The Zika AIRS (ZAP) Project Indoor Residual Spraying (IRS 2) Task Order Six

ZAP END OF YEAR REPORT JANUARY 1, 2018 - DECEMBER 31, 2018 Recommended Citation: Zika AIRS Project (ZAP). February 2019. End of Year Report. Rockville, MD. Abt Associates Inc. Contract No.: GHN-I-00-09-00013-00 Task Order: AID-OAA-TO-14-00035 Submitted to: United States Agency for International Development Submitted: February 14, 2019

Abt Associates Inc. 1 6130 Executive Boulevard 1 Rockville, Maryland 20852 1 T. 301.347.5000 1 F. 301.913.9061 1 www.abtassociates.com ZAP DOMINICAN REPUBLIC END OF YEAR REPORT JANUARY 1, 2018 – DECEMBER 31, 2018

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.

3 CONTENTS

Acronyms… ...... iv 1. Executive Summary...... 1 2. Progress and Outcomes ...... 2 2.1 Community Mobilization, Social and Behavior Change Communication...... 2 2.2 Vector Control...... 2 2.3 Entomological Monitoring ...... 4 2.4 Environmental Compliance and Security...... 10 2.5 Monitoring and Evaluation...... 11 2.6 Challenges… ...... 11 3. Improving Zika Response...... 13 3.1 Training and Institutional Capacity Building ...... 13 3.2 Government Engagement...... 13 3.3 Innovations 14 3.4 Integration of Cross-cutting Issues...... 14 3.4.1 Gender Equality and Female Empowerment...... 14 3.4.2 Youth 14 3.4.3 Policy And Regulatory Reform...... 15 4. Learning ...... 16 4.1 Pilots or Research...... 16 4.2 Publications and Presentations...... 17 5. Sustainability and Exit Strategy...... 18 Annex 1A. Monitoring and Evaluation: Zika Framework...... 20 Annex 1B. Monitoring and Evaluation: ZAP M&E PLAN (MEP)...... 21 Annex 2. Environmental Mitigation and Management Report...... 27 Annex 3. Training Report...... 35 Annex 4. Collaboration...... 36 Collaboration with Other USAID or USG Activities...... 36 Collaboration and/or knowledge sharing with Partner Entities in Host Government and other Donor Agencies ...... 36 ACRONYMS

BG Trap Biogents BG-Sentinel Trap BMP Best Management Practices Bti Bacillus thuringiensis israelensis CECOVEZ Center for Prevention and Control of Vector-borne Diseases and Zoonosis (formerly CENCET) CDC Centers for Disease Control and Prevention DPS/DAS Dirección Provincial/Area de Salud (Provincial/Area Health Directorate) HH Household IRS Indoor Residual Spraying M&E Monitoring and Evaluation MOH Ministry of Health PAHO Pan American Health Organization PMI President’s Malaria Initiative PPE Personal Protective Equipment SBCC Social and Behavior Change Communication SINAVE Sistema Nacional de Vigilancia Epidemiologica (National Epidemiological Surveillance System) UASD Universidad Autonoma de Santo Domingo USAID United States Agency for International Development VC Vector Control WHO World Health Organization ZAP Zika AIRS Project

iv 1. EXECUTIVE SUMMARY

The overall goal of the Zika AIRS Project (ZAP) is to reduce the burden of vector-borne diseases by enhancing the ability of the United States Agency for International Development (USAID) to implement mosquito control programs in Latin America and the Caribbean, including in the Dominican Republic (DR). ZAP DR includes the following technical components: (1) vector control, (2) entomological monitoring, and (3) capacity building. Under vector control, in 2018 ZAP DR tested the effectiveness of larviciding with Bacillus thuringiensis israelensis (Bti) in Espaillat Province to reduce mosquito density, in collaboration with the Provincial Health Directorate (Dirección Provincial de Salud, DPS). This approach included the dissemination of preventive messages and environmental clean-up activities. Results suggest that Bti along with social and behavior change communication and environmental clean-up had a positive effect on the reduction of larvae, pupae, and adult mosquitoes in the intervention sites. ZAP covered 95 percent of households in Espaillat through vector control visits with an 84 percent pupae reduction in positive containers after applications of Bti. The total number of people protected was 108,833, including 1,223 pregnant women, 27,548 women of reproductive age, and 9,090 children under the age of five. This result supports recommending the future use of Bti to the Ministry of Health (MOH).

ZAP DR also conducted a pilot test of lethal ovitraps in Province as a potential complementary vector control intervention. Although the effectiveness of ovitraps with Bti was clear, (none of the deposited mosquito eggs resulted in any offspring), this approach had a limited impact on reduction of adult mosquito density because there were other breeding sites in the intervention areas that were not controlled (Bti was not applied in the at the time of the pilot). The main lesson learned was that lethal ovitraps could be effective in combination with other vector control interventions.

In 2018, ZAP DR continued entomological monitoring support with the deployment of ovitraps in six provinces. This ZAP activity evolved toward transition over the course of the year, whereby DPS teams became capable of overall ovitrap management with limited ZAP support. This activity supports ZAP’s emphasis on sustainability. In addition to ovitraps, the ZAP team carried out entomological monitoring of the vector control activities in Espaillat and Monte Plata that were mentioned above. The project’s entomology team conducted baseline, follow-up, and post-intervention data collection to assess progress of the vector control work. The entomology team also continued insecticide resistance testing in 10 sentinel sites, which is an important contribution to the MOH’s resistance mapping.

Finally, in 2018 ZAP DR continued in-service trainings on vector control and entomology monitoring for DPS staff and community volunteers. The project provided technical and financial support for the implementation of a second cohort of the diploma-level training program geared toward DPS staff led by the Universidad Autonoma de Santo Domingo (UASD). This program was designed with ZAP support in 2017, and through the end of the reporting period, 61 graduates are involved in vector control and entomology activities in 28 of the DR’s 32 provinces.

To further build DPS capacity, ZAP DR designed a comprehensive DPS Strengthening Strategy. ZAP will implement the strategy in 2019 to consolidate successful progress, and document and systematize sustainable vector control and entomological monitoring practices among 16 targeted DPS across the country.

1 2. PROGRESS AND OUTCOMES

2.1 COMMUNITY MOBILIZATION, SOCIAL AND BEHAVIOR CHANGE COMMUNICATION In 2018, the Zika AIRS Project (ZAP) in the Dominican Republic (DR) used several community mobilization and social and behavior change communication (SBCC) strategies to achieve its objectives in vector control, entomological monitoring, and field implementation of insecticide resistance testing. Provincial health directorates (Direcciones Provinciales de Salud, DPSs) played an important role in interactions with target communities1. Community groups involved included neighborhood councils, community leaders, heads of school districts, and churches. ZAP also mobilized other partners such as daycare centers, nursing homes, and cemetery keepers.

Specifically, ZAP DR and collaborating community mobilizers and team leaders initiated field visits one week prior to starting household visits. This community mobilization consisted of visiting targeted homes across different to hand out informative fliers that included information on the type of intervention, starting date, duration, potential benefits, and a point of contact in case of questions or concerns. At the implementation stage, field technicians visited households to solicit their participation in project activities and, if so, their informed consent. Activities emphasized preventive behaviors, environmental clean-up measures, and vector control practices. 2.2 VECTOR CONTROL The main vector control intervention that the ZAP DR team implemented in 2018 was a limited community larviciding campaign with the biolarvicide Bacillus thuringiensis israelensis (Bti), and source reduction, in the province of Espaillat. The municipalities of Moca and San Victor participated as intervention sites encompassing approximately 30,000 households. The municipality of Gaspar Hernandez was a control site. The purpose of this activity was to develop local capacity for Bti use and to demonstrate its effectiveness against Aedes aegypti larvae found in breeding sites. Previously, the DR successfully used a liquid presentation of Bti occasionally to treat malaria-breeding sites, like ponds or lagoons. This was the first public health application of the granular formulation of Bti. In preparation for fieldwork, ZAP DR held meetings with various local stakeholders, mainly personnel from the Espaillat DPS, to introduce and describe ZAP’s approach. The DPS and ZAP DR worked on the selecting seasonal workers and supervisors to hire, train, and deploy. The project trained two assistants, two DPS supervisors, 11 team leaders, 76 technicians, and 13 mobilizers on the community approach for vector control, and one security guard was trained on security measures. To ensure quality implementation, the project established three supervisory levels: team leaders, DPS supervisors, and the project’s vector control team. These supervisors carried out direct and indirect supervision. General training included a brief description of the diseases transmitted by Aedes aegypti in the DR and their relevance to public health, types of vectors and their recognition, vector behaviors, communication skills, and preventive measures. ZAP also trained supervisors in supervision skills and tools, and mobilizers on awareness raising and community participation. Prior to Bti application, ZAP led a field assessment in collaboration with the DPS to identify potential intervention areas. Once intervention areas were identified, ZAP DR vector control technicians visited households to explain to homeowners the purpose of the activity and to elicit support through a signed

1 Espaillat province, in the municipalities of Moca, San Victor, Cayetano Germosen and Gaspar Hernandez; and the municipality of Monte Plata in the province of the same name.

