The PMI Vectorlink Project Uganda 2020 End of Spray Report Phase 1

THE PMI VECTORLINK PROJECT UGANDA 2020 END OF SPRAY REPORT

PHASE I: MARCH 2 - 28, 2020 PHASE II: MAY 25 – JUNE 20, 2020

Recommended Citation: The PMI VectorLink Project Uganda. August 2020. The PMI VectorLink Project Uganda 2020 End of Spray Report. 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: August 4, 2020 Approved on:

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 ...... iv Executive Summary ...... v 1. Country Background ...... 1 1.1 Project Background ...... 2 1.2 IRS Target Districts ...... 2 1.3 Insecticide Selection ...... 2 2. IRS Implementation Activities ...... 4 2.1 IRS Planning and Partner Collaboration ...... 4 2.2 IRS Planning ...... 4 2.2.1 Micro Planning ...... 4 2.2.2 Recruitment of Spray Teams ...... 4 2.2.3 Training 5 2.3 Spray Operations and Supervision...... 6 2.3.1 Operations Sites ...... 6 2.4 Logistics Needs and Procurement ...... 7 2.4.1 Logistics and Stock ...... 7 2.4.2 Seasonal Worker Payment ...... 8 2.5 Insecticide Procurement and Inventory ...... 9 2.6 IEC/SBC Activities and Outcomes ...... 9 2.6.1 Mobilization Structure During covid-19 pandemic ...... 10 2.6.2 Mobilization Approaches ...... 11 2.6.2.1 District, Sub-County and LC1 Leaders Sensitization ...... 11 2.6.2.2 Recruitment, training, and engagement of IRS community mobilizers ...... 11 2.6.2.3 Community Dialogues ...... 12 2.6.2.4 Radio Talk Shows, Spot Messages and Announcements ...... 12 2.6.3 Mass and Print Media ...... 12 2.7 Composition and Management of IRS Activities ...... 13 2.8 Gender Mainstreaming ...... 13 2.9 Post-Spray Review Meeting ...... 15 3. Entomology ...... 16 3.1 IRS Quality Assurance Assays ...... 16 3.2 Results of Fumigant Effect ...... 18 3.3 Pre-IRS Pyrethrum Spray Catches (PSCs) ...... 19 4. Environmental Compliance ...... 21 4.1 IRS Campaign Assessments ...... 21 4.1.1 Environment and Social Impact Assessment (ESIA) ...... 21 4.1.2 Environmental audit ...... 21 4.1.3 Pre-Season Environmental Compliance Assessments ...... 21 4.1.4 Mid- and Post-Season Environmental Inspections ...... 22 4.2 Incident Reports ...... 22 4.3 Health and Safety ...... 22

4.4 Demobilization and Waste Management ...... 23 4.4.1 Closure of site stores and soak pits ...... 23 4.4.2 Solid waste disposal ...... 23 5. Monitoring And Evaluation ...... 25 5.1 Data Collection, Entry, and Quality Assurance ...... 25 5.1.1 Data Collection ...... 25 5.1.2 VectorLink Collect database ...... 25 5.1.3 Data entry, tracking, storage, and security ...... 26 5.1.4 Data quality assurance ...... 26 5.1.5 MHealth 27 5.1.6 Directly Observed Spraying ...... 28 5.2 Supervision Findings ...... 28 5.3 Results ...... 28 5.3.1 Total Number of Structures and Population Captured in 2020 Spray Campaigns ...... 28 5.3.1.1 Structures found ...... 28 5.3.2 Population Protected ...... 30 5.4 Use of Mosquito Nets ...... 30 5.5 Insecticide Consumption and Spray Operator Performance Indicators ...... 30 6. Challenges, Lessons Learned, And Recommendations ...... 31 6.1 Challenges ...... 31 6.2 Lessons and Recommendations ...... 31 Annex A: National and District Staff Trained ...... 33 Annex B: 2020 Post-IRS Evaluation Meeting ...... 35 Annex C: Environmental Mitigation and Monitoring Report ...... 37 Annex D: Data Collection and Quality Assurance Tools ...... 43 Annex E: Monitoring and Evaluation Indicator Matrix ...... 44 Annex F: Supervision Tools and Results ...... 64 Annex G: Sub-County Summary of Campaign 2020 Spray Results ...... 65 Annex H: Number and Use of Mosquito Nets in 2020 Spray Campaign ...... 73 Annex I: Insecticide Use and Spray Operator Performance ...... 79 Annex J: 2020 Incidents Reports ...... 80 Annex K: Balance of Actellic 300CS and Sumishield Used in the 2020 Spray Campaign ...... 82

LIST OF TABLES Table 1: 2020 IRS Campaign Summary Results ...... vi Table 2: 2020 IRS Targets by District ...... 2 Table 3: IRS Trainings Conducted in 2020 ...... 5 Table 4: Number of People Trained with U.S. Government/DFID Funds to Support Vector Control Activities ...... 5 Table 5: Number of Seasonal Staff Hired ...... 6

Table 7: PPE and Other Supplies Received at The Central Warehouse in Bugiri and Lira ...... 7 Table 8: 2020 IRS Insecticide Usage Summary ...... 9 Table 9: Summary of People Reached Through Different Channels ...... 10 Table 10: Seasonal Workers During The 2020 IRS Campaign ...... 14 Table 11: Knockdown Rate and Mortality of Anopheles gambiae S.S. (Kisumu Strain) After Exposure to Different Actellic 300cs Sprayed Wall Surfaces in Three Districts, March 2020 ...... 17 Table 12: Knockdown Rate and Mortality of Anopheles gambiae S.S. (Kisumu Strain) After Exposure to Different Fludora Fusion Sprayed Wall Surfaces in Four Districts, March 2020 ...... 17 Table 13: Knockdown Rate and Mortality of Anopheles gambiae S.S. (Kisumu Strain) After Exposure to Different Sumishield Sprayed Wall Surfaces in Four Districts, June 2020 ...... 17 Table 14: Knockdown Rate and Mortality of Anopheles gambiae S.S. (Kisumu Strain) After Exposure to Different Fludora Fusion Sprayed Wall Surfaces in Four Districts, June 2020 ...... 18 Table 16: Different Categories of Waste Generated During 2020 Spray Campaign, and Planned Management Mechanism ...... 24 Table 17: Spray Coverage By District ...... 29

LIST OF FIGURES Figure 2: Practicing Spray Techniques...... 4 Figure 3: Social Distancing During IRS Morning Brief Dokolo District ...... 6 Figure 4: Imam Musa Rashid Speaking to One of His Subjects in Amolatar District ...... 11 Figure 5: Religious leader, DHE and RDC Otuke during talk show at voice of Lango FM Radio ...... 12 Figure 6 : District Operations Organogram ...... 13 Figure 7: Percentage Fumigant Knockdown Effect of Actellic 300 CS, SumiShield 50WG and Fludora Fusion Spraying on An. gambiae S.S. In Phase I And Phase II Districts, March And June 2020 ...... 19 Figure 8: Mean Number of Female Malaria Vectors Caught per House During Pre-IRS PSCs/ HLCs In The Two IRS Districts, February 2020 ...... 20 Figure 9: Delivering IRS Solid Waste for Incineration at Green Label Service Limited in Iganga...... 23 Figure 10: Reasons For Structures Not Sprayed during the 2020 IRS campaign ...... 30

iii

ACRONYMS BCC Behavior Change Communication BMP Best Management Practice CFV Control Flow Valve DCV Data Collection Verification DEC Data Entry Clerk DFID Department for International Development DHE District Health Educator DHIS 2 District Health Information Software 2 EC Environmental Compliance IEC Information, Education and Communication IRS Indoor Residual Spraying ITN Insecticide-Treated Nets M&E Monitoring and Evaluation MOH Ministry of Health NEMA National Environment Management Authority NMCD National Malaria Control Division 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 SOP Spray Operator ToT Training of Trainers VC Vector Control WHO World Health Organization

EXECUTIVE SUMMARY In 2020, the U.S. President’s Malaria Initiative (PMI) VectorLink project supported implementation of indoor residual spraying (IRS) in malaria-endemic districts in Uganda with funding from PMI through the United States Agency for International Development (USAID). USAID/PMI funds supported the IRS campaign in 10 districts (Budaka, Bugiri, Butaleja, Butebo, Kibuku, Lira, Namutumba, Pallisa, Serere and Tororo) and the United Kingdom’s Department for International Development (DFID) funded the campaign in 6 districts (Alebtong, Amolatar, Dokolo, Kaberamaido, Kalaki, and Otuke). The project conducted a two-phase IRS campaign in 16 districts with each phase of the campaign lasting 24 days. Phase I was conducted from March 2–March 28, 2020 and Phase II from May 25–June 20, 2020. The Phase II campaign was initially planned to start on April 20, however, it was delayed due to the government lockdown that was mandated in response to the COVID-19 pandemic. The project used three insecticides for the 2020 spray campaign: Fludora Fusion WP-SB and the remaining balance of Actellic 300CS and SumiShield 50WG, which were left over from the previous 2019 campaign. During the campaign, the project collaborated with each district’s leadership and Ministry of Health (MOH) staff to train, supervise, and spray the targeted structures (1,393,562 across the 16 districts) and ensure adherence to COVID-19 prevention guidelines. In response to the pandemic, the project made adjustments to program implementation while working through the district IRS and COVID-19 taskforces for Phase II IRS. This included provision of face masks, hand sanitizers and handwashing facilities at training and operation sites. Training of spray teams was conducted in small teams of 10 – 15 participants necessitating use of classrooms and other large venues such as churches and halls to ensure social distancing. COVID- 19 guidelines were incorporated in all training sessions. Posters with information on signs, symptoms and prevention of COVID-19 were posted at operation sites and strategic locations in the targeted villages. Radio talks hosted by district leaders, radio spots and announcements were used to disseminate key IRS messages and COVID-19 preventive messages. The following are project achievements and highlights from the 2020 spray campaign:

• The project sprayed 1,395,569 of the 1,475,422 structures found by spray operators (SOPs) in the 16 IRS target districts, resulting in 94.6% coverage. • The project protected 4,938,643 people, including 950,163 (19.2%) children under 5 years of age, and 132,089 (2.7%) pregnant women. • With PMI and DFID funding, the project trained 7,805 individuals to support vector control activities in the 16 districts. • The project consumed 72,500 bottles of Actellic 300CS; 28,161 sachets of SumiShield 50WG; and 480,934 sachets of Fludora Fusion WP-SB to spray 1,395,569 structures. SOPs sprayed approximately 2.4 structures per bottle/sachet of insecticide, which left 51,116 sachets of Fludora Fusion at the end of the spray round (Expiry: December 2021). This insecticide balance will be used for the 2021 spray campaign. • The project will incinerate all IRS insecticide-contaminated waste, including used masks, at Green Label Ltd., a private incineration plant in Iganga district. Other solid waste, including empty bottles and assorted plastics, will be recycled at Gentex Enterprise Ltd., while paper cartons will be recycled at Pulp and Paper Mills Ltd. • The project conducted wall bioassays within two weeks of spraying to assess the quality of spray in the target districts. The project recorded 100% mortality for susceptible An. gambiae s.s. This implies that the quality of spraying was satisfactory with no under-dosing of the spray surfaces. • The project worked closely with the MOH/National Malaria Control Division (NMCD), district local government, sub county leaders and other stakeholders to ensure successful implementation of IRS with strict adherence to COVD-19 prevention measures.

TABLE 1: 2020 IRS CAMPAIGN SUMMARY RESULTS

Funding PMI DFID Total Insecticide used Fludora Fusion WP-SB Fludora Fusion WP-SB and Actellic 300CS and SumiShield 50WG Number of districts covered by PMI/DFID- 10 6 16 supported IRS Number of structures found by spray operators 1,066,407 409,015 1,475,422 Number of structures sprayed 1,001,746 393,823 1,395,569 2020 spray coverage 93.9% 96.3% 94.6% Population protected with Total Pop: 3,847,573 1,091,070 4,938,643 PMI/DFID support Children < 5: 756,617 193,546 950,163 Pregnant 110,170 21,919 132,089 women: Length of campaign (total days) 24 24 48 Number of people trained with PMI/DFID 5,920 (96 district health teams, 1,885 (36 district health teams, 22 7,805 government funds to support vector control 47 MOH, 212 site supervisors, MOH, 86 site supervisors, 1,392 SOPs, activities 4,455 SOPs, 1,110 team 349 team leaders) leaders) Dates of PMI and DFID-supported IRS March 02–31, 2020 and May May 25, 2020–June 20, 2020 campaign 25, 2020–June 20 2020

1. COUNTRY BACKGROUND

Uganda has the sixth highest number of deaths per year from malaria in Africa. With approximately 11 million cases and over 10,000 deaths reported annually, Uganda has some of the highest reported malaria transmission rates in the world. Malaria is endemic in approximately 95% of the country, affecting over 90% of the population. It still remains as one of the leading causes of morbidity and mortality affecting mostly children under 5 years of age and pregnant women. According to the National Malaria Control Division (NMCD), malaria accounts for 30-50% of outpatient visits at health facilities, 15-20% of all hospital admissions, and up to 20% of all hospital deaths. In addition, malaria has an indirect impact on the economy and development in general. Household expenditure for malaria treatment places a large burden on the Ugandan population by consuming a larger proportion of income in the poorest households. Malaria also has a significant negative impact on the economy in Uganda due to loss of workdays due to illness, decreased productivity, and decreased school attendance. A single episode of malaria costs a family on average 3% of their annual income equivalent to USD 9.001 . Workers suffering from malaria may be unable to work for an estimated 5–20 days per episode. As a result, the Ministry of Health (MOH), through the National Malaria Control Division (NMCD), has put in place several policy guidelines to address the situation. According to the Uganda Malaria Reduction Strategic Plans (2014–2020 and 2021 – 2025), the vision of the of the Ministry is provide quality assured services for malaria prevention and treatment to all people in Uganda., The MOH/NMCD’s goal is to control and prevent malaria morbidity and mortality to minimize the social ill-effects and economic losses attributable to malaria. The President’s Malaria Initiative (PMI) supports NMCD implementation of malaria control activities through The Roll Back Malaria (RBM) Partnership, which includes other stakeholders, such as the Global Fund, the World Bank, the United Nations Children’s Fund, the United Kingdom’s Department for International Development (DFID), and the private sector. This partnership is based on three fundamental principles: one strategic plan under which all partners will work and contribute; one coordination mechanism to ensure maximum synergy and avoidance of duplications; and one monitoring and evaluation (M&E) plan to measure progress and assess impact. Figure 1: Map of Uganda Showing PMI- and DFID-Supported IRS Districts

1 The Uganda Malaria Reduction Strategic Plan 2014 - 2020

1.1 PROJECT BACKGROUND In September 2017, Abt Associates was awarded the PMI VectorLink Project to support the implementation of indoor residual spraying (IRS) and other vector control activities. Under the contract, Abt Associates is expanding entomological monitoring to guide programs focused on insecticide-treated bed nets (ITNs) and IRS. The VectorLink Uganda project targets three result areas as follows:

• Result 1: High-quality IRS program is implemented in target districts. • Result 2: IRS implementation is institutionalized, and Government of Uganda’s capacity to conduct IRS is expanded. • Result 3: Comprehensive (entomological, environmental, and epidemiological) monitoring and evaluation (M&E) of the IRS program is performed.

1.2 IRS TARGET DISTRICTS PMI VectorLink Uganda implements IRS in 16 high-burden malaria districts in the northern and eastern regions of Uganda. PMI funded implementation in ten districts, and DFID funded the other six districts (Figure 1). The selection of districts was based on the malaria burden in these districts, determined in collaboration with the MOH/NMCD and United States Agency for International Development (USAID)/PMI Uganda. Table 2 shows the targets for the 2020 campaign, by IRS district.

TABLE 2: 2020 IRS TARGETS BY DISTRICT

Target Target Funding District Phase Insecticide structures population Budaka 1 Actellic 300CS, Fludora Fusion WB-SB 62,586 253,195 Bugiri 1 Actellic 300CS, Fludora Fusion WB-SB 129,553 486,572 Butaleja 1 Actellic 300CS, Fludora Fusion WB-SB 69,143 294,092 Butebo 1 Actellic 300CS, Fludora Fusion WB-SB 40,813 155,123 Kibuku 1 Actellic 300CS, Fludora Fusion WB-SB 65,770 259,444 PMI Namutumba 1 Actellic 300CS, Fludora Fusion WB-SB 89,304 370,954 Pallisa 1 Actellic 300CS, Fludora Fusion WB-SB 94,569 356,892 Tororo 1 Actellic 300CS, Fludora Fusion WB-SB 178,351 636,213 Lira 2 Sumishield 50WP, Fludora Fusion WP-SB 172,558 519,377 Serere 2 Sumishield 50WP, Fludora Fusion WP-SB 114,502 365,899 Subtotal 1,017,149 3,697,761 Alebtong 2 Sumishield 50WP, Fludora Fusion WP-SB 97,235 262,930 Amolatar 2 Sumishield 50WP, Fludora Fusion WP-SB 67,055 182,696 Dokolo 2 Sumishield 50WP, Fludora Fusion WP-SB 80,472 208,345 DFID Kaberamaido 2 Sumishield 50WP, Fludora Fusion WP-SB 43,092 106,028 Kalaki 2 Sumishield 50WP, Fludora Fusion WP-SB 45,717 112,032 Otuke 2 Sumishield 50WP, Fludora Fusion WP-SB 42,842 120,298 Subtotal 376,413 992,329 Grand total 1,393,562 4,690,090

1.3 INSECTICIDE SELECTION The project used Fludora Fusion (a combination of clothianidin, a neonicotinoid, and deltamethrin, a pyrethroid) for the 2020 spray campaign in all 16 districts. The project used the remaining Actellic 300CS (pirimiphos–methyl, an organophosphate) from the 2019 campaign in the eight Phase I districts, and used the

remaining SumiShield 50WG (clothianidin, a neonicotinoid) from the 2019 campaign in the eight Phase II districts. In phase I districts, the project sprayed 177,274 structures with the remaining Actellic 300CS structures sprayed. For phase II spray campaign the remaining SumiShield sprayed 70,296 structures. (See Annex K for additional details). The decision to use these insecticides was based on data obtained from insecticide susceptibility tests conducted in 2019, which showed that the main malaria vector, An. gambiae s.l., was susceptible to these insecticides in all testing sites. These tests also confirmed the insecticide’s long residual life as documented in previous PMI-funded spray campaigns.

2. IRS IMPLEMENTATION ACTIVITIES 2.1 IRS PLANNING AND PARTNER COLLABORATION The project continued to collaborate with MOH/NMCD and district authorities to conduct quality IRS in all the 16 districts. This partnership and collaboration is evidenced through the multiple, joint activities the project held in conjunction with MOH/NMCD and the district authorities. Planning for the 2020 spray campaign began with VectorLink Uganda conducting the initial planning and quantification based on the total number of structures found in 15 districts during the 2019 campaign.

2.2 IRS PLANNING The project developed the Race to the Starting Line (RSL) document and an IRS activity schedule that were disseminated to stakeholders for review in planning for the IRS campaign. The RSL document served as a nine- week, pre-spray countdown that helped the team stay on top of deadlines leading up to the spray campaign. The RSL was later translated to an electronic version for ease of use and harmonization across spray schedules to protect vulnerable populations during historic peak transmission seasons. Because of the large scale of Uganda’s spray campaign, the project sprayed the target districts in two phases, lasting 24 operational days each. The project will continue with the two phased approach in 2021 with a two week interval between the two phases. In preparation for the spray campaign, the project’s field team worked with the MOH/NMCD to conduct courtesy visits in all 16 districts to inform the district stakeholders about the upcoming spray round. After the district planning and review meetings, the district health teams (DHTs) and the project staff sensitized the sub-county level leaders at their respective sub counties. These leaders cascaded the IRS messages to their local administrative units’ leaders (parish and village leaders) and communities.

2.2.1 MICRO PLANNING The field teams together with the DHT members also conducted micro-planning meetings with the sub-county leaders of all 16 districts to share the IRS schedule and solicit their support for IRS activities. During micro- planning, the team confirmed the availability of sub-county supervisors and parish storekeepers who had worked in the previous spray rounds; confirmed the availability of previously used parish stores; and discussed roll-out and implementation of the IRS operational plan in their respective sub-counties. Participants at the meetings included district malaria focal persons who are district vector control officers in a majority of the districts, district health educators (DHEs), district biostatisticians, district environment officers, district supply officers, and district health officers. These six district officers constitute the DHT during the campaign. During micro-planning, the team discussed several key issues that ranged from IRS activity schedule, recruitment of temporary IRS staff, districts’ roles and responsibilities to provide stores in all district operations sites and data centers, role of local leaders in supervision of IRS activities during the operations, renovation of IRS operations sites, progress in implementation of the planned activities, and the community mobilization plan. Team members agreed that daily feedback would be the cornerstone for success at each stage during project implementation.

2.2.2 RECRUITMENT OF SPRAY TEAMS FIGURE 2: PRACTICING SPRAY TECHNIQUES In collaboration with the DHT and sub-county leaders, the project confirmed the availability of previous spray team members The field teams also recruited new spray team members to replace those who had dropped out or were otherwise unavailable, as well as three parish mobilizers for each parish store to lead the daily community

mobilization activities at the village level. The spray teams had to undergo a medical examination to ascertain that they had no underlying medical condition before being fully enrolled for the IRS campaign.

2.2.3 TRAINING In 2020, the project conducted a series of training sessions aimed at enhancing IRS managers’ skills to implement and supervise IRS operations, and to strengthen their training and coaching capabilities. Table 3 shows the different trainings conducted by the project. The main objective of all the trainings was to improve the skills and performance of spray operators (SOPs), thus enhancing the quality of IRS activities. Table 4 shows the gender breakdown of participants at these trainings. The overall breakdown of training in 2020 is shown in annex A.

