in malaria risk areas through access to appropriate malaria preventive interventions by 2023. In Kenya, IRS is implemented in two of the country’s 47 counties, Homa Bay and Migori and is primarily funded by PMI/United States Agency for International Development (USAID). In 2017, IRS was restarted in Kenya after four years with support from PMI under the Africa Indoor Residual Spraying Project (AIRS). AIRS conducted IRS campaigns in six sub-counties in Migori (Awendo, Rongo, Nyatike, Suna East, Suna West, and Uriri) and expanded to eight more in Homa Bay (Homa Bay Township, Ndhiwa, Rachuonyo East, Rachuonyo North, Rachuonyo South, Rangwe, Suba North and Suba South) in 2018. In July 2018, AIRS transitioned to PMI VectorLink, which continued implementing IRS in the two counties in 2019 and 2020. As indicated in VectorLink Kenya’s approved work plan for 2019/20, IRS continued in the six sub-counties in Migori and the eight in Homa Bay, targeting 384,639 eligible structures for spraying and 1,930,279 people for protection. The 2020 campaign was conducted from February 10 to March 7 in Homa Bay County and from February 24 to March 21 in Migori County (Figure 1).

FIGURE 1: MAP OF KENYA SHOWING IRS INTERVENTION COUNTIES

VectorLink Kenya worked closely with the Ministry of Health (MOH) through the Division of National Malaria Programme (DNMP), Migori and Homa Bay county governments, the National Environment Management Authority (NEMA), the Ministry of Interior and Coordination of National Government, local and opinion leaders, and community and other stakeholders. The main objectives of the 2020 IRS campaign were as follows: VectorLink Kenya worked closely with the Ministry of Health (MOH) through the Division of National Malaria Programme (DNMP), Migori and Homa Bay county governments, the National Environment Management Authority (NEMA), the Ministry of Interior and Coordination of National Government, local and opinion leaders, and community and other stakeholders. The main objectives of the 2020 IRS campaign were as follows:

• Achieve spray coverage of at least 85% of the total structures targeted for spray (384,639) in each of the two counties. • Ensure compliance with environmental regulations and established best practices for IRS insecticide handling and usage. • Establish effective monitoring and evaluation (M&E) of all activities to measure the effect of IRS. • Conduct monthly entomological surveillance to inform VC decision making. • Support training and capacity building at the national, county, and sub-county levels to promote IRS sustainability. • Coordinate an integrated VC information, education, and communication (IEC) and behavior change communication (BCC) strategy and activities working to raise community awareness, understanding, and demand for IRS and ITNs. • Implement a cost-effective IRS campaign.

2. IRS IMPLEMENTATION ACTIVITIES 2.1 IRS PLANNING AND PARTNER COLLABORATION 2.1.1 IRS PLANNING Planning for the 2020 spray campaign began with VectorLink Kenya conducting the initial planning and quantification based on the total number of structures found in 2019 campaign. However, the funding available could not support the spraying of all the structures found in 2019, and required that VectorLink reduce its targets by 30%. VectorLink Kenya together with the DNMP and county governments held a pre-microplanning meeting to agree on major ways to save on costs as follows:

• Criteria for excluding the 30% of structures found in the 2019 campaign; these included urban areas, hard-to-reach areas, and areas with persistent refusals. • Replacing door-to-door mobilization with mass mobilization. • Merging some roles and re-aligning tasks under each cadre, for example, the e-inventory data clerk position was eliminated and its tasks were moved to the warehouse assistant position. • Making a corresponding reduction in seasonal personnel, for example, spray operators (SOPs) and team leaders, whose numbers are affected by the number of structures. • Eliminating the seasonal workers normally hired as a buffer to the needed numbers. • Aligning the Kenya trainings to the project standard of including only specific seasonal worker cadres. For example, historically, Kenya would allow site supervisors to attend the mHealth training, yet the site supervisors received similar training during training of trainers (ToT), which included a mHealth component. Trainings were streamlined to avoid duplication. • Reviewing the cost of refreshments during trainings and the menu for the heavy breakfast during the campaign. • Converting all trainings to non-residential with the exception of ToT and microplanning meetings. • Using on-the-job orientations instead of stand-alone trainings for washers, security guards, drivers, and health care workers. Washer and security guard orientation was conducted by VectorLink trained site coordinators. Drivers and health care workers orientation was conducted by VectorLink sub-county coordinator and sub-county’s own malaria control coordinators. Orientation lasted 1-2 hours except the driver orientation, which took four hours. • Merging team leader training into the five-day SOP training rather than holding it as an additional day of training for team leaders. Following the agreements in the pre-microplanning meetings above, and in close collaboration with PMI, DNMP, and Migori and Homa Bay county governments, VectorLink Kenya held microplanning meetings at the county level with participants from the county and sub-counties to finalize next steps. The meetings focused on reviewing the targeted number of structures, operations sites, and quantification of personnel required at each sub-county. Also discussed were the recruitment criteria, trainings and roles of various cadres and stakeholders, spray and mobilization calendars, supervision plans, spray team performance and target setting, spray and mobilization data flow, and the performance monitoring plan and disciplinary actions for data falsification.

2.1.2 TRAINING VectorLink Kenya conducted all scheduled IRS trainings in November and December 2019 and January 2020, and trained a total of 5,128 staff (50.3% male and 49.7% female to support VC activities. Each training comprised theoretical and practical sessions relevant to the targeted seasonal workers. Table 2 provides a breakdown of the different trainings.

TABLE 2: NUMBER OF SEASONAL STAFF TRAINED Training on IRS Delivery Other Trainings ToT for Spray Spray Data IEC Data Financial Pump Environmental m- Operators Operator Entry Logistics Mobilization Collection Washers Training Storekeepers Security Technician Compliance Health Categories of Persons Trained M F M F M F M F M F M F M F M F M F M F M F M F M F National supervisors (DNMP) 2 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 2 0 2 0 County supervisors 11 1 0 0 0 0 0 0 0 0 11 1 0 0 0 0 0 0 0 0 0 0 11 1 11 1 Sub-county supervisors 48 12 0 0 0 0 0 0 0 0 48 12 0 0 0 0 0 0 0 0 0 0 48 12 48 12 Site supervisors 68 22 0 0 0 0 0 0 0 0 68 22 68 22 0 0 0 0 0 0 0 0 68 22 68 22 SOP team leaders 0 0 190 107 0 0 0 0 0 0 190 107 190 107 0 0 0 0 0 0 0 0 190 107 12 11 Spray operators 0 0 984 796 0 0 0 0 0 0 984 796 984 796 0 0 0 0 0 0 0 0 984 796 63 80 Trainer of trainers 196 71 0 0 0 0 0 0 0 0 196 71 0 0 0 0 0 0 0 0 0 0 196 71 196 71 Embedded mobilizers 0 0 122 175 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Team lead mobilizers 0 0 0 0 0 0 0 0 124 281 124 281 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sub-location mobilizers 0 0 0 0 0 0 0 0 393 835 393 835 0 0 0 0 0 0 0 0 0 0 0 0 0 0 IEC assistants 5 9 5 9 0 0 0 0 5 9 5 9 0 0 0 0 0 0 0 0 0 0 5 9 5 9 County M&E assistants 0 0 2 0 2 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 M&E assistants 0 0 8 10 8 10 0 0 8 10 8 10 0 0 0 0 0 0 0 0 0 0 8 10 8 10 DEC team lead 0 0 0 0 0 2 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 0 DECs 0 0 0 0 30 23 0 0 0 0 30 23 0 0 0 0 0 0 0 0 0 0 30 23 0 0 IT/mHealth assistants 0 0 2 0 2 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 2 0 Site coordinators 49 19 49 19 0 0 49 19 49 19 49 19 49 19 0 0 49 19 0 0 0 0 49 19 49 19 Storekeepers 0 0 49 23 0 0 49 23 0 0 49 23 49 23 0 0 49 23 0 0 0 0 49 23 49 23 Logistics assistant 0 0 1 1 0 0 1 1 0 0 1 0 1 1 0 0 1 1 0 0 0 0 1 1 1 1 Warehouse assistant 0 0 2 0 0 0 2 0 0 0 2 0 2 0 0 0 2 0 0 0 0 0 2 0 2 0 Washers 0 0 7 152 0 0 0 0 0 0 0 0 7 152 0 0 0 0 0 0 0 0 7 152 0 0 Drivers 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 210 0 0 0 Security guards 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 123 14 0 0 123 14 0 0 Health workers for poisoning case 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 83 45 0 0 management County finance assistants 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 Sub-county finance assistants 0 0 8 8 0 0 0 0 8 8 0 0 0 0 8 8 0 0 0 0 0 0 0 0 0 0 Pump technicians 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 12 56 12 0 0 Environmental compliance assistant 1 1 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 Total 380 135 1429 1302 42 35 102 44 591 1162 2165 2211 1352 1120 8 10 102 44 123 14 56 12 2127 1320 519 260

2.1.3 PARTNER COLLABORATION VectorLink Kenya is part of the DNMP’s VC, Social Behavior Change (SBC), and Surveillance, Monitoring and Evaluation, Operations Research (SMEOR) Committees of Experts (CoEs). In 2020, PMI VectorLink provided the logistics and financial support for the five VC CoEs. CoE meetings are held quarterly. A special meeting was held in July 2019 to agree on the areas to spray and the insecticide to be used in 2020. In this meeting, the CoE agreed that IRS would continue for the fourth time in Migori County and for the third time in Homa Bay County using Actellic® 300CS. In addition, VC CoE, VectorLink Kenya attended four SBC and three SMEOR CoE meetings, one Malaria Elimination Committee, six mandatory USAID and three implementing partners sponsored meetings and two Malaria Health Sector Working Groups.

2.2 SPRAY OPERATIONS AND SUPERVISION The 2020 IRS operations were coordinated from 68 operations sites (28 in Migori and 40 in Homa Bay) spread across the 14 sub-counties. A total of 3,9241 seasonal workers (46.9% male; 53.1% female) were hired to support implementation of the 2020 spray campaign (Table 3a and 3b).

TABLE 3A: NUMBER OF SEASONAL STAFF HIRED, HOMA BAY COUNTY Homa Bay Rachuonyo Rachuonyo Rachuonyo Suba Suba Grand County-wide Ndhiwa Rangwe Cadre Township East South North North South Total M F M F M F M F M F M F M F M F M F Spray operators 1009 552 457 63 24 98 86 50 68 60 67 91 86 57 40 52 45 81 41 Embedded mobilizers 168 66 102 6 8 16 15 5 15 9 11 6 23 8 9 4 13 12 8 Sub-location mobilizers 743 238 505 9 31 75 85 42 27 20 43 55 133 16 68 6 57 15 61 IEC assistants 8 2 6 0 1 0 1 0 1 0 1 0 1 0 1 1 0 1 0 County M&E assistants 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 M&E assistants 11 5 6 0 1 0 2 0 1 0 1 2 0 0 1 1 0 2 0 DEC team lead 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DECs 30 17 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 IT/mHealth assistants 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Site coordinators 40 28 12 3 1 5 3 3 1 3 2 4 2 3 1 3 1 4 1 Storekeepers 42 25 17 2 2 6 2 3 1 1 5 5 1 4 0 1 4 3 2 Logistics assistant 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Warehouse assistant 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Washers 91 3 88 0 8 1 16 0 10 0 11 0 15 1 7 1 9 0 12 Security guards 81 71 10 4 4 15 1 7 1 9 2 11 1 8 0 8 0 9 1 County finance assistants 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sub-county finance assistants 9 4 5 1 0 1 1 0 1 0 1 1 0 0 1 0 1 1 0 Pump technicians 40 30 10 3 1 6 2 2 2 2 3 6 0 3 1 4 0 4 1 EC Assistant 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 2,279 1,045 1,234 91 81 223 214 112 128 104 147 181 262 100 129 81 130 132 127

1 “Hired” personnel do not include full-time government staff.

TABLE 3B: NUMBER OF SEASONAL STAFF HIRED, MIGORI COUNTY Grand County Awendo Nyatike Rongo Suna East Suna West Uriri Cadre Total M F M F M F M F M F M F M F Spray operators 771 432 339 56 60 95 61 64 50 66 52 56 53 95 63 Embedded mobilizers 129 56 73 9 10 12 15 6 13 12 8 5 13 12 14 Sub-location mobilizers 485 155 330 20 73 59 107 20 44 16 44 16 23 24 39 IEC assistants 6 3 3 0 1 0 1 1 0 1 0 1 0 0 1 County M&E assistants 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 M&E assistants 7 3 4 1 0 1 1 0 1 0 1 1 0 0 1 DEC team lead 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 DECs 23 13 10 0 0 0 0 0 0 0 0 0 0 0 0 IT/mHealth assistants 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 Site coordinators 28 21 7 3 1 6 1 3 1 3 1 2 2 4 1 Storekeepers 30 24 6 3 1 7 0 3 2 3 1 4 1 4 1 Logistics assistant 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 Warehouse assistant 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 Washers 68 4 64 0 10 0 15 0 10 1 9 0 10 3 10 Security guards 56 52 4 7 1 14 0 8 0 8 0 6 2 9 1 County finance assistants 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 Sub-county finance 7 4 3 1 0 2 0 0 1 0 1 0 1 1 0 assistants Pump technicians 28 26 2 4 0 6 1 3 1 4 0 4 0 5 0 EC assistant 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 1,645 797 848 104 157 202 202 108 123 114 117 95 105 157 131

Each operations site was managed by one VectorLink site coordinator and one MOH site supervisor. Each of them was in charge of three teams. Each team had six SOPs, and was led by one team leader. Each team was allocated one embedded mobilizer to accompany them every time they were in the field. Four sub-location mobilizers were hired and assigned to supervise and manage mass mobilization activities for each sub-location. Of the four sub-location mobilizers, one of them was appointed as the sub-location mobilizer team leader. At the operations sites, workdays started at 6-7 am with breakfast provided to all personnel. Breakfast was followed by the donning of personal protective equipment (PPE) by spray teams and health/physical checks of each SOP by team leaders, and then the distribution of spray supplies, insecticides, and equipment to the spray teams for the day’s work. Thereafter, the SOPs would head to the wash area to collect the 3 litres of waste water from barrels 1, 3, 5, and 7, which they would put into their spray tanks. After collecting the waste water, site supervisors and site coordinators would conduct a short morning mobilization meeting with all spray teams. During morning mobilization, the site supervisors, site coordinators, sub-county supervisors, county supervisors, and VectorLink technical team addressed house preparation, safety, insecticide mixing, the importance of accurate data collection, adherence to correct spray technique and environmental compliance, and other challenges observed or reported on the previous spray days. Most spray teams were transported to the field in vehicles. At Rariw site in Rangwe Sub-County in Homa Bay, spray teams rode their own bicycles. This year, VectorLink Kenya implemented the Walk to Work strategy, wherein spray teams sprayed communities close to the operations site. The project used standard permanent soak pits for end-of-day clean-up; SOPs conducted the clean-up daily, supervised by the team leaders and pump technicians. Before the campaign started, VectorLink Kenya developed spray calendars at the sub-location level with each team working in specific sub-locations and specific villages therein. In addition to the spray calendars, village maps were developed per sub-location in every operations site and were used as a guide to the teams. Site supervisors used the maps and spray calendar to assign the villages to be sprayed on particular days and maps would be updated to mark villages covered as the spray campaign progressed. These maps were helpful for coordination and discussions between site coordinator, site supervisor, team leaders and embedded mobilizers. The embedded mobilizers used the map to alert sub-location mobilizers which the villages were going to be sprayed next.