2 informed consent to carry out Bti application and environmental clean-up. Beginning in June 2018 ZAP DR vector control technicians made monthly visits to do source reduction, apply Bti, deliver SBCC messages, and monitor progress. During the first month of work, technicians visited their assigned zones to organize activities and define performance targets. In the first three months of the intervention, technician teams also visited 10 selected municipal cemeteries, 25 churches, 65 schools, six daycare centers, one nursing home, three health centers, and one correctional center to find and treat potential breeding sites. However, households were the focus of the Bti intervention.

The overall scale of this intervention is shown in Table 1. The number of households visited varied monthly due to some being found closed during working hours, uninhabited properties, rejections, or lack of an adult person at the time of visit.

Table 1: Summary of ZAP DR 2018 Vector Control Activities

June July August September October Households #%#%#%#%#% Visited 30,280 100.00% 29,865 100.00% 29,135 100.00% 29,648 100.00% 29,479 100.00% Treated 29,741 98.20% 26,754 89.60% 26,938 92.50% 27,981 94.40% 27,945 94.80% Closed 404 1.30% 2,697 9.00% 1,576 5.40% 741 2.50% 506 1.70% Refused 53 0.20% 222 0.70% 273 0.90% 369 1.20% 393 1.30% Uninhabited 82 0.30% 192 0.60% 348 1.20% 557 1.90% 635 2.20%

Regarding results achieved, ZAP DR vector control visits covered 95 percent of households in Espaillat, with an 84 percent pupae reduction in positive containers after applications of Bti. The total number of people protected was 108,833 (54,284 female and 54,549 male) including 1,223 pregnant women, 27,548 women of reproductive age, and 9,090 children under the age of five.

Overall, ZAP DR’s vector control intervention in Espaillat province ran without significant obstacles. Close management allowed the ZAP team to address issues such as distribution of field workers, and logistics and transportation, and to minimize incidental losses of larvicide (which were managed through reminders and sanctions). The ZAP team hosted several visits by representatives of the United States Agency for International Development (USAID), consultants from the Global Environmental Management Support (GEMS) project, and staff from the Ministry of Health (MOH), who recognized the work in progress and preliminary results achieved.

On November 29, 2018, ZAP held a closing ceremony and final evaluation of the Bti application activity with DPS and Center for Prevention and Control of Vector-borne Diseases and Zoonosis (CECOVEZ) representatives attending. The meeting acknowledged everybody’s roles and successes. ZAP DR conducted a client satisfaction survey among a random sample of 300 households, which showed that 82 percent of respondents reported fewer mosquitoes perceived at the household community level and 94 percent rated the ZAP activity as “very good.” Although a majority of respondents expressed interest in having a repeat larvicide treatment and clean-up interventions, approximately 62.6 percent noted that they also wanted “spraying or fogging” as a vector control intervention. This finding may reflect deeply ingrained beliefs that mosquito control should occur through high-scale MOH interventions rather than actions led by the families themselves. Based on results from a beneficiary satisfaction survey, ZAP DR observed that opportunities remain to influence community members to understand that society can play

3 a significant role in vector control and disease prevention by following self-care measures – encouraging families to do this is just as important as are outside interventions.

2.3 ENTOMOLOGICAL MONITORING

In 2018, ZAP DR conducted entomological monitoring of its Bti application as well as of implementation of ovitraps, both “regular” ovitraps (managed/deployed with technical support from ZAP DR) and “transition” ovitraps. ZAP DR’s use of “regular” ovitraps began in 2017, in an effort to expand CECOVEZ entomological monitoring coverage. “Transition” ovitraps came about to ensure that this method was sustainable at the DPS level, i.e., with no or very limited ZAP support.

During the reporting period, ZAP also continued insecticide resistance studies started in 2017. Below are highlights of these activities.

Entomological Monitoring for Bti Application

To assess the impact of Bti in Espaillat Province, ZAP DR performed entomological monitoring in households in Moca and San Víctor as intervention sites and Gaspar Hernández as a control site. Monitoring encompassed the surveillance of egg density (ovitraps), larvae and pupae surveys, and adult mosquito collection using Biogents BG-Sentinel (BG) traps and Prokopack aspirators.

As depicted in Figures 1 and 2, a comparison between baseline data with Bti application results among intervention sites (Moca and San Víctor) shows a considerable reduction in Aedes aegypti egg density as measured through ovitrap monitoring (with a 53.4 percent and 49.7 percent decrease, per ZAP quarterly periods), and through mosquito infestation as per the Breteau Index, with decreases of 55.0 percent to 71.1 percent respectively, were observed. (Reduction calculations are based in ZAP’s Quarterly Monitoring and Evaluation (M&E) reports; see Annex AI corresponding to the periods of June-August and September-November 2018.) Data also showed a slight decrease in the above indicators in the control site, which may be attributed to frequent household visits by ZAP entomology teams that may have motivated behavioral changes in the population such as household-led source reduction (though such potential changes have not been directly measured or validated by ZAP). These results were broadly shared with the DPS team in meetings and a closeout event.

4 Figure 1: Total number of eggs per municipality/ weeks April - December 2018

6,000 Moca San Víctor Gaspar Hernández (control) y

t 5,000 i l a Bti application p i c i n 4,000 u Figure 2: Breteau Index April - December 2018 m r e p

g 3,000 g e f o r

e 2,000 m u n l a t 1,000 o T

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 April May June July August September October November December

Baseline Project entomological weeks

53.4% decrease from baseline 49.7% decrease from baseline

5 80 Moca San Víctor Gaspar Hernández 70 Bti applitacion 60 x 50 e d n I u a 40 e t e r B 30

20

10

0 Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period Period 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 April May June July August September October November December

Survey periods Baseline

55.0 % decrease from baseline 71.1 % decrease from baseline

6 Larvae and pupae surveys showed that predominant potential breeding sites were 55-gallon water tanks: these tanks provided 58.6 percent of all breeding sites in Moca, 44.1 percent in San Víctor, and 50.4 percent in Gaspar Hernández (Table 2). In this area, running water is available only intermittently, and so families typically must store water for daily needs, which facilitates the proliferation of breeding sites. It is worth noticing that positive containers generally turned negative when treated. New containers, i.e. those families had to set up when running water was scarce, were positive until treated. Entomological indicators reflect these changes over time.

Table 2: Predominant Containers in the Larval and Pupal Surveys for Moca and San Victor (Bti application), and Gaspar Hernandez (control), April–December 2018

Moca San Víctor Gaspar Hernández (Control) Total Number of Positive Positive Positive Total Number Container Number of Number of Number of Containers Containers Containers Containers of Containers Type Containers Containers Containers with Larval (with larvae) (with larvae) (with larvae) presence

#%#%#%#%#%#%#%#% Tanks 4,306 58.6% 518 82.5% 13,227 44.1% 1,873 83.7% 4,923 50.4% 955 78.1% 22,456 47.7% 3,346 81.8% Pails 1,147 15.6% 26 4.1% 3,103 10.3% 151 6.7% 1,042 10.7% 80 6.5% 5,292 11.2% 257 6.3% Gallons 767 10.4% 7 1.1% 8,729 29.1% 87 3.9% 77 0.8% 12 1.0% 9,573 20.3% 106 2.6% jugs Others 1,127 15.3% 77 12.3% 4,949 16.5% 127 5.7% 3,724 38.1% 176 14.4% 9,800 20.8% 380 9.3% Total 7,347 100% 628 100% 30,008 100% 2,238 100% 9,766 100% 1,223 100% 47,121 100% 4,089 100%

Entomological data also showed that four mosquito species were collected in pupae stage: Aedes aegypti, Aedes albopictus, Toxorhynchites portoricensis, and Culex quinquefasciatus. Aedes aegypti was predominant in all collections, as shown in Figure 3.