TABLE 3: IRS TRAININGS CONDUCTED IN 2020 Training Dates Participants Trained Key Topic Areas Covered National training of IRS master • Jan 21–25, 2020 • 69 MOH/NMCD IRS planning, implementation, supervision, trainers (boot camp) • 132 district malaria community mobilization, environmental trainers management, spray techniques, logistics • 24 PMI VectorLink project quantification, and warehouse management staff Training of trainers (TOT) • Phase I Jan 27–31, 2020 • 716 participants: Site- IRS planning, implementation, supervision, • Phase II May 11–15, 2020 supervisors (298) mobilization, environmental compliance, and spray techniques Training of team leaders • Phase I Feb. 24–28, 2020 • 1,459 team leaders Spray techniques, pump maintenance, safe • Phase II May 18–22, 2020 handling of insecticides and environmental safety issues in IRS, community mobilization, supervision techniques, and directly observed spray Training of spray operators • Phase I Feb. 24–28, 2020 • 5,847 spray operators Spray techniques, pump maintenance, safe • Phase II May 18–22, 2020 handling of insecticides and environmental safety issues in IRS, community mobilization

Training of parish mobilizers • Phase I Feb. 24–28, 2020 • 889 parish mobilizers Community mobilization including IRS key • Phase II May 18–22, 2020 messages – before, during, and after and community engagement

Training of storekeepers • Phase I Jan 27–31, 2020 • 298 storekeepers Store management and inventory tracking, use • Phase II May 11–15, 2020 of mHealth tools Training of pump technicians • Phase I Jan 27–31, 2020 • 120 pump technicians Repair and servicing of sprayers, community • Phase II May 11–15, 2020 mobilization including IRS key messages – before, during, and after and community engagement Training of data entry clerks • Phase 1 Feb 25–28, 2020 • 75 DECs IRS data collection and management, integrity, (DECs) Phase II districts May 19– and security; IRS data entry and practice 21, 2020

TABLE 4: NUMBER OF PEOPLE TRAINED WITH U.S. GOVERNMENT/DFID FUNDS TO SUPPORT VECTOR CONTROL ACTIVITIES Category DFID supported districts PMI supported districts Grand Total Female Male Female Male DEC* - - 30 45 75 DHT 7 29 23 73 132 Logistic Assistant - 1 2 7 10 M&E/Project Assistant 1 4 4 7 16 MoH 4 18 8 39 69 Parish Mobilizer 43 215 146 485 889

Program Assistant - - 4 4 8 Pump Technician 1 28 1 90 120 Site Supervisor 14 72 31 181 298 Spray Operator 340 1,052 1,286 3,169 5,847 Storekeeper 14 72 54 158 298 Team Leader 75 274 310 800 1,459 Volunteer Vector Control Officers - - 3 8 11 Grand Total 499 1,765 1,902 5,066 9,232 DECs* - The same DECs were used for both Phase I&II

2.3 SPRAY OPERATIONS AND SUPERVISION In the 2020 spray campaign, IRS operations were coordinated from 298 operations sites (149 in each Phase) spread across the 16 districts and 222 sub-counties. A total of 10,5622 seasonal workers (69.3% male; 30.7% female) were hired to support implementation of the 2020 spray campaign (Table 5)

TABLE 5: NUMBER OF SEASONAL STAFF HIRED Cadre Male Female Total Data Entry Clerks 45 30 75 Logistic Assistants 8 2 10 M&E/Project Assistants 11 5 16 Parish Mobilizers 700 189 889 Program Assistants 4 4 8 Pump Technicians 118 2 120 Security Guards 600 292 892 Site Supervisors 253 45 298 Spray Operators 4,221 1,626 5,847 Storekeepers 230 68 298 Team Leaders 1,074 385 1,459 Volunteer Vector Control Officers 8 3 11 Wash Persons 50 589 639 Total 7,322 3,240 10,562

2.3.1 OPERATIONS SITES All 298 operation sites operated by VectorLink FIGURE 3: SOCIAL DISTANCING DURING IRS Uganda during the 2020 IRS campaign were located MORNING BRIEF DOKOLO DISTRICT in government health facilities and community owned structures. Across the 16 districts, all the district stores were housed in government structures except for two, in Kaberamaido and Serere that are in rented structures. Of the 298 operation sites used during the 2020 spray campaign, 193 (65%) were provided free of charge by the Government or community. The project also has two central warehouses one in Lira offered by the district local government and one in Bugiri that is rented for its central location as an IRS logistics (other than insecticide) distribution center. The project provided portable handwashing facilities and sanitizers at all operations sites in response to the COVID-19 pandemic and ensured that spray teams maintained social distancing at all

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

times. Arrival and departure of spray teams at the operation site was staggered to ensure limited number of persons at the site at any one time.

2.4 LOGISTICS NEEDS AND PROCUREMENT The project referenced the inventory records from the previous IRS campaign, and also conducted a logistics needs assessment in November 2019 to develop the logistics and procurement plan that considered:

• Spray data based on 2019 IRS performance • Available stock of materials, consumables, and equipment • Transport arrangements for distribution of equipment, materials, and supplies • Estimation of insecticide, personal protective equipment (PPE), and spray equipment required to fill any gaps Based on the information from each district, the project performed a detailed analysis to determine the total number of spray pumps and amount of PPE, insecticide, and other IRS materials needed. The two central warehouses in Lira and Bugiri served as the hubs for storage of other IRS commodities before distribution to the target districts. Fludora Fusion, Actellic 300CS and SumiShield 50WG were delivered directly to each district store.

2.4.1 LOGISTICS AND STOCK At the end of the 2019 spray campaign, there was a balance of 72,500 bottles of Actellic 300CS, 52,367 from the eastern region and 20,133 from the northern region. There was a balance of 28,161sachets of SumiShield 50WG as well from the northern region. The PMI VectorLink Project procured 532,095 sachets of Fludora Fusion for the 2020 IRS campaign. The receipt of locally procured supplies in the Lira and Bugiri warehouses started in mid-December 2019 (Table 7). These supplies were distributed to the district stores and subsequently to the parish stores. The distribution of spray supplies from the district stores to the parish stores in the Phase I districts took place from February 10-29, 2020, followed by Phase II districts from May 04 to May 20, 2020. To ensure proper tracking of the insecticide bottles and sachets, the project labeled each with a unique serial number at site store level, using the tracking serial number stickers procured internationally and locally. These tracking serial numbers were used by team leaders to monitor and track insecticide usage by the SOPs to avoid any potential pilferage or loss. The project procured handwashing barrels, soap, hand sanitizers and face masks and distributed to all operation sites for use during training and IRS operations as a response to COVID-19 prevention mitigation for IRS spray teams. Upon completion of the spray activity, the logistic team retrieved the equipment from the Phase I districts and transferred the required logistics to the Phase II districts to address any gaps and ensure a timely start to the spray campaign there.

TABLE 6: PPE AND OTHER SUPPLIES RECEIVED AT THE CENTRAL WAREHOUSE IN BUGIRI AND LIRA Item Description Totals Units International Procurement Respirators 20,028 Boxes Hard hats 256 Pieces Brackets (hard hats) 4,350 Pieces

Item Description Totals Units Activated charcoal 100 Bags for mobile soak pits Serialized inventory tags 107 Rolls @ 5,000 pieces.

Local Procurement HDPE Polythene sheets 495 Rolls (Gauge 800 & 1200) 60 Litre barrels 100 Pieces for mobile soakpits Wire mesh-nylon 375 Metres for mobile soakpits Fire extingushers (2 kg) 26 Pieces Washing soap 5,000 Bars Batteries 1,656 Pairs Soaks 7,491 Pairs Liquid Soap 548 Jerrycans Serialized inventory tags 600,000 Pieces Storekeepers ledgers 395 Pieces Vitamin E cream 355 Tins Spray operator Forms 6,590 Bundles @ 100pcs. Masks-(cloth) 11,396 Pieces Handwashing facilities 167 Units Hand Sanitizers 800 Litres IRS (Household) cards 1,400,000 Pieces Tooth brushes for cleaning spray pumps 2,971 Pieces Sanitary Towels 1108 Packs Pocket size calculators 110 Pieces Laptops for data entry 20 Pieces Phone Chargers 50 Pieces Samsung A2 core phones 100 Pieces Samsung A2 core screen guards 100 Sets Toolkit set (screw driver, pliers & adjuster) 135 Sets

2.4.2 SEASONAL WORKER PAYMENT The PMI VectorLink Uganda project made all payments to the spray team using mobile phone companies that offer e-wallet service like MTN Uganda, Airtel Uganda, Uganda Telecom and Africell. The process involved transfer of funds from the project bank account in Absa bank to be loaded on the mobile wallet, ready for payment to the recipients. The participants signed attendance sheets or check rolls indicating clearly their name, ID number (where applicable), mobile money number and their signatures. For the processing of payments, the District Coordinator sent the participants’ telephone numbers to finance for processing to ensure that payments were made to the right beneficiaries. The numbers were uploaded in the mobile platform for verification and matching. The mismatched numbers were communicated back to the District Coordinator and rectified. Payments to the spray teams were first matched with the M&E Database to ensure that participants are the ones who were originally trained. The payment process followed the rigorous process of voucher preparation, review and approval. After voucher approval, the accountant initiated the payments in the mobile platform for review by the Finance manager and approval by the Chief of Party. The mobile money payment process has been very helpful and efficient in ensuring participants received their payments in a timely manner. VL Uganda will continue to pay seasonal workers through this platform.

2.5 INSECTICIDE PROCUREMENT AND INVENTORY TABLE 7: 2020 IRS INSECTICIDE USAGE SUMMARY Category Quantity Unit Balance brought forward from 2019 72,500 Bottles of Actellic 300CS Balance brought forward from 2019 28,161 Sachets of SumiShield 50WG Total procured and received 532,050 Sachets of Fludora Fusion Total insecticide stock for 2020 campaign 632,711 Units Total insecticide usage for 2020 campaign 581,595 Units Balance of insecticide in Project Store 51,116 Sachets of Fludora Fusion

2.6 IEC/SBC ACTIVITIES AND OUTCOMES Information, education and communication/social behavior change (IEC/SBC) activities are vital for IRS implementation to ensure a successful spray campaign by promoting community acceptance of the intervention. PMI VectorLink Uganda’s SBC partner, Communication for Development Foundation Uganda (CDFU), spearheaded the implementation of IEC/SBC activities in the field. The primary objectives of the 2020 communication and mobilization efforts of the project IEC activities were:

• Informing the community about safety, precautionary requirements and the benefits of the new insecticide while refuting common myths about IRS. Sensitizing and mobilizing all targeted households before and during spray, and providing post-spray key messages ensuring acceptance and enhancing commitment and ownership of IRS by the community. • Promoting understanding and acceptance of IRS through targeted messaging and mobilization among non-compliant cult/religious sect communities. • Organized small group dialogues targeting identified areas that performed poorly indicated by the M&E performance spray data in the previous year • Informed householders about the details of house preparation for spraying, and post-spray practices. • Engaging communities to adopt and utilize different malaria prevention practices (Net use, IRS, Test and treat, IPTp, Environment management) for malaria elimination. • Promoting safety and uptake of prevention actions against COVID-19 transmission among spray teams and communities This was done through a mix of approaches ranging from door to door mobilization, small group community dialogues, one on one interactive communication before and during IRS in the community. The project also conducted interactive radio talk shows, radio spot messages and announcements, engaged key influential leaders on IRS campaign, pinned community posters and disseminated role posters and frequently asked questions (FAQs) on IRS to the leaders and community. Community mobilizers were engaged to ensure that households were adequately informed of actual spray dates, and that eligible structures were adequately prepared in advance of arrival of SOPs. Key SBC achievements during the 2020 spray campaign were:

• Sensitized 263 district leaders (195 males and 8 females) in the 16 project districts, in close collaboration with the DHEs. Including 278 religious and cultural leaders (230 males and 48 females) across all the 16 districts sensitized. • Sensitized 3,662 sub-county leaders (2,176 males and 1,486 females), and 6,894 Local Council (LC) I chairpersons (6,590 males and 304 females) to become IRS champions in mobilization for IRS.

• Distributed 3,799 IRS role posters to LC1s for passing key messages to the households, 3,496 community poster and 800 IRS leaflets of frequently asked questions (FAQs) to the 16 districts. These helped provide greater clarity regarding areas that were of concern to community members. The pictorial role poster helps inform and educate householders about the details of preparing their homes for spraying and post-spray safety requirements. • Distributed 1,000 Factsheets for COVID-19, 4,000 community posters for COVID-19, 2,000 Dos and Don’ts about COVID-19. • Conducted 64 radio talk shows with 649 callers (528 males and 121 females), and airing 1,410 radio spot messages and 65 radio announcements in the 16 districts to increase awareness about IRS. • Conducted 534 dialogues across the Phase I 8 districts, reaching out to 14,680 males and 13,976 females to pass on key messages about IRS to the communities. NOTE; Community dialogues were not held in Phase II districts due to COVID-19 guidelines that could not allow gathering people. • Oriented 47 media personnel from all 16 districts about IRS and how to answer questions on air regarding IRS. This included 2 people from print media. The project also oriented, equipped and engaged 33(26 males and 7 Females) frequent radio callers to mobilize through radio. • Recruited, trained and engaged 894 (694 male and 200 female) parish mobilizers to carry out door-to- door mobilization in the 16 districts. • Conducted 192 school outreaches reaching 104,344 pupils and or students (53,529 males, 50,815 females) (source: school registers). Table 9 provides a summary of people reached through the different mobilization channels employed in the 2020 spray campaign.

TABLE 8: SUMMARY OF PEOPLE REACHED THROUGH DIFFERENT CHANNELS SBC Approach Male Female Total Community dialogues 14,680 13,976 28,656 Radio talk show call-ins 528 121 649 Interpersonal communication (IPC)/door to door 24,161 29,773 53,934 District leaders’ sensitizations 195 68 263 Sub-county leaders’ sensitizations 2,176 1,486 3,662 LC1 sensitizations 6,590 304 6,894 Mobilizers recruited and trained for house-to-house mobilization 700 189 889 Total 49,030 45,917 94,947

2.6.1 MOBILIZATION STRUCTURE DURING COVID-19 PANDEMIC In April 2020, Uganda responded to the COVID-19 pandemic and put in place measures to protect the communities from the coronavirus. This included a nationwide lockdown which went into effect while the project was completing spraying of Phase I and implementing preparatory activities for Phase II districts. The lockdown delayed the planned April 20, 2020 start of spraying in Phase II districts by 4 weeks as approval was being sought from Uganda government leadership to integrate malaria activities with COVID-19 prevention efforts. To ensure continuity of the malaria prevention measures and commencement of IRS Phase II activities, the project worked closely with NMCD to receive clearance from MOH senior leadership to continue implementing IRS in the Phase II districts as an essential health service. The project worked with the local government leaders, the District IRS and COVID-19 taskforces to mobilize communities to safely implement quality IRS while adhering to the government directives and World Health Organization (WHO) COVID-19 prevention measures. The project implemented several measures including: provision of portable hand washing

facilities, soap and water to all sites, sanitizers and fabric face masks to all spray teams including mobilizers during training and N95 face masks for spray operators, team leaders and supervisors during IRS. The project ensured that data entry facilities were adequate in size to allow for DECs to be at least 2 meters apart to maintain social distancing as well as all other meetings duly hosted by the project as part of its routine or impromptu preparatory activities. Community mobilization issues were discussed during daily evening meetings in each district by all the supervision teams to establish solutions and there follow up assigned to the IEC/BCC project Assistants and the district IRS Focal person. In addition to overseeing daily mobilization activities in their respective districts, IEC/BCC Project assistants compiled weekly reports and updates on mobilization activities and progress for overall compilation and documentation of how the community has benefited from IRS and successes of mobilization efforts through different strategies and involvement of influential community leaders. The site storekeepers also relayed site level community mobilization updates daily to the DC for targeted support to the site.

2.6.2 MOBILIZATION APPROACHES

2.6.2.1 DISTRICT, SUB-COUNTY AND LC1 LEADERS SENSITIZATION

This activity was implemented in Phase I districts FIGURE 4: IMAM MUSA RASHID SPEAKING TO ONE OF HIS before the COVID-19 outbreak. The project in SUBJECTS IN AMOLATAR DISTRICT collaboration with the MOH conducted sensitization of all key stakeholders at both district and sub-county levels in the 16 IRS districts. Through this platform the project introduced the 2020 spray exercise, shared previous spray round experiences, successes and challenges, shared spray campaign activities, scheduled and discussed the mobilization plans, strategies for managing potential challenges in 2020 and innovative methods of increasing IRS compliance and promoting other malaria prevention and control practices. During these meetings, district leaders were urged to use all available resources and channels, such as the radio talk show airtime allocated to them to communicate IRS- related information to their communities. Sub-county task forces and the LCI chairpersons in all 16 districts were urged to show their support and help with door-to-door sensitization in their respective communities, which significantly increased IRS acceptance and overall coverage over and above the WHO recommended 85% for all the public health interventions implemented universally.

2.6.2.2 RECRUITMENT, TRAINING, AND ENGAGEMENT OF IRS COMMUNITY MOBILIZERS At each site level, which largely represented a sub county, the project hired 894 mobilizers (three per site) to supplement the efforts of sub county taskforce and other village leaders in sensitizing the communities on the integrated approaches for the prevention and control of malaria as well as staying safe against COVID-19. VectorLink Uganda replaced the previous traditional community dialogues that involved large community gatherings with radio programs like interactive radio talk shows, radio spot messages and announcements. Site level mobilizers dressed in full PPE (coverall, face mask and gloves) conducted door to door community mobilization as part of its interpersonal communication (IPC) strategy while observing COVID-19 guidelines of social distancing and minimal physical interactions. Prior to community sensitization, the project-hired mobilizers were trained on community approaches, net use, IRS, test and treat, IPTp, environment management to enhance their communication skills and integrated messaging for malaria control and prevention. They were also charged with informing householders about the details of house preparation for IRS, and post-spray safety practices. A key selection requirement for these site mobilizers was that he/she had to be either part of the Village Health Team (VHT) and/or must be living and known in that community to ensure acceptance of IRS

and utilize different malaria prevention practices (net use, IRS, test and treat, IPTp, environment management) for malaria elimination. Before the spray day, mobilizers would report to the site store, according to the site level work plan to get the name(s) of the village(s) to be sprayed the following day and linked up with the village chief/Local Council one chairperson (LCI) who guided them through house to house informing them of the spray date/day and on ways of preparing houses for spraying including giving safety measures and malaria prevention integrated messages. Further to the observance of the COVID-19 prevention guidelines, mobilizers were provided with coveralls, gloves, and face masks as part of their PPE and they were charged with assisting SOPs with house preparations and directly reported any challenges to the team leaders and later to the storekeeper at end of day cleaning. They also provided information on key facts, do’s and don’ts, signs and symptoms of COVID-19, addressed common concerns and misconception about IRS among the community members such as IRS leads to infestation of bed bugs, and causes impotency among men and miscarriages among women. During the Phase I campaign, community mobilization efforts were extended as far as institutions like schools, churches, leisure places like drinking spots, football grounds, and marketplaces to mobilize the general public about IRS and malaria fight.

2.6.2.3 COMMUNITY DIALOGUES During the implementation of IRS in the Phase I districts, the project implemented all the planned community dialogues featuring the project’s SBC team, DHEs, and DHT members and conducting up to 534 community dialogues. The dialogues focused on boosting IRS coverage amongst resistant and slow uptake communities that had considerably resisted IRS in the previous spray round and targeted areas that had attained low IRS coverage as indicated by the daily SMS report on spray performance in the previous Phase. These refusal communities were mainly religious sects and traditional healers in a few sub-counties of Bugiri, Butebo and Pallisa districts. The SBC team enlisted the support of cult/religious sect leaders to help overcome the resistance, which improved compliance.

2.6.2.4 RADIO TALK SHOWS, SPOT MESSAGES AND ANNOUNCEMENTS The project together with the DHEs and in FIGURE 5: RELIGIOUS LEADER, DHE AND RDC OTUKE consultation with the DHT and 16 district IRS task DURING TALK SHOW AT VOICE OF LANGO FM RADIO forces organized project-initiated interactive IRS radio programs. The DHEs in the districts took the lead in identifying, inviting, and briefing guest speakers for the talk shows. The major objectives were to sensitize community members and inform them about IRS; respond in depth to community concerns about the insecticide; and communicate what is expected of households during pre-spray and preparations during spraying, and precautions that need to be taken after spraying. Similarly, radio talk shows were aired in the districts to effectively communicate spray dates and IRS key messages, and to bolster mobilization amongst the target communities. Messages for Phase II were adjusted to incorporate relevant COVID-19 prevention measures.

2.6.3 MASS AND PRINT MEDIA The project through the communication partner CDFU reviewed, re-designed, printed and disseminated the communication materials based on the new insecticide and ensured that they are aligned with the Ministry of Health communication strategy and IRS requirements to reinforce community and radio activations. These materials included: IRS role posters, community poster and frequently asked questions (FAQs) leaflets. CDFU

pre-tested the materials, before finalizing and printing. These helped provide greater clarity regarding areas that were of concern to community members. The pictorial role poster helps inform and educate householders about the details of preparing their homes for spraying and post-spray safety requirements.

2.7 COMPOSITION AND MANAGEMENT OF IRS ACTIVITIES Together with the MOH/NMCD and district local governments, the project implemented a successful spray round in 2020. The project provided all the technical and logistical support required for the operation in the 16 districts and based all measures on lessons learned from the 2019 spray campaign. Some of the new measures the project implemented during this spray round included the increase from 276 to 298 site stores in the 16 districts to further reduce the distance some spray teams moved in the 2019 campaign and also respond to the poor road network in some areas. The increase was also an effort to improve project’s supervision efficiency and made it easier to promptly respond to site-level challenges during the campaign. The project also used trucks to transport the SOPs to the sites that were more than 10kms range and for the nearby sites SOPs largely used bicycles for easy access. The field team included the PMI VectorLink Project Uganda staff (seven district coordinators and seven store managers) and seven IEC/SBC coordinators (seconded by CDFU) who resided in the districts during IRS implementation. District coordinators and store managers were in charge of two districts, with the exception of one pair who spearheaded field operations in the three districts of Butebo, Pallisa, and Serere. The district coordinators, store managers, and IEC/SBC coordinators provided coordination and supportive supervision, working closely with the operations manager and the district and sub-county leaders as shown in Figure 6.

FIGURE 6 : DISTRICT OPERATIONS ORGANOGRAM

2.8 GENDER MAINSTREAMING The PMI VectorLink Project Uganda, recognizes gender equality and female empowerment as development goals in their own right, as well as approaches to achieving its vector control goals. The project identifies and then addresses inequalities between men and women across spray operations. As in previous IRS campaigns, approaches employed for achieving an impact included:

• Explicitly including gender issues in all trainings from TOT through cascade trainings.

