The Zika AIRS (ZAP) Project Indoor Residual Spraying (IRS 2) Task Order Six
ZAP GUATEMALA END OF YEAR REPORT JANUARY 1, 2018 – DECEMBER 31, 2018 Recommended Citation: Zika AIRS Project (ZAP). February 2019. ZAP Guatemala End of Year Report 2018. 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 GUATEMALA 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
Contents Acronyms ii 1. Executive Summary ...... 1 2. Progress and Outcomes...... 2 2.1 Community Mobilization, Social and Behavior Change Communication ...... 2 2.2 Vector Control ...... 3 2.2.1 Larviciding and Source Reduction...... 3 2.2.2 IRS………… ...... 5 2.3 Entomological Monitoring ...... 6 2.3.1 Entomological Monitoring for Larviciding and Source Reduction ...... 6 2.3.2 Entomological surveillance for IRS...... 11 2.4 Environmental Compliance and Safety...... 14 2.4.1 IRS Campaign ...... 14 2.4.2 Larvicide Campaign ...... 14 2.4.3 Security……...... 14 2.5 Monitoring and Evaluation...... 15 3. Improving Zika Response ...... 17 3.1 Training and Institutional Capacity Building ...... 17 3.2 Government Engagement...... 17 3.3 Innovations...... ……………………………………..17 3.4 Integration of Cross-cutting Issues ...... 18 3.4.1 Gender Equality and Female Empowerment...... 18 4. Learning...... 19 4.1 Challenges and Lessons Learned ...... 19 5. Sustainability and Exit Strategy ...... 20 Annex 1A. Monitoring and Evaluation: Zika Framework...... 21 Annex 1B. Monitoring and Evaluation: ZAP M&E PLAN (MEP) ...... 22 Annex 2. Environmental Mitigation and Management Report ...... 32 Annex 3. Selected Environmental Compliance Resources...... 52 Annex 4. ZAP Security Resources ...... 53 Annex 5. Training Report ...... 57 Annex 6. BCC interventions in 2018...... 59 Annex 7. Collaboration ...... 63 Annex 8. Aedes Indices from larviciding campaign in 2018 ...... 65
i ACRONYMS
AIRS Africa Indoor Residual Spraying BCC Behavior Change Communications BI Breteau index BMP Best Management Practices Bti Bacillus thuringiensis israelensis CDC Centers for Disease Control and Prevention CI Container Index COCODES Community Development Council EMMP Environmental Mitigation and Monitoring Plan EW Epidemiological Week HH Household HI House Index IRS Indoor Residual Spraying M&E Monitoring and Evaluation MOH Ministry of Health ODK Open Data Kit PAHO Pan American Health Organization PI Pupae Index PPE Personal Protective Equipment PROEDUSA Departamento de Promoción y Educación para la Salud (Department of Health Promotion and Education) USAID United States Agency for International Development VC Vector Control USAID United States Agency for International Development WHO World Health Organization ZAP Zika AIRS Project
ii 1. EXECUTIVE SUMMARY
This document is a compilation of the Zika AIRS Project (ZAP) in Guatemala’s key activities, progress, and lessons learned in 2018. Funded by the United States Agency for International Development (USAID), ZAP Guatemala aims to reduce the burden of vector-borne diseases by enhancing the capacity and supporting the efforts of the Ministry of Health (MOH) to control the country’s Zika outbreak. Table 1 lists the overall project objectives and highlights of 2018 results.
Table 1. ZAP Guatemala Objectives and Highlights 2018 Project Objectives 2018 Highlights/Results
Implement vector control activities, including larviciding with 87,369 households visited through Bacillus thuringiensis israelensis (Bti), environmental clean-up, and a total of 678,641 monthly visits reduction of breeding sites, as well as behavior change communication (BCC) for the elimination of mosquito breeding sites, through monthly visits in 70,000 targeted households.
Conduct an indoor residual spray (IRS) pilot in one of the 5,500 structures sprayed in 2018 priority departments as recommended by USAID and the MOH
In close coordination with the MOH, implement 3 sentinel sites with ongoing data entomological surveillance best practices and conduct vector collection and monitoring bionomic studies, routine monitoring, and data reporting to inform optimal cost-effective vector control interventions.
In coordination with other USAID implementing agencies, contribute to strengthening the capacity and skills of the government of Guatemala at the national and sub-national levels and of other local counterparts to plan and manage vector control and entomological activities aimed to reduce transmission of Zika and other arboviruses.
The geographical locations served by ZAP expanded from 11 municipalities in 2017 to 22 in 2018. The new municipalities are located in the same three departments (Chiquimula, El Progreso, and Zacapa) as the original 11; ZAP Guatemala selected these departments in coordination with the MOH and USAID Mission. This expansion involved training approximately 330 new seasonal workers for vector control and entomology work as well as the opening of two new entomological sentinel sites and entomology laboratories.
Overall, in 2018, ZAP-supported larviciding and IRS reached 273,281 beneficiaries. Its community-level BCC interventions reached 34,488 women and 24,432 men. Significant effort went into implementing BCC interventions at the household level as well as strengthening the coordination with community leaders and MOH authorities in all three targeted departments.
1 2. PROGRESS AND OUTCOMES
In 2018, in coordination with the Ministry of Health (MOH), the Zika AIRS Project (ZAP) in Guatemala continued implementation of vector control and entomological interventions initiated in 2017 and expanded key activities into an additional 15 municipalities. As of December 2018, ZAP Guatemala is implementing vector control intervention in 22 municipalities in three departments, Chiquimula, El Progreso, and Zacapa, entomological surveillance through sentinel sites in three municipalities, and community outreach and behavior change communication (BCC) interventions in 220 communities.