Figure 3: Overall Species Composition of Pupae Collections, April–December 2018

Moca 1.4 San Víctor Gaspar Hernández (control) 0.4 0.1 0.2 1.0 1.2

16.7 54.4 24.6

Ae. albopictus Ae. aegypti Other

The use of BG traps and Prokopacks inside dwellings captured the largest number of adult mosquitoes. Evidence on Aedes aegypti shows that they tend to bite and rest indoors, seeking dark moist places within the home. During the final collection periods, especially in the months of November and December 2018, ZAP DR noted a reduction in the number of gravid female mosquitoes in BG traps, with non-fed

7 mosquitoes prevailing. This reduction in gravid Aedes suggests a lower life expectancy of Aedes as well as a potential reduction in the probability of virus transmission, because transmission can only occur in mosquitoes that have already bitten.

The results highlighted above suggest that a successful application of Bti combined with physical elimination of breeding sites in Espaillat Province resulted in a decrease of all forms of mosquitoes, and therefore support a recommendation to use this approach for effective Aedes control to reduce Aedes- borne diseases in the DR.

Ovitrap Monitoring

During the final quarter of 2017, ZAP DR implemented ovitraps in six sentinel sites (provinces) to expand CECOVEZ coverage, develop local capacity, and demonstrate the effectiveness of ovitraps with attractant. This activity continued between March and May 2018 to complete an 18-week monitoring period. Results demonstrated that ovitraps with hay infusion attracted greater numbers of Aedes aegypti than plain water ovitraps (Figure 4). In addition, all trained technicians acquired strong skills to set up, monitor, and report data. ZAP DR managed 600 ovitraps, helping to expand CECOVEZ coverage to approximately 1,000 ovitraps nationwide. Figure 4: Effectiveness of Infusion vs Water Ovitraps, 2017-2018

Santo Domingo 21% 79%

Santiago 32% 68%

San Cristóbal 31% 69%

La Espaillat 29% 71%

La Altagracia 30% 70%

Azua 29% 71%

0% 20% 40% 60% 80% 100%

% Eggs in water Ovitraps % Eggs in infusion Ovitraps For implementation of “transition” ovitraps, ZAP trained 16 DPS facilitators who in turn trained a cadre of volunteers in each of the targeted provinces (Azua, La Altagracia, Santiago Areas I and III, San Cristobal, and Santo Domingo Area VIII). Limited assessments by ZAP DR technical staff indicate that trained personnel and volunteers continue to deploy and monitor ovitraps. ZAP DR provided a simple data analysis tool for DPS to use. With ZAP support in 2019, CECOVEZ will scale up ovitrap deployment and collect data using a mobile application. CECOVEZ will incorporate the data into a national entomological surveillance database that ZAP is also helping to set up.

As part of the transition process from ZAP’s support to sustainable ovitrap monitoring, the project provided limited assistance to the provinces of Azua, San Cristóbal, , La Altagracia and Santiago III). In each of the five provinces, ZAP supported the installation of 25 ovitraps (total 125), with collections occurring every three to five weeks. The most important challenge for the DPS in this process has been local logistics (i.e., limited transportation) since DPS teams usually have other tasks. In collaboration with the CAZ project, ZAP identified community technicians who could work as facilitators and volunteers to provide continuity to the ovitraps activities. To help scale up ovitrap implementation,

8 CECOVEZ drafted a technical reference guide and a plan to train all provincial teams on the guide in 2019; the ZAP team reviewed the guide and plan.

Larvicide and Insecticide Resistance Testing

Finally, as an extension to the mapping of larvicide and adulticide resistance, ZAP DR performed tests in the 10 sentinel sites in 2018. Table 3 shows the preliminary results from Centers for Disease Control and Prevention (CDC) bottle and World Health Organization (WHO) paper bioassays.

9 Table 3: Preliminary Results from CDC Bottle and WHO Paper Bioassays, 2018

2018 Tests

Pyrethroids Organophosphates Carbamates No. Sentinel Site Pirimiphos- Deltamethrin Permethrin Lambdacyalothrin Etofenprox Malathion Bendiocarb methyl CDC WHO CDC WHO CDC WHO CDC WHO CDC WHO CDC WHO CDC WHO 1 Barahona S R R R R S R S R R 2 Azua S R R R R S R R S CR 3 San Cristobal S R CR CR R R CR R CR 4 Higuey S R R R R R CR S CR 5 Cotui S R R CR R S R S R S CR 6 Manoguayabo S R CR R R R R 7 Villa Duarte S R CR R S R CR R S R 8 Moca S R R CR R R R S R R 9 Santiago S R R R S R R S CR 10 Dajabon S R R CR R S R S S CR

Susceptibility criteria: Mortality < 90% (WHO method) R Resistance Mortality <80% (CDC method) Mortality between 90-97% (WHO method) CR Confirm resistance Mortality between 80-98% (CDC method) S Susceptible Mortality > 98 %

Susceptibility tests were performed in 10 sites: Barahona, Azua, San Cristóbal, Higüey, Cotui, Manoguayabo, Villa Duarte, Moca, Santiago, and Dajabón. Deltamethrin resistance tested using the WHO method was registered in six sites, and susceptibility using the CDC test was registered in all 10 sites. There was resistance in all 10 sites to the other pyrethroids (permethrin and etofenprox). Suggested resistance to Lambdacyalothrin using the CDC method needs to be confirmed. Using the WHO method, malathion registered resistance in nine sites and pirimiphos-methyl registered resistance in eight sites. With the CDC method, there was malathion susceptibility in six sites. Suggested resistance to Pirimiphos-methyl using the CDC method needs to be confirmed in San Cristobal, Higuey, and Villa Duarte; the other three sites registered susceptibility. Bendiocarb, representing the carbamate group, registered resistance in four sites using the WHO method. Suggested resistance in six sites using the WHO method needs to be confirmed, and there is susceptibility in five sites with the CDC method. 2.4 ENVIRONMENTAL COMPLIANCE AND SECURITY When USAID approved the 2018-2019 ZAP DR work plan, the country had not yet registered Bti. ZAP had to request special Ministry of Agriculture permission to import the product through a local distributor. Once the government granted this approval, ZAP DR imported 600kg of Bti.

ZAP DR completed an environmental compliance and security assessment for the installation of three operations centers in Espaillat Province in alignment with the President’s Malaria Initiative’s (PMI’s) Best Management Practices (BMP) Manual used for indoor residual spraying (IRS) activities. The BMP guidelines for the proper handling and storage of insecticide are applicable to the handling and storage of

10 larvicide. Bti was stored in a cool environment (15-30 Celsius, or 59-86 Fahrenheit). The use of ovitraps for entomological monitoring and recurring collection of oviposition paper (pellon) required procedures for incineration in order to properly dispose of this biological material. Empty Bti containers were collected and sent to a certified recycling firm.

In terms of overall security during Bti implementation in 2018, ZAP reported seven incidents, related to loss of product, muggings, and worker accidents. 2.5 MONITORING AND EVALUATION ZAP DR collected data for routine monitoring and evaluation (M&E) of vector control and entomological activities using digital tools. ZAP developed these tools using ONA and Open Data Kit (ODK) platforms, which allowed for real-time monitoring with secure cloud storage technologies. In addition to data collection, the project’s M&E approach includes data management, the application of validation rules through the configuration of mobile devices used for data entry, and data visualization using Tableau. ZAP DR shared available vector control and entomological data with the MOH and other stakeholders in a timely and clear manner to contribute to decision making and corrective actions. Tool development was a joint effort of the project’s entomological monitoring and vector control teams, which held working sessions and tested the tools to make sure they met data quality and reporting needs. ZAP DR trained data collectors (including ZAP technicians, team leaders, and DPS supervisors) on the data collection process and filling out digital forms on the mobile application. It implemented quality control activities for timely data collection using supervision tools and standard audits. The use of self- audited data enabled the project to reduce the number of errors encountered in the M&E database. Annexes 1A and 1B display detailed results. 2.6 CHALLENGES In 2018, ZAP DR faced fewer challenges than in 2017. From a technical standpoint, planning and implementation of vector control activities required early contacts with Espaillat DPS counterparts to elicit support and engagement. The ZAP team had to be persistent but also flexible and patient, as DPS teams manage many competing demands. Field activities required accurate maps, for example, which were difficult to obtain. Nonetheless, the team demonstrated resourcefulness to develop creative solutions, such as using Google maps or direct observation to develop precise geographic data. As vector control activities scale up, the MOH will need quality cartography to plan and implement field activities. In Espaillat Province, visits to the control community of Gaspar Hernandez, located on the Atlantic coast, required additional time and effort by team members. In light of the need for long stays in the field by the technical team and support staff, ZAP arranged for short-term leases of private dwellings instead of hotels; this generated significant savings in lodging costs.