• Working directly with local authorities and women’s groups to increase the percentage of women the project hires. Staff shared information on the importance of hiring female SOPs and presented data that show that women are as effective as their male counterparts in spraying the targeted structures per day. The project also emphasized placing qualified women into supervisory roles and ensured that women had a chance to serve as storekeepers, site supervisors, team leaders, and parish supervisors. • Continuing promotion of a respectful work environment through dissemination of information on the project’s sexual harassment policy to all employees and stakeholders. • Revising training and mobilization documents to include more pictures and information about women in a range of IRS roles. • Ensuring that recruitment, mobilization, and training include women and respect women’s time constraints (when possible). • Ensuring that women who are pregnant or lactating are assigned to roles without exposure to insecticide like community mobilization and site stores security guard positions. • Encouraging women to take up leadership positions remains core as much as boosting their overall participation in spray activities. • Providing sex-disaggregated data for all indicators, as appropriate. • Continuing to reserve some positions for women whose minimal academic background precludes their serving in positions that require literacy and arithmetic; for example, most positions for day-time security guards were reserved for women. • Provision of sanitary napkins has continued to be one of the greatest motivators to women joining the program. During the 2020 IRS campaign, women represented 31.4% of all seasonal staff. The project continues to experience challenges related to gender norms in the IRS intervention areas, especially with regard to husbands having to give permission for women to be employed for IRS activities. Additionally, there is a widespread perception that IRS is an activity for men, which acts as a barrier to hiring more women for IRS. Limited access to transport required during the spray campaign and inability to ride a bicycle due to fear of breaching cultural norms also limits women’s participation, especially in urban areas and the eastern IRS districts. Restrictions on women owning a phone or a phone line is another limitation to women joining the program as the current payment method is by mobile money transfer. The project will continue to engage the communities to eliminate these bottlenecks. Table 10 provides details on female participation during the 2020 IRS campaign. The project continues to find ways to hire more women for different activities, especially for the washer role, which seems appealing to women candidates. Additionally, approximately one in four guards this year were women, an important success in a role usually dominated by men. The project will share lessons learned on engaging women in security functions with other PMI VectorLink country teams. In future years, the project will adapt its recruitment practices to move toward more egalitarian hiring across all cadres.

TABLE 9: SEASONAL WORKERS DURING THE 2020 IRS CAMPAIGN Participation Category Grand Total Female % Female Male Data Entry Clerk 30 45 75 40.0 Logistic Assistant 2 8 10 20.0 M&E Assistant 5 11 16 31.3 Parish Mobilizer 189 700 889 21.3 Program Assistant 4 4 8 50.0 Pump technicians 2 118 120 1.7

Security Guard 292 600 892 32.7 Site Supervisor 45 253 298 15.1 Spray Operator 1,626 4,221 5,847 27.8 Storekeeper 68 230 298 22.8 Team Leader 385 1,074 1,459 26.4 Volunteer Supervisor 3 8 11 27.3 Wash Person 589 50 639 92.2 Grand Total 3,240 7,322 10,562 31.4

2.9 POST-SPRAY REVIEW MEETING The project held one day IRS review meetings on July 14, 2020 (Mbale) and July 16, 2020 (Lira) to assess the overall performance of the 2020 IRS campaign. The meeting reviewed progress, achievements, and challenges, and examined how effectively this activity is contributing towards the project’s objectives, especially amidst COVID-19 pandemic. Key lessons from this review meeting will help guide the next spray planning and focus on the emerging issues and implementation gaps (Annex B). A total of 48 people participated in the IRS review meeting including 16 project staff, 3 CDFU representatives, 15 district malaria/IRS focal persons, and 14 district health officers. Some of the key lessons and recommendations made during the meeting include:

• Review the number of training days for spray operators and team leaders to provide sufficient time for training on spray techniques and data tools. • Conduct training of trainers/ supervisors close to the start of IRS to avoid loss of knowledge due to extended period of layover post-training. • Train all trainers comprehensively, and with focus on store management tools, to ensure delivery of uniform content to trainees at cascade level thus addressing conflicting instructions provided by different supervisors. • Explore opportunity for funding IRS sustainability/ exit activities at district level. • Involve district leaders in recruitment and ensure office of the District Health Officer (DHO) provide overall supervision oversight to the whole recruitment exercise. • Enhance quality of IRS intervention through improved technical skills, coordination and supervision.

3. ENTOMOLOGY 3.1 IRS QUALITY ASSURANCE ASSAYS PMI VectorLink Uganda in collaboration with the district-based Vector Control Officers conducted cone bioassay tests as a quality assessment in one sentinel site in each of the eight sentinel districts within two weeks of spraying:

• Bugiri, Butaleja, Kibuku and Tororo - Actellic 300CS and Fludora Fusion used • Dokolo, Lira, Otuke, and Serere – SumiShield 50WG and Fludora Fusion used

The tests were performed using susceptible Anopheles gambiae s.s. (Kisumu strain) in five houses per site purposefully selected to represent different wall types (plastered and painted, plain brick and mud wall surfaces) commonly found in the area all sprayed by different spray operators. The tests were performed according to VectorLink approved protocol (SOP009/01 of May 18, 2019). Two–three-day-old sugar-fed adults were exposed to the sprayed walls in the selected houses. Three test cones were placed at heights (bottom, middle and top, at approximately 0.5 m, 1.0 m, and 1.5 m above ground level, respectively) on sprayed wall surfaces. The control cone was affixed on a wall lined with a paperboard with adhesive in an unsprayed house to avoid any potential airborne effect. Batches of 10 two- to five-day-old non-blood-fed female susceptible An. gambiae s.s. (Kisumu strain) mosquitoes were introduced in each of the plastic cones. The mosquitoes were left in the cones for 30 minutes, after which they were transferred using an aspirator to insecticide-free paper cups supplied with sugar solution. The paper cups with exposed mosquitoes were then placed in a cardboard box covered with a damp towel. Knockdown was observed and recorded at 30 and 60 minutes, with final diagnostic mortality recorded at 24 hours holding period post-exposure for Actellic 300CS (pirimiphos–methyl CS). For SumiShield 50WG and Fludora Fusion test mortality, mosquitoes were monitored every 24 hours until 100% test mortality was achieved or up to day 5, whichever came first according to PMI VL SOP009/01 of 18 May 2019. SumiShield 50WG and Fludora Fusion achieved 100% test mortality within 24 hours of holding period post exposure. Tests for the airborne effect of Actellic 300CS, SumiShield 50WG and Fludora Fusion were conducted with susceptible An. gambiae s.s. (Kisumu strain) placed inside a mosquito net cage and hung 10cm away from the sprayed wall surface at a height of 1.0m above the ground with knock-down recorded at 30 mins and 60 mins after exposure. The mosquitoes were then transferred into clean paper cups that were kept for a 24-hour holding period for Actellic 300CS and the percentage mortality was calculated for each house and recorded according to PMI VL SOP009/01, 1st Issue, 18 May 2019. The results for the spray quality bioassays (conducted within two weeks after spraying) showed 100% test mosquito mortality in all the eight spray districts where the tests were conducted, clearly indicating that the spraying by the spray operators was not under dosed (Tables 11, 12, 13 and 14).

TABLE 10: KNOCKDOWN RATE AND MORTALITY OF ANOPHELES GAMBIAE S.S. (KISUMU STRAIN) AFTER EXPOSURE TO DIFFERENT ACTELLIC 300CS SPRAYED WALL SURFACES IN THREE DISTRICTS, MARCH 2020 Description Bugiri District Kibuku District Tororo District Bulesa Sub-County Kabweri Sub-County Rubongi Sub-County PP PB M CTL PP PB M CTL PP PB M CTL # mosquitoes 30 60 60 10 30 60 60 10 60 60 30 10 tested 30 min. knock- 96.7 75.0 58.3 0 100 88.3 86.7 0 95.0 63.3 86.7 0 down (%) 60 min. 100 100 100 0 100 100 100 0 100 100 100 0 Knock-down (%) % 24 hr 100 100 100 0 100 100 100 0 100 100 100 0 mortality Key: PP = Plaster painted; PB = Plain brick; M = Mud; CTL = Control TABLE 11: KNOCKDOWN RATE AND MORTALITY OF ANOPHELES GAMBIAE S.S. (KISUMU STRAIN) AFTER EXPOSURE TO DIFFERENT FLUDORA FUSION SPRAYED WALL SURFACES IN FOUR DISTRICTS, MARCH 2020

Bugiri District Butaleja District Kibuku District Tororo District Kapyanga Sub-County Butaleja Sub-County Busaba Sub-County Kasasira Sub-County Osukuru Sub-County

Description PP PB M CTL PP PB M CTL PP PB M CTL PP PB M CTL PP PB M CTL # mosq. 30 60 60 0 30 60 60 0 30 60 60 0 30 60 60 0 30 60 60 0 tested 30 min. knock- 100 100 100 0 100 100 91.7 0 100 100 91.7 0 96.7 100 88.3 0 53.3 66.7 91.7 0 down (%) 60 min. knock- 100 100 100 0 100 100 100 0 100 100 100 0 100 100 100 0 100 100 100 0 down (%) % 24hr 100 100 100 0 100 100 100 0 100 100 100 0 100 100 100 0 100 100 100 0 mortality Key: PP = Plaster painted; PB = Plain brick; M = Mud; CTL = Control TABLE 12: KNOCKDOWN RATE AND MORTALITY OF ANOPHELES GAMBIAE S.S. (KISUMU STRAIN) AFTER EXPOSURE TO DIFFERENT SUMISHIELD SPRAYED WALL SURFACES IN FOUR DISTRICTS, JUNE 2020 Description Dokolo District Lira District Otuke District Serere District Adok Sub-County Adekokwok Sub-County Adwari Sub-County Kyere Sub-County PP PB M CTL PP PB M CTL PP PB M CTL PP PB M CTL #mosquitoes 30 60 60 10 30 60 60 10 30 60 60 10 30 60 60 10 tested 30 min. knock-down 33.3 51.7 18.3 0 83.3 78.3 90.0 0 96.7 83.3 86.7 0 86.7 18.3 6.7 0 (%) 60 min. Knock-down 90.0 95.0 73.3 0 93.3 78.3 88.3 0 100 100 100 0 100 86.7 83.3 0 (%) % 24 hr mortality 100 100 100 0 100 100 100 0 100 100 100 0 100 100 100 0 Key: PP = Plaster painted; PB = Plain brick; M = Mud; CTL = Control

TABLE 13: KNOCKDOWN RATE AND MORTALITY OF ANOPHELES GAMBIAE S.S. (KISUMU STRAIN) AFTER EXPOSURE TO DIFFERENT FLUDORA FUSION SPRAYED WALL SURFACES IN FOUR DISTRICTS, JUNE 2020 Description Dokolo District Lira District Otuke District Serere District Agwata Sub-County Adekekwok Sub-County Otuke Town Council Olio Sub-County PP PB M CTL PP PB M CTL PP PB M CTL PP PB M CTL # mosq. 30 60 60 10 30 60 60 110 30 60 60 10 30 60 60 10 Tested 30 min. knock-down 100 96.7 93.3 0 83.3 100 95 0 100 98.3 100 0 100 95 91.7 0 (%) 60 min. knock-down 100 100 100 0 100 100 100 0 100 100 100 0 100 100 100 0 (%) % 24 hr 100 100 100 0 100 100 100 0 100 100 100 0 100 100 100 0 mortality Key: PP = Plaster painted; PB = Plain brick; M = Mud; CTL = Control

3.2 RESULTS OF FUMIGANT EFFECT The knockdown effect of Actellic 300CS (Pirimiphos-methyl), SumiShield 50WG (clothianidin); Fludora Fusion (clothianidin + deltamethrin) at 30 and 60 minutes post-exposure are shown in Figure 7. Of the 150 An. gambiae s.s. exposed in sprayed houses in March and June 2020 to assess fumigant effect of Actellic 300CS, 88.0% of the exposed mosquitoes on average, with 37.3% (n=56) of the exposed mosquitoes knocked down at 30 minutes and 82.7% (n=124) at 60 minutes post-exposure respectively. Of the 430 An. gambiae s.s. exposed in sprayed houses in March and June 2020 to assess fumigant effect of Fludora Fusion, 94.4% of the exposed mosquitoes on average died, with 39.8% (n=171) of the exposed mosquitoes knocked down at 30 minutes and 79.1% (n=340) at 60 minutes post-exposure, respectively. Of the 200 An. gambiae s.s. exposed in sprayed houses in March and June 2020 to assess fumigant effect of SumiShield 50WG, 88.5% of the exposed mosquitoes on average died, with 28.0% (n=56) of the exposed mosquitoes knocked down at 30 minutes and 71.5% (n=143) at 60 minutes post-exposure, respectively.

FIGURE 7: PERCENTAGE FUMIGANT KNOCKDOWN EFFECT OF ACTELLIC 300 CS, SUMISHIELD 50WG AND FLUDORA FUSION SPRAYING ON AN. GAMBIAE S.S. IN PHASE I AND PHASE II DISTRICTS, MARCH AND JUNE 2020 Plaster Painted Plain Brick Mud 120

100

40 % Knockdown 20

30min 60min 30min 60min 30min 60min 30min 60min Actellic Phase I Sumishield Phase II Fludora Fusion in Fludora Fusion in districts March 2020 districts June 2020 Phase I districts March Phase II districts June 2020 2020

3.3 PRE-IRS PYRETHRUM SPRAY CATCHES (PSCS) In February 2020, the District teams with support of PMI VectorLink Uganda staff conducted pre-IRS PSCs and HLCs in two selected sentinel sites in two Phase I IRS districts of Bugiri and Tororo. The pyrethrum spray catches (PSCs) were conducted in 20 houses per sentinel district according to VL SOP03/01 of 18 May 2019 and human landing collections (HLCs) indoors and outdoors in two houses per sentinel district for two consecutive nights from 6.00 p.m. to 7.00 a.m. according to VL SOP02/01 of 18 May 2019. Due to the COVID-19 restrictions, the assessment of indoor resting vector density and species composition pre- IRS in PPhase II districts of Lira ad Otuke and post-IRS vector density monitoring in Phase I districts was not done. A total of 49 female vectors (43 An. gambiae s.l. and 6 An. funestus s.l.) were collected in the pre-IRS PSCs and HLCs monitoring in Bugiri and Tororo districts (Table 15).

FIGURE 8: MEAN NUMBER OF FEMALE MALARIA VECTORS CAUGHT PER HOUSE DURING PRE-IRS PSCS/ HLCS IN THE TWO IRS DISTRICTS, FEBRUARY 2020

PSC Indoor HLCs Outdoor HLCs 4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

Mean Vectors No.Female of 0.5

0.0 An. gambiae s.l. An. funestus s.l. An. gambiae s.l. An. funestus s.l. Bugiri` Tororo

4. ENVIRONMENTAL COMPLIANCE In accordance with the Supplemental Environmental Assessment: 2020 – 2025, the PMI VectorLink Uganda Project used both Actellic 300CS (organophosphate class) and Fludora Fusion (clothianidin/deltamethrin combination) in eight PPhase I districts, followed by SumiShield and Fludora Fusion in eight PPhase II project districts. The project put a monitoring system in place to ensure that the IRS operations adhered to environmental compliance (EC) requirements, to protect spray actors, beneficiaries, and the environment in accordance with the PMI Best Management Practices (BMP) (Annex C).

4.1 IRS CAMPAIGN ASSESSMENTS 4.1.1 ENVIRONMENT AND SOCIAL IMPACT ASSESSMENT (ESIA) An ESIA was conducted by JBN Consults for the introduction and use of Fludora Fusion in IRS. The study, which was concluded and submitted to National Environmental Management Authority (NEMA) in December 2019, received a formal approval in February 2020. This was in conformance with the National Environmental Act requirements for projects with likely impacts to the environment.

4.1.2 ENVIRONMENTAL AUDIT An Environmental Audit conducted by Environmental Compliance Support (ECOS), was done for the eight PPhase II districts between June 8 and June 20, 2020. This audit is as directed by USAID/PMI. Results and feedback of the audit are yet to be communicated.

4.1.3 PRE-SEASON ENVIRONMENTAL COMPLIANCE ASSESSMENTS The project, in collaboration with the DHT, conducted two pre-season Environmental Compliance assessments (PSECAs) for all operations sites in the 16 project districts. The project did these assessments using checklists programmed on the Open Data Kit (ODK) platform installed on smartphones. The initial round of PSECAs focused on identifying IRS material needs, suitability of site locations, and rehabilitation and refurbishment needs for storerooms, soak pits, and bath shelters. In both Phase I and Phase II districts, the project conducted initial PSECAs well ahead of the arrival of IRS supplies. The lists of IRS materials needed, based on identified gaps for the 298 operations site stores, were generated and communicated to the store managers and district coordinators, who had the responsibility of overseeing all storeroom, soak pit, and bathroom refurbishments. The final PSECAs were completed the week prior the start of the campaign. The EC team confirmed that all gaps identified during the initial rounds of PSECAs were resolved for each site before authorizing the distribution of insecticides to the site for operations. These included: availability of material safety data sheets, emergency response procedure sheets, first aid kits, spill kits, danger signs, thermometers, and fire extinguishers. Also assessed were soak pit siting, rehabilitation status of soak pit and wash areas, and availability and privacy of bath shelters for male and female spray personnel. A total of 298 permanent soak pits were used for the disposal of insecticide-contaminated effluent. The walls of the 298 soak pits were lined with plastic sheets to prevent any percolation of effluent into the environment. In addition, in all 298 soak pits, the entire wash area was covered with polyethylene plastic sheets to prevent the wastewater from cleaning the outside of sprayers and PPE from seeping into the ground, and to direct it into the soak pit for treatment. To ensure adequate and standardized storage facilities, the project renovated the Amolatar and Butebo district stores to bring them up to the BMP recommended standard. The project also equipped all district stores with shelves, pallets, first aid kits, dustbins, and emergency spill kits to ensure health and environmental safety during the spray campaign. The project also equipped all the stores with thermometers to monitor temperatures within the site storerooms. In addition, the National Drug Authority (NDA) inspected all the 15 district stores to ascertain their suitability for storage of IRS equipment and insecticides. The district stores met NDA’s

requirements and were certified for the calendar year 2020. Unlike other years when certification was valid for 12 months, the current certifications are valid for a period of three years each.

4.1.4 MID- AND POST-SEASON ENVIRONMENTAL INSPECTIONS PMI VectorLink Uganda staff, jointly with the MOH supervisors, DHTs, and sub-county supervisors, were involved in routine supervision, and in mid-spray and post-spray environmental inspections in all 16 project districts. The supervision and environmental inspections were conducted using CommCare supervision and ODK tools installed on smartphones. All project staff and supervisors were charged with identifying areas of weakness, providing correction, and guiding SOPs on the spot. At the end of each day, the district coordinators and the supervision team held a general meeting to review progress, achievements, shortcomings, and constraints found, and forwarded the recommendations to the operations, logistics, and EC departments for further corrective actions. The EC team also reviewed the daily supervisory reports submitted by the field inspectors for immediate follow-up and action. However, a number of red flags based on the supervisory reports were due to reporting errors where in some instances presence of expired insecticide was reported at stores when this was not the case upon verification. A few times, connectivity issues in the field made it hard to get supervision reports on time. At the end of the spray campaign, all PPE, including coveralls and sprayers, was properly cleaned, and stored in the district stores for use in the next campaign. All unused insecticides were retrieved from parish stores and stored safely in the district stores for use in the next campaign. The project team ensured that soak pits were cleaned, covered with a polythene sheet, and locked, and that storerooms were washed and handed over to the owners.

4.2 INCIDENT REPORTS The PMI VectorLink Uganda project reported all incidents as they occurred during the 2020 spray campaign. The field team responded promptly to all these incidents, trying to understand the root cause of the incidents, and instituting remedial measures. When a SOP was either involved in a minor accident or exposed to insecticide and needed to take time off, that person was compensated for the time away and assigned lighter duties if the situation so demanded. In incidents of pilferage and data falsification, the perpetrators were immediately dismissed, and the matter handed over to the DHT for further actions. During the 2020 spray campaign, VectorLink Uganda recorded and reported all incidents (in total 15) of insecticide exposure, accidents and other health and safety concerns (Annex J).

4.3 HEALTH AND SAFETY In light of the COVID-19 pandemic, measures and guidance shared by the Ministry of Health in line with World Health Organization’s requirements were integrated into our operations, especially during PPhase II campaign. Some of the measures put in place included, sensitization of workers, provision and display of COVID-19 precaution messages. Social distancing, proper use of recommended nose masks, frequent hand washing or the use of alcohol-based sanitizers were promoted and enforced. Many, however, were encouraged to work from home, while conscious of possible signs and symptoms.

• To manage insecticide poisoning that may arise from insecticide inhalation, ingestion, or dermal entry during spray operations, the project collaborated with clinicians and laboratory technicians from 279 health centers and 13 hospitals in the 16 IRS districts to identify and respond to any signs and symptoms of insecticide poisoning, and manage incidents of poisoning. • The project conducted medical examination of all spray team members, including security guards and wash persons, to ensure that only healthy personnel fit for work are recruited. All females directly engaged in IRS activities received pregnancy tests and only those with negative tests were engaged in tasks that involved handling insecticides and contaminated waste.

• All site and district stores in the 16 project districts received first aid kits for use in the event of an accident or exposure to insecticide during spray operation. However, these were void of pharmaceuticals based on new guidance from PMI. Incidents that warranted administration of pharmaceuticals were referred to the nearest Government Health facilities. • During the spray campaign, the team leaders conducted daily morning health checks for the SOPs before departing to the field. This was to assess their physical fitness, any signs and symptoms related to insecticide poisoning, COVID-19, and any other health condition that could impede or compromise their safety while in the field. • The project also conducted a four-day (January 2020) inspection of 64 transportation vehicles at the Kampala office and Tororo field office before signing contracts. This was intended to ensure that all the vehicles met the PMI BMP health and safety requirements before they were deployed for the spray campaign. During the inspection, some of the gaps identified included among others, lack of emergency kits, expired motor insurances and driving licenses. The EC team in collaboration with the Logistics Coordinator ensured that vendors rectified identified gaps before deployment.

4.4 DEMOBILIZATION AND WASTE MANAGEMENT 4.4.1 CLOSURE OF SITE STORES AND SOAK PITS The project conducted post-IRS assessment and supervision at all 298 operations sites (soak pits) and site stores based on the standard smartphone checklists, to ensure that all the operations sites were cleaned appropriately, shut down, and handed back to both private and district-owned facilities. These inspections were done to ensure that there were no concerns regarding environmental health or safety after the spray campaign. The team immediately rectified any gaps identified during these assessments, such as uncovered soak pits.