Site supervisors and site coordinators accompanied their teams to the field. Upon arrival in the villages, the SOPs would be allocated households to be sprayed by the team leader with assistance by the embedded mobilizer and sub-location mobilizers. The village elders were also available to guide the teams in the community and provide security for them. The mobilizers and village elders played a key role in convincing the household owners to accept IRS for their households, thus enabling the SOPs to meet their daily targets. SOP daily performance targets were managed in a way that reduced the temptation to falsify data. It was clarified, during the micro-planning meetings and down the supervisory chain, that the average number of structures sprayed per day was indeed an average, and that seasonal workers should not be automatically sanctioned if they did not achieve it. Supervisors were required to do additional scrutiny and due diligence where performance results looked suspicious. Competitiveness among spray teams and operations sites was discouraged. IRS supervision was well structured and coordinated at county, sub-county, and ward levels and was guided by supervision plans. The county supervision team comprised the seven members of the County Health Management Team including the county malaria control coordinator. Each county supervisor was allocated a sub-county to oversee although they could rotate to other sub-counties as per the county-level supervision plan. VectorLink staff were also allocated a specific sub-county to oversee per week. Supervisors at the sub-county level comprised four Sub-County Health Management Team members: the sub-county malaria control coordinator (SCMCC), sub-county medical officer of health (SCMOH), sub- county public health officer (SCPHO), and one other member. Each member was allocated specific operations sites to oversee but could still rotate to other sites as guided by the sub-county supervision plan. At the ward/site level, the site supervisors and site coordinators were allocated specific teams to supervise. The team leaders were the first-line supervisors for the six SOPs. Team leaders conducted directly observed spraying (DOS) for each member daily. All supervisors used the standard mobile-based VectorLink supervisory tools, and team leaders used the DOS tool for supervision. Supervision focused on proper household preparation, use of correct spray technique, data collection, mobilization, and adherence to safety and environmental compliance requirements. During field supervision, some of the common issues addressed were reminding SOPs to spray ceilings made of sprayable surfaces, to record unsprayed structures, and to prepare households properly by getting all movable items out of the eligible structures. During the campaign, VectorLink Kenya hosted supervisory visits from PMI Washington, the PMI Mission, national MOH officials, namely, the heads of the DNMP and the Department of Strategic Health Programs, other DNMP officials assigned to IRS, and staff from the VectorLink home office in Rockville, Maryland, USA.

2.2.1 OPERATIONS SITES In 2020, VectorLink Kenya coordinated operations in 68 operations sites, 28 in Migori and 40 in Homa Bay (Table 4). Most of the sites were located in the government health facilities save for three, which were located in the local chief’s camp. VectorLink did not pay rent for storage sites. At Kochola and Kabondo, the health facility provided staff housing as stores. VectorLink Kenya paid rent for staff’s temporary housing. The project also had four temporary insecticide distribution centers: Kochola and Arombe in Migori County and Ogongo and Rachuonyo District Hospitals in Homa Bay, all of which were located in government health facilities.

TABLE 4: OPERATIONS SITES: NUMBER, LOCATION, AND OWNERSHIP OF OPERATIONS SITES Total Operations Number Provided by County Sub-county Sites Government Migori Awendo 4 4 Nyatike 7 7 Rongo 4 4 Suna East 4 4 Suna West 4 4 Uriri 5 5 Total Migori 28 28 Homa Bay Homa Bay Township 4 4 Ndhiwa 8 8 Rachuonyo East 4 4

Total Operations Number Provided by County Sub-county Sites Government Rachuonyo North 6 6 Rachounyo South 5 5 Rangwe 4 4 Suba North 4 4 Suba South 5 5 Total Homa Bay 40 40

2.2.2 KEY OPERATIONAL DETAILS

2.2.3 LOGISTICS AND STOCK PMI VectorLink Kenya hired and trained 72 storekeepers (30 in Migori and 42 in Homa Bay) to manage operations sites’ stores and temporary insecticide distribution centers. To support VectorLink warehouse staff, VectorLink hired two logistics assistants and two warehouse assistants, one of each in each county warehouse. All staff were trained on logistics management and record keeping. Before, during, and after the spray campaign, the storekeepers maintained and updated all logistics records, including stock cards and ledger books, for each item with details of transactions, quantities, dates, and destination. In 2020, operations sites’ storekeepers continued to serialize all bottles of insecticide before distributing them to team leaders. Each team leader signed the insecticide distribution card noting the total number of bottles received in the morning from the storekeeper. When issuing bottles to the SOPs, their team leader recorded the serial number of bottles given to each SOP against his/her name in the serialized Insecticide Tracker sheet and each SOP confirmed and signed for the bottles received. At the end of the spray day, these two documents were signed again as verification of the bottles returned, whether full or empty, from the field. In addition, VectorLink Kenya trained all SOPs to record on their Daily SOP form the serial number of each bottle that they mixed against the structure where they did the mixing. VectorLink Kenya adopted this verification and reconciliation process to strengthen insecticide stock management, reduce the risk of pilferage, and expedite investigation of any insecticide-related issue. During the IRS campaign, all stores were kept in good condition, with most storekeepers adhering to the stores procedures as trained. Any stores found not following BMPs were corrected as quickly as possible. Insecticide and other items were placed on pallets and, where available, on shelves. All supervisors continued to monitor the storekeeper’s performance on a daily basis and gave support where needed. Physical verification of the items in the stores was conducted to ascertain accuracy and in most cases were found to tally with the stores’ records. It was observed that storekeepers who were participating for the first time required more support especially during the first week of the campaign. The VectorLink Kenya technical team gave one-on-one support to these storekeepers as required.

2.2.4 SEASONAL WORKER PAYMENT VectorLink Kenya recruited two county finance assistants and 16 sub-county finance assistants2 to process payments. The sub-county finance assistants were responsible for obtaining required documents at the sub-county level and sending them to the county assistant for further review and processing. Sub- county assistants ensured time-sensitive documents (e.g., time sheets) were obtained in accordance with the payment schedule. All payments were made on time, with minimal issues. VectorLink Kenya continued to pay all seasonal workers through Safaricom’s Mpesa mobile payment system. As required, all the personnel recruited were informed that they must own a Safaricom line registered under their names. During training, all personnel were given the Mpesa declaration forms so they could fill out their personal information as well the registered Safaricom line where their money would be deposited. They were also expected to provide name and contact details of their next of kin. The forms with the Mpesa account numbers and phone number were collected, and once compiled, were validated for accuracy. Any inconsistencies and discrepancies were reported to the seasonal worker for resolution.

2 One finance assistant for each sub-county except for Ndhiwa and Nyatike has two assistants each.

VectorLink Kenya developed a payment plan for all seasonal workers and vendors, indicating the deadlines by which payments should be expected. The plan was explained to all seasonal workers during the various trainings.

2.3 INSECTICIDE PROCUREMENT AND INVENTORY In 2020, VectorLink hoped to rotate insecticides. However, SumiShield® 50WG remains unregistered for the past two years and Fludora® Fusion registration was still underway with the Pest Control Product Board. Consequently, VectorLink Kenya continued to use Actellic® 300CS in Migori for the fourth year and for the third year in Homa Bay. The continued use of Actellic® 300CS was approved by the DNMP’s VC CoE on July 19, 2019, on the basis of susceptibility studies indicating that An. gambiae s.l. mosquitoes in both counties were still susceptible to that insecticide. The balance of Actellic® 300CS brought forward from the 2019 campaign was 13,646. VectorLink estimated a total of 116,352 bottles would be required in 2020. During the spray campaign, 126,700 bottles were used, leaving a balance of 3,298 bottles (Table 5). The stock in hand comprises the following batch numbers: 9I 0382 (456), 9H2880 (468), 9H2680 (531), 9H3180 (781), 9H3182 (834), and 9I 0481 (228) with a manufacturing date of August 2019 and a shelf life of two years. The bottles therefore will expire in August 2021. In 2020, the project benefited from the UNITAID co-payment support for insecticide through the Next Generation IRS (NGenIRS) Project.

TABLE 5: 2020 IRS INSECTICIDE USAGE SUMMARY Balance brought forward in Kisumu warehouse 13,646 Total procured and received 116,352 Total in stock before campaign (Kisumu warehouse) 129,998 Total usage during the campaign 126,700 (72,644 in Homa Bay; 54,056 in Migori) Balance in Kisumu warehouse (Full) 3,298 Balance in Kisumu warehouse (Empty) 123

Since the U.S. and Kenyan Governments do not have a bilateral agreement to facilitate duty-free importation by VectorLink Kenya, the project worked closely with the Kenya Medical Supplies Authority (KEMSA), a state corporation under the MOH and established under the KEMSA Act 2013, to import, customs clear, and deliver all VectorLink international procurements, including insecticide, from the port of entry to Kisumu. Furthermore, in the absence of a bilateral agreement, all international shipments are subject to the Kenya Bureau of Standard’s pre-shipment importation requirement. VectorLink procurement staff and KEMSA worked hand in hand to coordinate and manage the pre-shipment inspection, shipping, and documentation requirements to facilitate importation. The insecticide arrived in the port of Mombasa on December 30, 2019. Due to the bureaucratic Kenya Revenue Authority customs system that affects all imports upon arrival at the port entry, insecticide clearance was slow but eventually granted, resulting in the delivery of insecticide on February 6, 2020. As delivery was so close to the start of the campaign, VectorLink requested that two trucks with 39,168 bottles be delivered directly to the Homa Bay county warehouse. The remainder was delivered to the Kisumu central warehouse for onward distribution to county distribution centers for further distribution to the operation sites. At the end of the spray campaign, all the empty insecticide bottles (used) and unused insecticides (full unopened bottles) were returned to the Kisumu warehouse for storage. The empty bottles were later collected for recycling in Nairobi.

3 One full case of empty bottles was left at the warehouse. These empties shall be disposed of with next year’s empties.

2.4 IEC/SBC ACTIVITIES AND OUTCOMES 2.4.1 ORGANIZATIONAL STRUCTURE In 2020, VectorLink replaced the previous door-to-door mobilization with mass mobilization, which emphasized the use of diverse channels of communication, a reduction in the number of mobilizers, and the introduction of new cadres of mobilizers. For the 2020 spray campaign, VectorLink Kenya in collaboration with the two county governments hired 14 IEC assistants, one per sub-county, and engaged a total of 1,633 sub-location mobilizers (986 in Homa Bay and 647 in Migori) and 297 embedded mobilizers (168 in Homa Bay and 129 in Migori). A key selection requirement was that a mobilizer had to be either a community health volunteer (CHV) or local village elder to ensure community ownership and to leverage the trust and goodwill of CHVs and elders to encourage acceptance within their communities. Sub-location mobilizers were tasked with attending community meetings and gatherings, for example, school, church, community baraza, women’s, and youth groups. On the spray day, they assisted with household allocation and household preparations. Sub-location mobilizers reported to the IEC assistants. The embedded mobilizers were part of the spray teams, reported to the team leader, and went ahead to announce arrival of the spray teams and assist with household preparation. The IEC assistants based in the sub-counties worked very closely with the sub-county coordinators and sub-county health promotion officers but they reported directly to the IEC/BCC coordinator. In addition to overseeing daily mobilization activities in their respective sub-counties, IEC assistants compiled weekly reports on the mobilization activities and progress and shared it with the IEC/BCC coordinator. They also documented success stories weekly to capture how the community has benefited from IRS.

2.4.2 MOBILIZATION APPROACHES PMI VectorLink engaged various mobilization channels to sensitize and mobilize the community (Table 6). At the county level, VectorLink worked with various key county departments (e.g., MOH, Education, Interior and Coordination of National Government, Water, National Environment Management Authority), representatives of those living with disabilities, and the dominant religious institutions. The ward sensitization meetings took place much closer to the spray campaign, targeting community stakeholders, such as ward administrators, assistant chiefs, and village elders, members of the county assemblies, ward education officials, church leaders, and ward-level MOH staff. The purposes of the sensitization meetings were to: (a) inform local leaders of their role in the IRS campaign, (b) sensitize local leaders to upcoming seasonal worker recruitment drives; (c) discuss the spray and mobilization calendars, and (d) engage local leaders to organize meetings to sensitize their communities. To further support coordination, the project provided airtime for the chiefs and assistant chiefs. Sub-location mobilizers begun mass mobilization six days before the spray campaign began. The sub- location mobilizers attended various meetings and gatherings and sent daily reports to site coordinators with dates, name of sub-location, villages covered, and any issues they were having. In these meetings, the sub-location mobilizers shared the spray and mobilization calendars to prepare the community members for IRS and inform them when their villages would be sprayed, shared key IRS messages, demystified myths and misconceptions, and generally created demand for IRS by giving facts on malaria prevention and benefits of IRS. For each meeting, sub-location mobilizers documented villages covered and mass mobilization forums attended, contact information of the group chair/ lead, and estimated the number and gender of attendees. This information was collected by the sub-location team leads, who summarized the data and sent a text to the site coordinator using a format given. A day before spray, sub-location mobilizers used megaphones to remind the household owners of the arrival of spray teams the next day. They also conducted minimal door-to-door mobilization in areas with significant refusals. On the day of the campaign, the sub-location mobilizers together with embedded mobilizers accompanied the spray team, walking ahead of the team, reminding household heads on what to do and helping with household preparation. Sub-location mobilizers also documented for re-visits the structures that could not be sprayed during the initial visit. These lists were handed over to the site supervisors, and the mobilizers followed up with absent households to reschedule when they would be available to have their structures sprayed.

IEC assistants supported mass mobilization by visiting health facilities to mobilize pregnant and nursing women in maternal and child health clinics as well as clients at comprehensive care clinics, urging them to allow their houses to be sprayed while emphasizing the benefits of IRS and use of nets. IEC assistants also engaged the deputy county commissioners regularly, sharing with them regular updates on IRS progress, seeking their support in addressing refusals, and using their administrative structures to mobilize the community. For example, the Deputy Commissioner used their regularly scheduled meetings in Rangwe and Suba South sub-counties to urge the community to accept spray and invited IRS supervisors to address the attendees on the benefits of spraying. The IEC assistants constantly reached out to the mobilizers through site coordinators, reminding them to prepare villages prior to SOPs arrival.

TABLE 6: CHANNELS OF COMMUNICATION, FREQUENCY OF USE, AND ESTIMATED NUMBER OF PEOPLE REACHED Total Estimate Number of Estimated Number Estimated of the Times Number of Times Number Number Used of People Used of People Total of People Channel of Communication (frequency) Reached (frequency Reached Frequency Reached Homa Bay County Migori County County sensitization meetings 1 29 1 30 2 59 Sub-county sensitization meetings 8 240 6 180 14 420 Ward sensitization meetings 40 3,200 28 2,240 68 5,440 Provincial administration meetings 8 367 6 258 14 625 Community barazas 41 1,080 85 2,704 126 3,784 Health facility meetings 151 2455 108 2330 259 4,785 Church announcements and meetings 207 11,616 515 30,773 722 42,389 Schools announcements and meetings 146 32,188 184 29,994 330 62,182 Regular (daily) market announcement 10 1358 32 1358 42 2,716 Youth groups 87 2,255 187 4,809 274 7,064 Community dialogues 36 1,242 89 3,645 125 4,887 Women’s groups 373 9,024 547 13,563 920 22,587 Other community gatherings 160 3,959 278 9,111 438 13,070 Special groups 57 1,712 113 2,959 170 4,671 Total 1,325 70,725 2,179 103,954 3,504 174,679

A total of 7,096 villages were visited in the first contact between our mobilizers and the attendees in these gatherings out of 8,811 potential villages (80.5% mobilization progress). Participants were encouraged to pass the messages to their families and friends, so more people would be reached. The frequency column represents how many times a given type of channel was visited on a face-to-face contact with the sub- location mobilizers.