In general, DPS continued to experience limited operational capacity for vector control and entomological monitoring. DPS technicians must manage diverse and complex programmatic requirements. In addition, limited means of transportation or periodic lack of equipment (such as larviciding kits, entomological survey supplies, and microscopes) hinders implementation of field activities. To ensure that DPS supervision visits were completed, ZAP covered the cost of fuel.

In 2018, the MOH deepened the decentralization or “deconcentration” process that the country began in late 2016. As part of deconcentration, the MOH required DPS to take on “collective health” competencies and tasks from central ministry units. Collective health refers to public health services, such as vector control, that focus on the population level, as opposed to clinical services that focus on individuals. The problem, however, is that the deconcentrated entities have limited resources and

11 technical capacity to adequately carry out their new roles and responsibilities. ZAP, for example, had to provide furniture, equipment, and supplies to implement ovitraps and expand MOH ovitrap coverage. Strengthening vector control and entomology monitoring at the local level continues to be an important focus of the ZAP DR team.

12 3. IMPROVING ZIKA RESPONSE

3.1 TRAINING AND INSTITUTIONAL CAPACITY BUILDING In 2018, ZAP DR continued to focus on building the capacity of local counterparts. A key activity was the establishment in 2017 of a diploma program in vector control and entomology applied to public health. The program was designed by the MOH, ZAP DR, and Universidad Autonoma de Santo Domingo (UASD). UASD manages it, and the university’s entomology laboratory supports academic activities. The aim is to give provincial MOH technical staff practical knowledge and basic skills to organize and manage vector control operations. The program aligns with the Pan American Health Organization’s (PAHO’s) regional initiative to strengthen integrated vector control in a sustainable fashion and trained MOH staff will be able to sustain the national program in the near future Key lessons learned are highlighted in Text box 1.

To date, the diploma program has trained 61 participants from 28 of 32 provinces. In March 2018, 31 participants completed all academic requirements and graduated from the diploma program. In September 2018, a second cohort began studies; they graduated in December 2018.

UASD has voiced its intention to maintain the diploma Textbox1: Lessons learned from the DR’s diploma program in vector control and program as an ongoing academic offering, with the possibility entomological monitoring of evolving into a master’s program. UASD has also  Participants improved knowledge and skills expressed interest in consolidating its entomology laboratory on vector control and field entomology. through a research grant from the Ministry of Higher  Participants exhibited positive attitudes Education, Science and Technology (MESCYT) and other and technical capacity in vector control. sources. UASD and CECOVEZ have discussed signing an  Training contributed to enhance local MOU for ongoing collaboration with insecticide resistance technical capacity. studies and other areas of entomological practice. Textbox 1  Training and a university degree offered opportunities for professional growth. shows a few key lessons learned from the DR’s diploma program.

ZAP DR also provides in-service training, coaching, and “learning by doing” for local health teams; this capacity strengthening is sustainability-oriented. For example, as discussed under Ovitrap Monitoring in Section 2.3, once the ovitrap activity ended in March 2018, and following USAID recommendations, in July ZAP trained 16 ovitrap facilitators to train volunteers as local resource persons to support the transition ovitrap model. Overall in 2018, ZAP DR trained 119 people (63 men and 56 women).

Finally, in late 2018 ZAP DR developed a costing tool for the DPS to use to estimate the costs of vector control and entomological monitoring activities. Further details are described in Section 3.3, Innovations.

A detailed summary of ZAP DR supported training for 2018 is provided in Annex 3. 3.2 GOVERNMENT ENGAGEMENT During the reporting period, ZAP DR continued to work with key government counterparts, including CECOVEZ, formerly known as CENCET. Despite changes in senior leadership at the MOH in 2018, ZAP maintained a strong working relationship with the Office for DPS Support and several DPS at the local level. As appropriate, ZAP worked with municipal governments to enable field activities, such as Espaillat’s Bti application and environmental clean-up. For example, the municipality of Moca facilitated trash collection and contributed to environmental clean-up activities. A few municipal employees also

13 served as team leaders and field technicians on ZAP vector control teams. All participating local governments assisted in clean-up and Bti application activities in cemeteries, a common location of mosquito breeding sites.

3.3 INNOVATIONS In 2018 ZAP DR adopted innovative practices in project implementation, as highlighted below:  Collected M&E data using mobile phone technology. These applications allowed for faster and more accurate data collection and processing, and real-time data analysis. For example, the time it took to do analysis was reduced from five working days to one. In addition, the project’s M&E team developed dynamic visualizations of project data (i.e., dashboards), which helped to interpret and disseminate results and facilitate decision making in vector control, such as the identification and location of high-larvae density “hot spots” that may need targeted intervention.  During the final quarter of 2018, ZAP DR started discussing with CECOVEZ the development of an entomological monitoring tool, a new feature in the MOH’s National Epidemiological Surveillance System (Sistema Nacional de Vigilancia Epidemiologica, SINAVE). The purpose is to assist the MOH develop an entomological surveillance module that will collect entomological risk data (ovitrap egg density, larvae and pupae concentration, adult mosquito infestation, and insecticide resistance patterns). The data will contribute to national and local decision making on vector control priorities and effective disease prevention. ZAP’s guidance and technical support has been a welcome contribution to address some challenges in the development of this important tool.  In October 2018, ZAP DR developed a digital tool to carry out costing of vector control and entomological monitoring at the provincial level. Sixteen DPS teams participated in a workshop and eight have completed a practical exercise. The project developed the costing tool to assist DPS teams with budgeting, resource management, and operational planning. 3.4 INTEGRATION OF CROSS-CUTTING ISSUES

3.4.1 GENDER EQUALITY AND FEMALE EMPOWERMENT ZAP DR’s gender component was integrated into all entomologic surveillance and vector control activities performed by the project in Espaillat and Monte Plata. Each entomologic and vector control training included discussion of important gender topics, such as gender awareness, interpersonal communications, gender-equity messaging, and feedback tools. In addition, the personnel selection and placement criteria required the equal treatment of men and women; leadership positions were offered to women, who led nearly half of the workgroups (8 of 17).

Properly equipped and signed bathrooms for men and women were created at the operations center. Interpersonal relationships were monitored to ensure respect across the team, and reinforced with messaging and reminders about equality and respect in the workplace, and discouraging harassment. A suggestion box was installed at each operations center, so the teams could express their complaints.

ZAP DR designated a gender focal point who provided guidance and oversaw the development of a specific gender action plan. She participated in a ZAP regional gender workshop.

3.4.2 YOUTH In 2018, the ZAP DR team continued to hire, train, and deploy seasonal workers to implement field activities such as Bti application in Espaillat or lethal ovitrap testing in Monte Plata. Most seasonal

14 workers were under 35 years of age (66 percent of entomology staff and 72 percent of vector control staff). By hiring young people, ZAP DR helped alleviate difficult economic conditions at the local level. Over 30 percent of seasonal workers had professional degrees, suggesting a challenging labor market for young people in the DR.

3.4.3 POLICY AND REGULATORY REFORM As described in previous reports, the DR has been implementing a health reform process since the early 2000s. To this end, the country introduced significant changes in health care financing through pooled insurance mechanisms and a separation of functions, whereby health care delivery has been taken away from direct MOH control. Public hospitals, clinics, and other service providers are currently under the National Health Service, a semi-autonomous entity in charge of service delivery. The MOH keeps its stewardship role (rectoria), including health policy making, quality assurance, licensing, and general oversight of the health system. In addition, the MOH must deliver public health services, such as vector control, disease surveillance and prevention, and health education. Delivery of these services, also known as “collective health” services, is a key responsibility of DPSs. Since 2016, the structure and functions of the DPS has been further clarified. This is the rationale for ZAP DR to support DPSs in the implementation of effective vector control and entomological surveillance activities, including work in 2018 such as the costing support and planning DPS strengthening strategies for 2019.

15 4. LEARNING

4.1 PILOTS OR RESEARCH In 2018, ZAP DR performed one pilot study on the use of lethal ovitraps as a vector control method in . The pilot included four sentinel sites (three intervention and one control) and covered 1,200 households (900 intervention and 300 control). Based on local cartography, ZAP divided all households into blocks of 300. It initiated baseline entomologic surveillance in August 2018, with collection of larvae and pupae and capture of adult mosquitoes with Prokopacks. Vector control activities started in September 2018 with deployment of lethal ovitraps along with environmental clean-up and source reduction in all pilot intervention sites.

Entomologic results revealed the effectiveness of hay + Bti infusion to lure gravid and semi-gravid Aedes aegypti during the pilot study. Although eggs could hatch inside these ovitraps, the larvae died and thus did not progress to pupae or adult forms. Entomological data showed an overall reduction in breeding sites; it is likely that environmental clean-up and follow-up household visits also triggered changes in behavior toward vector control in addition to lethal ovitraps. Table 4 shows results achieved in Monte Plata.