4.4.2 SOLID WASTE DISPOSAL The project collected and segregated all solid FIGURE 9: DELIVERING IRS SOLID WASTE FOR INCINERATION wastes generated from the spray campaign in Phase I and II districts and had them AT GREEN LABEL SERVICE LIMITED IN IGANGA quantified. All empty insecticide bottles and used polythene sheets were recycled at Gentex Enterprises, while uncontaminated paper cartons was delivered to Pulp and Paper Mills Ltd. in Jinja district, and all contaminated waste paper material (material safety data sheets, empty insecticide sachets, insecticide-impregnated papers), used nose masks, and insecticide cardboards was incinerated at Green Label Service Limited incinerator in Iganga. The project has kept records of the recycling and disposal certificates issued for these three categories of waste, in compliance with the National Environment Act, 2019 and the National Environment (Waste Management) Amended Regulations 2006. Table 17 below shows the different categories of waste generated and their respective management mechanisms.

TABLE 14: DIFFERENT CATEGORIES OF WASTE GENERATED DURING 2020 SPRAY CAMPAIGN, AND PLANNED MANAGEMENT MECHANISM Type of Waste Weight (kg) Disposal Site Disposing Company Planned Management Mechanism Actellic bottles 7,282 Matuga Gentex Enterprises Ltd Recycling into culverts, floor boards and other products not harmful to health Empty sachets (SumiShield & Fludora 5,993 Iganga Green Label Services Ltd Incineration Fusion)

Damaged helmets 407 Matuga Gentex Enterprises Ltd Recycling

Damaged face shields 436 Matuga Gentex Enterprises Ltd Recycling

Other assorted plastics (damaged 548 Matuga Gentex Enterprises Ltd Recycling basins, barrels, measuring jugs, and jerrycans) Alkaline batteries 99 Iganga Green Label Services Ltd Encapsulation in concrete & landfilled Used nose & mouth masks 2,023 Iganga Green Label Services Ltd Incineration

Contaminated bicycle cushions 1,063 Iganga Green Label Services Ltd Incineration HDPE polythene sheets 3,284 Matuga Gentex Enterprises Ltd Recycling

LDPE polythene sheets 258 Matuga Gentex Enterprises Ltd Recycling

Damaged hand gloves, aprons, neck 667 Iganga Green Label Services Ltd Incineration protectors & filter clothes Empty aerosol cans 127 Iganga Green Label Services Ltd Shredding, autoclaving & recycling Damaged spray pump parts & assorted 284 Iganga Green Label Services Ltd Treatment & recycling contaminated wastes Damaged gumboots 811 Iganga Green Label Services Ltd Treated, shredding & recycling Empty paper cartons 10,920 Jinja Uganda Pulp and Paper Mills Ltd Recycling into products not harmful to health

5. MONITORING AND EVALUATION During the 2020 spray campaign, the project’s M&E team focused on strengthening the M&E system while reflecting on lessons learnt in the previous project year. The key IRS M&E activities implemented include:

• Update the existing M&E plan to include reporting needs and requirements. • Updating organization units in VectorLink collect District Health Information Software 2 (DHIS2) database system • Emphasize accuracy of both the data collection and the data entry process, through comprehensive trainings and supervision at all levels. • Streamline and standardize data flow to minimize data transcription errors and facilitate timely reporting. • Communicate IRS data and information to stakeholders in a timely and clear manner. • Ensure IRS data security and storage for future reference through establishment and enforcement of a proper storage facility.

5.1 DATA COLLECTION, ENTRY, AND QUALITY ASSURANCE 5.1.1 DATA COLLECTION The PMI VectorLink Uganda Project, used data collection tools that were developed to ensure the collection of all PMI requested indicators. In addition to the routine data recording checks built into the data collection process, the supervisory staff used the data quality assurance tools detailed in Annex D.

5.1.2 VECTORLINK COLLECT DATABASE In 2020, VectorLink Uganda continued to use the DHIS-2 system for spray data entry, cleaning, and reporting. The system had multiple advantages, including the ability to have real time view of data entry progress, development of powerful dashboards, and pivot tables to track performance and remote interaction with the system from any location. The project granted access to the stakeholders in the MOH, the NMCD, PMI Mission office and the VectorLink project staff. Prior to the start of 2020 campaign, the M&E team with support from operations department gathered geographical information to village level and generated unique SOP codes to identify the seasonal staff in the program as well as spray targets to sub-location level. These were then set up in the system prior to the start of the campaign to enable entry and reporting. VectorLink Collect (VLC) has four main event programs that reflect the mobilization and spray hardcopy data collection forms. For Uganda this majorly includes spray details and spray totals since the country doesn’t as yet collect mobilization data unlike other VL countries. The details represented each observation on the spray data form as a row and the totals represented the summation of the contents of each observation per row. However, VL Uganda used only two of the four main event programs i.e., spray details and spray totals because no mobilization data was collected. The database had additional built-in tools to enhance reporting:

• Desktop Event Capture: An offline data entry platform with in-built validation checks to ensure accurate data entry even in places with no internet connectivity. It was installed in every data entry clerk’s (DEC’s) machine, pointing to the live server where data was synced at the end of each day. DECs were not supposed to log out of the system until the end of the campaign.

• Duplicate Finder: An application run after the data entry to identify any duplicated IRS numbers that were not as a result of revisits in the field (i.e., true duplicates of IRS numbers either from data entry errors or errors from the field). • Mop up Tool: A tool used to mark any revisited structures in the system as reported in the daily SOP form, to retain the “updated” event in the database to prevent double counting of eligible structures. • Variance Reports: A custom, HTML report within the VLC identified data inconsistencies resulting from mismatches between the details and the totals programs for both spray and mobilization. • Data cleaning was a progressive exercise, with DECs at each data center dedicated to this role. All forms that were identified to have errors were returned to the field before being entered in the system. Duplication of IRS numbers was the most common error identified, mainly due to SOP error as they recorded the numbers. To resolve these errors, after confirmation with the hardcopy forms, the field teams went back to the structures for verification. Some of the spray data duplicates were the result of revisited structures not indicated as revisits in the Daily Spray Operator forms; once identified, ‘revisit’ was indicated on the form and an edit was made in the system. In addition, the data collection process was characterized by SOPs misunderstanding of the definition for a structure and a homestead or household. In some instances, the same IRS number was given to all structures that they found in a household, thus creating duplicate IRS numbers in the database. • The VLC worked well for final spray data reporting. In rare instances, power outages resulted in locally stored, offline data being lost when the desktop machines shut off in the middle of data entry leading to re-entering of data. Overall, the M&E team ensured all the data entry machines had internet connectivity with increased bandwidth and a power back-up generator throughout the campaign to ensure consistent, reliable data entry and reporting throughout the 2020 IRS campaign. • The project trained a total of 75 DECs, 16 district biostatisticians, and 16 M&E assistants on the use of this database. The participation of district staff helped ensure skills transfer, ownership, and use of spray data by stakeholders in planning surveillance-related activities in these districts.

5.1.3 DATA ENTRY, TRACKING, STORAGE, AND SECURITY Data entry was conducted at four data centers, in Lira, Mbale, Soroti, and Tororo. Based on network availability at the various data centers, the DECs used a combination of web-based and offline desktop-based data entry, both of which linked to the central DHIS2 database, for final storage and reporting. To ensure the secure storage of all data collected by PMI VectorLink Uganda, all completed paper forms were filed by geographical area and date and transferred to the Tororo field office for final storage. Electronic data was secured by back-up PMI VectorLink database servers, cloud-hosted by BAO Systems.

5.1.4 DATA QUALITY ASSURANCE During the national training (boot camp) and district level TOTs, the M&E team emphasized definitions of key IRS terms and reporting indicators, compliance with M&E protocols, and proper data collection. They also trained field staff and supervisors on supervisory responsibilities and data security. The M&E team engaged in supervising fieldwork during spray operations. While observing data collection and entry in the field, the team identified issues and was able to correct errors on the spot. The data recording problems included how to complete the IRS card, how to write IRS numbers, how to write complete insecticide serial numbers, how to compute the total number of people in a structure and those protected, and when and how to give IRS numbers. In addition, errors observed after reviewing the cards were discussed during the first week of the spray together with site field team, which resulted in improvements in the observed gaps over the course of the campaign. Annex E shows the overall monitoring and evaluation plan.

5.1.5 MHEALTH The PMI VectorLink Project Uganda continued to work in partnership with Dimagi LLC to use the CommCare mobile health (mHealth) system for the 2020 IRS campaign. Using the system, the project staff, MOH staff, and district supervisors were able to conduct routine standard supportive supervision, access real-time spray data, conduct data verification at the household level, and remind spray teams about regulations and operational procedures through daily job aid messages. The system enabled real-time sharing of data and facilitated results- based decision-making. The team monitored operation site level spray progress through daily SMS. The mHealth reporting tools used throughout the campaign included:

• Supervisory Tools The supervisory application tool was used by site supervisors, MOH supervisors, and DHTs to support IRS supervisory activities. The application was accessible through CommCare, and users received training during the boot camp and the TOT trainings. The mobile phone application contained multiple forms covering key supervisory functions, including morning mobilization, storekeeper performance, household preparation, SOP performance, and end-of-day clean-up. Users completed forms during their routine supervision activities and submitted data to the CommCare system. Based on the information reported each day, CommCare used daily email alerts to report any red flags that the supervision teams had observed during the campaign. Examples of red flags included sprayer leakages, refusals by households, and need for additional items at the operation sites, such as gloves and sprayer spare parts. In total, the PMI VectorLink Uganda supervision team completed 77,723 of these supervisory forms (Annex F).

• Data Collection and Verification - During Phase I spray campaign, MOH supervisors, DHT, site supervisors, M&E assistants, program Assistants, Logistic Assistants and project staff used the Data Collection and Verification (DCV) mobile tool to validate household-level information on the spray status in randomly sampled households. They verified the collected information by comparing it with the daily SMS Phone Mobile Technology data, and Spray Operator forms. The project verified this information with households’ information as entered into VLC using the findings of the spray coverage for each of the tools. For Phase I, the spray coverage for each of the tools is as follows; DCV 96.1%, PMI VectorLink Collect database 93.8% Performance Monitoring Tracker (PMT) 93.8% (within the 5% error). The project is reviewing further the supervision structure to provide more efforts to validate the data as they are being collected.

• Performance Monitoring Tracker - During training, the storekeepers learned how to manage the spray performance tracker sheet at their respective operation sites. They received instruction on how to maintain a constant flow of up-to-date operational data on the spray performance sheet, which served as the basis for the daily PMT short message service (SMS) system. At the end of each spray day, the storekeepers sent the aggregated data from the day’s operations via SMS to the Telerivet system; this system populated the daily PMT emails reporting spray progress and coverage figures from the operation sites to the chief of party, operations manager, the M&E manager, and home office backstop team. The PMI VL Uganda team used the report to monitor sites with low spray coverage, fluctuating progress, and increased insecticide consumption. The report was further used to compile the weekly PMI report supported to the donor.

• Job Aid Messages - Supervisors, SOPs, team leaders, and storekeepers also received SMS messages throughout the IRS campaign to remind them about key topics including SOPs’ daily structure targets, the importance of wearing PPE and avoiding eating while on duty. The project also sent emergency messages to the site storekeepers and site supervisors to remind them about the daily spray data

card collection, to ensure quick entry of data into the VL collect IRS database. Other messages that supervisors sent via SMS included ensuring proper use of PPE by the spray team, delivery of correct messages on malaria prevention to homeowners, and the need to meet the daily target of 10 structures per SOP. Findings from the Home Owner Preparation Tool informed some of the job aids, especially on house preparation and safety.

5.1.6 DIRECTLY OBSERVED SPRAYING The data were captured by supervisors when they directly observed SOPs’ insecticide mixing and spray techniques. The gaps identified were corrected on the spot. The information collected complemented PMT reports and mHealth supervisory feedback and helped focus supervisory efforts on teams with identified red flags. This in turn helped supervisors institute timely corrective measures during spraying and provide overall feedback about issues regarding spray techniques. The senior management team joined the national supervisors and the DHT in supportive supervision for each district. The project assigned 4–7 supervisors per district (depending on targeted structures) to facilitate supervision, better management of IRS quality, and follow-up using Directly Observed Spraying and DCV. All supervisors conducted supervision activities based on the supervision plan prepared ahead of the operation. Accordingly, the team conducted continuous follow-up of activities over the course of the IRS operation. Team leaders used this tool to oversee and improve SOPs’ performance and spray quality. Team leaders conducted supervisory visits throughout the spray campaign to observe SOPs’ performance and record whether or not the SOPs correctly mixed the insecticide and complied with spray techniques as well as with personal, household, and environmental safety procedures. Any gaps identified during the observed visit were recorded, creating a red flag in the database, and corrected on the spot. Daily alerts were sent to supervisors, containing a summary of all red flags from the previous day, which enabled supervisors to monitor closely the quality of SOPs’ performance and take corrective action to address any errors and ensure better quality of spray operations.

5.2 SUPERVISION FINDINGS The supervisors carried out daily data verification using the DCV form. This helped verify the data the SOPs collected and enabled them to compare these data with spray card data. The findings from the analysis of the data collected for a period of 24 operational days of the campaign informed both mop-up activity and strategies to monitor any possible data falsification amongst the spray teams. The project used DCV in Phase I only and there were no errors in performance reports between VLC and the daily SMS performance monitoring tracker. During the campaign, the project noticed improvements in insecticide usage rate (IUR) as the campaign progressed; this is attributed to supervisors’ compliance with the use of the Directly Observed Spraying tool that supported improvements in spray techniques.

5.3 RESULTS 5.3.1 TOTAL NUMBER OF STRUCTURES AND POPULATION CAPTURED IN 2020 SPRAY CAMPAIGNS 5.3.1.1 STRUCTURES FOUND The SOPs found a total of 1,475,422 eligible structures in Phases I and II of the 2020 spray campaign of which 1,395,569 were sprayed, resulting in an overall spray coverage rate of 94.6%. All districts exceeded the minimum required coverage rate of 85%. District-level data are presented in Table 18. Detailed spray data by sub-county is shown in Annex G.

TABLE 15: SPRAY COVERAGE BY DISTRICT Structures Sprayed % Population Spray campaign District Structures found Population Found Structures Sprayed Spray Coverage Population Pregnant Women Children <5 years Protected Protected Protected old Protected Phase I Budaka* 61,589 249,237 54,230 88.1* 231,271 6,645 48,083 92.8 Bugiri 134,480 554,941 125,887 93.6 530,876 16,219 113,336 95.7

Butaleja 76,654 328,596 75,133 98.0 326,252 10,110 71,459 99.3 Butebo 43,178 162,032 41,199 95.4 160,618 5,592 32,632 99.1 Kibuku 64,825 263,861 60,050 92.6 250,807 8,016 55,565 95.1

Namutumba 88,082 364,008 84,936 96.4 356,941 12,971 71,502 98.1

Pallisa 104,098 395,881 97,010 93.2 379,546 12,649 78,613 95.9 Tororo 191,425 720,190 178,332 93.2 688,916 16,032 125,455 95.7 Phase I Total 764,331 3,038,746 716,777 93.8 2,925,227 88,234 596,645 96.3 Phase II Alebtong 103,911 281,690 99,286 95.5 272,078 5,325 47,074 96.6 Amolatar 72,264 194,307 69,545 96.2 188,529 4,002 33,835 97.0

Dokolo 86,914 224,808 82,210 94.6 216,614 4,048 36,030 96.4 Kaberamaido 46,860 136,429 46,248 98.7 135,694 2,658 25,120 99.5 Kalaki 49,014 141,502 48,213 98.4 139,821 2,890 26,688 98.8

Lira 179,041 545,672 164,396 91.8 519,070 11,090 77,099 95.1

Otuke 50,052 141,712 48,321 96.5 138,334 2,996 24,799 97.6 Serere 123,035 408,943 120,573 98.0 403,276 10,846 82,873 98.6 Phase II Total 711,091 2,075,063 678,792 95.5 2,013,416 43,855 353,518 97.0 Grand Total 1,475,422 5,113,809 1,395,569 94.6 4,938,643 132,089 950,163 96.6 *Budaka district: Spraying was suspended and could not be completed in one subcounty in the district due to the death of a spray operator.

A total of 79,853 structures were not sprayed and this was attributed to: presence of sick persons (13.9%, 11,135 structures), locked structures (65.6%, 52,390 structures), funerals (1.8%, 1,418 structures), refusal (10.3%, 8,247 structures), sacred structure/ shrine (0.5%, 407 structures), and other reasons (7.8%, 6,191 structures) as shown in Figure 10.

FIGURE 10: REASONS FOR STRUCTURES NOT SPRAYED DURING THE 2020 IRS CAMPAIGN

5.3.2 POPULATION PROTECTED IRS provided protection to a total of 4,938,643 people, including 132,089 pregnant women and 950,163 children under five years of age across 16 project districts.

5.4 USE OF MOSQUITO NETS Across the 16 districts, households reported having 1,791,320 nets, which is higher than 1,648,816 mosquito nets that were reported last year. Additionally, 387,660 children under five years of age were reported as having slept under a mosquito net the previous night (Annex H). The results on nets reveal a community challenge in regard to availability and usage with a net coverage of one net for every three people which is below the national target of 1:2.

5.5 INSECTICIDE CONSUMPTION AND SPRAY OPERATOR PERFORMANCE INDICATORS Spray operators used 581,594 bottles/sachets of Actellic 300CS, Fludora Fusion and SumiShield 50WG during the 2020 spray campaign. On average, spray operators sprayed 9.9 structures per day, and 2.4 structures were sprayed per bottle/sachet of insecticide. Annex I provides a detailed breakdown of insecticide use and spray operator performance per district.

6. CHALLENGES, LESSONS LEARNED, AND RECOMMENDATIONS 6.1 CHALLENGES PMI VectorLink Uganda conducted a two phased campaign in 2020; March 2 – 28, 2020 for Phase I districts and May 25 - June 20, 2020 for Phase II districts. These were some of the challenges encountered:

• The ever changing administrative units posed a major challenge in planning for IRS and data capture, human resource and other logistics allocations. • Some gaps in coordination between district and sub county levels were evident in some districts thus affecting the implementation processes and delivery. • The USAID non facilitation policy of field allowances to salaried government staff, who are critical in IRS training and supervision, slowed down activity implementation in Phase I of the IRS campaign. • Rising level of water in Lake Kyoga and Lake Kwania due to increased rainfall led to flooding in areas around the lake shores cutting off access to some communities and displacement of people in Serere, Amolatar, Dokolo and Kaberamaido districts. This affected up to 2,488 structures with a population of 11,453 people. • Pockets of resistant communities mainly due to religious and cultural beliefs still posed a huge challenge to IRS implementation with such communities requiring more input in terms of mobilization and supervision. • Suspension and subsequent non implementation of IRS in one sub-county in Budaka district due to the death of a spray operator reduced coverage. • COVID-19 adaptation guidelines necessitated realignment of the budget and taking care of costs that were not previously planned for e.g. procurement of fabric masks for training and for the cadres that were not previously planned for, procurement of hand washing facilities for operation sites as well as sanitizer among others. • COVID-19 lockdown affected data entry and cleaning especially of Phase I data, as data centers could not be accessed and some data clerks deserting data entry due to prolonged lockdown (March 21- May 26, 2020) and infection apprehension. • COVID-19 caused temporary urban to rural movement and closure of institutions that left many structures locked and household information could not be captured.

6.2 LESSONS AND RECOMMENDATIONS • Coordination of IRS through the COVID-19/ IRS task force facilitated integration of IRS campaign activities and improved participation of leaders and performance. • Regular engagement of leaders and stakeholders enhanced their participation in mobilization and implementation oversight. • The use of data to guide support supervision enhanced performance of spray operations. • Suspension of some government activities due to COVID-19 lockdown provided opportunities for government staff to provide undivided attention to IRS campaign and hence improved performance. • Intensive media campaign through radio talk shows, radio spots and announcements and integration with COVID-19 messaging improved community compliance.

• Change of insecticide improved acceptance as there was fatigue in use of Actellic 300CS due to the unpleasant smell and staining of wall surfaces. • Ensure that all trainers are comprehensively trained to ensure delivery of uniform information to trainees at cascade level. This will address conflicting instructions provided by different supervisors. Conduct training of supervisors close to the start of IRS to avoid loss of knowledge due to extended layover post training.

• Opportunity should be explored to provide resources for sustainability activities at district level. • Involve district leaders in recruitment and ensure office of the District Health Officer (DHO) on behalf of the Chief Administrative Officer (CAO) supervise the recruitment exercise and provide oversight to the sub county leaders.

ANNEX A: NATIONAL AND DISTRICT STAFF TRAINED Training on IRS Deliverable Other Trainings

Grand

Total Category of persons Total (M/F)

trained TOT Training Security Trainers Reporting Safety and and Safety and Security Operation Site test guidelines Transport Safety and Enumeration Pump Technician Technician Pump Data Capture and Spray Operations SBC, MobilizationSBC, EC, Washing,EC, Fire Training of Master Store Management Updated WHO tube tube WHO Updated National Training on Training National Poison Management

M F M F M F M F M F M F M F M F M F M F M F M F Total Data Entry Clerks ------45 30 ------45 30 75 DHT 102 30 102 30 102 30 102 30 102 30 102 30 102 30 102 30 102 30 102 30 102 30 102 30 132 Logistic Assistants 8 2 8 2 8 2 8 2 - - 8 2 8 2 8 2 8 2 - - 8 2 8 2 10 M&E/Project Assistants 11 5 11 5 ------11 5 ------11 5 16 MoH 57 12 57 12 57 12 57 12 57 12 57 12 57 12 57 12 57 12 57 12 57 12 57 12 69 Parish Mobilizers - - 700 189 ------700 189 - - - - 700 189 889 Program Assistants 4 4 4 4 4 4 4 4 - - 4 4 4 4 4 4 4 4 4 4 4 4 4 4 8 Pump Technicians 118 2 - - 118 2 ------118 2 120 Site Supervisors 253 45 253 45 253 45 253 45 - - 253 45 253 45 253 45 253 45 253 45 253 45 253 45 298 Spray Operators - - 4,221 1,626 - - 4,221 1,626 - - 4,221 1,626 4,221 1,626 - - 4,221 1,626 - - - - 4,221 1,626 5,847 Storekeepers 230 68 230 68 230 68 230 68 - - 230 68 230 68 230 68 230 68 230 68 230 68 230 68 298 Team Leaders - - 1,074 385 1,074 385 1,074 385 - - 1,074 385 1,074 385 1,074 385 1,074 385 1,074 385 1,074 385 1,074 385 1,459 Volunteers 8 3 8 3 8 3 8 3 - - 8 3 8 3 8 3 8 3 8 3 8 3 8 3 11 Total 791 171 6,668 2,369 1,854 551 6,007 2,764 159 42 6,013 2,210 5,957 2,175 2,336 841 6,657 2,364 1,728 547 1,736 549 6,831 2,401 9,232 *Participants trained across all project areas.