2.4.3 MASS AND PRINT MEDIA In addition to sensitization and mass mobilizations, VectorLink Kenya engaged Radio Lake Victoria, one of the leading national Luo radio stations, to disseminate IRS messages, including demystifying myths and misconceptions; spray calendars; and areas to be sprayed. During live talk shows, IRS beneficiaries were given a chance to ask questions. VectorLink issued 12 radio advertisements (two per week for six weeks) and 36 radio mentions (three per day, two days a week for six weeks), held six radio call-in talk shows (one radio talk show per week for six weeks), and booked 12 radio spots. These were all done over the spray campaign period. For the weekly call in radio talk shows, VectorLink involved county and sub- county MOH staff from both counties.

PMI VectorLink used different print materials to sensitize the public: 11,026 posters distributed in all operations sites and posted on IRS vehicles and strategic places like health facilities, chiefs and assistant chief’s offices, schools, and government offices; 74 roadside banners at operations sites; 4 street banners used during the IRS flag-off event in both counties; 350 T-shirts issued to county leaders, VectorLink staff, county and sub-county supervisors during the flag-off event; 2,008 mobilizer guides for use by the mobilizers as they engaged the community; and 6,544 copies of IRS key messages distributed to all participants who attended the sensitization meetings at county, sub-county, and ward levels.

2.5 CAPACITY BUILDING The Government of Kenya and USAID have put at the center of their partnership the Journey to Self- Reliance (J2SR). This is an approach in which all projects that the United States funds in Kenya must support local partners to devise approaches that will enable them to implement activities in a manner that will solve development problems while relying on locally available resources and capabilities. In this respect, PMI VectorLink Kenya has placed great emphasis on capacity building throughout IRS implementation, along the following axes:

• Support DNMP in drafting of VC key strategic documents. PMI VectorLink Kenya supported the DNMP in the writing of four key strategic documents in the KMS 2019–2024: the IRS Implementation Strategy, Mosquito Surveillance Guidelines, the Integrated Vector Control Strategy, and the Insecticide Resistance Management Plan. The project is in negotiation with the DNMP so that as soon as these documents are available (expected in May 2020), a dissemination workshop will be held to set an action plan for implementation, especially of the Integrated Vector Control Strategy and Insecticide Resistance Management Plan. • Support DNMP in holding VC CoE meetings. These are quarterly meetings during which an average of 25 VC experts and stakeholders in the country meet to plan and/or make major decisions about VC. The experts and stakeholders are drawn from the DNMP, Division of vector borne disease (DVBD), PMI, the World Health Organization (WHO), KEMSA, and research institutions like the Kenya Medical Research Institute (KEMRI) and other public health implementers. The meetings are organized by DNMPs vector control focal point and are attended by the VectorLink Kenya chief of party, the technical manager, and other project technical leads, as appropriate. • Participate in other CoE meetings and working groups. As the sole IRS implementer in Kenya, VectorLink participates in the SBC and SMEOR to provide an IRS perspective. VectorLink participates in the Malaria Health Sector Working Committee sponsored often by PMI MEASURE Evaluation project. • Involve the MOH at all levels. To transfer skills on IRS planning and implementation, VectorLink Kenya actively involves the DNMP, and county and sub-county public health officials in a variety of IRS activities such as microplanning, ToT, and SOP trainings. In addition, the project works alongside county and sub-county environmental compliance officials to conduct pre- and post-environmental compliance assessments, using smartphones and coming up with a list of deficiencies for the operations team. Furthermore, VectorLink staff have provided on-the-job mentorship. For example, the Homa Bay county malaria control coordinator was newly appointed following a staff reshuffle within the ministry, and the VectorLink Homa Bay county coordinator was tasked with mentoring him on IRS. Similarly, the SCMCCs in Suna West and Nyatike were mentored by the VectorLink sub-county coordinators in these areas following staff reshuffles by Migori County. They were taken through the step-by-step processes in IRS planning and implementation and supported to successfully supervise the campaign.

2.6 GENDER MAINSTREAMING In 2020, VectorLink Kenya continued to advocate for involvement of women in the various project activities. During microplanning meetings, VectorLink advocated for recruitment of women for every role on a 50/50 basis where possible. Every sub-county steering committee was tasked to ensure this metric was met. During ToT and subsequent trainings, all participants were taken through gender-related topics such as freedom from harassment and workplace safety for all. The project also made copies of the sexual 12

harassment guidelines, which were posted in all operations sites and offices for reference by all personnel. In addition to the guidelines, VectorLink developed a one-page work ethics document outlining all the key work ethics to abide by while employed. Sexual harassment and reporting of such harassment was covered as well. In 2020, VectorLink Kenya observed a small decrease in female participation in its activities for the listed cadres compared with 2019. The number females hired for seasonal positions decreased slightly from 56.4% in 2019 to 53.1% in 2020. This was largely driven by elimination of certain cadre of seasonal workers, which women usually fill, due to structural changes to the IRS campaign this year. For example, IEC supervisors were eliminated with changes in mobilization and the e-inventory data clerk role was merged into the warehouse assistant role.

2.7 OVERVIEW AND RESULTS OF COST AND OPERATIONAL EFFICIENCY STRATEGIES In 2020, VectorLink Kenya rolled out the Walk to Work strategy for SOPs for two days of the campaign. The main aim was to reduce the cost of transporting SOPs in vehicles. Each operations site reviewed its calendar and selected specific days when spray teams were likely not to require a vehicle. The schedules were made in such a way that the vehicles would not operate (rest days) on alternate days. Even though this worked well in most operations sites, those sites with one vehicle had to obtain a vehicle from a nearby site, to ferry SOPS to work in the morning. Furthermore, since spray teams were allocated sub- locations for spray, those spray areas that were situated far away from the operation site made it impossible for those teams to walk to work. The cost saving from this initiative this year was USD 22,540 (8% of the overall cost for SOP vehicles). To more effectively implement this strategy, VectorLink will (a) develop the vehicle resting schedule at the same time with spray calendar, and (b) apply the Walk to Work strategy strategically, for example, for spray teams assigned to areas close to the operation sites rather than blanket application over a specific period or set a criteria for where the Walk to Work strategy works best taking into consideration terrain, and distance from the operations site. PMI VectorLink Kenya continued the use of their own bicycles for SOP transportation in Rariw operations site in Rangwe Sub-County, Homa Bay County. The site had a total of 28 SOPs and five team leaders. Five members of the spray teams were female. All SOPs recruited owned a bicycle and knew how to ride. In terms of cost, it would have cost KES 462,0004 (USD 4,620) to hire SOP vehicle transportation. The project spent a total of KES 281,6005 (USD 2,816) for the SOP bike allowance and pump holders. Like other supervisors in other sites, the site supervisor and site coordinator were given a weekly allowance for motorbike hire. Consequently, the motorcycle allowance was not factored into the cost saving calculation as this cost was not unique to the site.6 This initiative saved approximately USD 1,804. In the last ten years or so, bicycle use and ownership had declined in Kenya with the introduction of boda boda (motorcycle taxis) and ease of ownership of motorcycles. It has been easy for VectorLink Kenya to use bicycles at Rariw operation site as the CHVs in this area had been provided bicycles by the Anglican Development Services (ADS) for community work. Keeping in mind this context, VectorLink shall attempt to scale up the use of bicycles in at least two operations sites, if possible In 2020, PMI VectorLink Kenya implemented the pull system for insecticide distribution to SOPs. Typical insecticide use is about three structures per insecticide bottle (250 square meters) and, with a daily target of nine structures, VectorLink would issue 4-5 bottles to an SOP in prior years. A SOP would use at least three bottles and might return the others unopened. Based on prior data falsification and insecticide pilferage incidents, VectorLink determined that the extra bottles tempted unscrupulous SOPs to steal them. To obviate this temptation, in 2020, VectorLink issued each SOP only three bottles of insecticide. The team leader was issued one extra bottle per SOP, which would be used at an SOP’s request once s/he had exhausted the initial three bottles. Before issuing the fourth bottle, however, the team leader checked with the rest of the SOPs on the team if they had extra mixed insecticide. As a result, the amount of mixed insecticide returned to the site at end of day was minimal. On a case-by-case basis,

4 Three SOP transport vehicles at KES 7,000 per day for 24 days. 5 SOP bicycle allowance for 33 bicycles at KES 300 per day for 24 days for a total of KES 237,600; Pump holder purchase and repairs at total of KES 44,000. 6 This year, the allocation of specific sub-location to spray teams necessitated the issuance of motorcycle allowance to all site supervisors and coordinators to enable them to keep up with their assigned spray teams.

the number of bottles issued to SOPs could be increased if a supervisor deemed that there was high demand of IRS in a particular area at a particular time.

3. ENTOMOLOGY 3.1 IRS RESIDUAL EFFICACY AND MOSQUITO INSECTICIDE SUSCEPTIBILITY In 2019, we collected larvae in Migori and Homa Bay (both IRS sites) and in non-IRS sites in Kisumu, Siaya, Bungoma, Busia, Kwale, and Turkana counties. An. gambiae s.l. larvae were reared at the KEMRI- Centre for Global Health Research site in Kisumu. WHO susceptibility tests for pirimiphos-methyl (0.25%) were conducted according to PMI VectorLink Standard Operating Procedure (SOP) 06/01 on emergent adults aged 2-5 days except for An. funestus from Siaya, which were collected and tested as F0 adults from houses. All mosquitoes tested were susceptible to pirimiphos-methyl, the active ingredient in Actellic® 300CS, including those collected in Migori and Homa Bay, where Actellic® 300CS was subsequently sprayed in 2020 (Figure 2).

FIGURE 2: SUSCEPTIBILITY OF AN. GAMBIAE S.L. AND AN. FUNESTUS TO PIRIMIPHOS-METHYL IN KENYA IN 2019

3.2 RESIDUAL EFFICACY The quality of spraying was checked in Migori and Homa Bay counties by conducting cone bioassays in two villages that were randomly chosen from the list of operations sites. The villages used for testing in Homa Bay County were Liera in Rachuonyo North Sub-County and Kagur in Homa Bay Township Sub- County. In Migori County, the villages were Njiri in Rongo Sub-County and Wachara in Nyatike Sub- County. In each village, 10 randomly sprayed structures were selected for testing; seven were mud-walled (the most common wall type) and three were cement. Cone bioassay testing was done according to VectorLink SOP 09/01. It used an insectary-reared susceptible An. gambiae Kisumu strain, aged 2–5 days. The temperature range during exposure was 20– 30°C and relative humidity was 46–81%. The insectary strain of An. gambiae Kisumu was confirmed to be susceptible to pirimiphos-methyl, with 100% mortality reached using 0.25% WHO papers. Mortality of cone bioassays was scored at 24 hours post exposure. A control cone was set on a plywood board outside of each sprayed structure in a shady area. To determine the airborne fumigant effect of the insecticide, a small cage (20cm x 20cm x 20cm) with 10 An. gambiae Kisumu was placed 1 m above the ground and 10– 15 cm from the sprayed wall for an exposure of 30 minutes with mortality recorded at 24 hours post exposure.

During quality assurance bioassays conducted within one week after IRS was done, a total of 1,285 An. gambiae Kisumu strain were exposed to Actellic® 300CS-sprayed walls; 490 were used in cages to test the fumigant effect and another 410 were used as controls. The average control mortality was always less than 5%. In all villages, there was 100% mortality of mosquitoes exposed to both mud and cement walls except in Liera village in Homa Bay County (Figure 3). VectorLink Kenya investigated potential reasons for this and decided to spray an additional three structures, two mud and one cement, under the direct supervision of the technical manager, before conducting an additional cone bioassay. Before spraying the three houses, measurements were taken of interior spray surfaces and, afterwards, the amount of insecticide sprayed was recorded to confirm spraying was conducted according to label specifications; 100% mortality was recorded and spray quality was assured. The three houses will act as a positive control and will be followed concurrently with the other 10 randomly selected structures in Homa Bay. Cone tests conducted one month after spraying produced 100% mortality in all sites in Migori and Homa Bay for mud and cement substrates.

FIGURE 3. MEAN MONTHLY MORTALITY (24H) OF SUSCEPTIBLE AN. GAMBIAE KISUMU ® FOLLOWING CONE BIOASSAY ON WALLS SPRAYED WITH ACTELLIC 300CS IN 2020

Mortality due to fumigant effect varied by site and type of house in the two counties but 24 hour mortality was <50% in all sites (Table 7).

TABLE 7: NUMBER OF AN. GAMBIAE KISUMU STRAIN EXPOSED TO WALLS SPRAYED WITH ® ACTELLIC 300CS AND PERCENTAGE MORTALITY 24 HOURS AFTER EXPOSURE Sub- Wall Number 24hr % County County Site Type Exposed Mortality Mud 70 5.7 Liera Cement 30 10 Rachuonyo Liera positive Mud 20 25 Homa Bay control Cement 10 30 Homa Bay Mud 70 44.3 Kagur town Cement 30 16.7 Mud 70 17.1 Rongo Njiri Cement 30 70 Migori Mud 70 24.3 Nyatike Wachara Cement 30 43.3 Total 430 28.6

Malaria vectors in Migori and Homa Bay were susceptible to pirimiphos-methyl in 2019, before being sprayed with Actellic® 300CS in 2020. Mortality was slightly below 100% in Liera after spraying, but this may have been caused by a few mosquitoes resting on the cone and avoiding the sprayed wall, as mortality one month after spraying reached 100%. VectorLink Kenya has temporarily suspended monthly

cone bioassay in accordance with WHO and PMI guidance on entomological activities during COVID 19 pandemic, but plans to resume testing as soon as it is feasible. The project shall continue to monitor the residual effect of Actellic® 300CS over the next year until mortality falls below 80% for two consecutive months. In general, cone bioassay results show that spray quality in Migori and Homa Bay was at acceptable levels.

4. ENVIRONMENTAL COMPLIANCE In 2020, VectorLink Kenya IRS operations were covered by the Supplemental Environmental Assessment (SEA) prepared and approved for 2017–2021; it was developed with the DNMP and in accordance with the provisions of US 22 CFR (216). The approved SEA authorizes the use of three classes of pesticide (pyrethroids, carbamates, and organophosphates) and three new active ingredients/combinations (clothianidin, the clothianidin/deltamethrin combination, and chlorfenapyr, when a PQ listing is received). For the 2020 spray campaign, VectorLink Kenya prepared a Letter Report in November 2019 that highlighted the environmental compliance plan and the choice of insecticides for the campaign.

4.1 IRS CAMPAIGN ASSESSMENTS 4.1.1 PRE-SEASON ENVIRONMENTAL COMPLIANCE ASSESSMENT In November and December 2019, VectorLink Kenya in collaboration with county MOH officers conducted the first Pre-season Environmental Compliance Assessments (PSECAs) in 40 operations sites in Homa Bay County and in 28 in Migori County. This first PSECA doubled as the project’s site needs assessment aimed at gathering site-specific repair and/or refurbishment requirements in readiness for greenlighting of the sites for the 2020 spray campaign. At the end of the PSECA, VectorLink’s environmental compliance officer (ECO) prepared a worklist of site-specific recommendations that guided planning and implementation of operations sites refurbishments. Based on the worklist, VectorLink Kenya refurbished 67 of the 68 operations sites in the two counties. The project permanently decommissioned and relocated the wash area, bathing areas, and fixed soak pit at the Homa Bay County Health Management Team operations site from one area to another within the same compound to make room for a major county development project near the original location. Site repairs and refurbishment works were completed in Homa Bay and Migori by January 17 and February 7, 2020 respectively, in preparation for the second and final PSECAs. VectorLink Kenya in collaboration with the respective county MOH and NEMA officers conducted the final PSECAs in all 40 operations sites in Homa Bay County on January 21–31 and in all 28 sites in Migori County on February 10–14. These final assessments confirmed that the site refurbishments recommended by the initial PSECA were addressed, and that sites met the PMI Best Management Practice (BMP) requirements and were ready for the IRS campaign. Upon confirmation of site environmental compliance, the VectorLink Kenya ECO and the home office environmental compliance manager reviewed reports submitted via smartphone checklists during the inspections from each operations site, and then certified the greenlighting of all 40 operations sites in Homa Bay County on January 27 and February 3 and all 28 sites in Migori County on February 17.