During the study’s progress, a reduction of the Aedic indexes on the sentinel intervention sites and control site was noted, except in Block 2 where BI actually increased. Although entomological results suggest lethal ovitraps can have an impact on aquatic forms, their overall effect on adult mosquito density could not be determined from the pilot study since other potential breeding sites were not treated, for example. We may conclude that lethal ovitraps may be a complementary method of vector control, together with interventions such as breeding site elimination, environmental clean-up, and social behavior change.

Table 4: House Index, Container Index, and Breteau Index in Entomological Monitoring Sentinel Sites, August–December 2018

Site Index Period 1 to Period 18 HI 68.00% - 30.00% Block 1 CI 98.31% - 5.70% BI 116 - 48 HI 46.00% - 38.00% Block 2 CI 67.31% - 24.18% BI 70 - 74 HI 26.00% - 6.00% Block 3 CI 100.00% - 4.52% BI 66 - 14 Block 4 HI 66.00% - 20.00% (Control) CI 93.33% - 6.09%

16 BI 112 - 24 Note HI=House Index, CI=Container Index, and BI=Breteau Index 4.2 PUBLICATIONS AND PRESENTATIONS In addition to ZAP DR’s 2018 focus on implementation of field activities, including deployment of ovitraps, vector control campaign, testing of lethal ovitraps, and completing susceptibility studies, the project team contributed to several formal presentations, as follows:  Multiple internal presentations and contributions to regional trainings/workshops, including hosting in the DR the regional entomology workshop and an M&E meeting. A ZAP DR team member actively participated in the regional vector control workshop in Honduras.  A poster presentation on insecticide resistance, including DR results, made by Nelson Grisales at the 67th Annual Meeting of the American Society for Tropical Medicine and Health (ASTMH) in New Orleans, Louisiana. Three members of the ZAP DR entomology team contributed to the presentation.  In late 2018, ZAP DR submitted three abstracts to the American Mosquito Control Association (AMCA), for presentation at its 85th Annual Meeting in February 2019. All abstracts were accepted. One abstract discusses results of an IRS intervention carried out in San Cristobal Province in 2017; a second abstract describes capacity building in ovitrap deployment; and a third abstract addresses ZAP DR’s mobile methods for data collection. ZAP plans to present all abstracts at the annual meeting.

17 5. SUSTAINABILITY AND EXIT STRATEGY

During the reporting period, ZAP DR continued implementing the field activities described in above this report. In addition, the project sponsored a second cohort of the vector control and entomology diploma program at UASD, a costing workshop, and targeted in-service trainings, also as described above. Given USAID’s guidance to consider sustainability as a cross-cutting theme, the project team included in the 2018-2019 work plan an activity aimed at improving the performance of several DPS. The concept evolved into “DPS Strengthening” based on feedback from the MOH and other partners, and given the role of DPS teams in the delivery of priority public health interventions, such as vector control and entomology monitoring. This strategy, designed in 2018, will begin implementation in 2019.

Throughout 2018, the ZAP DR team held internal discussions on the scope and content of the DPS Strengthening Strategy. The team prepared and shared a concept note with the ZAP home office team and USAID/DR, and discussed it with the MOH Office of DPS Support, CECOVEZ, and PAHO/DR. The Strategy has been informed by WHO’s Global Integrated Vector Control Strengthening Initiative2 and PAHO’s Regional Action Plan on Entomology and Vector Control 2018-20233 put forth to guide countries in Latin America and the Caribbean toward the above goal. In addition, the strategy is consistent with the MOH’s current efforts to improve DPS performance through implementation of a quality improvement approach for government agencies, based on the Common Assessment Framework.4

ZAP DR plans to guide project efforts in 2019 in alignment with these strategies, and to maintain and build upon the results achieved during 2017 and 2018. Implementation of its DPS Strengthening Strategy will allow it to systematize and consolidate prior work under a coherent vision toward sustainability, taking into consideration WHO/PAHO’s global strategy. ZAP’s approach has focused on PAHO’s pillars of training human resources, strengthening entomological laboratory capacity, improving vector control and entomological practices, providing equipment and supplies, and enhancing monitoring and evaluation systems and tools. Table 5 displays how project achievements will inform and contribute to the strategy.

Table 5: ZAP Contributions to DPS/DAS Strengthening

ZAP Contributions to Key Activities Expected Results Needed DPS/DAS Inputs Engaged leadership: selected - Intersectoral provincial directors motivated For vector control: participation to support vector control/ - IRS - Reduction in entomology activities; also - Larvicide application entomological risk (i.e., central MOH support. - Lethal ovitraps vector population Trained human capital: - Environmental clean-up density) graduates of diploma program; - SBCC messaging in-service training participants

2 World Health Organization. 2017. Global vector control response 2017–2030. Geneva. Licence: CC BY-NC-SA 3.0 IGO. Pan American Health Organization. 2018. Action Plan on Entomology and Vector Control 2018-2023. Resolution CD 56-R2 of the 56th Directing Council, Washington, DC, USA. 3 PAHO. Op cit. 4 Ministerio de Administración Pública. 2014. Marco Común de Evaluación (CAF). Capacitación de Equipos de Autoevaluación para el Mejoramiento de la Calidad en la Administración Pública. Santo Domingo, RD.

18 ZAP Contributions to Key Activities Expected Results Needed DPS/DAS Inputs Knowledge and skills developed: For entomology monitoring: - Stabilization or protocols and field practices reduction in incidence implemented through IRS, - Ovitraps of arboviral disease larvicide application, lethal - Entomology surveys ovitraps, regular ovitraps - Adult form monitoring - Beneficiary satisfaction - Susceptibility studies with collective health Information systems: Cross-cutting: services development of entomology monitoring module for SINAVE; - Intersectoral availability of mobile data participation collection applications, real-time - Gender considerations analysis, and data visualization tools.

19 ANNEX 1A. MONITORING AND EVALUATION: ZIKA FRAMEWORK

FY 2017 FY 2018 Cumulative Indicator INDICATOR Year results to Number Q1 Q2 Q3 Q4 End date Percent (%) of communities where 75% 100% 1a physical vector control activities are *100% N/A N/A - (3 of 4) (4 of 4) being implemented¹ Percent (%) of communities in which 42.9% 57.1% 92.9% 88.9% 1b vector monitoring activities are being *96% - (6 de 14) (8 de 14) (13 of 14) (8 of 9) implemented² Number of people trained in vector 1c 474 94 156 34 62 - control Percent (%) change in mosquito egg 49.7% 53.4% density, from baseline, in targeted (38.14- 1d N/A N/A N/A (38.14- - geographic areas (Baseline- 19.19)/38.1 17.76)/38.14 Current/Baseline) % 4 55.0% 71.1% % change in mosquito frequency, from 1e N/A N/A N/A (54.5- (54.5- - baseline, in targeted geographic areas 24.5)/54.5 38.75)/54.5

# communities with members actively 5a participating in Zika monitoring, 58 6 8 14 8 - prevention, and/or support activities

Additional information:  2017 Vector control activities consisted on performing Indoor Residual Spraying (IRS) in the San Cristóbal province.²  By 2018, Vector control activities were based on larvicide application in the Moca, San Víctor and Cayetano Germosén municipalities, and lethal Ovitraps in the Monte Plata municipality.²  Entomological monitoring was conducted in all municipalities where vector control activities were implemented. Additionally, susceptibility tests and entomological surveillance through ovitraps were performed as a support to MOH.  1D and 1 indicators correspond to the entomological monitoring activities in Moca and San Víctor municipalities.  The denominator for Indicator 1b decreases to 9 because part of the activities were completed for the reporting period, therefore they were not included in the targets established for Q4. Definition of community in the country: Community is defined at the cluster level (subdivisions of barrios within San Cristobal) in the Dominican Republic for 2017, and at the municipality level for FY 2018.¹

Approximate number of people in each community (i.e. municipality/ region): Moca - 158,820, Cayetano Germosén 6,911, Gaspar Hernández 37,378, San Víctor - 21,009, and Monte Plata 26,192

Type of Index for Indicator 1 e (e.g. house index, container index, Breteau index, or Stegomyia index), oviposition index, or via pupal demographic surveys: Determined using Breteau index