ANNEX B: 2020 POST-IRS EVALUATION MEETING Districts/ Date Professional category Sex

M F Total Budaka, Bugiri, Butaleja, Butebo, Kibuku, Malaria focal Persons Namutumba, Pallisa and Tororo: July 14, District Health Officers 12 3 15 2020 Alebtong, Amolatar, Dokolo, Kaberamaido, Malaria focal Persons Kalaki, Lira, Otuke and Serere: July 16, District Health Officers 14 0 14 2020 PMI VectorLink Staff/ Other Implementing Technical Team (COP, DCOP, Operations Manager, partners Logistics Cordinators, District Coordinators; IEC 14 5 19 Cooridnators, M&E Manager, CDFU) Total 40 8 48

ANNEX C: ENVIRONMENTAL MITIGATION AND MONITORING REPORT Mitigation Measure Status of Mitigation Measures Issues Relating to Required Remarks Conditions

Pre-contract vehicle • All drivers of transportation • The gaps identified were • The EC team and the logistics inspection and vehicles were trained on safety emergency kits including coordinator ensured all certification of vehicles precautions to undertake while first aid kits, fire vendors install these items to used for project staff and pesticide and transporting insecticides and extinguishers, jerks and meet the criteria specified in transportation project staff during spray wheel spanner. In addition, the BMP before passing the campaign. They were issued with some had nonfunctional vehicles that initially lacked training certificates and made to brake lights, faulty emergency kits such as first sign Abt vehicle usage policy. headlamps, indicators and aid kits, fire extinguishers, • A total of 63 vehicles were horns in both trucks and jerk and wheel spanners. inspected: 9 trucks for passenger vehicles. A few Those with nonfunctional transportation of SOPs, 4 for drivers didn’t have valid brake lights, faulty insecticides and 51 were licenses headlamps, indicators and passenger vehicles. horns had them fixed. • The vehicle drivers submitted • Provision of spill response kit their phone numbers during the for trucks has been made training. They received mandatory in all IRS spray appropriate PPE including rounds. respiratory masks and coveralls, and spill response procedures. • All insecticide transportation trucks were provided the spill response kit and polythene sheets to lay down on the vehicle floor before loading the insecticide.

Mitigation Measure Status of Mitigation Measures Issues Relating to Required Remarks Conditions

Store identification, • Parish stores and wash areas • At some sites (mostly • Need to either hire private siting of soak pit on high were sited 30 meters away from offered by Government), facilities where control can be grounds, above schools and residences, and residents grew crops close exercised or a budget be floodplains, and away from sensitive receptors more than 100 meters from water to wash areas. Efforts to secured to either compensate sources. maintain a 30 meter buffer farmers or pay for a safety • All soak pits were built to were futile, partly due to the protection zone standard design (2m x1m x 1m economic impact of Covid- deep), the walls lined with 19 shut down. polythene sheets with all five contents installed (sawdust, charcoal, bigger stones, smaller stones, and gravel as the top layer), to avoid percolation of effluent and allow ample time for treatment of effluent respectively. • All wash areas were sloped toward a soak pit and covered with polythene sheets to avoid seepage, and to gather and discharge all the wastewater generated from the wash area into the soak pit.

Medical examination of • All female recruits were screened • The equipment available to • Pregnancy test kits used were the spray team for for pregnancy. the examiners was a carryover from the previous fitness to handle and insufficient for year, purchased by the use insecticide during • In addition, all spray team spray campaign personnel were given a health comprehensive medical project. fitness test. The process was examinations of the spray • However, with the current carried out by trained clinicians team. policy limiting procurement of and laboratory personnel. • The number of clinicians medical supplies, including • For Phase I districts, Marie conducting medical exams pharmaceuticals, provision of Stopes, a private medical facility were limited in number, thus pregnancy test kits by conducted the medical campaign leading to long queues and Government prior to 2021 since there was no facilitation for delays. campaign can’t be government officials. However, guaranteed. Should there be for Phase II districts, government no provision, ladies l may not facilities were used following be recruited. reinstatement of facilitation

Preparedness to handle • All sites stores were stocked with • Government health • Depending on Government cases of insecticide first aid kits, containing vitamin E facilities, especially HC II’s facilities comes with delays exposures during spray cream, eye wash in form of and HCIII’s were sometimes campaign bottled water, gauze and ill stocked with pain killers, bandage. activated charcoal and • Due to the ban to purchase sodium sulfate in case of pharmaceuticals, the project insecticide poisoning depended on Government facilities for extra medical attention

Mitigation Measure Status of Mitigation Measures Issues Relating to Required Remarks Conditions

Training of spray teams • 298 storekeepers for secured • on proper storage of parishes stores were trained on • The new BMP (2020) insecticides, mixing and insecticide storage, handling, use of insecticide to requirement to use rinse ensure that there is no good housekeeping, emergency water from barrel 7 for the community and response, how to handle next day’s use will be environmental insecticide spillage, and promote incorporated into the contamination due to health and safety of SOPs. forthcoming TOT/Cascade improper insecticide • All stores received danger trainings. storage and handling warning signs, emergency response procedures, spill response procedures, and SOPs’ received health and safety instructions. • Use of PPE was incorporated into all training provided. SOPs received PPE and a pair of neck cover protection. • Training on the mixing of insecticide (Actellic 300CS, SumiShield 50WG and Fludora Fusion) was done at district-level TOT and during cascade training at sub-county level. Training discussed mistakes in mixing of insecticides that can compromise proper insecticides use. Phase I districts used Actellic 300CS and Fludora Fusion while all Phase II districts used SumiShield and Fludora Fusion. • At all parish stores, the supervision team ensured that all wastewater and remaining insecticides from barrels1, 3, 5, and 7 were reused as make up water the following day.

Team leaders • The team leaders were supplied • No confirmed report of SOPs conducting the physical with the Spray Operator Early eating while on duty was inspection of spray Morning Health checklist to received operators to ensure that they are healthy, conduct health checks on SOPs. provided with breakfast, • For 2020 campaign, the project and wearing PPE before ensured that all SOPs were departure to the field provided with breakfast before donning PPE and departing to the field, to avoid SOPs being tempted to eat while on duty.

Mitigation Measure Status of Mitigation Measures Issues Relating to Required Remarks Conditions

SOPs giving messages • SOPs sent out the key messages • It was noted in other places • Writing of the expected time to homeowners to to homeowners during the spray during the direct interviews for opening doors should be remove all items before in Phase I and Phase II. with homeowners that marked on houses. Or spraying, close the door for at least 2 hours, and • All immovable items were although SOPs provided provision be made for placing open the door for 30 covered completely with plastic relevant information, some seals on doors, only to be minutes to allow fresh sheets before spraying. home owners had difficulty opened by team leaders or air in, then sweep from in estimating time, given designated persons, could the door inward and that some didn’t have help reduce risks of exposure collect the dead watches or phones to tell due to inaccurate estimation mosquitoes and other time. Their estimation of of time by home owners who insects and dump them time could therefore be have no watches into a pit latrine. inaccurate Continue to sleep under mosquito nets and wash itchy skin and go to health clinic if they experience any symptoms of insecticide exposure

Provision of adequate • For each site store in Phase I and • Isolated reports on wash • Consistent use of face shields facilities and supplies for II, ropes for drying overalls were persons not using face by wash persons during triple end-of-day clean-up provided, 7 barrels, and 2 basins shields during triple rinsing rinse will continue to be were supplied to hold leftover came up emphasized, in compliance insecticide, wastewater, wash with BMP 2020 requirements strainers, soak control flow valves (CFVs) and nozzles during and after the triple rinsing process respectively. • Necessary PPE were provided to ensure safety

Identification of solid • The two-year memorandum of • The project EC team have waste handling firms understanding (MOU)s that were been involved in the signed with 3 companies – supervision of the recycling Gentex Enterprises Ltd to recycle and disposal process by the all HPDE and LDPE plastics, waste firms to ensure high- Pulp and Paper Mills Ltd to level compliance. recycle all the insecticide cardboard and other paper waste, and Green Label Services Ltd to incinerate all used nose masks, bicycle cushions and other contaminated, combustible waste IRS waste materials – are still in effect.

Mitigation Measure Status of Mitigation Measures Issues Relating to Required Remarks Conditions

Management of IRS • All wastes generated by the • Upon completion of disposal, wastes project during the spray the firms will provide campaign and collected and respective segregated at the parish store destruction/recycling were transferred to the certificates in line with MoUs designated wastes storage facilities in Bugiri and Kaberamaido districts. The process of quantification, packaging, and transportation to the recycling and disposal firms was handled by the EC team

Pump service, • All pumps were checked and • The most commonly • Old pumps that often broke maintenance, and repaired at the district stores prior encountered challenge in down should be replaced in calibration to the campaign to ensure no the pumps was the failure of the next campaign. leaking pump is put in the parish CFVs and pump leaks. • Faulty CFVs should be store for the spray exercise. Each replaced parish store was provided a spare pump. • In addition to pump technicians, SOPs, supervisors, and team leaders were trained on pump maintenance. • The team leaders and SOPs did a daily check of their pumps to ensure no leakage and conducted regular. • The parts of pumps that were found to be faulty during the campaign were replaced.

Choice of sites for • Though the sites selected for • During siting of soak pits, disposal of wastewater soak pit construction met the areas with high water table including MSP sites, BMP requirement, one site, in and those prone to floods according to PMI BMPs Malaba Town Council, became were avoided non-compliant after heavy precipitation for a good number of days. The amount of precipitation made the water table rise and the soak pit was shut down and relocated before the start of the spray campaign.

IEC campaigns to inform • The project produced and shared • Low resistance was • Due to the Covid-19 outbreak, homeowners of their IRS community roll posters and experienced due to the use WHO guidelines were responsibilities for frequently asked questions and of SumiShield and Fludora integrated into IRS health and safety during the spray campaign answers. Fusion that don’t have operations. • Precautions and guidelines on strong odors or leave • The use of radios was mostly Covid-19 were equally stains on walls used for sensitization of communicated and distributed to communities so as to lessen all sites, both English and the physical interactions local languages

Mitigation Measure Status of Mitigation Measures Issues Relating to Required Remarks Conditions

Maintain records of all • Records of all pesticide issued, • Cases of pilferage of • Perpetrators were dismissed insecticide issuance, delivered, returned, and returned insecticides were reported deliveries, receipts, and empties are kept on stock cards in Namutumba, Budaka and the return of empty sachets/bottles with a back-up in a ledger. Butaleja districts

ANNEX D: DATA COLLECTION AND QUALITY ASSURANCE TOOLS Data Collection Tool Purpose Training Participants Registration Form Used by lead trainer at training workshops to capture category and number of people trained, disaggregating by participants’ sex. Daily Spray Operator Form Used by spray operators during spray operations to capture data on: structures found, structures sprayed and not sprayed, population protected and not protected, mosquito net usage, and insecticide used. This tool also captures meta-data including: geography, spray actors’ names and codes, household names, structures type, sex of respondent, household IRS number, etc. Daily insecticide serialized tracker Used by storekeepers and team leaders for daily distribution and monitoring of insecticide stock and usage. Daily spray performance summary form Used by storekeepers to summarize the daily data from each spray team to assess performance on a daily basis. Data Quality Assurance Tool Purpose Data Collection Verification (DCV) Form To check the accuracy of data collected in the field, i.e., ensure that the data written on the Daily Spray Operator Forms match the information reported by households and/or the data recorded on the IRS Cards disseminated to households. Direct Observed Spraying (DOS) Ensure spray quality, specifically insecticide mixing and spray technique, but also including personal, household and environmental safety, and ensure any gaps identified are immediately corrected.

ANNEX E: MONITORING AND EVALUATION INDICATOR MATRIX

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

Objective 1: Implementation of Malaria Vector Control (VC) Interventions 1.1 Successfully execute IRS and other malaria vector control programs 1.1.1 Annual country work plan Project records 1 1 1 1 1 1 developed and submitted on Annually time 1.1.2 Number of eligible structures Project records PMI 940,017 1,008,109 1,008,109 1,017,149 1,017,149 1,001,746

targeted for spraying Annually DFID 347,680 361,196 361,196 376,413 376,413 393,823

1.1.3 Number of eligible structures Project records PMI 799,014 950,939 950,939 934,512 1,017,149 1,001,746 sprayed with IRS Annually

DFID 295,528 341,370 341,370 357,057 376,413 393,823 1.1.4 Percentage of total structures Project records 85% PMI 94.3 85% PMI 91.9 85% PMI 93.9% targeted for spraying that were Annually sprayed with a residual insecticide (spray coverage) DFID 94.5 DFID 94.9 DFID 96.3%

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

1.1.5 Number of people protected by Project records Sex PMI 3,419,524 3,504,041 3,632,388 3,490,673 3,697,761 3,847,573 IRS Annually M: 1,829,533 M: 1,737,896 M: 1,852,167 M: 1,914,704 Pregnant M: M: 1,709,390 W: 1,802,855 W: 1,752,777 W: 1,845,594 W: 1,932,886 women 1,651,665 W: 1,794,651 Preg women: Preg women: Preg women: Preg women: W: 99,619 99,622 99,622 110,170 Children <5 1,767,859 Preg women: Children <5: Children Children <5: Children <5: Preg. 99,619 716,548 <5: 686,032 686,032 756,617 women: 85,510 Children <5: Children 716,548 <5: 677,933 DFID 930,990 932,115 974,330 988,484 1,028,030 1,091,070 M: 455,254 M: 456,136 M:456,136 M: 492,114 M: 515377 M: 540,960 W: 475,736 W: 475,79 W: 475,979 W: 496,370 W: 512653 W: 550,128 Preg. Preg women: Preg women: Preg women: Preg women: Preg women: women: 21,971 21,971 19,455 19,455 21,919 17,994 Children <5: Children <5: Children Children Children Children 175,842 175,842 <5: 176,504 <5: 176,504 <5: 193,546 <5: 168,515

1.1.6 EOSR submitted within 45 Project 1 1 1 1 1 1 days after the end of spray Annually (including completing M&E Plan and Environmental Mitigation and Monitoring Report 1.1.7 Post-spray Data Quality Audit Data Collection N/A N/A 1 TBD N/A N/A conducted within 90 days of Forms, annually spray completion 1.1.8 Number of Insecticide Treated Project records Channel N/A N/A N/A N/A N/A N/A Nets (ITNs) distributed, by Annually channel

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

1.1.9 Conducted at least one Project records Channel N/A N/A N/A N/A N/A N/A process assessment of the quality of ITN distribution Annually planning, the quality of household registration, and/or ITN distribution implementation during a mass ITN distribution campaign 1.1.10 Operational routine monitoring Project records Channel N/A N/A N/A N/A N/A N/A systems for continuous ITN distribution established and Annually disaggregated by channel 1.1.11 ITN durability monitoring data Project records N/A N/A N/A N/A N/A N/A collection completed on time Annually as planned in a given project year 1.2 Provide technical assistance and planning support for IRS and other integrated malaria vector control activities 1.2.1 Number of VC project training Project training Technical area 1 13 1 1 0 0 workshops targeting NMCP records Job function IRS and other host country staff Annually 1.2.2 Number of NMCP and other DHIS2 logs Job function N/A N/A N/A N/A 5 5 vector control host country Annually IRS staff accessing DHIS2 M&E 1.3 Ensure safe and judicious use of insecticides and other malaria vector control products 1.3.1 Number of vector control Project training Sex (# and %) 10,656 8,463 8,463 8,580 8,580 9,232 personnel trained in records Job function environmental compliance and M: 6,820, 64% M: 6,080, 71.8% M: 6,080, W M: 6,189, 72.1% M: 6,189, M: 6,831, 74% personal safety standards in Annually W: 2,383, 28.2% 71.8% W: 2,391, 27.9% 72.1% W: 2,401, 26% vector control implementation W: 3,836, 36% Parish W: 2,391, Parish mobilizers mobilizers 818 27.9% 889 M:700, W:

3 Boot camp

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

W: 2,383, M:644, W: 174, Parish 189, Parish 28.2% Parish mobilizers 818 supervisors 0 M:0, supervisors 185 M:644, W: 174, W: 0, M:129, W: 56, Parish Pump Technicians Pump supervisors 120 M: 118, W:2, Technicians 111 185 M:129, W: Site supervisors M: 107, W:4, 56, 328 M: 222, W: 45, Site supervisors Pump Spray operators 276 M: 222, W: Technicians 5,847 M:4,221, 54, 111 M: 107, W:1,626, Spray operators W:4, Site Storekeepers 298 5,528 M:3,886, supervisors M: 230 W: 68, W:1,642, 276 M: 222, W: Team leaders Storekeepers 54, 1,459 M:1,074 W: 276 M: 204 W: Spray 385, 72, operators 5,528 Data clerks 75 Team leaders M:3,886, M:45, W:30, 1,238 M:912 W: W:1,642, Project Assists 8 326, Data clerks Storekeepers M: 8 W: 4, M&E 60 M:31, W:29, 276 M: 204 W: Assistants 16 M: project 72, 11 W: 5, MOH 69 Assistants 15 M: Team leaders M:57 W:12, 6 W: 9, M&E 1,238 M:912 W: National 4trainers Assistants 8 M: 2 326, Data 230 M:179 W:51, W:6, MOH 10 clerks 60 M:31, Malaria focal M:9 W:1, W:29, project persons 16 M: 14, National trainers Assistants 15 W: 1, 21 M:11 W:10, M: 6 W: 9, M&E IRS Technical Malaria focal Assistants 8 M: persons 15 M: 2 W:6, MOH 10 14, W: 1, IRS M:9 W:1, Technical National trainers 21

4 National trainers include: DHTs, MOH, Logistic Assistants, Program Assistants, and District volunteers

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

M:11 W:10, Malaria focal persons 15 M: 14, W: 1, IRS Technical 1.3.2 Number of health workers Project training Sex (# and %) 51 64 75 0 75 0 receiving insecticide poisoning records case management training M: 41, 80% M: 43, 67.2% M: 50, 66.7 % M: 50, 66.7 % Annually W: 10, 20% W: 21, 32.8% W: 25, 33.3% W: 25, 33.3%

1.3.3 Number of adverse reactions Incident Report Type of 0 0 0 0 0 0 to pesticide exposure Forms exposure documented Annually

1.4 Strengthen capacity of NMCPs, vector control personnel, and other institutions to implement and manage IRS and other vector control activities 1.4.1 Total number of people trained Project training Sex (# and %) 10,656 8,463 8,463 8,580 8,580 9,232 to support VC in targeted records areas5 VC M: 6,820, 64% M: 6,080, 71.8% M: 6,080, M: 6,189, 72.1% M: 6,189, M: 7,481, 69.5% Annually intervention W: 3,836, 36% W: 2,383, 28.2% 71.8% W: 2,391, 27.9% 72.1% W: 3,282, 30.5% type W: 2,383, W: 2,391, Parish mobilizers IRS IRS 28.2% IRS 27.9% 889 M:700, W: Parish 189, Parish IRS mobilizers 818 IRS supervisors 0 M:0, M:644, W: 174, Parish W: 0, Parish mobilizers 818 Pump Technicians supervisors 185 M:644, W: 174, 120 M: 118, W:2, M:129, W: 56, Parish Site supervisors Pump supervisors 298 M: 253, W: 45, Technicians 111 185 M:129, W: M: 107, W:4, 56, Pump

5 The definition of this indicator was changed since the first submission of the M&E Plan to include only SOPs, Team Leaders, and Supervisors, hence the discrepancy between the target and results for Y1.