4.1.2 MID-SEASON ENVIRONMENTAL COMPLIANCE ASSESSMENT Throughout the actual spray operations, all supervisors including VectorLink staff, officers from the county MOH and NEMA offices performed smartphone-assisted mid-spray inspections and supervision to monitor compliance of all spray activities. Supervisory reports were auto-generated on a daily schedule upon submission of the smartphone-based inspection checklists. Some of the supervisory reports raised red flags, which the environmental compliance and operations teams in the field followed up for implementation of the required corrective actions, where applicable. A number of red flags were the result of erroneous reporting by the supervisors; in these cases, the environmental compliance, operations, and M&E field teams provided on-the-job refresher training to encourage supervisors to be more careful when filling the smartphone supervisory checklists and thus to minimize future errors. All non-compliance issues reported by red flags were addressed during the daily morning assemblies at each operations site. At the sub-county level, weekly meetings were held to address any persistent issues and the action points followed up through thrice-weekly county-level meetings for oversight and monitoring of the progress made towards resolving the issues. Annex A presents the VectorLink Kenya Environmental Mitigation and Monitoring Report (EMMR).

4.2 INCIDENT REPORTS During the 2020 spray campaign, VectorLink Kenya recorded and reported two incidents of insecticide exposure and other health and safety concerns (Table 8).

TABLE 8: 2020 INCIDENT REPORTS

Brief Description and Incident Outcome Incident Number Location actions taken Insecticide Exposure: Mixed SOP saw an ophthalmologist Pala Masogo operations site, KEN-022520-001- insecticide discharged and at Homa Bay County Homa Bay Township Sub- Exposure splashed on SOP’s face Referral Hospital; SOP has County, Homa Bay County made a full recovery. Health and Safety: Death of None; Cause of death not Arombe operations site, Suna SOP; cause of death unrelated linked to IRS; VectorLink West Sub-County, Migori KEN-031020-002- to IRS assisted family with post- County Health and Safety mortem and funeral related costs. Fraud: The project was alerted Reported situation to police N/A to fake RFQ using “AIRS KEN-051220-003- Kenya Project/Abt Fraud Associates” name.

4.3 DEMOBILIZATION AND WASTE MANAGEMENT 4.3.1 DEMOBILIZATION VectorLink Kenya began demobilizing all operations sites in Homa Bay on March 9, and in Migori on March 23. All logistics and spray equipment from the 68 operations sites were taken back to the respective county warehouses. The unused insecticide, empty insecticide bottles, and all uncontaminated solid wastes were transported to the central warehouse in Kisumu. All contaminated solid wastes from both counties were stored temporarily in a shipping container at the Kochola operations site in Rongo Sub-County, Migori, prior to collection on April 1 and incineration by April 3. All site stores were cleaned with soap and water to decontaminate them, soak pits were covered with polythene sheets and soil, and the surroundings of wash area were cleared of vegetation and locked. VectorLink Kenya together with county MOH environmental and public health representatives conducted post-IRS inspections of the 40 operations sites in Homa Bay on March 16–25 and the 28 sites in Migori on March 30–April 3. The mid- and post-spray inspections recommended the following changes for 2021:

• Relocation of Omboga and Got Kojowi operations sites in Homa Bay County because of persistent slow drainage of the sites’ soak pits. • Rehabilitation of all existing soak pits in Homa Bay County, which have been used for three consecutive spray campaigns (2018–2020) in accordance with PMI BMP, and of the soak pits at the Agenga and Bware operations sites in Migori, where the rinse wastewater from clean-up activities drains very slowly. • Soil and water sample analysis at six sites where water from soak pits puddles and drains slowly, to determine the extent of environmental harm, if any. The sites with the poorly performing soak pits are Got Kojowi, Omboga, Sino, and Nyamrisra in Homa County and Agenga and Bware operations sites in Migori County. • Periodic maintenance of wash area and soak pit surroundings in both counties to prevent overgrowth of vegetation and thereby minimize the overall site refurbishment costs prior to the next IRS campaign. • Introduction of the use of mobile soak pits in operations sites with more than 25 SOPs in both counties, to decongest and reduce the time SOPs take during end-of-day clean-up activities.

4.3.2 WASTE MANAGEMENT In November 2019, VectorLink Kenya developed a Waste Management Plan (WMP) to guide the collection, storage, handling, transport, and disposal of all waste generated from the spraying. Logistics, warehousing, and operations teams including site coordinators and storekeepers were taken through this WMP during their training. All liquid wastes generated during spray operations were strictly managed at operations site wash areas and any contaminated wastewater was drained into the soak pits. Each soak pit was built with filter media that included a charcoal layer that was meant to absorb any active ingredient in the wastewater draining through the soak pits. All solid wastes were separated by content and type and were first segregated as contaminated or uncontaminated. The wastes in these two categories were then separated into plastics and non-plastics. All contaminated plastic was cleaned at the wash areas with soap and water to decontaminate it and then put with the non-contaminated plastics and polythene wastes. Storekeepers and logistics assistants stored all contaminated solid wastes separately from uncontaminated wastes. During demobilization, all sites packaged their contaminated solid wastes and transported them to the Kochola operations site in Rongo Sub-County, Migori, for temporary storage prior to final disposal. Uncontaminated solid wastes including empty insecticide bottles, assorted polythene/plastics and carton as well as ordinary paper, were transported to the main warehouse in Kisumu for temporary storage prior to final disposal. VectorLink Kenya incinerated all its contaminated wastes and recycled all the uncontaminated wastes. Table 9 presents the project’s waste quantification and disposal details; certificates of waste disposal from the three disposal sites are on file and available on request.

TABLE 9: SOLID WASTE QUANTIFICATION AND DISPOSAL Amount of Disposal Waste Type Disposal Site Date of Disposal Waste Method VINTZ Plastics Empty Actellic® 300CS bottles 126,688 bottles Recycling March 31–April 4, 2020 Limited Assorted polythene and other 1560 VINTZ Plastics plastic wastes including Recycling March 31–April 4, 2020 Kilograms Limited broken basins and barrels Kamongo Waste Ordinary paper and carton 7850 Recycling Paper (Kenya) April 1–3, 2020 wastes Kilograms Limited Contaminated solid wastes Environmental & (nose masks, absorbent soil 1980 Combustion for spill response, used dry Incineration April 1–3, 2020 Kilograms Consultants Limited cell batteries, contaminated (ECCL) cardboard, etc.)

5. MONITORING AND EVALUATION 5.1 DATA COLLECTION, ENTRY, AND QUALITY ASSURANCE 5.1.1 DATA COLLECTION PMI VectorLink Kenya revised the mobilization strategy from door-to-door to mass mobilization. This resulted in a complete overhaul of the mobilization data collection tools that were used in the previous campaigns. The mass mobilization data collection tools consisted of the Community Mass Mobilization Form (CMMF); Mass Mobilization Roll Call (MMRL), used for every meeting attended by the sub- location mobilizers; and the summary of the Community Mass Mobilization Progress (CMMP) at the operations site level (Table 10). The CMMF and MMRL are filled by the sub-location mobilizers, who send a summary of the data via text messages to the site coordinators to enable planning for spraying activities for each new day and updating of the site-level tool.

TABLE 10: MASS MOBILIZATION DATA COLLECTION TOOLS Tool Purpose of tool Frequency Person Responsible Community Mass Summarizes details of the Whenever a sub-location Sub-location Mobilization meeting/forum attended in terms mobilizer attended a mass mobilizer Form (CMMF) of the people reached by gender, mobilization forum. Has location of the meeting, and space to document 5 contact details of the meeting meetings. chairperson. Mass Lists the gender of each meeting Whenever a sub-location Sub-location Mobilization Roll participant and the villages they mobilizer attended a mass mobilizer Call (MMRL) came from. mobilization forum. It was filled for each forum. Community Mass Charts all the villages mobilized. Daily as per the Short Site coordinator Mobilization Messaging Service (SMS) Progress (CMMP) report from the sub- location mobilizers.

Overall, spray data collection tools were maintained from prior campaigns with minor adjustments to IRS Sticker and Daily SOP form and the introduction of IRS Sticker Tracker to enhance accountability and curb data falsification (Table 11). Notably, SOPs applied IRS stickers directly to eligible structures during the campaign, as opposed to mobilizers doing this during door-to-door mobilization in prior years. In the former campaigns where mobilizers were issuing stickers, between the time mobilizers issued a sticker to when a SOP arrived at the structure, homeowners may have removed the sticker (or due to quality issues, stickers may have fallen off by themselves), necessitating the issuance of new stickers. The improved adhesive resulted in few stickers peeling and failing off and issuance of stickers by SOPs reduced the time lapse. This change resulted in a 50% reduction (300,000 to 150,000) in the number of replenishment stickers used during the IRS 2020 campaign.

TABLE 11: SPRAY DATA COLLECTION TOOLS Person Tool Purpose Enhancements Responsible IRS Sticker To identify eligible structures, Reduced sticker size by removing SOPs provide unique structure IRS redundant details, using improved number, and document spray status adhesive and ink. IRS Sticker To track stickers issued to, used by, A newly introduced tool; SOP and SOPs, team Tracker and returned by SOP to reconcile team leader sign off during issuance leader sticker use and reduce misuse. Form and return of stickers each day. printed on the back side of the Insecticide Tracker form. The form was used to compare IRS sticker numbers used with the IRS numbers reported on Daily SOP form

Person Tool Purpose Enhancements Responsible Daily Spray To report standard VectorLink Added household head name to assist SOPs, team Operator spray data together with insecticide in structure location at re-visits, leader, form use. replaced recording of insecticide supervisors, opened from village level to structure village elder, level, and added a space for village and/or elder to sign off form as proof of mobilizers verification of spray data reported for that village.

The VectorLink team deployed a multi-modal data collection strategy for spray data capture at the SOP level. SOPs collected spray data using either paper forms or a mobile device. At the end of each workday, the team leaders verified and summarized the data onto the Team Leader Summary form and handed the forms over to the site supervisors and site coordinators for further verification. After signing off on all SOP and Team Leader Summary forms, site coordinators recorded a summary of the data onto the Spray Performance Tracking Sheet (SPTS) at the operations site. Operations site teams used the SPTS to make quick decisions on the team’s performance and insecticide consumption. The site coordinators would then hand over the forms to the sub-county M&E assistant, who would review and submit the forms to the VectorLink staff conducting supervision in that sub-county to deliver them to the data center for entry into the database. The data forms tracking booklet was designed to document the flow of the data forms from the field to the data centers. The booklet consisted of three carbon leaflets, which were signed by both the M&E assistant and the VectorLink supervisor collecting the data forms. Two signed leaflets would be torn off to accompany the forms to the data centers and signed by data entry clerks (DECs) at the data center upon receipt. The signed second leaflet would be returned to the M&E assistant to staple with the third leaflet in the field.

5.1.2 DATA ENTRY VectorLink Kenya used the VectorLink Collect DHIS 2 database for the second consecutive IRS campaign, to capture and manage IRS data. VectorLink hired 24 DECs in Migori and 31 DECs in Homa Bay to enter paper-based structure information and clean data as per the pre-defined M&E protocols. In 2019, both the mobilizer and spray data were keyed into the database. With the transition to mass mobilization this year, only the daily SOP form data were entered into the VectorLink Collect database. Furthermore, the database was programmed to accommodate SOP form changes, including the collection of insecticide mixing data at structure-level (i.e., recording the serial number of bottle opened). For data captured via smartphone, spray results were synced directly to the VectorLink Collect server at the end of each day.

5.1.3 DATA QUALITY ASSURANCE VectorLink used standardized data collection tools and provided comprehensive training for all seasonal workers, support staff, and supervisors in data collection, entry, and cleaning. For paper-based data collection, all data forms were verified by the site supervisors and M&E assistants before the forms were submitted to the data centers. In the field, the village elder or the mobilizers were to sample and authenticate the data recorded by the SOPs. DECs also verified the data forms to confirm summations before entering them into the database, and they returned forms with logical errors to the field. A double data entry system to ensure completeness of spray data was used at the data centers. The database has a variance check, duplicate finder, and mop-up tools that check the data for anomalies that must be further reviewed by both the M&E and the spray field teams. For mobile data collection, built-in form validations prevented errors at the point of collection in the field. Team leaders reviewed and synced data at the end of each day, and DECs used downstream VectorLink Collect cleaning tools to equally identify and correct duplicates. To verify the community meetings and activities mobilizers reported as attended, IEC assistants would sample a few meetings, at least one in each sub-location, and directly call the meeting’s organizer listed on the CMMF to confirm that the meeting took place and mobilization was conducted In addition, IEC assistants attended meetings that sub-location mobilizers were scheduled to attend. In 2020, VectorLink expanded its DCV activity to a total of 6,548 from 3,966. In prior year, DCVs were conducted only by M&E assistants and specific cadres of supervisors, such as VectorLink project supervisors. This year, all supervisors except team leaders were issued a smartphone loaded with DCV tools to enable them to conduct DCVs. Each supervisor was given a target of submitting at least three 22

DCVs per day; M&E assistants were to submit six DCVs per day. DCV was conducted at the structure level to ensure accuracy of data that SOPs reported from the field. Overall, VectorLink Collect spray coverage versus DCV findings differed by 2.4%, well within the +/- 5% margin.

5.2 MHEALTH In 2020, VectorLink Kenya continued to use mHealth applications to support quick decision making across different components of the program designed in Commcare, Open Data Kit (ODK), and using the DHIS 2 Android Capture applications. A total of 454 Samsung Galaxy mobile phones were installed with the relevant mHealth applications and a secure applications lock software.

5.2.1 SCALE UP OF THE VECTORLINK COLLECT DHIS 2 MOBILE INITIATIVE In 2019, VectorLink Kenya successfully implemented a SOP mobile spray data collection initiative among 30 SOPs at Dede Dispensary site in Migori County to assess the feasibility of the initiative. Based on the lessons learned, in 2020, the project scaled up the initiative to five operations sites; two in Homa Bay County and three in Migori County. It also expanded the initial focus on SOP data collection to the completion of the daily summary Team Leader Summary form and DOS forms by the team leader. A total of 143 SOPs, 23 team leaders, and 5 site supervisors received intense training on how to key in data, record GPS, use the filter process, and summarize all information in the mobile team leader summary form. A total of 1,417 DOS data submissions and about 2,880 SOP team leader summaries were made by the team leaders during the 24 days of the spray campaign in the mobile initiative sites. SOPs reported a total of 38,476 eligible structures found, of which 35,707 were sprayed, across the five operations sites.