20 ANNEX 1B. MONITORING AND EVALUATION: ZAP M&E PLAN (MEP)

MEP Indicators

Year 1: Year 2: Results Results Data Source(s) Performance YEAR 1 : YEAR 2 : and Reporting Disaggregate Indicator Targets October Targets January 1 Frequency 26 - 2018- December December 31 21, 2017 2018 Component 1: Implement safe and high-quality VC programs and provide operational management support 1.1.1 Percentage Data source: Total (All N/A N/A 85% 84% reduction of breeding Vector Control Department/ sites testing positive for technician data region/ pupae in permanent collection form municipality water sources combined) Reporting Moca N/A N/A N/A 79% frequency: Monthly San Víctor N/A N/A N/A 92%

Cayetano N/A N/A N/A 91% Germosén

1.1.2 Number of people Data source: Total (All N/A N/A 92,934 108,833 residing in households Vector Control Department/ visited by vector technician data region/ control technicians collection form municipality combined) Reporting By Gender N/A N/A N/A 54,549 frequency: Annually Male

By Gender N/A N/A N/A 54,284 Female

By Pregnant N/A N/A N/A 1,223 Women

21 By Women of N/A N/A N/A 27,548 Reproductive Age

By Children <5 N/A N/A N/A 9,090

By Men (18 N/A N/A N/A N/A years and older) 1.1.3 Number and Data source: Total (All N/A N/A 30,978; 85% 29,479; 95% percentage of Vector Control Department/ households receiving technician data region/ one vector control visit collection form municipality per intervention cycle5 combined) Collection Moca6 N/A N/A frequency: Monthly Quarterly

22,345; 76% San Víctor N/A N/A

5,193; 18% Cayetano N/A N/A Germosén

1,941; 6% 1.2.1 Number of Data source: By Spray 15,000 11,790 N/A N/A structures targeted for Previous spray Campaign spraying3 campaign data, enumeration data (targets); Daily Spray Operator Forms (results)

Reporting frequency: Daily per spray campaign 1.2.2 Number of Data source: Daily By Spray 15,000 11,739 N/A N/A structures sprayed with Spray Operator Campaign IRS3 Forms

Reporting frequency: Daily per spray campaign

5The “intervention cycle” is defined as the frequency with which one household is visited. Typically for vector control activities this is once per month 6 The numbers and percentages of households receiving one vector control visit per municipality, are based in the total of households visited in the last month of larviciding activities.

22 1.2.3 Percentage of Data source: Daily By Spray 85% 99.6% N/A N/A total structures Spray Operator Campaign targeted for spraying Forms that were sprayed with a residual insecticide Reporting (Spray Coverage) 3 frequency: Daily per spray campaign 1.2.4 Number of Data source: Daily By Spray N/A 38,591 N/A N/A people residing in Spray Operator Campaign structures sprayed Forms (Number of people protected by IRS) 3 Reporting frequency: Daily per By Gender N/A 18,866 Males N/A N/A spray campaign 19,725 Females

By Pregnant N/A 614 N/A N/A Women

By Women of N/A N/A N/A N/A Reproductive Age By children <5 N/A 5,426 N/A N/A years old 1.2.5 Number and Data source: By Spray 4 sites; 100% 4 sites; 100% N/A N/A percentage of soak pits Project records – Campaign and storehouses Reports submitted inspected and approved by district prior to spraying3 environmental By Soak Pit 3 Soak Pits; 3 Soak Pits; N/A N/A officers 100% 100%

Reporting frequency: By Storehouse 1 1 N/A N/A Each spray season Warehouse ; Warehouse; 100% 100%

Component 2: Contribute to the collection and analysis of Routine entomological data 2.1 Number of Data source: N/A 54 52 9 9 entomological sentinel Entomological sites supported by ZAP reports and ZAP Bti Espaillat Dominican Republic country work plan 1. Moca monitoring species 2. San Víctor composition Reporting frequency: 3. Gaspar Annually Hernández

Ovitraps CECOVEZ 4. Santiago

23 5. Santo Domingo 6. Azua 7. San Cristóbal 8. La Altagracia

Lethal Ovitraps 9. Monte Plata

2.2 Number of Data source: N/A N/A N/A 9 8 entomological sentinel Entomological sites supported by ZAP reports Bti Espaillat Dominican Republic 1. Moca monitoring egg density, Reporting frequency: 2. San Víctor larval density, and pupal Annually 3. Gaspar density Hernández

Ovitrap CECOVEZ 4. Santiago 5. Santo Domingo 6. Azua 7. San Cristóbal 8. La Altagracia 2.3 Number of Data source: N/A 54 52 4 4 entomological sentinel Entomological sites supported by ZAP reports Bti Espaillat Dominican Republic 1. Moca established to monitor Reporting frequency: 2. San Víctor adult density Annually 3. Gaspar Hernández

Lethal Ovitraps 4. Monte Plata

2.4 Number and Data source: N/A N/A N/A TBD; TBD% 1: 7% percentage of Entomological - Moca entomological reports monitoring sentinel sites measuring all seven Reporting frequency: entomological Annually indicators 2.5 Number and Data source: By Type of 10; 100% 4; 40% 5: 100% 10: 71% percentage of sentinel Entomological Insecticide - Deltamethrin sites that tested at reports Deltamethri - Permethrin least one insecticide n - Lambdacyhalot from each of the Reporting - Permethrin frequency: - hri three classes of - Etofenprox insecticides Annually Lambdacyhal othri - Malathion

24 recommended for - Etofenprox - Pirimiphos- vector control - Malathion Methyl - Pirimiphos- - Bendiocarb Methyl - Bendiocarb

2.6 Number and Data source: By Type of 10; 100% 4; 40% 5: 100% 4: 29% percentage of sentinel Entomological Larvicide - Temefos sites that tested at least reports - Temephos - BTI one larvicide from each - Bacillus - Metopreno of the three7 classes of Reporting thuringiensis - Diflubenzuron larvicides frequency: recommended for Annually vector control 2.7 Number and Data source: By Spray 9; 100%9 9; 100% N/A N/A percent of homes Entomological Campaign receiving wall bioassays reports conducted after the completion of spraying Reporting By Type of N/A N/A N/A N/A at monthly intervals to frequency: Monthly evaluate insecticide Insecticide decay8 Component 3: Capacity Building and Human Resources

3.1 Number of people Data source: Project By Campaign 72 135 N/A N/A trained to deliver IRS3 records – Training in target departments reports By Gender N/A 121 N/A N/A Male Reporting frequency: Annually By Gender N/A 14 N/A N/A Female

Percentage of N/A 10.3% N/A N/A Women Trained 3.2 Total number of Data source: Project Total (All N/A N/A 118 119 people trained to records – Training Department/ conduct vector control reports region/ in target departments municipality Reporting frequency: combined) Annually By Gender N/A N/A N/A 47 Male

By Gender N/A N/A N/A 72 Female

By Type of N/A N/A N/A BTI: 93; lethal Vector ovitraps: 26

7 These three classes include: organophosphates, insect growth regulators, and biopesticides 3 Only for countries implementing IRS 9 The wall bioassays were conducted with deltamethrin only.

25 Control Activity 4 3.3 Total number of Data source: Project By Year 116 99 80 132 people trained to records – Training conduct Entomological reports By Gender N/A 11 N/A 49 Surveillance in target Male departments (sentinel Reporting frequency: sites) Semi-annually By Gender N/A 88 N/A 83 Female By Position10 N/A Entomologic N/A Entomological al Team Team Leaders: Leaders: 10 5 Entomologic Entomological al Technicians: Technicians: 124 89 Supervisors:3 By N/A N/A N/A N/A Department/ region/ municipality 3.4 Number and Data source: Project Total (All N/A 7; 10% 8; TBD% 10; 42% percentage of women records – Department/ hired in supervisory Contracts signed region/ roles in non-IRS target municipality departments Reporting frequency: combined) Annually Moca N/A N/A N/A 3; 30% San Víctor N/A N/A N/A 2; 20%

Gaspar N/A N/A N/A 1; 10% Hernández Cayetano N/A N/A N/A 1; 10% Germosén

Monte Plata N/A N/A N/A 3; 30%

3.5 Number and Data source: Project Total (All N/A 9; 37.5% N/A N/A percentage of women records – Department/ hired in supervisory Contracts signed region/ roles in IRS target municipality 11 departments Reporting frequency: combined) Annually N/A N/A N/A N/A By Department/ region/ municipality