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

Site supervisors Technicians Spray operators 276 M: 222, W: T111 M: 107, 5,847 M:4,221, 54, SOPs 5,528 W:4, Site W:1,626, M:3,886, supervisors Storekeepers 298 W:1,642, 276 M: 222, W: M: 230 W: 68, Storekeepers 54, SOPs 5,528 Team leaders 276 M: 204 W: M:3,886, 1,459 M:1,074 W: 72, Team W:1,642, 385, leaders 1,238 Storekeepers Data clerks 75 M:912 W: 326, 276 M: 204 W: M:45, W:30, Data clerks 60 72, Team Project Assists 8 M:31, W:29, leaders 1,238 M: 8 W: 4, M&E project M:912 W: 326, Assistants 16 M: Assistants 15 M: Data clerks 60 11 W: 5, MOH 69 6 W: 9, M&E M:31, W:29, M:57 W:12, Assistants 8 M: 2 project National trainers6 W:6, MOH 10 Assistants 15 230 M:179 W:51, M:9 W:1, M: 6 W: 9, M&E Malaria focal National trainers Assistants 8 M: persons 16 M: 14, 21 M:11 W:10, 2 W:6, MOH 10 W: 1, Malaria focal M:9 W:1, IRS Technical persons 15 M: National staff 19 M: 12 W: 7 14, W: 1, IRS trainers 21 Technical staff M:11 W:10, 19 M: 12 W: 7 Malaria focal persons 15 M: 14, W: 1, IRS Technical staff 19 M: 12 W: 7

6 National trainers include: DHTs, MOH, Logistic Assistants, Program Assistants and District volunteers

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

1.4.2 Number of people trained Project training Sex (# and %) 1,126 1,136 1,136 663 663 848 during IRS TOT records M: 901, 20% M: 888, 78.2% M: 888, 78.2% M: 533, 80.4% M: 533, 80.4% M: 703, 82.9% Annually W: 225, 20% W: 248, 21.8% W: 248, W: 130, 19.6% W: 130, 19.6% W: 145, 17.1% 21.8% Storekeepers Storekeepers Storekeepers 298 276 M: 204 W:72 276 M: 204 M: 230 W:68 Site supervisors W:72 Site supervisors 276 M: 222 W: Site 298 M: 253 W: 45 54 and pump supervisors and pump Technicians 276 M: 222 W: Technicians 120 111 M: 107 W: 4 54 and pump M: 118 W: 2 Technicians 111 M: 107 W: 4 1.4.3 Total number of people hired to Project records Sex (# and %) 10,278 10,877 10,877 9,635 9,635 10,763 support VC in target districts Job function Annually VC M: 6,578, 64% M: 7,388, 67.9% M: 7,388, M: 6,587, 68.4 % M: 6,587, 68.4 M: 7,481, 69.5% intervention W: 3,700, 36% W: 3,489, 32.1% 67.9% W: 3,048, 31.6% % W: 3,282, 30.5% type W: 3,489, Parish W: 3,048, Parish mobilizers IRS IRS 32.1% mobilizers 818 31.6% 889 M:700, W: Parish M:644, W: 174, Parish 189, Parish mobilizers Parish mobilizers 818 supervisors 0 M:0, 818 M:644, supervisors 185 M:644, W: 174, W: 0, W: 174, M:129, W: 56, Parish Pump Technicians Parish Pump supervisors 120 M: 118, W:2, supervisors Technicians 185 M:129, W: Site supervisors 185 M:129, 111 M: 107, W:4, 56, Pump 328 M: 222, W: 45, W: 56, Pump Site supervisors Technicians SOPs 5,847 Technicians 276 M: 222, W: 111 M: 107, M:4,221, W:1,626, 111 M: 107, 54, SOPs 5,528 W:4, Site Storekeepers 298 W:4, Site M:3,886, supervisors M: 230 W: 68, supervisors W:1,642, 276 M: 222, W: Team leaders 276 M: 222, Storekeepers 54, SOPs 5,528 1,459 M:1,074 W: W: 54, SOPs 276 M: 204 W: M:3,886, 385, 5,528 72, Team W:1,642,

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

M:3,886, leaders 1,238 Storekeepers Data clerks 75 W:1,642, M:912 W: 326, 276 M: 204 W: M:45, W:30, Storekeepers Data clerks 60 72, Team Project Assists 8 276 M: 204 W: M:31, W:29, leaders 1,238 M: 8 W: 4, M&E 72, Team project M:912 W: 326, Assistants 16 M: leaders 1,238 Assistants 15 M: Data clerks 60 11 W: 5, MOH 69 M:912 W: 6 W: 9, M&E M:31, W:29, M:57 W:12, 326, Data Assistants 8 M: 2 project Security Guards clerks 60 W:6, Security Assistants 15 5892 M: 600, W: M:31, W:29, Guards 546 M: M: 6 W: 9, M&E 292, Wash project 388, W: 158, Assistants 8 M: persons 639, M: Assistants 15 Wash persons 2 W:6, Security 50, W:589 M: 6 W: 9, 574, M: 56, Guards 546 M: M&E W:518 388, W: 158, Assistants 8 107 W: 4IRS Wash persons M: 2 W:6, 574, M: 56, Security W:518 Guards 546 M: 388, W: IRS 158, Wash persons 574, M: 56, W:518 1.4.4 Number of government/district Project records VC 1,040 915 915 486 486 212 officials who acted as intervention supervisors during VC Annually type M: 647, 20% M: 712, 77.8 % M: 712, 77.8 M: 389 , 80.0 % M: 389 80.0% M: 167 80.0% campaigns W: 393, 20% W: 203, 22.2% % W: 97 , 20.0 % W: 97 , 20.0 % W: 45 , 20.0 % W: 203, DHT 165, M: DHT 165, M: DHT 132, M: 102, IRS IRS 22.2% 127, W: 38, 127, W: 38, W: 30, MOH: 69, IRS MOH: 45, M:40, MOH: 45, M:40, M:57, W:12, Site W:5, Site W:5, Site supervisors 276, supervisors 276, supervisors M:222, W:54 M: 222, W:54 276, M:222, IRS W:54 IRS 1.5 Promote gender equality in all facets of planning and implementation

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

1.5.1 Number of women hired to Project records Returning 3,767, 100% % 3,408, 90.5% 3,048, 31.6% 3,048, 31.6% 3,282, 30.5% support VC campaigns female 3,408; 90.5% Parish Parish Parish mobilizers Annually seasonal mobilizers W: mobilizers W: Parish 889 W: 189, workers hired 174, Parish 174, Parish mobilizers W: Parish supervisors in a more supervisors supervisors W: 174, Parish 0 W: 0, senior W: 56, Pump 56, Pump supervisors W: Pump Technicians capacity Technicians Technicians 56, Pump 120 W:2, Site W:4, Site W:4, Site Technicians supervisors 328 supervisors supervisors W: W:4, Site W: 45, W: 54, SOPs 54, SOPs supervisors W: SOPs W:1,642, W:1,642, 54, SOPs W:1,626, Storekeepers, Storekeepers, W:1,642, Storekeepers W: W: 72, Team W: 72, Team Storekeepers, 68, leaders W: leaders W: 326, W: 72, Team Team leaders W: 326, Data Data clerks leaders W: 326, 385, clerks W:29, W:29, project Data clerks Data clerks W:30, project Assistants W: 9, W:29, project Project Assists W: Assistants W: M&E Assistants Assistants W: 4, 9, M&E W:6, Security 9, M&E M&E Assistants Assistants Guards W: 158, Assistants W:6, W: 5, W:6, Security Wash persons Security MOH W:12, Guards W: W:518 Guards W: 158, Security Guards 158, Wash Wash persons W: 292, Wash persons W:518 persons W:589 W:518

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

1.5.2 Number and percentage of Project records VC 573, 30% 451, 23.0% 451, 23.0% 436, 25.7% 436, 25.7% 430, 24.5% women hired in supervisory intervention roles in target areas for vector Annually type IRS IRS IRS IRS IRS IRS control activities Job function TLs: 303, 23.9% TLs: 303, TLs: 326, 26.3% TLs: 326, TLs: 385, 26.4% Subcounty 23.9% Site 26.3% Site supervisors: supervisors: 39, Subcounty supervisors:54, Site 54, 17.8% 19.7% supervisors: 19.6% supervisors: Parish Parish 39, 19.7% Parish 54, 19.6% supervisors: 0, supervisors: Parish supervisors: 56, Parish 0.0% 107, 22.5% supervisors: 30.3% supervisors: Project 107, 22.5% 56, 30.3% assistants: 2, Project 28.6% assistants: 2, 28.6%

1.5.3 Number and percentage of Project training Sex 45, 100% 45, 100% 45, 100% 45 , 100% 8580, 100% 9,232 , 100% staff (permanent and records seasonal) who have Job function completed gender awareness Annually training 1.5.4 Number and percentage of Project records Sex (# and %) 1, 17% 2, 28.6% 2, 28.6% 2, 28.6% 2, 28.6% 2, 28.6% women in senior leadership roles in VectorLink country Annually offices

1.6 Implement and support social behavioral change communication and mobilization activities

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

1.6.1 Number of radio spots and talk Project records VC 56 talk shows and 60 talk shows 500 radio 30 Radio talk 30 Radio talk 64 Radio talk shows aired intervention 280 spots and 280 spots shows, shows, 600 shows, 600 shows, 1280 Annually type 1,500 radio Radio spots, Radio spots, Radio spots, IRS IRS spots 75 Radio 75 Radio 75 Radio announcements announcement announcements IRS s IRS IRS IRS 1.6.2 Number of print materials Project records VC 7,090 print 7,090 print 9,000 7,267 posters 7,267 posters 21,655 posters disseminated Annually intervention materials materials posters, 1,500 1,500 leaflets 1,500 leaflets 1600 leaflets type leaflets IRS IRS IRS IRS IRS 1.6.3 Number of people reached Project records VC 2,175,257 11,810 2,175,257 0 0 2260 with vector control and/or SBC intervention M: 982 messages via door-to-door Annually type IRS F: 1,304 messaging Sex M: 5,647 F: 6,163

1.6.4 Number and percentage of Project records N/A N/A N/A N/A N/A N/A people who feel that the proposed action (sleeping Annually under an ITN/accepting IRS) will reduce their risk of malaria

1.6.5 Number and percentage of Project records VC N/A N/A N/A N/A N/A N/A people with a favorable intervention attitude toward the Annually type practice/product (i.e., ITNs, IRS) 1.6.6 Number and percentage of Project records VC N/A N/A N/A N/A N/A N/A people who believe that the intervention majority of their friends and Annually type

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

community members practice the behavior 1.7 Environmental compliance 1.7.1 SEA (with Environmental Project records 1, 100% 1, 100% 1, 100% 1, 100% 1, 100% 0 Mitigation and Monitoring Plans) or Letter Report Annually submitted at least 60 days prior to the start of vector control campaigns 1.7.2 Number and percentage of Project records Soak pit type 462, 100% 462, 100% 370, 100% 279, 100% 279, 100% 306, 100% permanent and mobile soak pits inspected and approved Annually 276, 100% 276, 100% 298, 100% perm. prior to IRS campaigns permanent soak permanent Soak-pits and 8, pits and 3 soak pits and 100% mobile soak 100%mobile 100 , pits soak pits 100%mobile soak pits 1.7.3 Number and percentage of Project records Storehouse 462, 100% 462, 100% 370, 100% 276, 100% 276, 100% 298, 100% storehouses inspected and type approved prior to IRS Annually campaigns 1.7.4 Number and percentage of Project records 462, 100% 462, 100% 370, 100% 292 , 100% 292 , 100% 315, 100% fixed soak pits that are District 15 District 16 compliant with PMI’s Best Annually 1 Central Ware 1 Central Ware Management Practices house house 276 at parish 298 at parish store stores

2. Entomological and Epidemiological Data to Drive Decision-Making 2.1 Vector control activities monitored via entomological and epidemiological data

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

2.1.1 Number and percentage of Entomological VC 5, 100% 57 100% 6, 100% 6, 100% 6, 100% 6, 100% project-supported reports intervention entomological sentinel sites Annually type IRS IRS IRS IRS IRS IRS established to monitor vector bionomics and behavior (vector species, distribution, seasonality, feeding time, and location) 2.1.2 Number and percentage of Entomological VC 1, 100% 1, 100% 38 100% 3, 100% 3, 100% 3, 100% entomological monitoring reports intervention sentinel sites measuring all Annually IRS IRS IRS IRS IRS IRS five basic PMI entomological monitoring indicators (i.e., species composition, abundance, and seasonality of malaria vector, insecticide susceptibility and resistance intensity; mechanism of resistance; quality assurance and residual efficacy monitoring of IRS programs; or vector behavior: feeding time and location)

7 Bugiri, Otuke, and Tororo (current IRS districts); Apac (previous IRS project district, sprayed in February–March 2017 by the MOH); and Soroti (a non-IRS district) 8 Bugiri, Lira, and Tororo.

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

2.1.3 Number and percentage of Entomological VC 5, 100% 5, 100% 6, 100% 6, 100% 6, 100% 6, 100% entomological monitoring reports intervention sentinel sites measuring at Annually IRS IRS IRS IRS IRS IRS least one advanced PMI indicator (i.e., identification of mosquito infectivity; parity rates; or blood-meal analysis)

2.1.4 Number and percentage of Entomological Insecticide 11, 100% 5, 45.5% 169 100% 8 8, 100% 0 insecticide resistance testing Reports type Pyrethroid, sites that tested at least one Annually organophosphat insecticide from the pyrethroid, e, carbamate, organophosphate, carbamate, clothianidin, clothianidin, and chlorfenapyr chlorfenapyr groups 2.1.5 Number of wall bioassays Entomological 18010 194 4811 96 96 296 conducted within two weeks of Reports 96 Phase I and spraying to evaluate the quality Annually 200 Phase II of IRS

2.1.6 Number and percentage of Entomological 180, 100% 194, 107.8% 4812, 100% 96, 100% 96,100%, 296 cone bioassays conducted Reports within two weeks of spraying Annually with greater than 98% test mortality recorded

9 Apac, Arua, Bugiri, Gulu, Hoima, Kamwenge, Kanungu, Katakwi, Kitgum, Lira, Moroto, Nakaseke, Rakai, Soroti, Tororo, and Wakiso. (Apac, Arua, Bugiri, Kanungu, Lira, Moroto, Rakai and Tororo) 10 12 wall bioassay cones are tested per district for all the current 15 IRS districts. Repeat tests done in Budaka and Namutumba to ascertain quality 11 12 wall bioassay cones are tested per district for the current IRS districts of Kaberamaido, Lira, Pallisa and Tororo 12 12 wall bioassay cones are tested per district for the current IRS districts of Kaberamaido, Lira, Pallisa and Tororo

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

2.1.7 Number of wall bioassays Entomological Insecticide 31213 120 33614 192 192 344 conducted after the completion Reports type of spraying at monthly intervals Annually Actellic 300CS Actellic 300CS to evaluate insecticide decay

2.1.8 Number of vector susceptibility Entomological Insecticide 60 60 60 36 60 0 tests for different insecticides Reports type Pirimiphos conducted in selected sentinel Annually Pirimiphos methyl: 8 sites methyl: 10 Bendiocarb: 7 Bendiocarb: 10 Deltamethrin: 7 Deltamethrin: 10 Alpha Alpha cypermethrin: 4 cypermethrin: 10 Permethrin: 6 Permethrin: 10 Clothianidin: 4 Clothianidin: 5 Chlorfenapyr: 0 Chlorfenapyr: 5 2.1.9 Number of countries with an Project records N/A N/A N/A N/A N/A N/A integrated vector control Annually analytics dashboard available for decision making

2.1.10 Number of staff (VectorLink- Project training Sex (# and %) 12 12 45 0 0 0 contracted or non-VectorLink) records Job Function Entomological trained in entomological Annually monitoring monitoring 2.2 NMCPs develop country-level IRS and other malaria vector control strategies

13 Post-IRS routine monthly monitoring wall bioassay studies for Pallisa would be from June to December = 7*12 =84, while post-IRS routine monthly monitoring wall bioassay studies for Kaberamaido, Lira, and Tororo would be from July to December = 3*6*12 = 216, giving a total of 300 cone tests. VectorLink had expected to start post-IRS routine monthly monitoring wall bioassay studies for Pallisa in June, but instead started in May, now giving a total of 312. =120 bioassays had been conducted as of 31/08/2018. Routine monthly monitoring wall bioassays are still ongoing. By December 2018, a total of 312 bio-assay were conducted 14 Post-IRS routine monthly monitoring wall bioassay studies for Pallisa and Tororo would be from May to December = 2*8*12 =192, while post-IRS routine monthly monitoring wall bioassay studies for Kaberamaido and Lira would be from July to December = 2*6*12 = 144 giving a total of 336 cone tests.

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

2.2.1 Developed an integrated Project records N/A N/A N/A N/A N/A N/A malaria vector control strategy, Annually including a plan for monitoring and managing insecticide resistance supported by the project

2.2.2 Completed integrated data and Project records N/A N/A N/A N/A N/A N/A visualization landscaping for Annually vector control decision making complete

2.2.3 Implemented subnational Project records 0 0 0 0 0 0 insecticide as part of an IRM Annually strategy

2.3 Build capacity of NMCPs and local institutions to collect, analyze, and use data for strategic malaria control decision-making 2.3.1 Number of individuals trained Project training Job function 12 12 45 0 0 0 from NMCPs and national records organization institutions to review and interpret data for integrated Annually vector control decision-making

2.3.2 Proportion of targeted Capacity Job function N/A N/A N/A N/A N/A N/A individuals who report using Assessments Organization new analytical tools and/or Thrice over skills in their planning, project life resourcing, implementation, or measurement activities 3. Procure insecticides for IRS and support the delivery and storage of IRS and other malaria vector control products 3.1 Cost-effective procurement mechanism established

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

3.1.1 Number and percentage of Procurement Insecticide 1, 100% 1, 100% 1, 100% 2 1 1 insecticide procurements that records Annually type Actellic 1 Actellic 1 Actellic 1 had a pre-shipment QA/QC SumiShield 1 test at least 60 days prior to spray campaign 3.1.2 Number and percentage of Procurement Insecticide 1, 100% 1, 100% 1, 100% 1, 100% 1, 100% 1, 100% insecticide procurements records Annually type received on time to allow the initiation of spray operations as scheduled 3.1.3 Number and percentage of Procurement VC 1, 100% 1, 100% 1, 100% 1, 100% 1, 100% 1, 100% international equipment records Annually intervention IRS IRS IRS IRS IRS IRS procurements, including PPE, type received on time to allow the initiation of vector control campaigns as scheduled 3.1.4 Number and percentage of Procurement 1, 100% 1, 100% 1, 100% 1, 100% 1, 100% 1, 100% local procurements for PPE records Annually received on time to allow the initiation of spray operations as scheduled 3.1.5 PPE procured according to Procurement N/A N/A N/A N/A N/A N/A workforce composition records Annually 3.2 Robust inventory management and logistics systems established 3.2.1 Number and percentage of Project training VC 462, 100% 462, 100% 370, 100% 276, 100% 276, 100% 298, 100% logistics and warehouse records intervention IRS IRS IRS 72f 204 m 72F, 204 M 68 F, 230 M managers trained in vector type M: M: M: IRS IRS IRS control supply chain Annually Sex W: W: W: IRS IRS IRS management M: 204 M: 204 M: 230 W:72 W:72 W: 68

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

3.2.2 Number and percentage of Inventory and Insecticide 462, 100% 462, 100% 370, 100% 276, 100% 276, 100% 298, 100% operations site warehouses stock records type Actellic 300CS Actellic 228, Actellic 228, Actellic 228, Actellic 298, where physical inventories can Annually Sumishield 48 Sumishield 48 Sumishield 48 Sumishield 298 be verified by daily stock (Lira 26 sites (Lira 26 sites (Lira 26 sites records and Dokolo 22 and Dokolo 22 and Dokolo 22 sites) sites) sites) 3.2.3 Successfully completed spray Inventory and Insecticide 1, 100% 1, 100% 1, 100% 1, 100% 1,100% 1, 100% operations without an stock records type Actellic 300CS insecticide stock-out Annually 4. Innovation 4.1 Conduct operational research or monitoring to scale up new tools, methods, and approaches 4.1.1 Number of operational Project records Type of 0 0 5 0 0 0 research studies on promising Innovation new tools or new Annually methods/approaches to existing tools that are implemented 4.2 Create and share knowledge through dissemination of best practices and lessons learned 4.2.1 Number of innovations, best Project records Technical 1 0 5 5 0 0 practices, and other data or Area lessons learned shared with Annually other partners or international institutions for global reporting on the Vector Learning Exchange 4.2.2 Number of individuals who use Project records N/A 21 0 21 2 2 0 the Vector Learning Exchange Annually

4.2.3 Number of symposia and/or Project records Technical area 1 1, Entomology 1 1 1 0 presentations submitted to and accepted at global Annually conferences

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

4.2.4 Number of success stories Project records 1 1 1 1 1 4 written or videos produced and shared on the VectorLink Annually project website 4.2.5 Number of peer-reviewed Project records Technical area 1 0 1 1 1 0 journal articles submitted and Annually accepted 4.2.6 Number of critical guidance, Project records Technical area 1 0 1 1 1 1 standards, or plans that incorporate disseminated Annually findings/best practices

4.3 Develop and deploy cost-savings approaches 4.3.1 Number of innovative or novel Project records VC 115 1 1 1 1 1 approaches implemented to intervention IRS IRS IRS IRS IRS achieve cost savings in IRS Annually type and integrated malaria vector control programs

4.3.2 Number of cost-effectiveness Project records VC 0 0 1 1 1 1 assessments of existing intervention IRS IRS IRS IRS approaches in the Annually type implementation of IRS and integrated malaria vector control programs 4.4 Cultivate public-private partnerships

15 Engaging other implementing partners to use their existing infrastructure to conduct IRS-related mobilization.

# Performance Indicator Data Source(s) Annual Targets and Results and Reporting Year 1 Year 2 Year 3 Year 4 Year 5 Frequency

Target Result Target Result Target Result Target Result Target Result Disaggregation(s)

4.4.1 Number of private sector Project records Private sector 516 0 0 0 0 0 entities engaged with to organization establish public-private Annually partnerships to increase the quality and coverage of malaria vector control activities globally

16 Engaging other implementing partners to use their existing infrastructure to conduct IRS-related mobilization

ANNEX F: SUPERVISION TOOLS AND RESULTS End of day clean-Up Home Owner preparation Spray operator morning Store Keeper and spray operator mobilization Performance performance

Spray District campaign Target Target Target Target Achievement% Achievement% Achievement% Achievement% # of supervisions # of supervisions # of supervisions # of supervisions

Phase I Budaka 448 361 80.6 460 501 108.9 2280 2665 116.9 501 517 103.2 Bugiri 688 466 67.7 700 479 68.4 3480 2272 65.3 479 574 119.8 Butaleja 508 346 68.1 520 537 103.3 2580 3794 147.1 537 551 102.6 Butebo 328 46 14 340 145 42.6 1680 761 45.3 145 179 123.4 Kibuku 428 205 47.9 440 255 58 2180 1888 86.6 255 448 175.7 Namutumba 468 235 50.2 480 370 77.1 2380 1264 53.1 370 281 75.9 Pallisa 548 143 26.1 560 616 110 2780 1733 62.3 616 523 84.9 Tororo 908 787 86.7 920 665 72.3 4580 4335 94.7 665 1055 158.6 Total 4,324 2,589 59.9 4420 3,568 80.7 21,940 18,712 85.3 3,568 4,128 115.7 Phase II Alebtong 580 648 111.7 580 671 115.7 2900 5306 183 580 768 132.4 Amolatar 440 241 54.8 440 995 226.1 2200 2379 108.1 440 468 106.4 Dokolo 560 324 57.9 560 415 74.1 2800 2275 81.3 560 503 89.8 Kaberamaido 540 366 67.8 540 458 84.8 2700 4235 156.9 540 455 84.3 Kalaki 500 483 96.6 500 458 91.6 2500 4485 179.4 500 596 119.2 Lira 880 814 92.5 880 1021 116 4400 6033 137.1 880 1023 116.3 Otuke 600 435 72.5 600 1342 223.7 2800 4573 163.3 600 459 76.5 Serere 780 552 70.8 780 779 99.9 3900 4353 111.6 780 813 104.2 Total 4,880 3,863 79.2 4,880 6,139 125.8 24,200 33,639 139 4,880 5,085 104.2 Grand Total 9,204 6,452 70.1 93,00 9,707 104.4 46,140 52,351 113.5 8,448 9,213 109.1