5.2.2 DIGITIZED SUPERVISORY FORMS Digitized checklists were designed and used for supervision across the program; ODK detailed checklists used by VectorLink staff were on ODK while checklists used by MOH staff were in the Commcare application. These included (a) 4,831 morning mobilization and transport vehicle inspections to assess compliance before the teams departed for the field in the morning; (b) 11,760 homeowner preparations and checks of SOP performance to assess the passing of key messages and observe spraying at the structure level; (c) 1,209 storekeeper performance checks to ensure compliance with storage requirements and stock-keeping records; and (d) 2,768 end-of-day clean-up inspections to check compliance at wash areas. For any gaps the supervisors noted, the digitized checklists would generate daily alerts (red flags) to all supervisors and decision makers, who would then take the necessary action. The sub-county coordinators followed up with the supervisors in their sub-counties for action and/or support.

5.2.3 PERFORMANCE MANAGEMENT TRACKER Each of the 68 site coordinators received a mobile phone to submit the daily reports to Commcare HQ via Telerivet. After spray data verification on spray forms and sign off and posting of summarized data on SPTS, the site coordinators submitted the four key indicators to the Commcare HQ platform via SMS into a Performance Management Tracker (PMT). The key indicators reported in the PMT included: the number of SOPs that worked for the day, number of structures found, number of structures sprayed, and number of insecticide bottles/sachets used during the campaign. VectorLink technical team and county level supervisors used the PMT to provide VectorLink management team and county level supervisor’s real time data to facilitate quick decision making.

5.2.4 JOB AID MESSAGES The M&E manager and the technical team designed messages sent as job alerts to the different cadres of seasonal staff in both English and Dholuo languages. These messages spanned different aspects of the project, including finance and administration, IEC/BCC, operations, M&E, environmental compliance, and gender. The main objective was to reinforce and enhance compliance during the campaign. For example, “Data falsification and insecticide pilferage is a crime and is not tolerated in the project and will result in dismissal and forfeiting of all accrued unpaid dues” was sent to spray team supervisors, SOPs, team leaders, and mobilizers every week on Tuesday, Thursday, and Saturday; “Be sure to observe each of your team members daily while spraying for IRS spraying technique compliance. Correct, where necessary” was sent to team leaders each Monday and Wednesday.

5.3 RESULTS Overall, VectorLink Kenya found 482,831 structures, sprayed 436,472 structures, and protected 1,792,495 people (Table 12). A total of 46,359 found structures were not sprayed: 34,425 in Homa Bay County and 11,934 in Migori County.

TABLE 12: SPRAY COVERAGE BY SUB-COUNTY

Spray- Spray- Total Children <5 Pregnant Structures Structures Structures Structures Spray Population Population Females Males Years Old Women Sub-County Targeted Found Sprayed Not Sprayed Coverage Found Protected Protected Protected Protected Protected HOMA BAY COUNTY Homabay Township Sub-County 18,838 23,774 20,823 2,951 87.6% 101,765 91,703 46,090 45,613 8,965 2,387 Ndhiwa Sub-County 39,744 53,919 46,111 7,808 85.5% 214,637 184,737 90,513 94,224 24,436 4,626 Rachuonyo East Sub-County 25,478 32,995 29,120 3,875 88.3% 133,382 120,786 61,028 59,758 12,042 2,385 Rachuonyo North Sub-County 38,207 45,174 41,531 3,643 91.9% 189,807 175,880 84,349 91,531 18,969 3,507 Rachuonyo South Sub-County 27,430 35,572 31,256 4,316 87.9% 131,365 117,176 58,123 59,053 11,560 1,807 Rangwe Sub-County 21,075 28,251 24,944 3,307 88.3% 117,727 104,362 50,323 54,039 11,933 2,048 Suba North Sub-County 20,939 25,738 22,917 2,821 89.0% 105,187 95,133 46,870 48,263 10,727 2,123 Suba South Sub-County 26,381 30,566 24,862 5,704 81.3% 118,499 97,672 48,423 49,249 12,151 2,068 Sub-Total 218,092 275,989 241,564 34,425 87.5% 1,112,369 987,449 485,719 501,730 110,783 20,951 MIGORI COUNTY Awendo Sub-County 25,137 31,510 29,557 1,953 93.8% 127,526 120,911 58,463 62,448 14,585 2,657 Nyatike Sub-County 33,812 39,987 37,505 2,482 93.8% 162,104 152,934 76,276 76,658 20,120 4,031 Rongo Sub-County 24,648 30,926 28,921 2,005 93.5% 131,893 123,448 60,114 63,334 13,355 2,576 Suna East Sub-County 25,464 30,743 29,641 1,102 96.4% 128,419 124,041 60,861 63,180 15,123 3,378 Suna West Sub-County 23,502 28,718 27,059 1,659 94.2% 113,491 107,617 54,370 53,247 16,227 3,126 Uriri Sub-County 33,984 44,958 42,225 2,733 93.9% 186,256 176,095 87,740 88,355 21,675 4,008 Sub-Total 166,547 206,842 194,908 11,934 94.2% 849,689 805,046 397,824 407,222 101,085 19,776 Grand Total 384,639 482,831 436,472 46,359 90.4% 1,962,058 1,792,495 883,543 908,952 211,868 40,727

The three leading reasons for non-spray were refusals, structures with sick people who could not leave the structures, and structures found to be locked when SOPs arrived at them to spray (Figures 4 and 5).

FIGURE 4: REASONS FOR NON-SPRAY HOMA FIGURE 5: REASONS FOR NON-SPRAY MIGORI BAY COUNTY COUNTY

In 2020, SOPs sprayed an average of 10 structures per day and 3.4 structures per bottle of insecticide.

TABLE 13: INSECTICIDE BURN RATE AND SOP PERFORMANCE BY SUB-COUNTY Sub-County Structures Spray Insecticide Number of Structures Sprayed Burn Rate ed Bottles Used SOPs per SOP per Day HOMA BAY COUNTY Homabay Township Sub-County 20,823 6,297 87 10 3.3 Ndhiwa Sub-County 46,111 12,915 184 10 3.6 Rachuonyo East Sub-County 29,120 8,692 118 10 3.4 Rachuonyo North Sub-County 41,531 13,285 177 10 3.1 Rachuonyo South Sub-County 31,256 9,594 127 10 3.3 Rangwe Sub-County 24,944 7,068 97 11 3.5 Suba North Sub-County 22,917 7,403 97 10 3.1 Suba South Sub-County 24,862 7,390 122 8 3.4 Sub-Total 241,564 72,644 1,009 10 3.3 MIGORI COUNTY Awendo Sub-County 29,557 8,132 116 11 3.6 Nyatike Sub-County 37,505 11,089 156 10 3.4 Rongo Sub-County 28,921 7,483 114 11 3.9 Suna East Sub-County 29,641 7,818 118 10 3.8 Suna West Sub-County 27,059 7,917 109 10 3.4 Uriri Sub-County 42,225 11,617 158 11 3.6 Sub-Total 194,908 54,056 771 11 3.6 Grand Total 436,472 126,700 1,780 10 3.4

Malaria epidemiological data demonstrate the number of malaria cases reported at the health facilities in the counties where IRS was implemented. Figure 6 shows a decline in the number of malaria cases reported since reintroduction of IRS in 2017 in Migori and 2018 in Homa Bay through 2019.

FIGURE 6: MALARIA CASES BASED ON EPIDEMIOLOGICAL DATA FROM MIGORI AND HOMA BAY COUNTIES, 2010–2020

Source: Kenya Health Information Software, accessed in April 2020 The Monitoring and Evaluation Plan Indicator Matrix (Annex B) shows how VectorLink Kenya has performed on the standard project-wide indicators.

6. CHALLENGES, LESSONS LEARNED, AND RECOMMENDATIONS

6.1 CHALLENGES • The coronavirus pandemic: On March 11, 2020, WHO announced the global pandemic. On March 15, just as the project began the last week of spray in Migori, the Kenya Government announced closing of schools. The project had planned to spray educational institutions (e.g., universities, boarding schools, colleges) in the last two days of the spray campaign; however, with schools and dormitories closed, there was no one to open them for spray. PMI and WHO issued guidance supporting the continuation of IRS as an essential public health intervention on March 25 and April 10, respectively. Prior to the guidance, DNMP had informed VectorLink that it supported the continuation and completion of the 2020 campaign through March 16-21, the final week of spray, despite the WHO pandemic announcement. • Replacing door-to-door mobilization with mass mobilization: Some households were not prepared for spray on the spray date because the community members claimed they had not been visited by a mobilizer as in previous years nor had heard the spray dates announced. VectorLink hired and trained mobilizers who were embedded with the spray teams to assist with actual spray day mobilization and house hold preparation. Nevertheless, there were times that SOPs had to conduct household preparation, which slowed their daily progress. • Refusals and locked structure: Locked households were encountered in areas of the Homa Bay sub-counties of Rangwe, Ndhiwa, Rachuonyo North, and Rachuonyo South because the harvest season was going on simultaneously. Sacks of maize were stored in rooms of eligible structures, making it impossible for SOPs to spray. Also, during the second week of spray, Seventh Day Adventists in areas of Homa Bay were in a week of prayer, and these homeowners would not agree to remove household items to prepare their structures for spray. Other refusals were due to beliefs that insecticide brings bedbugs, smells, and wall discoloration despite having mobilizers, administration leaders and supervisors addressing these misconceptions. • Undocumented found structures: Even though there was improved documentation of found but not sprayed structures, as supported by DCV reports and direct supervision of spray teams, unmarked, unsprayed structures were still found. Emphasis was laid on this especially in the last week of the campaign, to ensure all structures found were well documented whether sprayed or not. • Missing villages in the spray calendar: VectorLink uses an official list of villages provided by the MOH and Ministry of Interior & Coordination of National Government offices, yet a few SOPS reported data from villages that were not in the spray calendar nor the VectorLink Collect database. Some of these villages existed but were not on the list while others were newly established and were not yet gazetted and listed. The local administration assured the project that these villages would be officially listed by the next spray cycle. • Duplicated IRS numbers: Some Daily SOP forms were submitted with duplicate IRS numbers and some stickers were identified as having duplicate IRS numbers and blanks. This was also experienced in the mobile data collection sites. • Spray team movements limited by mode of data collection. With the implementation of a multi-modal data collection strategy across operations sites, it was difficult to reassign teams using mobile data collection in real-time to work in other geographic areas. Because the mobile devices were configured per SOP to only capture data for a defined list of villages based on the

operations site catchment, if spray teams from mobile sites needed to be reallocated to support neighboring sites during IRS, the teams needed to switch to paper-based collection. • Walk to Work strategy: The new spray calendar that allocated spray teams to specific villages meant some teams would require vehicular transportation throughout campaign, especially in sub-counties with difficult terrain, like Rachuonyo North, Ndhiwa, and Suba South in Homa Bay County and Nyatike in Migori. In such terrain, walking was cumbersome. In such situations, vehicles use during rest days was prioritized for spray teams in far and difficult terrain areas. • Weather affecting spray progress and data flow: Unexpectedly heavy rainfall in North Kadem and Aneko sub-locations in Nyatike Sub-County, Migori, caused flooding and impassable roads, which limited the movement of some teams. It also delayed some data collection by the M&E assistants since the forms would be rained on leading to late submission.

6.2 LESSONS LEARNED • The mobilizers comprised CHVs and village elders. Use of village elders resulted in higher acceptance of IRS in the villages they mobilized. They were also effective in addressing refusals. • For the mobile data collection operations sites, taking photos of the stickers using smartphones shortened the time it would have taken to resolve duplicated IRS number queries. However, some homeowners got uneasy, especially when the SOPs did not explain why they were taking the photos. Capturing the GPS coordinates for the structures made it easy for the M&E team and supervisors to locate these structures during re-visits. Maps showing sprayed and non- sprayed structures enhanced the knowledge of which areas to focus on during the campaign. • Homeowner unpreparedness on the day of spray forced SOPs to assist with home preparation and slowed their spray progress. The embedded and sub-location mobilizers were of great help in assisting in household preparation, especially when they were known to the homeowner, and their help saved SOP time. In some villages, the use of megaphones to announce the impending arrival of spray teams had a negative effect, with some homeowners hiding from the teams. In these areas, mobilizers minimized their use of megaphones. • Issuance of stickers by the SOPs reduced waste by minimizing the time between mounting of the stickers and actual spray. The accountability enhanced by the use of the IRS Sticker Tracker reduced insecticide waste and loss among SOPs. • Sorting of stickers and arrangement by serial number at all levels, from the production point to the satellite stores at issuance, minimized cases with duplicates and blank IRS numbers. • The use of pens in filling out data collection forms promoted awareness among the SOPs and prevented their erasure and possible, falsifying data that used to be common when entered in pencil. To correct errors, SOPs were instructed to cross once and countersign with a date, ensuring the former entries remained visible. • Targeted mop-ups worked well in achieving spray coverage. Based on the list of non-sprayed structures from the VectorLink Collect database and alerts from the mobilizers, teams made re- visits to areas that had been missed earlier in the campaign in both counties. • Development of spray calendars per team per sub-location made it easy for team leaders to allocate structures to the SOPs with assistance from the embedded mobilizer. This improved documentation of the found structures whether sprayed or not. It also made it easy to follow up on the missed structures. • The pull system for insecticide distribution worked well in curbing insecticide pilferage. • Engaging mobilizers who are familiar with the areas in which they worked increased the community’s acceptance of IRS. Engaging CHVs as embedded mobilizers was more effective than having embedded mobilizers who commuted daily to the villages without a transportation allowance

6.3 RECOMMENDATIONS • Mass mobilization should be implemented in 2021, supplemented with door-to-door mobilization by sub-location mobilizers where a majority of the population does not participate in community meetings. The number of sub-location mobilizers should be determined by the number of villages in the sub-location and vastness of these sub-locations. The number of embedded mobilizers should also be increased for the vast sub-locations. • Given the success the project had engaging village elders and administrative leaders, especially in refusal hot spots, more of elders should be involved in future mobilization activities. This will enhance acceptance in the community. • PMI VectorLink will continue to emphasize in SOP and team leader training the importance of documenting all found structures, sprayed or not. Supervisors will also be reminded to check on this regularly as they conduct the DCVs. • The Walk to Work strategy will require more operations sites or mapping of areas that are more suitable instead of a blanket application across all sites to minimize fatigue among the spray teams. The schedule for vehicle resting days will be incorporated into the spray calendars. • Scale-up of the mobile data collection to five sites was a success. We recommend further scale-up of the initiative, ideally to a campaign-wide implementation. This would result in real-time, structure-level data available for operations decision-making every single day across the IRS campaign. Feasibility of a full-scale roll out will depend on resource availability, and will require procurement of mobile devices, back-up power supplies, protective cases, and data bundles. The project will re-envision the M&E seasonal staff organization hierarchy to place greater emphasis on in-field support, with lean data center personnel for minimal data cleaning activities. Significant up-front investments will be required, however costs in subsequent years will be much lower to maintain the mobile-based reporting system.