10 This includes entomological team leaders and entomological technicians 11 For countries implementing IRS

26 ANNEX 2. ENVIRONMENTAL MITIGATION AND MANAGEMENT REPORT

Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

Research and Development  ZAP DR implemented a laboratory manual with  All the laboratory personnel were trained.  Periodic follow-up was done to the lab standard operating procedures (SOPs). The SOPs personnel.  Implement laboratory environmental, health, and safety  Final waste disposal is performed by UASD. include information on the safe handling and use of (EHS) manuals with standard operating procedures  There’s no dangerous wastes disposal laboratory equipment and safe handling of  Well filter was done by a contractor under (SOPs), or use existing SOPs, for laboratory operations in certificate. accordance with country-specific compliance mechanisms. pesticides in accordance with CDC and WHO ECO supervision. guidelines. ZAP DR also provided trainings on the  Construction and approval were by  Implement SOPs for the safe storage, transport, and use SOPs to laboratory personnel. ECO of equipment, chemical reagents, pesticides, and supplies in conformance with international best practices (e.g.,  Decree 126-09 (Regulations on Waste Generated by WHO, FAO) and host country requirements. Health and Related Centers) for handling lab generated waste was implemented.  Provide training to workers on the approved SOPs or Waste Management Plan (WMP) developed for properly  A carbon well filter to absorb pesticides was handling and disposing of wastes (i.e. waste generated installed, to manage water providing from material from insecticide resistance testing). cleaning on the lab.  Contractors who carried out minor repair activities  Periodic inspections will be performed.  Inspections were done by ECO. Small-Scale Construction in the UASD entomology lab have a license. 1. Ensure construction activities are in conformance with Licensed contractors removed and disposed waste, international best practices and host country laws and and documented it on a report that was provided to regulations. Refer to the “Small-Scale Construction” chapter HO. Repair activities were also done in the facilities of the USAID Sector Environmental Guidelines used for OLAS activities in Monte Plata and for (www.usaidgems.org/sectorGuidelines.htm) larvicide application in Espaillat, respectively, and were picture documented.

27 Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

2. Ensure contracted company complies with international  Contractors who carried out repair activities had  Contractors had the necessary permits.  Periodic inspections will be performed. best practices and host country laws/regulations. the necessary permits to fulfill their work. National  Periodic inspections will be performed to  Inspections were done by ECO. regulations for handling hazardous/non-hazardous verify proper storage and final disposal of the waste were implemented. If a contractor or contracting company was not hired: generated waste.  It was verified with the contractor that the areas  Implement WMP, or equivalent SOPs, for properly had no presence of asbestos. disposing of construction waste. Follow international best management practices and host country laws and  It was verified that the paint was lead-free. regulations.  Instruct workers on the WMP/SOPs on proper handling and disposing of construction waste.  If the presence of asbestos is suspected all work will stop and a licensed contractor or contracting company will be hired to manage the hazardous waste in question such as asbestos and lead.  No lead-based paint shall be used. Paint will be stored properly so as to avoid accidental spills or access by children; empty cans will be disposed of in an environmentally safe manner away from areas where contamination of water sources might occur; and the empty cans will be broken or punctured so that they cannot be reused as drinking or food containers. Vector Control for Larviciding Campaigns:  An international regulated biological larvicide was  It was verified that a supplier for the selected  Purchases were done with approbation 1. Health and Environmental Impacts selected. larvicide was available in the country. from the parent company.  Larvicide selection for any USAID-supported Zika  A record of the full BTI containers delivered to TL  Registry forms had to be always available.  A manual count of the full and empty was performed including his signature. ECO containers was performed and then program is subject to the criteria listed in the Zika  Security measures were ECO supervised. Programmatic PERSUAP and host country requirements. verified this process. matched to the warehouse clerk records.  Procurement and inventory logs must be maintained.  Security measures using BMP as a guide were performed.  ECO provided final approbation.  Ensure storage facility and PPE are appropriate for the active ingredient used and in accordance with approved SOPs.  Distribute insecticides to facilities that can manage such commodities safely in storage, use, and disposal (i.e. in a manner generally equivalent to Implementing Partner’s own SOPs/WMP).  Distribute larvicide to technicians trained to properly manage the storage and use of larviciding materials.  Ensure PPE is appropriate as directed by the IP guidelines.

28 Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

2. Occupational Risk  The original baseline PPE requirements for Bti  Consenting homeowners are informed by the  ECO performed verification visits were selected based on the manufacturer’s label ZAP team that Bti will not cause adverse  Inspect and certify vehicles used for larvicide team  There was no evident respiratory (VectoBac®) and recommendations described in effects to residents or their pets when applied transport prior to contract. problems, fatigue, weakness, alcohol the Zika PERSUAP around their homes. However, if the intoxication, in the inspected  Train drivers of certified vehicles (https://ecd.usaid.gov/repository/pdf/48501.pdf), homeowners witness the VC technicians personnel.  Provide cell phone and appropriate personal protective which included the use of water-proof gloves and applying the Bti with gloves and a dust mask, equipment (PPE) during larvicide transportation. NIOSH-approved dust/mist filtering respirator it may create the perception that the larvicide  Supervisors directly observed the (meeting at least N-95, R-95, or P-95 standards). is not safe. PPE is also not recommended if it technicians during household visits.  Procure, distribute, and train all workers with potential However, upon further evaluation by the ZAP causes discomfort and provides challenges Team leaders also took care to remind larvicide contact on the use of PPE. team, it was determined that water-proof gloves with wearing it in hot-weather environments. technicians at the morning meeting the and NIOSH-approved dusk respirators are not correct application of BTI.  Ensure health and safety testing as appropriate for the  The inspection was not carried out to all the necessary for minimizing work hazards given that campaign larvicide (i.e. pregnancy testing if not using Bti) technicians in the CV, it was carried out Bti is not toxic to humans and inhalation is not a randomly.  Train operators on mixing pesticides and the proper use likely route of exposure per the manufacturer’s and maintenance of application equipment. Safety Data Sheet (VBC-0019, Revision 1). Also,  In the few cases were the technicians the  Enforce application and clean-up procedures. risks associated with dermal exposure were found correct application of BTI, the supervisors to be minimal because Vector Control (VC) made sure to address the issues immediately. technicians do not have direct contact with the active ingredient when it is applied. Instead, a measuring spoon is used to measure and apply the needed amount of Bti directly into the targeted water basins or sinks, which helps to minimize direct contact with the active ingredient.  An occasional physical inspection of technicians was carried out, to check for obvious respiratory problems, fatigue, weakness, alcohol intoxication, among others.  The technicians were trained in application of BTI. 3. Health and Safety Risk  Previous to BTI application, mobilizations where  Larvicide is harmless for living beings.  Material was reviewed previous to be Implement Information, Education and Communication people were informed about the project and handled to homeowners. (IEC) campaigns to inform homeowners of responsibilities advised about larvicide application were done. and precautions including source reduction by eliminating or covering standing water.

29 Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

4. Storage  Security adjustments using BMP as a guide were  Adjustments were ECO supervised.  ECO performed verification visits. performed.  Storage facilities and transportation vehicles must be  Registry forms had to be always available.  A manual count of the full and empty physically secured to prevent theft.  A record of the full BTI containers delivered to TL containers was performed and then  Maintain records of all larvicide receipts, issuance, and was performed including his signature. ECO matched to the warehouse clerk return of empty containers. verified this process. records.  Reconcile number of houses treated vs. number of containers used.  Examine houses treated to confirm application  Perform physical inventory counts during the application season.  Technicians should store larvicide in a locked bag within a secure location. 5. Ecological Risk  The original baseline PPE requirements for Bti  Consenting homeowners are informed by the  ECO performed verification visits.  Train applicators on the Zika Programmatic PERSUAP were selected based on the manufacturer’s label ZAP team that Bti will not cause adverse operational requirements, SOPs, PMI BMPs, and (VectoBac®) and recommendations described in effects to residents or their pets when applied approved WMP, developed for the safe and effective the Zika PERSUAP around their homes. However, if the storage, distribution, application, and disposal of (https://ecd.usaid.gov/repository/pdf/48501.pdf), homeowners witness the VC technicians insecticides which included the use of water-proof gloves and applying the Bti with gloves and a dust mask, NIOSH-approved dust/mist filtering respirator it may create the perception that the larvicide  Ensure application equipment and PPE are appropriate (meeting at least N-95, R-95, or P-95 standards). is not safe. PPE is also not recommended if it for the active ingredient used and in accordance with However, upon further evaluation by the ZAP causes discomfort and provides challenges approved SOPs, and maintain equipment. team, it was determined that water-proof gloves with wearing it in hot-weather environments.  No application of larvicides within 30 yards of beekeeping and NIOSH-approved dusk respirators are not sites necessary for minimizing work hazards given that Bti is not toxic to humans and inhalation is not a likely route of exposure per the manufacturer’s Safety Data Sheet (VBC-0019, Revision 1). Also, risks associated with dermal exposure were found to be minimal because Vector Control (VC) technicians do not have direct contact with the active ingredient when it is applied. Instead, a measuring spoon is used to measure and apply the needed amount of Bti directly into the targeted water basins or sinks, which helps to minimize direct contact with the active ingredient.