ANNEX G: SUB-COUNTY SUMMARY OF CAMPAIGN 2020 SPRAY RESULTS Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Alebtong Abako 13,515 36,622 13,255 98.1 36,073 804 5,546 98.5 Abia 11,673 30,937 11,116 95.2 29,798 534 5,308 96.3 Akura 10,091 27,724 9,604 95.2 26,609 496 4,527 96.0 Alebtong TC 2,722 8,038 2,624 96.4 7,847 125 1,135 97.6 Aloi 13,508 36,236 12,624 93.5 34,292 627 6,030 94.6 Amugu 11,175 31,427 10,965 98.1 30,951 671 5,611 98.5 Apala 9,081 24,378 8,701 95.8 23,653 386 3,978 97.0 Awei 10,227 27,753 10,032 98.1 27,382 480 4,509 98.7 Omoro 21,919 58,575 20,365 92.9 55,473 1,202 10,430 94.7 Alebtong Total 103,911 281,690 99,286 95.5 272,078 5,325 47,074 96.6 Amolatar Agikdak 5,535 14,548 5,357 96.8 14,130 315 2,703 97.1 Agwingiri 8,154 22,256 7,858 96.4 21,624 408 3,629 97.2 Akwon 4,293 10,748 3,994 93.0 10,127 214 1,826 94.2 Amolatar TC 5,038 15,428 4,708 93.4 14,681 274 2,214 95.2 Aputi 7,527 20,193 7,386 98.1 19,870 413 3,607 98.4 Arwotcek 8,187 21,035 7,742 94.6 20,122 380 3,771 95.7 Awelo 6,601 16,360 6,429 97.4 16,055 330 2,819 98.1 Etam 5,411 14,616 5,328 98.5 14,442 309 2,644 98.8 Etam TC 1,896 4,820 1,857 97.9 4,742 77 879 98.4 Muntu 6,526 18,192 6,003 92.0 17,012 390 3,072 93.5 Namasale 9,139 25,286 9,057 99.1 25,100 551 4,900 99.3 Namasale TC 3,957 10,825 3,826 96.7 10,624 341 1,771 98.1 Amolatar Total 72,264 194,307 69,545 96.2 188,529 4,002 33,835 97.0 Budaka Budaka 3,753 13,198 3,109 82.8 12,689 331 2,787 96.1 Budaka TC 4,533 18,550 3,695 81.5 16,270 383 2,775 87.7

Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Iki-iki 3,802 14,467 3,046 80.1 12,265 340 2,501 84.8 Kabuna 2,081 8,428 1,927 92.6 7,963 232 1,608 94.5 Kachomo 5,739 20,863 5,154 89.8 19,070 666 3,912 91.4 Kaderuna 3,303 13,630 3,263 98.8 13,538 389 2,878 99.3 Kadimukoli 3,656 16,676 3,133 85.7 15,288 577 3,396 91.7 Kakoli 1,792 7,222 1,587 88.6 6,669 193 1,617 92.3 Kakule 4,515 16,184 3,672 81.3 15,180 389 3,106 93.8 Kameruka 5,141 19,896 4,519 87.9 18,367 584 3,700 92.3 Kamonkoli 1,366 5,716 1,076 78.8 4,819 132 981 84.3 Kamonkoli TC 2,935 12,628 2,622 89.3 11,792 244 1,956 93.4 Katira 3,754 14,433 3,370 89.8 13,189 317 2,694 91.4 Lyama 1,921 8,487 1,695 88.2 7,854 242 1,905 92.5 Mugiti 3,990 16,583 3,885 97.4 16,320 435 3,275 98.4 Naboa TC 3,526 15,220 3,202 90.8 14,396 495 3,145 94.6 Nansanga 3,534 17,367 3,408 96.4 16,986 462 3,642 97.8 Tademeri 2,248 9,689 1,867 83.1 8,616 234 2,205 88.9 Budaka Total 61,589 249,237 54,230 88.1 231,271 6,645 48,083 92.8 Bugiri Budhaya 12,103 46,375 11,650 96.3 45,168 1,766 10,191 97.4 Bugiri Eastern Division 7,031 25,928 6,083 86.5 23,003 724 4,017 88.7 Bugiri Western Division 5,052 19,378 4,994 98.9 19,253 563 3,531 99.4 Bulesa 14,245 55,192 13,080 91.8 51,874 1,524 10,231 94.0 Bulidha 6,790 26,692 6,248 92.0 25,492 829 5,362 95.5 Buluguyi 10,004 43,309 9,063 90.6 40,101 1,069 9,186 92.6 Busowa TC 1,666 6,543 1,510 90.6 6,303 190 1,307 96.3 Buwunga 14,456 63,915 13,481 93.3 61,619 1,781 13,205 96.4 Iwemba 8,010 35,735 7,508 93.7 34,053 860 7,823 95.3 Kapyanga 12,836 56,787 11,947 93.1 54,080 1,497 12,017 95.2 Muterere 12,744 49,510 12,270 96.3 48,176 1,906 10,478 97.3 Nabukalu 13,747 60,693 12,965 94.3 58,351 1,883 12,949 96.1 Namayemba TC 2,256 9,163 2,141 94.9 8,960 225 1,717 97.8 Nankoma 7,452 30,916 7,126 95.6 30,276 737 6,315 97.9

Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Nankoma TC 6,088 24,805 5,821 95.6 24,167 665 5,007 97.4 Bugiri Total 134,480 554,941 125,887 93.6 530,876 16,219 113,336 95.7 Butaleja Budumba 6,111 24,741 5,962 97.6 24,327 661 5,227 98.3 Busaba 9,715 41,625 9,627 99.1 41,464 1,612 9,088 99.6 Busabi 5,332 21,595 5,304 99.5 21,558 577 4,453 99.8 Busolwe 4,088 16,275 4,051 99.1 16,234 428 3,374 99.7 Busolwe TC 3,915 17,116 3,673 93.8 16,760 460 3,067 97.9 Butaleja 4,501 19,430 4,349 96.6 19,408 560 4,235 99.9 Butaleja TC 5,702 25,504 5,600 98.2 25,355 692 5,821 99.4 Himutu 5,830 25,112 5,717 98.1 24,968 834 5,591 99.4 Kachonga 6,532 31,006 6,403 98.0 30,905 939 7,578 99.7 Mazimasa 10,545 45,902 10,379 98.4 45,504 1,358 9,523 99.1 Nawanjofu 6,045 26,970 5,939 98.2 26,826 931 6,396 99.5 Naweyo 8,338 33,320 8,129 97.5 32,943 1,058 7,106 98.9 Butaleja Total 76,654 328,596 75,133 98.0 326,252 10,110 71,459 99.3 Butebo Butebo 8,823 32,391 8,662 98.2 32,208 1,319 6,942 99.4 Butebo TC 4,212 15,594 3,973 94.3 15,281 648 2,989 98.0 Kabwangasi 8,076 35,428 7,554 93.5 35,060 1,025 7,065 99.0 Kabwangasi TC 1,042 4,273 996 95.6 4,262 202 860 99.7 Kakoro Rural 7,542 24,580 6,950 92.2 24,486 779 4,943 99.6 Kakoro TC 2,190 7,138 2,080 95.0 7,111 271 1,421 99.6 Kanginima 2,721 8,757 2,531 93.0 8,555 258 1,568 97.7 Petete 8,572 33,871 8,453 98.6 33,655 1,090 6,844 99.4 Butebo Total 43,178 162,032 41,199 95.4 160,618 5,592 32,632 99.1 Dokolo Adeknino 10,608 26,248 9,654 91.0 24,552 632 4,704 93.5 Adok 8,974 23,202 8,590 95.7 22,769 458 4,176 98.1 Agwata 7,637 19,468 7,242 94.8 18,985 313 3,103 97.5 Amwoma 6,883 17,592 6,568 95.4 17,139 351 2,859 97.4 Bata 9,398 24,151 8,836 94.0 22,913 392 3,827 94.9 Dokolo 6,419 17,666 5,954 92.8 16,832 317 2,943 95.3 Dokolo TC 7,392 19,205 7,162 96.9 18,823 300 2,841 98.0

Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Kangai 7,437 20,560 7,258 97.6 20,429 328 3,215 99.4 Kwera 7,772 17,755 7,690 98.9 17,674 348 2,653 99.5 Okwalongwen 6,549 17,655 5,474 83.6 15,250 296 2,768 86.4 Okwongodul 7,845 21,306 7,782 99.2 21,248 313 2,941 99.7 Dokolo Total 86,914 224,808 82,210 94.6 216,614 4,048 36,030 96.4 Kaberamaido Alwa 6,851 19,835 6,802 99.3 19,762 325 3,385 99.6 Aperkira 6,568 19,113 6,517 99.2 19,100 376 3,749 99.9 Kaberamaido 7,952 21,171 7,887 99.2 21,059 467 3,537 99.5 Kaberamaido TC 3,778 12,561 3,706 98.1 12,399 235 2,005 98.7 Kobulubulu 4,917 13,296 4,731 96.2 13,285 229 2,404 99.9 Ochero 7,140 22,231 7,067 99.0 22,044 436 4,446 99.2 Ochero Town Council 2,818 8,240 2,813 99.8 8,231 169 1,636 99.9 Okile 3,709 11,331 3,644 98.2 11,172 264 2,276 98.6 Oriamo 3,127 8,651 3,081 98.5 8,642 157 1,682 99.9 Kaberamaido Total 46,860 136,429 46,248 98.7 135,694 2,658 25,120 99.5 Kalaki Anyara 6,672 17,325 6,625 99.3 17,220 355 3,340 99.4 Apapai 5,111 15,132 5,056 98.9 15,016 324 2,582 99.2 Bululu 5,994 17,646 5,981 99.8 17,613 388 3,381 99.8 Kakure 4,040 12,968 3,981 98.5 12,865 294 2,693 99.2 Kalaki 7,166 21,985 6,850 95.6 21,310 411 4,060 96.9 Ocelakur 4,182 13,300 4,128 98.7 13,183 328 2,883 99.1 Ogwolo 5,721 14,464 5,684 99.4 14,392 316 2,469 99.5 Otuboi 7,552 21,364 7,339 97.2 20,918 368 4,032 97.9 Otuboi TC 2,576 7,318 2,569 99.7 7,304 106 1,248 99.8 Kalaki Total 49,014 141,502 48,213 98.4 139,821 2,890 26,688 98.8 Kibuku Bulangira 3,371 12,886 2,923 86.7 11,876 291 2,625 92.2 Buseta 5,932 22,533 5,107 86.1 20,077 754 4,521 89.1 Goli Goli 2,089 9,280 2,006 96.0 9,045 266 2,132 97.5 Kabweri 5,554 22,403 5,410 97.4 22,006 510 4,502 98.2 Kadama 1,841 7,157 1,728 93.9 6,809 231 1,536 95.1 Kadama TC 1,725 7,111 1,628 94.4 6,856 204 1,413 96.4

Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Kagumu 5,150 20,556 4,990 96.9 20,135 615 4,743 98.0 Kakutu 2,343 9,765 2,039 87.0 8,863 201 1,991 90.8 Kasasira 2,305 10,448 2,183 94.7 10,110 331 2,405 96.8 Kasasira TC 1,538 7,326 1,509 98.1 7,196 201 1,263 98.2 Kibuku 3,687 15,448 3,617 98.1 15,290 607 3,464 99.0 Kibuku TC 3,820 15,214 3,495 91.5 14,280 613 3,264 93.9 Kirika 3,307 12,812 3,219 97.3 12,560 357 2,792 98.0 Kituti 1,472 5,556 1,318 89.5 5,087 164 1,125 91.6 Lwatama 4,406 17,444 3,886 88.2 16,679 514 3,678 95.6 Nabiswa 5,163 19,693 5,047 97.8 19,459 640 3,828 98.8 Nandere 2,255 8,877 2,152 95.4 8,584 329 1,805 96.7 Nankodo 3,467 15,414 3,404 98.2 15,229 461 3,660 98.8 Tirinyi 2,397 10,117 1,959 81.7 8,785 329 2,051 86.8 Tirinyi TC 3,003 13,821 2,430 80.9 11,881 398 2,767 86.0 Kibuku Total 64,825 263,861 60,050 92.6 250,807 8,016 55,565 95.1 Lira Adekokwok 11,623 41,762 10,570 90.9 40,606 588 4,988 97.2 Adyel Division 12,953 48,039 11,622 89.7 44,269 1,198 5,898 92.2 Agali 11,310 30,900 10,463 92.5 29,347 504 4,867 95.0 Agweng 17,267 45,865 16,894 97.8 45,098 892 7,562 98.3 Amach 20,575 54,626 19,401 94.3 51,936 1,123 7,655 95.1 Aromo 16,637 46,220 16,011 96.2 44,932 1,035 8,429 97.2 Barr 18,004 48,067 16,303 90.6 45,284 688 7,685 94.2 Central Division 6,292 27,985 5,995 95.3 27,538 903 2,922 98.4 Lira 13,826 50,534 12,386 89.6 46,892 791 6,321 92.8 Ngetta 15,415 45,316 14,335 93.0 43,319 690 5,838 95.6 Ogur 16,042 45,491 15,261 95.1 44,172 856 7,267 97.1 Ojwina 14,523 44,773 11,558 79.6 40,618 1,334 5,685 90.7 Railways Division 4,574 16,094 3,597 78.6 15,059 488 1,982 93.6 Lira Total 179,041 545,672 164,396 91.8 519,070 11,090 77,099 95.1 Namutumba Bugobi 6,442 25,524 6,037 93.7 24,422 1,118 5,425 95.7 Bulange 10,495 43,612 10,420 99.3 43,380 1,741 9,059 99.5

Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Ivukula 9,400 38,219 8,562 91.1 37,552 1,323 7,692 98.3 Kagulu 3,287 11,871 3,026 92.1 11,701 274 2,157 98.6 Kibaale 3,025 12,332 2,991 98.9 12,212 493 2,463 99.0 Kibale 3,320 13,884 3,313 99.8 13,850 657 2,917 99.8 Kiwanyi 6,385 26,967 6,322 99.0 26,783 923 5,045 99.3 Kizuba 6,576 26,148 6,535 99.4 26,003 929 5,281 99.4 Magada 1,665 7,825 1,651 99.2 7,814 207 1,652 99.9 Mazuba 2,939 14,907 2,911 99.0 14,844 455 3,419 99.6 Nabweyo 5,793 23,827 5,606 96.8 23,289 1,112 4,941 97.7 Namutumba 6,467 24,642 6,447 99.7 24,572 775 4,456 99.7 Namutumba TC 6,262 24,675 6,068 96.9 24,098 896 4,490 97.7 Nangonde 7,824 32,961 7,403 94.6 31,482 1,097 6,576 95.5 Nawaikona 3,917 17,793 3,614 92.3 16,863 424 2,764 94.8 Nsinze 4,285 18,821 4,030 94.0 18,076 547 3,165 96.0 Namutumba Total 88,082 364,008 84,936 96.4 356,941 12,971 71,502 98.1 Otuke Adwari 4,157 11,496 3,926 94.4 10,971 196 2,000 95.4 Alango 7,717 22,387 7,329 95.0 21,670 354 3,140 96.8 Ogor 7,215 19,884 7,076 98.1 19,606 456 3,664 98.6 Ogwete 7,101 23,610 7,031 99.0 23,461 693 5,262 99.4 Okwang 9,832 26,323 9,607 97.7 25,840 487 4,441 98.2 Olilim 6,360 18,062 6,121 96.2 17,655 383 3,276 97.7 Orum 4,928 12,787 4,787 97.1 12,537 290 2,090 98.0 Otuke TC 2,742 7,163 2,444 89.1 6,594 137 926 92.1 Otuke Total 50,052 141,712 48,321 96.5 138,334 2,996 24,799 97.6 Pallisa Agule 2,931 12,734 2,715 92.6 12,066 452 2,858 94.8 Agule TC 2,587 10,378 2,445 94.5 9,955 351 2,233 95.9 Akisim 4,433 16,532 3,603 81.3 14,317 420 3,081 86.6 Apopong 7,962 29,829 6,846 86.0 27,168 726 6,069 91.1 Boliso I 3,916 13,127 3,586 91.6 13,093 465 2,526 99.7 Chelekura 4,513 16,453 4,484 99.4 16,387 484 3,306 99.6 Gogonyo 9,516 38,475 9,071 95.3 37,057 1,301 8,264 96.3

Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Kameke 5,748 20,671 5,633 98.0 20,418 819 4,019 98.8 Kamuge 5,403 22,485 5,117 94.7 21,656 587 4,805 96.3 Kamuge TC 1,311 5,100 1,236 94.3 4,916 127 975 96.4 Kasodo 5,969 21,614 5,572 93.3 20,598 471 3,652 95.3 Kaukura 2,337 8,340 2,138 91.5 7,881 225 1,791 94.5 Kibale 1,719 6,069 1,542 89.7 5,780 187 1,193 95.2 Kibale TC 4,636 16,089 4,084 88.1 14,879 455 3,180 92.5 Oboliso 1,165 4,292 1,130 97.0 4,197 151 911 97.8 Obutet 2,503 10,138 2,355 94.1 9,704 460 2,337 95.7 Olok 5,819 23,327 5,607 96.4 22,812 659 4,867 97.8 Opwateta 6,344 21,755 6,276 98.9 21,616 806 4,563 99.4 Pallisa 6,281 22,369 5,852 93.2 21,086 797 4,231 94.3 Pallisa TC 13,076 54,647 12,097 92.5 52,618 1,919 9,060 96.3 Puti-Puti 5,929 21,457 5,621 94.8 21,342 787 4,692 99.5 Pallisa Total 104,098 395,881 97,010 93.2 379,546 12,649 78,613 95.9 Serere Atiira 9,046 28,320 8,804 97.3 27,841 605 5,208 98.3 Bugondo 13,354 41,241 13,231 99.1 40,965 1,004 8,223 99.3 Kadungulu 8,738 30,550 8,612 98.6 30,231 877 7,018 99.0 Kadungulu Town Council 4,375 14,541 4,327 98.9 14,429 374 3,261 99.2 Kasilo TC 1,832 5,967 1,780 97.2 5,849 140 1,074 98.0 Kateta 22,274 79,175 21,919 98.4 78,370 2,378 17,452 99.0 Kidetok Town Council 5,951 19,752 5,701 95.8 19,134 560 4,087 96.9 Kyere 21,829 72,133 21,409 98.1 71,219 1,926 14,252 98.7 Labori 8,277 29,744 7,894 95.4 28,708 1,055 6,683 96.5 Olio 12,274 39,582 12,068 98.3 39,158 736 7,166 98.9 Pingire 10,489 33,570 10,328 98.5 33,155 920 6,764 98.8 Serere TC 4,596 14,368 4,500 97.9 14,217 271 1,685 98.9 Serere Total 123,035 408,943 120,573 98.0 403,276 10,846 82,873 98.6 Tororo Akadot 1,338 4,621 1,249 93.3 4,449 82 844 96.3 Eastern Division 8,394 44,860 8,292 98.8 44,527 1,234 4,426 99.3 Iyolwa 4,040 16,323 3,818 94.5 15,797 403 3,610 96.8

Sprayed Structures Structures Population Structures Pregnant Children <5 % Population District Subcounty Spray Population found Found sprayed women years old Protected Coverage (%) protected protected protected Iyolwa TC 3,172 13,819 3,065 96.6 13,586 307 2,661 98.3 Katajula 1,238 4,686 1,128 91.1 4,324 116 940 92.3 Kirewa 10,182 36,451 8,994 88.3 34,242 859 6,791 93.9 Kisoko 6,759 26,463 6,621 98.0 26,010 501 4,871 98.3 Kwapa 10,606 35,100 9,770 92.1 32,775 548 5,386 93.4 Magola 8,658 29,676 8,144 94.1 28,796 669 5,311 97.0 Malaba TC 3,929 13,245 3,317 84.4 12,026 264 2,045 90.8 Mella 6,695 23,490 6,331 94.6 22,473 362 3,934 95.7 Merikit 8,622 33,033 7,686 89.1 30,441 640 5,771 92.2 Molo 6,768 23,781 6,190 91.5 22,412 374 4,067 94.2 Morukatipe 2,234 7,521 2,036 91.1 7,031 119 1,375 93.5 Mukuju 9,811 33,438 9,038 92.1 32,055 545 5,982 95.9 Mulanda 6,566 25,618 6,290 95.8 24,929 699 5,190 97.3 Mwelo 4,702 15,431 4,669 99.3 15,338 327 2,795 99.4 Nabuyoga 6,446 24,896 5,963 92.5 23,976 594 5,183 96.3 Nabuyoga TC 4,274 16,305 3,771 88.2 15,427 396 3,288 94.6 Nagongera 9,365 35,102 8,348 89.1 32,395 757 6,485 92.3 Nagongera TC 5,370 20,900 4,968 92.5 19,779 443 3,205 94.6 Nyangole 4,490 15,606 4,437 98.8 15,471 481 2,992 99.1 Osukuru 13,176 47,082 12,276 93.2 44,955 915 7,702 95.5 Pajwenda TC 3,541 14,206 3,317 93.7 13,461 410 2,794 94.8 Paya 10,066 38,096 9,465 94.0 36,796 839 7,831 96.6 Petta 6,931 25,142 6,266 90.4 23,602 538 4,384 93.9 Rubongi 11,704 43,759 11,194 95.6 42,256 1,422 7,254 96.6 Soni 1,223 4,450 1,123 91.8 4,261 80 856 95.8 Sopsop 6,154 23,339 5,863 95.3 22,609 471 4,687 96.9 Western Division 4,971 23,751 4,703 94.6 22,717 637 2,795 95.6 Tororo Total 191,425 720,190 178,332 93.2 688,916 16,032 125,455 95.7 Grand Total 1,475,422 5,113,809 1,395,569 94.6 4,938,643 132,089 950,163 96.6

ANNEX H: NUMBER AND USE OF MOSQUITO NETS IN 2020 SPRAY CAMPAIGN # of Children Total # of Average # % < 5 <5 Sleeping District Subcounty Mosquito Nets Nets/ Sleeping Sleeping Under Mosquito Found Structure under Net Nets Alebtong Abako 3,274 4 1,092 33.4 Abia 3,613 3 1,345 37.2 Akura 2,501 4 1,010 40.4 Alebtong TC 1,475 2 416 28.2 Aloi 4,685 3 1,646 35.1 Amugu 2,589 4 1,071 41.4 Apala 2,873 3 994 34.6 Awei 2,925 3 1,115 38.1 Omoro 8,421 2 3,443 40.9 Alebtong Total 32,356 3 12,132 37.5 Amolatar Agikdak 2,686 2 1,034 38.5 Agwingiri 4,429 2 1,458 32.9 Akwon 2,902 1 934 32.2 Amolatar TC 3,309 1 931 28.1 Aputi 5,719 1 1,972 34.5 Arwotcek 7,107 1 2,330 32.8 Awelo 5,060 1 1,510 29.8 Etam 4,540 1 1,646 36.3 Etam TC 1,601 1 578 36.1 Muntu 3,320 2 1,163 35.0 Namasale 6,848 1 2,563 37.4 Namasale TC 2,482 2 804 32.4 Amolatar Total 50,003 1 16,923 33.8 Budaka Budaka 3,192 1 1,431 44.8 Budaka TC 4,752 1 1,162 24.5 Iki-iki 2,668 1 953 35.7 Kabuna 1,193 2 517 43.3 Kachomo 4,472 1 1,697 37.9 Kaderuna 2,148 2 972 45.3 Kadimukoli 2,195 1 1,001 45.6 Kakoli 1,308 1 595 45.5 Kakule 2,743 1 1,183 43.1 Kameruka 1,826 2 863 47.3 Kamonkoli 1,112 1 378 34.0 Kamonkoli TC 3,740 1 702 18.8 Katira 1,377 2 595 43.2 Lyama 1,594 1 745 46.7 Mugiti 1,770 2 680 38.4 Naboa TC 2,478 1 1,064 42.9 Nansanga 4,161 1 1,576 37.9 Tademeri 2,199 1 1,090 49.6