ANNEX A: ENVIRONMENTAL MITIGATION AND MONITORING REPORT (EMMR) Implementing Organization: Abt Associates Inc. Geographic Location of USAID-funded activities: Homa Bay and Migori Counties, Kenya Period covered by this Report: 2019/20

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 1a. Insecticide selection for any USAID- An organophosphate insecticide (Actellic® 300CS) that is supported malaria program is subject to the WHO-recommended for IRS was used for the 2020 spray criteria listed in the USAID Programmatic campaign in Homa Bay and Migori counties and in line with Environmental Assessment, country SEAs, Kenya’s 2017–2021 SEA as approved by USAID/PMI. and host-country requirements. 1b. Procurement and inventory logs must be Insecticide quantification for spray operations in the two maintained. counties informed their requisition via international procurement. Required importation permits and clearance documentation were availed and delivery documents submitted upon receipt of the 116,352 imported bottles of Actellic® 300CS insecticide. 1c. Ensure storage facility and personal County warehouses and operations site stores used to store protective equipment (PPE) are appropriate the organophosphate insecticide were equipped with adequate for the active ingredient used and in overalls, nose masks, rubber gloves, safety goggles, and accordance with approved SOPs. gumboots for use by storekeepers and logistics personnel. Such storage facilities were selected in areas located away from floods or sensitive receptors, and on secure structures with adequate lighting and ventilation. 1d. Distribute insecticides to facilities that can Distribution of the insecticide was in three tiers with chain of A few of the operations site stores selected for For future IRS campaigns in affected sites manage such commodities safely in storage, custody and stock management documents at each level, from storage of insecticide, empty bottles, and in the two counties e.g., Migori County use, and disposal (i.e., in a manner generally the main warehouse in Kisumu to respective county contaminated wastes were small in size and Referral Hospital and Bware operations equivalent to Implementing Partner’s own warehouses and finally to operations site stores. All thereby filled up before the end of the two- sites in Migori and Kitare operations site SOPs/WMP) storekeepers, and warehouse and logistics assistants were week period scheduled for start of reverse in Homa Bay, a logistical plan needs to trained together in each county on safe handling, storage, logistics. put in place to collect solid wastes from transport, and management of wastes arising from the use of these storerooms at an interval of less the organophosphate insecticide. than two weeks.

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 2a. Inspect and certify vehicles used for Pre-contract inspections of vehicles used for IRS operations Some vehicle vendors experienced mechanical For future IRS campaigns, the insecticide or team transport prior to were conducted at the sub-county level at selected operations breakdowns of a few vehicles already certified environmental compliance team will contract. sites on December 9–20, 2019. The vehicles were re-inspected for IRS and the drop-out of some trained continue to advocate for vehicle vendors prior to certification between January 20 and February 7, drivers; in response, they replaced the vehicles to have back-up vehicles and drivers 2020, for compliance with PMI VectorLink Project and drivers. Often, the affected vendors failed standing by for inspection and requirements. A total of 217 vehicles were hired to transport to report such changes in a timely manner to certification /training for each operations supervisors, SOPs, and logistics to support the 2020 IRS the environmental compliance team, and as a site to minimize the challenges operations. result, turnaround time for site inspection of a experienced in 2020. replacement vehicle or on-the-job training for a new driver took up to two days. 2b. Train drivers The drivers’ safety training was decentralized and conducted Some of the trained drivers failed to turn up for A centralized drivers’ safety training for at the sub-county level on February 3–6, 2020, in Homa Bay the spray operations on day 1 and a few IRS would enable the trainer(s) to address and on February 17–20, 2020, in Migori. All 217 drivers dropped out during the campaign. The common problems, challenges, and whose vehicles were inspected and certified for IRS operations team with guidance from the ECO FAQs, thereby reducing the number of operations were trained on safety issues such as observing provided an on-job safety training for all trainees who drop out as well as those speed limits, maximum vehicle carrying capacity, proper use replacement drivers. who fail to follow correct procedures as a of PPE, spill and emergency response procedures, and Abt’s Some drivers were reluctant to decontaminate result of information becoming distorted policy on motor vehicle use during the IRS campaign. The their vehicles at the end of each spray day, in decentralized training. project sexual harassment guidelines were also incorporated in forcing the site coordinators and supervisors to the drivers’ training. personally oversee such clean-up for compliance. 2c. Ensure availability of cell phone, personal All the 217 trained drivers provided their cell phone contacts, protective equipment (PPE) and spill kits which were shared with the site coordinators at each during insecticide transportation. operations site. Storekeepers at each operations site and warehouses provided PPE and spill response kits for all logistics and spray team vehicles. 2d. Initial and 30-day pregnancy testing for All female SOPs, site coordinators, storekeepers, pump Medical supplies for pregnancy testing were female candidates for jobs with potential technicians, and washers underwent pregnancy tests at insufficient in most public health centers. This insecticide contact. selected health centers in Homa Bay and Migori counties on forced the project to pre-pay for the service January 27–31, 2020, and February 10–14, 2020, respectively. charge per head to enable the MOH to procure Those who tested positive were re-assigned to positions that the supplies in time for the pregnancy testing. did not expose them to the insecticide, mostly as mobilizers. 2e. Health test all spray team members for All SOPs, washers, pump technicians, site coordinators, and Out of a total of 2,443 seasonal workers duty fitness. storekeepers underwent a medical fitness examination at examined for duty fitness and pregnancy, selected health centers in Homa Bay and Migori counties on 21 were found unfit and were assigned January 27–30, 2020, and February 10–13, 2020, respectively. other duties that did not expose them They were examined for physical fitness, respiratory directly to the insecticide. problems, and allergic reactions to the insecticide.

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 2f. Procure, distribute, and train all workers Local and international procurement of all the required PPE with potential insecticide contact on the use and IRS commodities was done well in advance and the items of PPE. were distributed to the operations sites a week before the SOP training. This timely provision enabled the training of spray teams starting with the ToT workshop and cascading down to the training of seasonal workers on matters of safety, hygiene, and personal protection against potential insecticide exposures, incidents, and accidents. 2g. Train operators on mixing insecticides The ToT workshop emphasized pump maintenance and Several operations sites in Migori and Homa For future campaigns, additional CFVs and the proper use and maintenance of correct insecticide mixing procedures. The same training was Bay reported issues of clogged control flow should be procured as a buffer to replace application equipment. cascaded down to the SOPs and pump technicians training valves (CFVs). CFVs that becomes clogged as a result of with specific illustrations on how to properly clean the spray a malfunction and cannot be pump using the triple rinsing procedure and ensuring cleaning fixed/unclogged through cleaning. of pump parts. 2h. Provide adequate facilities and supplies Proper site repairs and refurbishments were done in all 68 for end-of-day clean-up. operations sites in Migori and Homa Bay in line with the site needs assessment that was conducted during the pre-spray period. All sites had fenced-off wash areas with an adjacent soak pit to manage any IRS waste water arising from cleaning of PPEs and spray pumps. Two separate temporary bathing units covered with canvas sheets were provided in each site, so that male and female spray team members could bathe at the end of each spray day. Enough plastic basins and barrels, soap, and water were provided for the end-of-spray day clean- up. 2i. Enforce application and clean-up Supervisors at the site, sub-county, and county led the mHealth supervision reports indicated that Future IRS campaigns need to reinforce procedures. monitoring and enforcement of clean-up procedures. Directly some team leaders were busy compiling daily the importance of adequate supportive observed end-of-day clean-up supervisors, aided by summary reports instead of monitoring their supervision of spray and clean-up smartphone checklists, were conducted daily by team leaders team members during the end-of-day clean-up. procedures during the ToT workshop, and field supervisors from the MOH, VectorLink Kenya, and As a result, there were reported cases of clogged and team leader and pump technician NEMA. CFVs arising from improper cleaning of the training. pump part. Out of the 615 end-of-day clean-up inspections carried out in both counties, three reported issues of team leaders not supervising the clean-up process.

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 3a. Implement Information, Education and IEC on IRS key messages was carried out mainly through A number of households in Homa Bay and For future IRS campaigns, a combination Communication (IEC) campaigns to inform mass sensitization and mass mobilization and periodically Migori counties reported not being reached of both mass and door-to-door homeowners of responsibilities and reinforced through media using local Dholuo-language radio with sensitization or mobilization key mobilization would better serve in the precautions, including washing itchy skin and stations. Such IEC strategies focused on key messages about messaging about the 2020 IRS campaign. This delivery of key messages for an IRS going to a health clinic if symptoms develop homeowner responsibilities before, during, and after spraying presented challenges with household campaign and have as many targeted and do not subside. of the houses. preparation; since some households were not households prepared for the spraying on prepared for spraying when SOPs made their the announced day(s) when SOPs visit scheduled visit, they had to be skipped and their villages. marked for a re-visit. For those who were If mass mobilization is again adopted as willing to have their houses sprayed, SOPs and the main strategy, it should be emphasized mobilizers assisted in house preparation. to homeowners that door-to-door mobilization will not be conducted so that they do not postpone spraying of their structures while they wait for mobilizers to physically present for one-on-one IRS messaging. 3b. Ensure health facility staff are aware of The orientation of health care workers on management of IRS insecticide poisoning management. insecticide poisoning as well as other IRS-related incidents and/or accidents was decentralized and conducted at the operations site level in Homa Bay and Migori counties on January 20–24, 2020, and February 3–7, 2020, respectively. 4a. Storage facilities and transportation All insecticide storage rooms in the 68 IRS operations sites vehicles must be physically secured to prevent were located in fenced and gated premises with double locks theft. on the door leading to the separate insecticide room. Two trained security guards manned each of the stores 24 hours a day, one during the day and the other at night. Logistics vehicles that transported insecticide and empty bottles to and from the operations sites were either fully metal-covered trucks or had lockable metal roll cages to secure the insecticide while in transit. 4b. Maintain records of all insecticide An elaborate supply chain system was established by the At the point of receipt of insecticide, receipts, issuance, and return of empty project to manage receipt and dispatch of insecticide from the empty bottles, and other IRS containers. Kisumu main warehouse to the Homa Bay and Migori central commodities, a mandatory physical count warehouses and on to the 68 site stores. The same system of the delivered commodities was tracked dispatch and receipt of empty bottles and other IRS enforced to enhance accountability. commodities. Stock-keeping and inventory control documents maintained at the various levels included ledger books, GRNs, delivery notes, GINs, stock cards, and serialized Insecticide Tracker sheets and booklets.

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 4c. Conduct analysis comparing number of MOH site supervisors and VectorLink site coordinators houses treated vs. number of containers used. updated the PMT sheet on a daily basis after verify the insecticide burn rate for each team based on information on the Team Leader Summary forms. A PMT sheet was provided at each operations site to track daily spray performance per team and provide a reconciliation of number of structures sprayed vs. number of insecticide bottles used by the spray teams. 4d. Examine houses treated to confirm Enhanced smartphone-aided DCV inspections at individual In some instances, supervisors had challenges in Supervisors were advised to use a application. structures in targeted spray areas were conducted by all IRS recognizing the actual spray status. This was combination of evidence of spray supervisors from the VectorLink Kenya staff, MOH, and common where insecticide residue was invisible including interviewing the homeowner. NEMA a day after SOPs sprayed an area. The DCV reports due to wall type, or the door marking was For future IRS campaigns, it will be checked on the actual situation on the ground for sprayed and rubbed off and the SOP signed the sticker emphasized to SOPs to maintain signing unsprayed structures vs what the SOPs reported in the data despite the spray status. of the stickers only after spraying the forms. Where applicable, the DCVs gathered information on structures. the date of spray, evidence of spray, and structure population information. 4e. Perform physical inventory counts during Storekeeper performance inspections guided by a smartphone For future IRS campaigns, storekeepers the application season. checklist were conducted on a daily basis by supervisors at who join the project for the first time each of the 68 IRS operations site storerooms to physically need sufficient in-house and on-job verify all commodity stocks against the records indicated by training on inventory control and the storekeepers on the stock cards, ledger books, and other management, which includes proper inventory control documents. house and record-keeping. They also require focused support on their areas of weakness when supervisors conduct a storekeeper performance inspection and physical inventory verification. 5a. For shipments of insecticide over water, The 2020 IRS campaign in Migori and Homa Bay was sachets/ bottles will be packed in 220 liter conducted on the mainland only and therefore all the open-top barrels with a water-tight top and a insecticide was transported and distributed via road. No water locking ring, or in a similar durable container. crossing was done. Waterproof labeling must be affixed to the barrel, with the identity of the pesticide, number of bottles inside, the weight, the type of hazard posed by the contents, and the PPE to be worn when handling the barrel.

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 5b. Train applicators on the SEA operational Environmental health, SOP, and homeowner safety requirements, SOPs, PMI BMPs, and requirements and procedures as provided in the approved approved WMP developed for the safe and VectorLink Kenya 2017–2021 SEA, the PMI BMPs for IRS, effective storage, distribution, application, as well as the project’s WMP were included in the training of and disposal of insecticides. SOPs and other spray team members including washers, pump technicians, drivers, and all supervisors. 5c. Ensure application equipment and PPE With pirimiphos-methyl as an active ingredient in the Prior to their training, SOPs went to the are appropriate for the active ingredient used organophosphate insecticide (Actellic® 300CS) used for IRS in operations site stores to conduct a PPE and in accordance with approved SOPs, and Homa Bay and Migori, Hudson X-Pert sprayers were used dress rehearsal to ensure that the PPE at maintain equipment to avoid leaks. along with the procured PPE that included helmets with face the sites for their training and use during shields, neck cloths, nose masks, coveralls, and gumboots. the application period were of the correct Spare tool kits were also available to assist the pump sizes. technicians with repair and maintenance of the Hudson sprayers. 5d. Maintain application equipment. A total of 68 pump technicians were recruited and trained on The pump technicians had a one-day For future IRS campaigns, pump the repair and maintenance of the Hudson X-pert sprayer orientation since a majority of them had technicians training days need to be pumps in Homa Bay and Migori counties, one pump previously worked on the project in the same reviewed to allow the technicians, technician for each operations site. capacity. The very few new ones were at a especially newly recruited ones, to interact disadvantage in doing both the theoretical and with the pumps and pump parts and practical orientation in a day. understand how to repair and maintain the pumps. 5e. No application of insecticides within 30 During their five-day training, SOPs were instructed not to yards of beekeeping sites. spray structures within 30 meters of beekeeping sites and other sensitive ecosystems. Considering that Homa Bay and Migori counties border Lake Victoria, all structures within 30 meters of the highest water mark of the lake were earmarked and skipped during IRS. This was achieved with enforcement and support supervision that was provided by all the team leaders and supervisors. 6a. Handling, treatment, and disposal of In October 2019, the VectorLink Kenya ECO conducted a 1,980 kg of IRS contaminated wastes were nonhazardous (general waste) and hazardous pre-disposal visit to the identified IRS solid waste disposal disposed of at ECCL incineration facility wastes must be in accordance with the facilities and inspected their compliance with the PMI BMPs in Migori. 7,850 kg of ordinary paper and approved WMP/SOPs and the PMI BMPs. and NEMA requirements. During this inspection, memoranda carton wastes were recycled at Kamongo The WMP, which outlines SOPs for of understanding for collection and environmentally safe Waste Paper Ltd. 126,688 empty Actellic® managing waste processes, must be in disposal of IRS contaminated and uncontaminated solid 300CS bottles and 1,560 kilograms of accordance with PMI BMPs and host-country wastes were effected between VectorLink Kenya and ECCL, polythene and other plastic wastes were requirements VINTZ Plastics Ltd, and Kamongo Waste Paper Ltd as per recycled at VINTZ Plastics Ltd. SOPs outlined in the approved WMP for VectorLink Kenya. Incineration and recycling certificates are attached as addendum to this EMMR.