30 Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

6. Environmental Risk  A list of external providers was requested to the  Currently, ECO is selecting the company due  Selected company has to have a current  Handling, treatment, and disposal of nonhazardous Ministry of environment and natural resources for to BTI application being finished in the environmental permit. non-hazardous waste disposal (recycling), taking November – December period. (general waste) and hazardous wastes must be in  Entrance to the area was ECO into account their compliance with the best national accordance with the approved WMP/SOPs, in  Locks were changed to avoid unauthorized responsibility. and international guidelines. accordance with the PMI BMPs. The WMP, which personnel entrance.  The company will issue a container outlines SOPs for managing waste processes, must be in  A specific area for storing produced containers was  395 of containers will be discarded. elimination certificate. accordance with international best practices (i.e. WHO, assigned. FAO) and host country requirements  When the company responsible for the BTI  Monitor waste storage and management during campaign containers disposal has been chosen, ECO will visit  Monitor disposal procedures post-campaign their facilities to verify compliance with national and international guidelines. 7. Disposal  The only waste that was generated is the empty BTI  Wastes will only be disposed in incinerators that comply containers. They are not hazardous waste with PMI BMPs and international standards (i.e. WHO and FAO guidelines).  Collect and maintain treatment and disposal documents and records on file  The USAID operating unit financing the activity must prepare an amended SIEE pertaining to the specific site and circumstance as part of the decision to procure or manage incineration services. The Global Health Contracting Officer Representative must approve the amended SIEE with concurrence by the GH BEO prior to detailed design, procurement, or operation. For incinerators with capacities to burn >100kg of waste per hour, this will result in a Positive Determination and require a scoping study, and potentially, an EA.

31 Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

Vector Control for Indoor/ Outdoor Residual Spraying N/A Campaigns 1. Health and Environmental Impacts  Insecticide selection for any USAID-supported Zika program is subject to the criteria listed in the USAID Programmatic Environmental Assessment, country SEAs, and host country requirements.  Procurement and inventory logs must be maintained.  Ensure storage facility and personal protective equipment (PPE) are appropriate for the active ingredient used and in accordance with approved SOPs.  Distribute insecticides to facilities that can manage such commodities safely in storage, use, and disposal (i.e. in a manner generally equivalent to Implementing Partner’s own SOPs/WMP)

2. Occupational Risk N/A  Inspect and certify vehicles used for insecticide or team transport prior to contract.  Train drivers  Ensure availability of cell phone, personal protective equipment (PPE) and spill kits during insecticide transportation.  Initial and 30-day pregnancy testing for female candidates for jobs with potential insecticide contact.  Health test all spray team members for duty fitness.  Procure, distribute, and train all workers with potential insecticide contact on the use of PPE.  Train operators on mixing insecticides and the proper use and maintenance of application equipment.  Provide adequate facilities and supplies for end-of-day cleanup.  Enforce application and clean-up procedures.

32 Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

3. Health and Safety Risk N/A a. Implement Information, Education and Communication (IEC) campaigns to inform homeowners of responsibilities and precautions, including washing itchy skin and going to health clinic if symptoms develop and do not subside b. Ensure health facility staff are aware of insecticide poisoning management 4. Storage N/A  Storage facilities and transportation vehicles must be physically secured to prevent theft.  Maintain records of all insecticide receipts, issuance, and return of empty containers.  Conduct analysis comparing number of houses treated vs. quantity of insecticide used.  Perform physical inventory counts during the application season. 5. Ecological Risk N/A  For shipments of insecticide over water, sachets/ bottles will be packed in 220 liter open top barrels with a water- tight top and a locking ring, or in a similar durable container. Waterproof labeling must be affixed to the barrel, with the identity of the pesticide, quantity of insecticide, the type of hazard posed by the contents, and the personal protective equipment to be worn when handling the barrel.  Train applicators on the SEA operational requirements, SOPs, PMI BMPs, and approved WMP, developed for the safe and effective storage, distribution, application, and disposal of insecticides  Ensure application equipment and PPE are appropriate for the active ingredient used and in accordance with approved SOPs, and maintain equipment to avoid leaks.  Maintain application equipment  No application of insecticides within 30 yards of beekeeping sites

33 Outstanding issues related to the Description of Mitigation Measures for these activities Mitigation measures state Comments as required in Section 2.6 of ZAP IRS 2 Task Order Six necessary conditions

6. Environmental Risk N/A  Handling, treatment, and disposal of nonhazardous (general waste) and hazardous wastes must be in accordance with the approved WMP/SOPs and the PMI BMPs. The WMP, which outlines SOPs for managing waste processes, must be in accordance with PMI best practices and host country requirements  Choose sites for disposal of liquid wastes, including fixed and mobile soak pit sites according to PMI BMPs  Construct fixed and mobile soak pits with charcoal according to the BMPs to adsorb insecticide from rinse water  Maintain soak pits as necessary during season  Monitor waste storage and management during campaign  Monitor disposal procedures post-campaign 7. Disposal N/A  Wastes will only be disposed in incinerators that comply with PMI BMPs  Collect and maintain treatment and disposal documents and records on file  Country-level USAID EC documentation must contain guidance on proper disposal of wastes

34 ANNEX 3. TRAINING REPORT

ZAP Dominican Republic Trainings: January to December 2018 – No duplicate data

Total Name and Description of Total Total No Dates Participants Training Women Men # Vector Control Vector control for larviciding April 9th, 10th, 11th, 1 93 58 35 activities 12th, 13th, 14th Vector control for lethal ovitraps 2 August 21st 23 14 9 activities Vector control digital tool for 3 August 30th 3 0 3 lethal ovitrap Entomology Entomological surveillance - January 30th and 31st 1 69 42 27 Espaillat province | February 1st and 2nd 2 Larvae and Pupa survey. March 6th and 8th 12 10 2 Workshop for entomological 3 March 6th, 7th and 8th 10 4 6 surveillance Entomological surveillance - 4 May 1st and 2nd 41 27 14 Monte Plata province 5 Ovitrap train of trainers July 20th 3 3 0 Workshop for entomological 6 August 17th 24 11 13 surveillance, Santiago province Workshop for entomological 7 August 24th 17 10 7 surveillance, Workshop for entomological 8 September 6th 22 10 12 surveillance, Santiago province Workshop for entomological 9 September 19th 23 10 13 surveillance, Altagracia province Workshop for entomological 10 surveillance, San Cristóbal September 28th 17 12 5 province Community Engagement Community Engagement December 12th and 11 25 12 13 workshop. 13th, 2017

35 ANNEX 4. COLLABORATION

COLLABORATION WITH OTHER USAID OR USG ACTIVITIES

In the Dominican Republic, the USAID Mission sponsors several activities related to Zika prevention and control, including service delivery (ASSIST project, Family Health International activities, Profamilia), communications (Breakthrough Action project), social support to affected families (UNICEF), and vector control (ZAP project managed by Abt Associates, CAZ project led by Save the Children). These Zika partners hold monthly meetings to share information, present updates, and identify opportunities for support and synergy. The Breakthrough Action project, for example, organized several communications trainings in 2018 where other partners participated to strengthen key skills in the area. Local partners, such as DPS, were also able to benefit and learn from such trainings.

In 2018, the CAZ and ZAP projects shared limited interactions. ZAP presented occasional progress reports to enable CAZ to understand the scope of ZAP’s work. ZAP, however, did train CAZ facilitators and volunteers to support ongoing field activities, such as transition ovitraps.

Another example of collaboration with other USG activities is ZAP’s current work on the development of an entomological surveillance module with CECOVEZ. This activity started in 2016 with CDC’s support through the Tephinet project. In 2018, USAID/DR asked ZAP to continue support to this initiative given the importance of the activity to strengthen strategic information related to vector control.

COLLABORATION AND/OR KNOWLEDGE SHARING WITH PARTNER ENTITIES IN HOST GOVERNMENT AND OTHER DONOR AGENCIES

During the reporting period, ZAP shared information with the MOH and several DPS on progress achieved through implementation of field activities. With DPS teams, the collaboration actually went beyond information sharing since they became active partners in implementation, serving as supervisors or monitors. This involvement enabled DPS teams to follow closely and learn from ZAP’s work. Other key partners in the Dominican Republics were UASD on implementation of the VC/entomology diploma program, described above. ZAP shared information with the Pan American Health Organization to keep them abreast of progress and identify opportunities for joint support to the MOH.

36