# of Children Total # of Average # % < 5 <5 Sleeping District Subcounty Mosquito Nets Nets/ Sleeping Sleeping Under Mosquito Found Structure under Net Nets Budaka Total 44,928 1 17,204 38.3 Bugiri Budhaya 7,992 1 4,088 51.2 Bugiri Eastern Division 9,562 1 3,004 31.4 Bugiri Western Division 7,123 1 2,198 30.9 Bulesa 11,347 1 4,470 39.4 Bulidha 2,674 2 1,246 46.6 Buluguyi 7,101 1 3,607 50.8 Busowa TC 1,043 1 438 42.0 Buwunga 11,921 1 4,989 41.9 Iwemba 4,209 2 2,198 52.2 Kapyanga 9,973 1 4,406 44.2 Muterere 6,412 2 3,011 47.0 Nabukalu 9,027 1 4,342 48.1 Namayemba TC 1,440 1 565 39.2 Nankoma 4,760 1 1,959 41.2 Nankoma TC 3,980 1 1,684 42.3 Bugiri Total 98,564 1 42,205 42.8 Butaleja Budumba 3,624 2 1,634 45.1 Busaba 5,443 2 2,643 48.6 Busabi 2,060 3 1,046 50.8 Busolwe 2,017 2 853 42.3 Busolwe TC 5,169 1 1,810 35.0 Butaleja 1,860 2 899 48.3 Butaleja TC 2,438 2 1,125 46.1 Himutu 1,945 3 1,079 55.5 Kachonga 3,840 2 1,877 48.9 Mazimasa 6,822 2 3,237 47.4 Nawanjofu 2,843 2 1,593 56.0 Naweyo 3,429 2 1,616 47.1 Butaleja Total 41,490 2 19,412 46.8 Butebo Butebo 4,126 2 1,826 44.3 Butebo TC 889 4 360 40.5 Kabwangasi 2,064 4 635 30.8 Kabwangasi TC 304 3 114 37.5 Kakoro Rural 4,027 2 1,239 30.8 Kakoro TC 1,416 1 414 29.2 Kanginima 964 3 411 42.6 Petete 2,800 3 1,010 36.1 Butebo Total 16,590 2 6,009 36.2 Dokolo Adeknino 6,878 1 2,335 33.9 Adok 5,197 2 1,811 34.8 Agwata 8,097 1 2,027 25.0 Amwoma 4,495 1 1,366 30.4 Bata 4,206 2 1,486 35.3 Dokolo 2,432 2 944 38.8 Dokolo TC 3,430 2 1,172 34.2 Kangai 5,022 1 1,624 32.3 Kwera 4,831 2 1,199 24.8 Okwalongwen 2,199 2 890 40.5

# of Children Total # of Average # % < 5 <5 Sleeping District Subcounty Mosquito Nets Nets/ Sleeping Sleeping Under Mosquito Found Structure under Net Nets Okwongodul 5,543 1 1,342 24.2 Dokolo Total 52,330 2 16,196 30.9 Kaberamaido Alwa 3,218 2 1,184 36.8 Aperkira 5,668 1 2,060 36.3 Kaberamaido 3,384 2 1,102 32.6 Kaberamaido TC 2,593 1 703 27.1 Kobulubulu 2,504 2 892 35.6 Ochero 5,432 1 2,167 39.9 Ochero Town Council 2,400 1 853 35.5 Okile 3,110 1 1,189 38.2 Oriamo 1,166 3 471 40.4 Kaberamaido Total 29,475 2 10,621 36.0 Kalaki Anyara 1,528 4 616 40.3 Apapai 1,709 3 721 42.2 Bululu 6,009 1 2,013 33.5 Kakure 2,147 2 955 44.5 Kalaki 4,804 1 1,921 40.0 Ocelakur 4,431 1 1,900 42.9 Ogwolo 1,905 3 658 34.5 Otuboi 3,629 2 1,540 42.4 Otuboi TC 780 3 377 48.3 Kalaki Total 26,942 2 10,701 39.7 Kibuku Bulangira 2,808 1 1,289 45.9 Buseta 4,796 1 2,006 41.8 Goli Goli 1,248 2 630 50.5 Kabweri 3,554 2 1,519 42.7 Kadama 1,659 1 723 43.6 Kadama TC 1,515 1 664 43.8 Kagumu 2,091 2 1,097 52.5 Kakutu 1,461 1 664 45.4 Kasasira 1,537 1 774 50.4 Kasasira TC 935 2 370 39.6 Kibuku 2,494 1 1,092 43.8 Kibuku TC 3,073 1 1,273 41.4 Kirika 3,631 1 1,561 43.0 Kituti 912 1 323 35.4 Lwatama 3,608 1 1,716 47.6 Nabiswa 6,251 1 2,130 34.1 Nandere 2,109 1 942 44.7 Nankodo 2,369 1 1,124 47.4 Tirinyi 1,261 2 558 44.3 Tirinyi TC 2,041 1 789 38.7 Kibuku Total 49,353 1 21,244 43.0 Lira Adekokwok 13,261 1 2,383 18.0 Adyel Division 16,501 1 3,250 19.7 Agali 4,662 2 1,250 26.8 Agweng 4,769 4 1,493 31.3 Amach 251,686 0 3,248 1.3 Aromo 6,579 2 2,552 38.8

# of Children Total # of Average # % < 5 <5 Sleeping District Subcounty Mosquito Nets Nets/ Sleeping Sleeping Under Mosquito Found Structure under Net Nets Barr 7,199 2 2,255 31.3 Central Division 11,814 1 1,763 14.9 Lira 13,425 1 3,027 22.5 Ngetta 5,892 2 1,743 29.6 Ogur 5,898 3 1,748 29.6 Ojwina 12,483 1 3,100 24.8 Railways Division 4,834 1 1,042 21.6 Lira Total 359,003 0 28,854 8.0 Namutumba Bugobi 4,660 1 2,036 43.7 Bulange 8,984 1 3,298 36.7 Ivukula 10,671 1 3,953 37.0 Kagulu 1,894 2 520 27.5 Kibaale 2,704 1 929 34.4 Kibale 2,878 1 965 33.5 Kiwanyi 2,963 2 1,090 36.8 Kizuba 3,964 2 1,645 41.5 Magada 1,176 1 473 40.2 Mazuba 2,871 1 1,117 38.9 Nabweyo 4,257 1 1,521 35.7 Namutumba 4,236 2 1,491 35.2 Namutumba TC 4,977 1 1,589 31.9 Nangonde 7,822 1 3,153 40.3 Nawaikona 1,552 2 397 25.6 Nsinze 4,666 1 1,292 27.7 Namutumba Total 70,275 1 25,469 36.2 Otuke Adwari 2,885 1 1,013 35.1 Alango 6,677 1 1,459 21.9 Ogor 3,669 2 1,596 43.5 Ogwete 2,641 3 1,577 59.7 Okwang 5,146 2 1,890 36.7 Olilim 2,650 2 1,045 39.4 Orum 2,296 2 898 39.1 Otuke TC 2,127 1 593 27.9 Otuke Total 28,091 2 10,071 35.9 Pallisa Agule 4,521 1 1,876 41.5 Agule TC 3,079 1 1,297 42.1 Akisim 1,764 2 662 37.5 Apopong 6,116 1 2,815 46.0 Boliso I 1,929 2 826 42.8 Chelekura 5,711 1 1,954 34.2 Gogonyo 8,671 1 3,680 42.4 Kameke 4,712 1 1,833 38.9 Kamuge 1,552 3 738 47.6 Kamuge TC 419 3 190 45.3 Kasodo 6,157 1 1,742 28.3 Kaukura 1,929 1 869 45.0 Kibale 719 2 312 43.4 Kibale TC 2,135 2 965 45.2 Oboliso 1,124 1 563 50.1

# of Children Total # of Average # % < 5 <5 Sleeping District Subcounty Mosquito Nets Nets/ Sleeping Sleeping Under Mosquito Found Structure under Net Nets Obutet 1,430 2 574 40.1 Olok 6,671 1 2,960 44.4 Opwateta 5,073 1 1,876 37.0 Pallisa 3,043 2 1,232 40.5 Pallisa TC 7,816 2 2,729 34.9 Puti-Puti 2,339 2 956 40.9 Pallisa Total 76,910 1 30,649 39.9 Serere Atiira 8,048 1 2,806 34.9 Bugondo 16,165 1 5,612 34.7 Kadungulu 11,223 1 4,967 44.3 Kadungulu Town Council 5,811 1 2,523 43.4 Kasilo TC 2,640 1 891 33.8 Kateta 28,305 1 11,718 41.4 Kidetok Town Council 7,374 1 2,902 39.4 Kyere 28,552 1 10,375 36.3 Labori 7,499 1 3,651 48.7 Olio 13,975 1 4,641 33.2 Pingire 14,116 1 4,692 33.2 Serere TC 5,628 1 932 16.6 Serere Total 149,336 1 55,710 37.3 Tororo Akadot 1,199 1 474 39.5 Eastern Division 267,397 0 3,163 1.2 Iyolwa 4,222 1 2,255 53.4 Iyolwa TC 4,427 1 1,853 41.9 Katajula 925 1 455 49.2 Kirewa 5,188 2 2,316 44.6 Kisoko 6,273 1 2,523 40.2 Kwapa 8,634 1 2,696 31.2 Magola 8,016 1 2,875 35.9 Malaba TC 3,716 1 1,101 29.6 Mella 6,235 1 2,375 38.1 Merikit 7,154 1 2,962 41.4 Molo 6,382 1 2,427 38.0 Morukatipe 1,938 1 815 42.1 Mukuju 8,318 1 2,988 35.9 Mulanda 4,779 1 2,055 43.0 Mwelo 3,432 1 1,353 39.4 Nabuyoga 4,263 1 2,088 49.0 Nabuyoga TC 3,175 1 1,530 48.2 Nagongera 7,190 1 3,321 46.2 Nagongera TC 4,739 1 1,361 28.7 Nyangole 3,139 1 1,383 44.1 Osukuru 518 1 137 26.4 Osukuru 13,714 1 4,068 29.7 Pajwenda TC 3,254 1 1,400 43.0 Paya 7,615 1 3,790 49.8 Petta 6,583 1 2,656 40.3 Rubongi 12,903 1 4,065 31.5 Soni 586 2 294 50.2

# of Children Total # of Average # % < 5 <5 Sleeping District Subcounty Mosquito Nets Nets/ Sleeping Sleeping Under Mosquito Found Structure under Net Nets Sopsop 4,616 1 2,029 44.0 Western Division 245,144 0 1,452 0.6 Tororo Total 665,674 0 64,260 9.7 Grand Total 1,791,320 1 387,660 21.6

ANNEX I: INSECTICIDE USE AND SPRAY OPERATOR PERFORMANCE Spray operator performance Sachet/ Bottle Use and Distribution Campaign District Average # of unit structures per spray Average # of sachets/ bottles Average # of structures operator per day per spray operator per day sprayed per insecticide unit (Sachet/ bottle) Phase I Budaka 8.6 3.4 2.6 Bugiri 9.5 4.4 2.2 Butaleja 10.9 4.2 2.6 Butebo 10.0 4.5 2.2 Kibuku 9.0 3.3 2.7 Namutumba 9.6 4.0 2.4 Pallisa 10.4 4.0 2.6 Tororo 9.8 4.3 2.3 Total 9.7 4.1 2.4 Phase II Alebtong 10.2 4.0 2.5 Amolatar 10.1 3.4 2.9 Dokolo 10.1 4.8 2.1 Kaberamaido 10.6 4.0 2.7 Kalaki 10.5 3.7 2.8 Lira 9.5 4.2 2.3 Otuke 11.2 3.9 2.9 Serere 10.5 4.2 2.5 Total 10.2 4.1 2.5 Grand Total 9.9 4.1 2.4

ANNEX J: 2020 INCIDENTS REPORTS

Incident Number Brief Description Actions and Incident Outcome Location UGA-030520-001- Death of a three week old baby An autopsy was performed. Kosit A village, Kadimukoli Sub-county, Health and Safety (premature) was reported about 6 However, results of examination Budaka District hours after the structure was sprayed are not yet out UGA-030920-002- SOP sustained a simple fracture to X-ray and plaster cast was Omalingai village, Agule Sub county, Health and Safety his leg after falling off his bicycle applied at Mbale Regional Pallisa District Referral Hospital. SOP recovered. UGA-030520-003- SOP was nauseated by the pungent SOP took a rest and recovered Busowobi village, Nabukalu Sub-county, Health and Safety smell of Actellic 300CS leading to next day Bugiri District vomiting. UGA-031020-004- SOP was bitten by a dog while mixing Antibiotics and anti-rabies Mifumi village, Kirewa Sub-county, Tororo Health and Safety insecticide vaccination were administered at District Kirewa and Mulanda Health Centres. UGA-031120-005- SOP collapsed at end of day at the An autopsy was performed but Nakasenyi Operations Site, Lyama Sub- Health and Safety operation site and was later results are pending. The cause of county, Budaka District pronounced dead at Lyama Health death is still under investigation. Centre III. Spraying in the sub county was suspended UGA-031230-006- SOP could not account for the Matter was reported to Nampologoma site, Nabiganda town Fraud insecticide on return from the field Nabiganga Police Station. SOP council, Butaleja District was dismissed UGA-032020-007- Two SOPs were assaulted by a home Assailant were arrested and a Kisoko village, Kisoko Sub-county, Tororo Health and Safety owner while conducting IRS case was opened at Rubongi District Sub-county police station. Both SOPs received medical attention at REK clinic UGA-032020-008- SOP sustained a cut to his head after SOP later received treatment and Magola village, Magola Sub-county, Health and Safety knocking it against a metallic window stitches at Tororo hospital Tororo District during house preparations UGA-032320-009– SOP was bitten by a dog while on his Antibiotics and anti-rabies Namudyawa village, Kamuge Sub- Health and Safety way to spray a household vaccination were administered at county, Pallisa District Kamuge Health Centre III UGA-032420-010- Loss of insecticides by SOPs was Incident was registered at Kagulu Sub-county, Namutumba District Theft reported Magada Police post and suspects were apprehended and dismissed UGA-030520-011- N95 masks meant for IRS were The matter was reported to Central site of Namutumba District and Theft obtained from storekeepers by health district leadership were notified Nansanga site of Budaka District workers through coercion for use as a response to COVID-19 UGA-052120-012– Assorted items were stolen from the The matter was reported to police Namayemba Store, Namayemba Town, Theft project’s warehouse in Bugiri district and is under investigation Bugiri District during the Covid-19 lockdown period. UGA-060120-013- SOP was bitten by a dog as he was Antibiotics and anti-rabies Alere village, Amugu Subcounty, Health and Safety preparing to leave the house he had vaccination were administered at Alebtong District just sprayed Alebtong Health Center IV

Incident Number Brief Description Actions and Incident Outcome Location UGA-060320-014- Site Supervisor sustained a fracture He was admitted to Kumi Akano Parish, Ogur Sub-country, Lira Transport Accident to the left hip bone as a result of a Orthopedics hospital for District road accident management. He recovered UGA-060520-015- SOP suffered a soft tissue injury to Incident was reported to Lira Elii village, Agali Sub- county, Lira District Health and Safety hi s lef t arm following an assault by a Central Police Station and home owner as he prepared for IRS assailant was arrested. SOP received medical attention at Anyangatir HC III

ANNEX K: BALANCE OF ACTELLIC 300CS AND SUMISHIELD USED IN THE 2020 SPRAY CAMPAIGN District Sub-county Sachets of Insecticide Used # Spray days Actellic Sumishield 300CS Kibuku Bulangira and Bulangira TC 422 0 6 Kibuku Sty and Kibuku TC 948 0 6 Kadama, Kadama TC and Nandere 808 0 6 Nabiswa 655 0 6 Kasasira, Kasaira TC and Nankodo 833 0 6 Kirika 461 0 6 Tirinyi 723 0 6 Buseta and Kituti 808 0 6 Lwatama and Tirinyi TC 534 0 6 Kakutu 460 0 6 Kagumu 621 0 6 Goli-Goli 281 0 6 Kabweri and Kenkebu 667 0 6 Kibuku Total 22 8221 0 Namutumba Bugobi 1068 0 6 Bulange 1075 0 6 Ivukula 420 0 6 Namautumba TC 1059 0 6 Ivukula 669 0 6 Kagulu 379 0 6 Namutumba 808 0 6 Kiwanyi 811 0 6 Kizuba 879 0 6 Nangonde 688 0 6 Magada 715 0 6 Kibale TC and Kibale 772 0 6 Kibale TC and Nabweyo 833 0 6 Nsinze 507 0 6 Nawaikona 480 0 Namutumba Total 17 11163 0 Budaka Budaka TC 636 0 6 Ikiki, Ikiki TC and Kakoli 630 0 6 Kachomo 687 0 6 Kadimukoli 452 0 6 Kakule 576 0 6 Kameruka 534 0 6 Kamonkoli 489 0 6 Katiira 412 0 6 Kabuna 573 0 6 Mugiti 562 0 6 Naboa 478 0 6

District Sub-county Sachets of Insecticide Used # Spray days Actellic Sumishield 300CS Lyama and Tademere 642 0 0 Nansanga 470 0 6 Budaka 603 0 6 Budaka Total 19 7744 0 Butebo Butebo 966 0 6 Butebo TC 528 0 6 Kabwangasi 604 0 6 Petete 1094 0 6 Kakoro 896 0 6 Kanginima 561 0 6 Kabwangasi 462 0 6 Butebo Total 7 5111 0 Pallisa Apopong 1071 0 6 Gogonyo 1262 0 6 Chelakura 471 0 6 Kameke 908 0 6 Kamuge 778 0 6 Kibale 405 0 6 Kasodo 703 0 6 Agule 812 0 6 Olok 603 0 6 Akisim 498 0 6 Kibale 204 0 6 Opwateta 697 0 6 Puti-Puti 1148 0 6 Pallisa TC 2256 0 6 Pallisa Total 14 11816 0 Bugiri Budhaya 1326 0 6 Buluguyi 1364 0 6 Iwemba 831 0 6 Bulidha 1260 0 6 Buwunga 1017 0 6 Bulesa 1645 0 6 Namayemba 848 0 6 Nabukalu 1700 0 6 Muterere 1612 0 6 Nankoma 1298 0 6 Busowa TC 899 0 6 Kapyanga 948 0 6 Eastern Division-Municipality 1071 0 6 Western Division-Municipality 844 0 6 Bugiri Total 14 16663 0 Tororo Western Division 182 0 3 Nagongera TC and Katajula 442 0 3 Iyolwa 722 0 3 Kasoli 297 0 3 Kirewa 632 0 3 Kisoko 239 0 3 Kwapa 705 0 3

District Sub-county Sachets of Insecticide Used # Spray days Actellic Sumishield 300CS Pajwenda TC 386 0 3 Magola 528 0 3 Malaba TC 422 0 3 Merikit 559 0 3 Nagongera 627 0 3 Mella 212 0 3 Molo 255 0 3 Mukuju 517 0 3 Mulanda 768 0 3 Nabuyoga 1354 0 3 Rubongi 775 0 3 Osukuru 715 0 3 Paya 510 0 3 Petta 630 0 3 Sopsop 305 0 3 Tororo Total 24 11782 0 Grand Total (Actellic 300CS) 72,500 0 Amolatar Akwon 0 148 2 Agikdak 0 217 2 Agwingiri 0 192 2 Agwingiri 0 121 2 Amolatar TC 0 203 2 Awelo 0 280 2 Aputi 0 253 2 Arwotcek 0 336 2 Namasale TC 0 186 2 Etam 0 291 2 Muntu 0 230 2 Namasale 0 210 2 Namasale 0 128 2 Amolatar Total 11 2795 Otuke Orum 0 81 2 Alango 0 273 2 Okwang 0 243 2 Olilim 0 229 2 Ogor 0 260 2 Ogwete 0 235 2 Otuke TC 0 89 2 Adwari 0 164 2 Okwang 0 136 2 Orum 0 75 2 Otuke Total 8 1785 Lira Adekokwok 0 503 2 Adyel 0 391 2 Agali 0 538 2 Agweng 0 665 2 Amach 0 855 2 Aromo 0 800 2 Barr 0 871 2

District Sub-county Sachets of Insecticide Used # Spray days Actellic Sumishield 300CS Central Division 0 365 2 Lira 0 533 2 Ngetta 0 661 2 Ogur 0 785 2 Ojwina 0 655 2 Railway Division 0 265 2 Lira Total 13 0 7887 Serere Atiira 0 346 2 Bugondo 0 601 2 Kadungulu 0 510 2 Kyere 0 810 2 Kasilo TC 0 64 2 Labori 0 235 2 Kateta 0 870 2 Olio 0 463 2 Serere TC 0 213 2 Pingire 0 606 2 Serere Total 10 4718 Dokolo Okwalongwen 0 225 2 Dokolo 0 243 2 Adeknino 0 147 2 Kangai 0 267 2 Agwata 0 341 2 Amwoma 0 281 2 Okwongodul 0 310 2 Kwera 0 295 2 Adok 0 412 2 Dokolo TC 0 370 2 Bata 0 338 2 Dokolo Total 11 0 3229 Kaberamaido Alwa 0 266 2 Kaberamaido 0 275 2 Aperikira 0 219 2 Kobulubulu 0 185 2 Ochero TC 0 240 2 Okile 0 164 2 Oriamo 0 114 2 Ochero 0 160 2 Kaberamaido TC 0 170 2 Kaberamaido Total 9 0 1793 Kalaki Anyara 0 252 2 Kalaki TC 0 137 2 Kalaki 0 152 2 Bululu 0 219 2 Otuboi 0 237 2 Otuboi 0 189 2 Ocelakur 0 166 2 Ogwolo 0 200 2 Kakure 0 164 2

District Sub-county Sachets of Insecticide Used # Spray days Actellic Sumishield 300CS Apapai 0 188 2 Kalaki Total 10 0 1904 Alebtong Abia 0 440 2 Omoro 0 360 2 Amugu 0 430 2 Awei 0 400 2 Aloi TC 0 210 2 Abako 0 510 2 Alebtong TC 0 140 2 Ocokober 0 230 2 Aloi 0 320 2 Angetta 0 220 2 Akura 0 420 2 Apala 0 370 2 Alebtong Total 12 0 4050 Grand Total Sumishield 0 28161