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 6b. Choose sites for disposal of liquid wastes, All 28 operations sites used in Migori County for the 2018 Several soak pits were periodically reported to For Homa Bay County, all the fixed soak including fixed and mobile soak pit sites and 2019 IRS campaigns were retained, repaired, and have formed a puddle and drained slowly pits have served for more than two IRS according to PMI BMPs refurbished for use in the 2020 spray campaign. In Homa Bay, during or after the PPE and end-of-day clean- campaigns and are due for an overhaul in all 40 IRS operations sites used in the 2019 campaign were up activities. For Homa Bay, these soak pits are preparation for the next spray campaign. retained, repaired, and refurbished for the 2020 spray located at Omboga, Nyamrisra, Sino, and Got The soak pit at Omboga site has reported campaign. A total of 68 operations sites in both counties were Kojowi operations sites. For Migori, these soak slow drainage since 2018 and will be assessed for environmental compliance as per the provisions pits are located at Agenga and Bware operations earmarked for relocation if needed. The of the PMI BMPs for IRS and were greenlighted for the 2020 sites. two soak pits in Migori will be inspected IRS campaign. during site repairs in preparation for the next spray campaign and repaired accordingly to address the slow drainage. 6c. Construct fixed and mobile soak pits with Fixed soak pits set up adjacent to cemented wash area slabs charcoal according to the BMPs to adsorb were used to manage IRS waste water. All 71 soak pits in the insecticide from rinse water. 68 operations sites in Homa Bay and Migori were built and filled with wood shavings, charcoal, stones, and gravel as filter media for the waste water; the charcoal was the main absorbent material for the insecticide from the rinse water. 6d. Maintain soak pits as necessary during the All soak pits and wash area surroundings were cleared of After IRS, the soak pits were securely season. vegetation before during and after the IRS campaign. Each covered, wash areas locked, and the area plastic pipe retrofitted onto the soak pits was unclogged within and around the soak pits and regularly to ensure uniform distribution of effluent over the bathing areas cleared of vegetation filter media. periodically and at least once a month. 6e. Monitor waste storage and management Solid wastes (contaminated and uncontaminated) were A few of the operations site stores were small in during campaign. segregated and stored separately at the operations site size and filled up with solid wastes before the storerooms. Proper documentation of the wastes was kept, end of the two-week period scheduled by the including stock/bin cards and goods issue notes, when logistics team for the start of reverse logistics. transferring the wastes from the stores to the central This forced the logistics team to arrange for warehouses in Migori and Homa Bay. The waste containers frequent collection of the wastes from such were also clearly labelled, indicating the type and quantity of storerooms. the waste where applicable.

Outstanding Issues Relating to Required Mitigation Measure Status of Mitigation Measures Conditions Remarks 6f. Monitor disposal procedures post- The VectorLink Kenya ECO oversaw the destruction and IRS solid waste disposal certificates are campaign recycling of all uncontaminated paper/carton wastes as well as attached as addendum to this EMMR. plastic/polythene wastes at Kamongo Wastepaper Ltd and VINTZ Plastics Ltd, respectively, March 31-April 4, 2020. Both recycling facilities are licensed by NEMA and certified by the Directorate of Occupational Safety and Health Services. The ECO also provided oversight and guidance on the collection and incineration of all IRS contaminated wastes at the ECCL facility in Migori, a private facility licensed by NEMA to incinerate hazardous wastes. All 1,980 kgs of IRS contaminated wastes were thermally destroyed on April 1-3, 2020. 7a. Wastes will only be disposed in ECCL’s incineration facility in Nairobi and the EASL incinerators that comply with PMI BMPs. incineration facility in Migori are privately owned, NEMA- Collect and maintain treatment and disposal licensed facilities, and the only incinerators in Kenya that meet documents and records on file all the requirements of the PMI BMPs for incineration of IRS contaminated solid wastes. ECCL entered into a memorandum of understanding with VectorLink Kenya for collection and disposal of all contaminated solid wastes. 7b. Country-level USAID environmental The VectorLink Kenya project work plan, Letter Report, and compliance documentation must contain WMP as approved by PMI/USAID contained and provided guidance on proper disposal of wastes guidance for proper solid and liquid waste disposal for the 2020 IRS campaign. Certificates of solid wastes destruction after the 2020 spray campaign are on file and available upon request.

ANNEX B: MONITORING AND EVALUATION INDICATOR MATRIX

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result Objective 1: Implementation of Malaria Vector Control (VC) Interventions 1.1 Successfully Execute IRS and Other Integrated Malaria VC Activities Number and percentage of Project records Country completed annual country 1.1.1 X 1 1 N/A N/A N/A N/A N/A N/A N/A N/A work plans developed and Annually submitted on-time Number of eligible structures Project records Country Project records 465,862 551,689 384,639 482,831 1.1.2 TBD TBD TBD targeted for spraying Annually Annually Number of eligible structures Project records Country Project records 395,983 507,777 326,943 436,472 1.1.3 sprayed with IRS[1] Annually Annually Percentage of total structures Project records Country Project records 85% 92.0% 85% 90.4% TBD TBD TBD targeted for spraying that were 1.1.4 sprayed with a residual Annually Annually insecticide (Spray Coverage) Project records Country Project records 1,914,537 2,011,860 1,930,279 1,792,495 Sex Annually Pregnant women Annually Female: Children <5 883,543 (49.3%); Male: 908,952 (50.7%) Number of people protected 1.1.5 TBD TBD TBD by IRS Pregnant women: 40,727

Children under 5: 211,868 Number and percentage of Project records Country vector control project country programs submitting an Annually 1.1.6 X 1 1 N/A N/A TBD TBD TBD EOSR within 45 days after the end of spray (including completing MEP and EMMR) 1.1.7 Number and percentage of X Data Collection Country 1 1 N/A N/A

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result IRS country programs that Forms conduct a Post-Spray Data Quality Audit within 90 days Annually of spray completion Number of Insecticide Project Records 1.1.8 Treated Nets (ITNs) Annually Channel N/A N/A N/A 0 TBD TBD TBD distributed, by channel Number and percentage of Project Records countries completing ITN 1.1.9 durability monitoring data X Annually Country N/A N/A N/A N/A TBD TBD TBD collection as planned in a given project year Number and percentage of Project Records Country PMI-funded durability Country monitoring surveys with Annually 1.1.10 X N/A N/A N/A N/A TBD TBD TBD reports submitted within 90 days of the end of data collection 1.2 Strengthen Capacity of NMCPs, VC Personnel, and Other Institutions to Implement and Manage IRS and Other VC Activities Project Training 5,12810 Total Records Male: 2,578 Total number of people Country (50.3%) 1.2.1 trained to support VC in VC Intervention 6,5457 6,5718 5,1859 TBD TBD TBD Annually target areas Sex Female: 2,550 Job Function (49.7%) 1.2.2 Total number of people Project Training Total 6,54511 2,87012 5,18513 2,30914 TBD TBD TBD

7 208 supervisors, 2,111 SOPs, 325 spray operator TLs, 2617 mobilizers, 111 IEC supervisors, 4 IEC assistants, 70 storekeepers, 66 site coordinators, 66 pump technicians, 170 washers, 134 security guards, 241 drivers, 31 M&E assistants, 108 DECs, 2 EC assistants, 2 Logistics assistants, 3 warehouse assistants, 14 F&A clerks, 264 HCWs 8 215 supervisors, 2,158 SOPs, 325 spray operator TLs, 139 standby SOPs, 2596 mobilizers, 87 IEC supervisors, 4 IEC assistants, 72 storekeepers, 68 site coordinators, 7 stand by site coordinators, 68 pump technicians, 179 washers, 137 security guards, 232 drivers, 21 M&E assistants, 10 standby M&E Assistants, 2 IT/mHealth assistants, 76 DECs, 10 standby DECs, 2 EC assistants, 2 Logistics assistants, 2 warehouse assistants, 17 F&A clerks, 197 HCWs (Magunga Re-spray: 8 supervisors, 42 SOPs, 7 SOP TLs, 46 mobilizers, 2 IEC supervisors, 1 storekeeper, 1 site coordinator, 1 pump technician, 4 washers, 2 security Guards, 5 drivers, 1 M&E assistant, 3 DECs, 2 HCWs)s 9 208 supervisors, 1,781 SOPs, 297 SOP TLs, 1,929 mobilizers, 14 IEC assistants, 72 storekeepers, 68 site coordinators, 68 pump technicians, 158 washers, 137 security guards, 216 drivers, 20 M&E assistants, 2 IT/mHealth Assistants, 55 DECs, 2 EC assistants, 2 Logistics assistants, 2 warehouse assistants, 18 F&A clerks, 136 HCWs 10 164 supervisors, 1780 SOPs, 297 SOP TLs, 1,930 Mobilizers, 14 IEC assistants, 72 Storekeepers, 68 Site Coordinators, 68 Pump technician, 159 Washers, 137 Security Guards, 18 Sub County M&E Assistants, 2 County M&E Assistants, 2 IT/mHealth Assistants, 53 DECs, 2 DEC Team Leads, 2 EC Assistants, 2 Logistics assistants, 2 Warehouse assistants, 210 Drivers, 16 Sub County F&A Assistants, 2 County F&A Assistants, 128 HCWs 11 208 supervisors, 2,111 SOPs, 325 spray operator TLs, 2617 mobilizers, 111 IEC supervisors, 4 IEC assistants, 70 storekeepers, 66 site coordinators, 66 pump technicians, 170 washers, 134 security guards, 241 drivers, 31 M&E assistants, 108 DECs, 2 EC assistants, 2 Logistics assistants, 3 warehouse assistants, 14 F&A clerks, 264 HCWs

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result trained to support VC in Records Country target areas with USG VC Intervention Female: 957 funds[2] Annually Sex (41.4%) Job Function Male: 1,352 (58.6%) Project Training 295 304 235 267 Total Number of people trained Records Country during the Master (National) Female: 71 1.2.3 VC Intervention TBD TBD TBD Training and/or IRS Training Annually (26.6%) Sex of Trainers. Male: 196 Job Function (73.4%) Project Training 3,924 18 Total Records Country Total number of people hired Female: 2,082 1.2.4 VC Intervention ,601215 6,32616 5,04917 TBD TBD TBD to support VC in target areas. Annually (53.1%) Sex Male: 1,842 Job Function (46.9%) Number of VC project Project Training Country 1.2.5 training workshops targeting Records Technical Area 1 1 1 0 DNMP and other host Job Function

12 215 supervisors, 2,158 SOPs, 325 spray operator TLs, 139 standby SOPs, 2596 mobilizers, 87 IEC supervisors, 4 IEC assistants, 72 storekeepers, 68 site coordinators, 7 stand by site coordinators, 68 pump technicians, 179 washers, 137 security guards, 232 drivers, 21 M&E assistants, 10 standby M&E Assistants, 2 IT/mHealth assistants, 76 DECs, 10 standby DECs, 2 EC assistants, 2 Logistics assistants, 2 warehouse assistants, 17 F&A clerks, 197 HCWs (Magunga Re-spray: 8 supervisors, 42 SOPs, 7 SOP TLs, 46 mobilizers, 2 IEC supervisors, 1 storekeeper, 1 site coordinator, 1 pump technician, 4 washers, 2 security Guards, 5 drivers, 1 M&E assistant, 3 DECs, 2 HCWs)s 13 208 supervisors, 1,781 SOPs, 297 SOP TLs, 1,929 mobilizers, 14 IEC assistants, 72 storekeepers, 68 site coordinators, 68 pump technicians, 158 washers, 137 security guards, 216 drivers, 20 M&E assistants, 2 IT/mHealth Assistants, 55 DECs, 2 EC assistants, 2 Logistics assistants, 2 warehouse assistants, 18 F&A clerks, 136 HCWs 14 164 supervisors, 1780 SOPs, 297 SOP TLs, 1,930 Mobilizers, 14 IEC assistants, 72 Storekeepers, 68 Site Coordinators, 68 Pump technician, 159 Washers, 137 Security Guards, 18 Sub County M&E Assistants, 2 County M&E Assistants, 2 IT/mHealth Assistants, 53 DECs, 2 DEC Team Leads, 2 EC Assistants, 2 Logistics assistants, 2 Warehouse assistants, 210 Drivers, 16 Sub County F&A Assistants, 2 County F&A Assistants, 128 HCWs 15 208 supervisors, 1913 SOPs, 325 SOP TLs, 21 M&E Assistants, 70 Store keepers, 66 Site Coordinators, 66 pump technicians, 2 Logistics assistants, 3 warehouse assistants, 76 DECs, 2617 mobilizers, 78 IEC supervisors, 170 washers, 134 security guards, 241 drivers, 14 F&A clerks, 4 IEC Assistants, 2 EC assistants, 2 E-inventory Clerks 16 215 supervisors, 1991 SOPs, 325 SOP TLs, 139 standby SOPs, 21 M&E Assistants, 72 Store keepers, 68 Site Coordinators, 68 pump technicians, 2 Logistics assistants, 2 warehouse assistants, 76 DECs, 2596 mobilizers, 87 IEC supervisors, 179 washers, 137 security guards, 202 drivers, 17 F&A clerks, 4 IEC Assistants, 2 EC assistants (Magunga Re-spray: 8 supervisors, 42 SOPs, 7 SOP TLs, 46 mobilizers, 2 IEC supervisors, 1 storekeeper, 1 site coordinator, 1 pump technician, 4 washers, 2 security Guards, 5 drivers, 1 M&E assistant, 3 DECs) 17 208 supervisors, 1781 SOPs, 297 SOP TLs, 20 M&E assistants, 2 IT/mHealth assistants,72 Storekeepers, 68 Site coordinators, 68 pump technicians, 2 Logistics assistants, 2 warehouse assistants, 55 DECs, 1,929 mobilizers, 158 washers, 137 security guards, 216 drivers, 18 F&A clerks, 14 IEC Assistants, 2 EC assistants 18 1780 SOPs, 1,525 Mobilizers, 14 IEC assistants, 72 Storekeepers, 68 Site Coordinators, 68 Pump technician, 159 Washers, 137 Security Guards, 18 Sub County M&E Assistants, 2 County M&E Assistants, 2 IT/mHealth Assistants, 53 DECs, 2 DEC Team Leads, 2 EC Assistants, 2 Logistics assistants, 2 Warehouse assistants, 16 Sub County F&A Assistants, 2 County F&A Assistants

19 14 SCMCCs, 14 SCHRIOs, 2 CMCC, 2 CHRIO, 1 National M&E and 1 National program officer 20 14 SCMCCs, 14 SCHRIOs, 2 CMCC, 2 CHRIO, 1 National M&E and 3 National program officer 21 208 supervisors, 2,111 SOPs, 325 spray operator TLs, 2617 mobilizers, 111 IEC supervisors, 4 IEC assistants, 70 storekeepers, 66 site coordinators, 66 pump technicians, 170 washers, 134 security guards, 241 drivers, 31 M&E assistants, 108 DECs, 2 EC assistants, 2 Logistics assistants, 3 warehouse assistants, 22 215 supervisors, 2,158 SOPs, 325 spray operator TLs, 139 standby SOPs, 2596 mobilizers, 87 IEC supervisors, 4 IEC assistants, 72 storekeepers, 68 site coordinators, 7 standby site coordinators, 68 pump technicians, 179 washers, 137 security guards, 232 drivers, 21 M&E assistants, 10 standby M&E Assistants, 2 IT/mHealth assistants, 76 DECs, 10 standby DECs, 2 EC assistants, 2 Logistics assistants, 2 warehouse assistants (Magunga Re-spray: 8 supervisors, 42 SOPs, 7 SOP TLs, 46 mobilizers, 2 IEC supervisors, 1 storekeeper, 1 site coordinator, 1 pump technician, 4 washers, 2 security Guards, 5 drivers, 1 M&E assistant, 3 DECs) 23 208 supervisors, 1781 SOPs, SOPTL 297, Mobilizers 1929, IEC Assistants 14, Storekeepers 72, Site Coordinator 68, Pump technician 68, Washers 158, Security Guards 137, M&E Assistants 20, IT/mHealth Assistants 2, DECs 55, EC Assistants 2, Logistics assistants 2, Warehouse assistants 2, Drivers 216 24 164 supervisors, 1780 SOPs, 297 SOP TLs, 1,930 Mobilizers, 14 IEC assistants, 72 Storekeepers, 68 Site Coordinators, 68 Pump technician, 159 Washers, 137 Security Guards, 18 Sub County M&E Assistants, 2 County M&E Assistants, 2 IT/mHealth Assistants, DECs 53, 2 DEC Team Leads, 2 EC Assistants, 2 Logistics assistants, 2 Warehouse assistants, 210 Drivers

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result receiving insecticide poisoning Records Sex (# and %) case management training Male: 83 Annually (64.8%) Female: 45 (35.2%) Number of adverse reactions Country Incident Report to pesticide exposure Type of Exposure Forms 1; 1.3.3 0 0 0 documented that resulted in a Occupational referral for medical care Annually Number of SEAs and Letter Project Records Country Reports submitted at least 60 1.3.4 days prior to the X Annually 1 1 N/A N/A TBD TBD TBD commencement of VC campaigns Number and percentage of Project Records - Country 66 68 (100% 69 68 (100%) permanent and mobile soak PSECAs 1.3.5 pits inspected and approved TBD TBD TBD prior to IRS campaigns or Annually before first use Number and percentage of Project Records - Country 70 72 72 72 (100%) storehouses inspected and PSECAs Storehouse Type (102.8%) 1.3.6 approved prior to IRS campaigns Annually 1.4 Promote Gender Equality in all Facets of Planning and Implementation Number and percentage of Project Records Country 2,525 2,08226 1.4.1 women hired to support VC Sex (# and %) 3,000 3,43325 (50% of TBD TBD TBD (53.1%) campaigns Annually Job Function all hired) Number and percentage of Project Records Country women hired in supervisory Sex (# and %) 1.4.2 247 20627 19628 64 29 (36.0%) TBD TBD TBD roles in target areas for VC Annually Job Function activities

25 21 Site coordinators, 22 storekeepers, 18 Security guards, 53 supervisors, 130 SOP TLs, 819 SOPs, 67 Alternate SOPs, 169 washers, 1957 mobilizers, 45 IEC supervisors, 15 pump technicians, 8 finance assistants, 3 IEC assistants, 1 EC assistant, 1 Logistics assistant, 7 M&E Assistants, 42 DECs(Magunga Re-spray: 1 supervisor, 1 SOP TL, 18 SOPs, 29 Mobilizers, 1 IEC Supervisor, 3 washers, 2 DECs) 26 19 Site coordinators, 23 storekeepers, 14 Security guards, , 796 SOPs, 152 washers, 1,010 mobilizers, 12 pump technicians, 10 F&A assistants, 9 IEC assistants, 1 EC assistant, 1 Logistics assistant, 10 M&E Assistants, 23 DECs, 2 DEC team leads 27 130 SOP TLs, 21 Site coordinators, 45 IEC supervisors, 7 M&E Assistants, 1 Logistics assistant (Magunga Re-spray: 1 SOP TL, 1 IEC supervisor) 28 149SOP TLs, 34 Site Coordinators, 10 M&E Assistants, 1 IT/mHealth Assistant, 1 Logistics Assistant, 1 Warehouse Assistant 29 19 Site Coordinators, 10 M&E Assistants, 1 Logistics Assistant, 23 storekeepers, 2 DEC team leads, 9 IEC Assistants

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result Project Records Country 5,03933 (97.5% Number and percentage of Sex (# and %) overall) trainees (permanent and 1.4.3 Annually Job Function 6,05830 6,85331 5,08832 TBD TBD TBD seasonal) who have completed Female: 2,519 gender awareness training Male: 2,520 Number and percentage of Project Records Country women in senior leadership 1.4.4 X 3 3 (100%) N/A N/A TBD TBD TBD roles in VectorLink country Annually Sex (# and %) offices 1.5 Implement and Support SBCC and Mobilization Activities Project Records Country 51334 5635 3536 3037

Number of radio spots and Annually VC Intervention 1.5.1 TBD TBD TBD talk shows aired Talk Show or Radio Spot Number of print materials Project Records Country 472,01338 728, 58339 416,98240 20,00641 1.5.2 TBD TBD TBD distributed to or targeted at

30 208 supervisors, 1913 SOPs, 325 SOP TLs, 21 M&E Assistants, 70 Store keepers, 66 Site Coordinators, 66 pump technicians, 2 Logistics assistants, 3 warehouse assistants, 76 DECs, 2617 mobilizers, 78 IEC supervisors, 170 washers, 134 security guards, 241 drivers, 14 F&A clerks, 4 IEC Assistants, 2 EC assistants, 36 permanent staff 31 215 supervisors, 1991 SOPs, 325 SOP TLs, 139 standby SOPs, 21 M&E Assistants, 72 Store keepers, 68 Site Coordinators, 68 pump technicians, 2 Logistics assistants, 2 warehouse assistants, 74 DECs, 2 E-inventory DECs, 2596 mobilizers, 87 IEC supervisors, 179 washers, 137 security guards, 202 drivers, 17 F&A clerks, 4 IEC Assistants, 2 EC assistants, 35 permanent staff, (Magunga Re- spray: 8 supervisors, 42 SOPs, 7 SOP TLs, 46 mobilizers, 2 IEC supervisors, 1 storekeeper, 1 site coordinator, 1 pump technician, 4 washers, 2 security Guards, 5 drivers, 1 M&E assistant, 3 DECs) 32 208 supervisors, 1781 SOPs, 297 SOP TLs, 20 M&E assistants, 2 IT/mHealth Assistants, 72 Storekeepers, 68 Site coordinators, 68 pump technicians, 2 Logistics assistants, 2 warehouse assistants, 55 DECs, 1,929 mobilizers, 158 washers, 137 security guards, 216 drivers, 18 F&A clerks, 14 IEC Assistants, 2 EC assistants 39 permanent staff 33 164 supervisors, 1780 SOPs, 297 SOP TLs, 1,930 Mobilizers, 14 IEC assistants, 72 Storekeepers, 68 Site Coordinators, 68 Pump technician, 159 Washers, 137 Security Guards, 18 Sub County M&E Assistants, 2 County M&E Assistants, 2 IT/mHealth Assistants, 53 DECs, 2 DEC Team Leads, 2 EC Assistants, 2 Logistics assistants, 2 Warehouse assistants, 210 Drivers, 16 Sub County F&A Assistants, 2 County F&A Assistants, 39 permanent staff 34 1 Talk show per week per county, 1 radio spot per day per hour for three weeks 35 1 Talk show per week for 8 weeks (Radio nam lolwe), 1 radio spots 4 times per day for 12 days (Radio Ramogi). 36 25 spots and 10 talk shows 37 24 radio spots and 6 talk shows 38 465,862 IRS stickers, 69 banners, 2617 mobilizer pocket guides, 3465 posters 39 706,282 IRS stickers, 73 banners, 2748 mobilizer pocket guides, 10710 posters (8,770 IRS stickers during re-spray) 40 403,871 IRS stickers, 78 banners, 2,008 mobilizer pocket guide, posters 11,025 41 11,026 posters, 78 banners, 350 T-shirts, 2008 mobilizer guides, 6,544 copies of IRS key messages distributed

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result beneficiaries Annually VC Intervention Number of people reached Project Records Country N/A N/A N/A with vector control and/or VC Intervention 1.5.3 N/A TBD TBD TBD SBCC messages via door-to- Annually Sex door messaging 2. Entomological and Epidemiological Data to Drive Decision-Making 2.1 Vector Control Activities Monitored via Entomological and Epidemiological Data Number of project-supported Entomological Country entomological sentinel sites Reports VC Intervention established to monitor vector 2.1.1 19 19 7 21 14 (67%) TBD TBD TBD bionomics (vector species, Annually distribution, seasonality, feeding time, and location) Number and percentage of Entomological Country 19 19 (100%) 21 14 (67%) vector bionomics monitoring Reports sites measuring all basic VC Intervention entomological indicators Annually 2.1.2 TBD TBD TBD (species composition, indoor and outdoor human biting rates, hourly human biting rates, indoor resting densities) Number and percentage of Entomological Country 19 (100 %) 21 14 (67%) vector bionomics monitoring Reports sites measuring the following IRS or 2.1.3 all advanced entomological Annually Entomology Only TBD TBD TBD indicators: sporozoite rates Program and entomological inoculation rates Number and percentage of Entomological Country 12 (100%) 11 11 (100%) insecticide resistance Reports monitoring sites that tested all VC Intervention 2.1.4 TBD TBD TBD priority insecticides for the Annually relevant local vector control intervention Number and percentage of Entomological Country 40 50 (100%) 40 37 (92.5%) houses in which WHO cone Reports bioassays were conducted Insecticide Type 2.1.5 within two weeks of spraying Annually TBD TBD TBD with greater than 98% test mortality recorded for IRS countries Number and percentage of Entomological Country 40 50 (100%) 24 na (0%) sites that conducted WHO Reports 2.1.6 cone bioassays after the Insecticide Type completion of spraying at Annually

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result monthly intervals until test mortality drops below 80% for two consecutive months for IRS countries Number of countries with an Project Reports Country integrated vector control

2.1.7 analytics dashboard created by X Annually NA N/A N/A TBD TBD TBD NA PATH, available for decision- making Number of people trained Project Records Country (VectorLink and non 2.1.8 4 4 4 4 TBD TBD TBD VectorLink staff) in Annually Sex (# and %) entomological monitoring Number and percentage of Entomological Country N/A 0% sites in which WHO cone Records 2.1.9 bioassays were conducted to N/A N/A TBD TBD TBD evaluate bio-efficacy of bed Annually nets 2.2 NMCPs Develop Country-Level IRS and Other Malaria VC Strategies Number and percentage of Project Records Country countries with an integrated malaria vector control Annually

2.2.1 strategy, including a plan for X N/A N/A N/A N/A TBD TBD TBD monitoring and managing insecticide resistance supported by the project Number and percentage of Project Records Country countries with a data and visualization dashboard Annually 2.2.2 complete for IRS and/or X N/A N/A N/A N/A TBD TBD TBD entomology data in VectorLink Collect for vector control decision making Number of countries that Project Records Country N/A N/A 2.2.3 implement sub-national X N/A N/A TBD TBD TBD insecticide rotation Annually 2.3 Build capacity of NMCPs and local institutions to collect, analyze, and use data for strategic malaria control decision-making Number of individuals trained Project Training Country from NMCPs and national Records Job Function Total institutions to review and Organization 2.3.1 Job Function N/A N/A N/A 0 TBD TBD TBD interpret data for integrated Annually Organization vector control decision making Number and percent of Capacity Country Total 2.3.2 N/A N/A N/A N/A TBD TBD TBD targeted individuals that Assessments Job Function Job Function

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result report using new analytical Organization Organization tools and/or skills in their Thrice Over Project planning, resourcing, Life implementation, or measurement activities

3. Procurement and Logistics 3.1 Cost-Effective Procurement Mechanism Established Number and percentage of Procurement Country insecticide procurements that Records had a pre-shipment QA/QC Insecticide Type 3.1.1 X 1(100%) 1(100%) N/A N/A TBD TBD TBD test, done by a third party, at Annually least 60 days prior to spray campaign Number and percentage of Procurement Country insecticide procurements Records 3.1.2 received on-time to allow for Insecticide Type 1(100%) 1(100%) 1 (100%) 1 (100%) (100%) the initiation of spray Annually operations as scheduled Number and percentage of Procurement Country targeted countries with Records international equipment VC Intervention 3.1.3 procurements, including PPE, X Annually 1(100%) 1(100%) N/A N/A TBD TBD TBD received on-time to allow for the initiation of vector control campaigns as scheduled Project Records Country Number of VectorLink staff 3.1.4 X 1(100%) 1(100%) N/A N/A TBD TBD TBD trained on procurement Annually 3.2 Robust Inventory Management and Logistics Systems Established Number and percentage of Project Training Country 8242 (100%) logistics and warehouse Records VC Intervention

3.2.1 personnel (seasonal and full- Sex 3 3 (all men) 3 Male: 57 time) trained in VC supply Annually Job Function Female: 25 chain management Number and percentage of Inventory and Country 70 72 (100%) 72 72 (100%) operations site warehouses Stock Records 3.2.2 where physical inventories can be verified by daily stock Annually records 3.2.3 Number and percentage of X Inventory and Country 1(100%) 1(100%) N/A N/A TBD TBD TBD

423 Warehouse Managers, 2 Warehouse Assistants, 72 Storekeepers, 2 Logistics Assistants, 2 EC Assistants, 1 Supply chain coordinator (counted only warehouse managers in previous reports)

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result IRS countries that successfully Stock Records completed spray operations Insecticide Type without an insecticide stock- Annually out

4. Innovation 4.1 Conduct operational research or monitoring to scale up new tools, methods, and approaches Number of operational 143 N/A 0 0 research studies on promising Total Number new tools or new 4.1.1 Type of TBD TBD TBD methods/approaches to Innovation existing tools that are implemented 4.2 Create and share knowledge through dissemination of best practices and lessons learned Number of innovations, best Project Records Country TBD N/A N/A N/A practices, and other data or lessons learned shared with Annually Technical Area 4.2.1 other partners or international X TBD TBD TBD institutions for global reporting on the Vector Learning Exchange Number of individual Project Records N/A 4.2.2 members who use the Vector X Annually Country N/A N/A N/A N/A TBD TBD TBD Learning Exchange Technical Area Number of symposia and/or Project Records Country 144 145 1 146 presentations submitted to 4.2.3 X TBD TBD TBD and accepted at global Annually Technical Area conferences Number of success stories Project Records Country 1 0 1 0 written or videos produced 4.2.4 TBD TBD TBD and shared on the VectorLink Annually project website Project Records Technical Area N/A N/A N/A N/A Number of peer-reviewed Annually Country 4.2.5 journal articles submitted and X TBD TBD TBD

accepted Technical Area

43 Small scale house screen pilot under Section 8.3 44 The DHIS 2 mobile pilot, awaiting confirmation 45 SOP mobile data collection initiative abstract 46 Feasibility of door to door mobile data collection for Indoor Residual Spray Operations decision making presented at the 68Th ASTMH conference, Maryland USA

Data Source(s) Annual Targets and Results Global Project and Reporting Dis- # Performance Indicator Indicator Frequency aggregation Year 1 Year 2 Year 3 Year 4 Year 5 Target Result Target Result Target Result Target Result Target Result Number of contributions to Project Records Country N/A N/A TBD 0 vector control global or 4.2.6 TBD TBD TBD country policy and/or Annually guidance documents 4.3 Develop and deploy cost-savings approaches Number of innovative or Project Records Country TBD 247 148 149 novel approaches implemented to achieve cost Annually VC Intervention 4.3.1 TBD TBD TBD savings in IRS and integrated malaria vector control programs Number of cost effectiveness Project Records Country 150 251 TBD 0 assessments of existing approaches in the Annually VC Intervention 4.3.2 TBD TBD TBD implementation of IRS and integrated malaria vector control programs 4.4 Cultivate public-private partnerships Number of private sector Project Records Country entities engaged with to establish public private Annually 4.4.1 partnerships to increase the TBD 0 0 0 TBD TBD TBD quality and coverage of malaria vector control activities globally

47 DHIS 2 mobile pilot for reporting at Dede dispensary and Bicycle use at Rariw 48 Scale up of the mobile pilot 49 Mobile initiative scaled up to 5 operations sites in IRS 2020 50 Data from Kenya will be incorporated into the global project-level cost assessment 51 Bicycle use at Rariw and DHIS 2 mobile pilot for reporting at Dede dispensary