2.1 COMMUNITY MOBILIZATION, SOCIAL AND BEHAVIOR CHANGE COMMUNICATION
Taking into account lessons learned from 2017, in 2018 ZAP Guatemala expanded its strategy to reach targeted beneficiaries and overcome the challenges posed by the low risk perception and awareness about Zika that the beneficiary population shows. In coordination with the MOH Department of Health Promotion and Education (Departamento de Promoción y Educación para la Salud, PROEDUSA), ZAP placed priority on minimizing the use of printed materials; instead, it increased the use of education- entertainment efforts to promote the change of behaviors and practices. It hired three local communicators who were familiar with the targeted communities and their local practices and culture, and who had established networks in place for the dissemination of messages. Additional details about these efforts are provided below.
BCC Capacity Building with MOH. In 2018, ZAP began transferring BCC capacity to the MOH and community leaders through the development of skills and approaches. To do this, ZAP involved PROEDUSA in the design and approval of ZAP BCC material and methodologies. While, ZAP did collaborate with ZICORE for environmental clean-up messaging, it was necessary for ZAP to develop our own materials because none previously existed that focused on the larvicide intervention activities. This approach proved to be effective and productive as ZAP received suggestions that helped to improve the project’s materials, and also received PROEDUSA’s technical validation for ZAP mass media messages. Overall, their active participation supported a sense of ownership by the MOH for all ZAP materials and reinforced PROEDUSA’s commitment that it will continue using ZAP materials after the project ends. BCC for ZAP Vector Control. The main approach for communication to support community mobilization and behavior change in alignment with ZAP’s general vector control program is through the use of education and entertainment for the general targeted population (household members) through the use of mass media messages, and of puppet shows, songs, and other ‘playful’ entertainment. These sessions were done in 404 schools across El Progreso, Zacapa and Chiquimula. ZAP also participated in health fairs and church events where it presented to audiences various elements of the mosquito lifecycle and the importance of certain household practices to prevent mosquito breeding sites. During routine household vector control visits, ZAP teams used a learning-by-doing methodology with household members to empower families on household-level mosquito control practices. Overall, ZAP’s BCC interventions reached 34,488 women and 24,432 men during in-person communication activities. BCC for IRS. To meet the indoor residual spraying (IRS) targets, ZAP used lessons learned from the 2017 IRS campaign and significantly intensified all BCC interventions, including the high-visibility media
2 (TV reports, public service announcements, press conference) involving senior Zacapa authorities (governor, Zacapa City mayor, and Head of the Health Area) supporting the IRS campaign. Overall, the 2018 IRS campaign required a coordinated BCC intervention with messages for: a) IRS community mobilization field workers: The ZAP Guatemala team designed the communication materials, taking ideas from the vector control staff. The materials included flyers with messages like: “Hoy es el día” and “Cinco pasos para después del Rociamiento” and posters about “Acción Habitacional” that mobilizers distributed to homeowners. Additionally, the ZAP team used the “Beto el Rociador” character to disseminate spray messages, and they introduced “Betty la Rociadora” to represent the female sprayers in Zacapa. b) IRS beneficiaries: ZAP used specific BCC approaches to address risk awareness and to help motivate homeowners to accept IRS during the 2018 IRS campaign. ZAP adopted an integrated approach that included working in close coordination with community leaders, and using mass media, and routine interpersonal communications at the household level. The mass media strategy was coordinated with institutional communicators for radio and TV spots/ interviews, with community development councils (COCODESs), and with owners of three mobile units with loudspeakers, which accompanied the sprayers each day. The BCC team also established strategic alliances with the private sector. One sponsor (Sabrosita.com) collaborated with the project and provided a mobile unit. Likewise, the local TV cable company provided free air time for IRS messages. ZAP also worked in coordination with the Communication Department at the Rafael Landivar University in the design and editing of materials. See Annex 6 for more details about the community mobilization efforts and BCC materials development. 2.2 VECTOR CONTROL
2.2.1 LARVICIDING AND SOURCE REDUCTION ZAP Guatemala continued to implement comprehensive vector control in collaboration with the MOH. ZAP’s standard vector control approach consists of broad community engagement and ongoing household-level source reduction through environmental management, and larviciding with Bacillus thuringiensis israelensis (Bti). In 2018, ZAP Guatemala continued this model with the MOH and each of the three departmental health authorities. Based on this plan, 35,000 households in Chiquimula, 20,000 households in El Progreso, and 15,000 households in Zacapa were targeted for larviciding in 2018. To serve the new locations in 2018, ZAP hired 112 seasonal workers which brought the number of seasonal workers to 181 (including two local ZAP supervisors in Zacapa) by December 2018. 139 vector control technicians worked individually and 20 pairs were assigned to cover 34 localities, distant or considered at-risk areas, in order to prevent incidents. These areas are located in El Progreso and Zacapa. See Figure 1 for a map of ZAP intervention areas.
ZAP Guatemala continued using its supervision model: It used MOH staff from the departmental-level vector control teams on a full-time basis. For the duration, these MOH staff were under ZAP supervision. It also opened small warehouses in Sanarate (El Progreso) and Huité (Zacapa); the municipalities provided the respective warehouses at no cost to ZAP.
To ensure a smooth work flow and collaboration, each municipality team held monthly meetings to solve problems and share experiences. The ZAP teams used WhatsApp groups as a tool for daily communication and problem solving. ZAP conducted two trainings in 2018 to reinforce household messaging, as well as proper larvae and pupae identification. In addition, vector control teams participated in different activities like health fairs, municipal fairs, and cleaning campaigns.
3 FIGURE 1. MAP OF ZAP GUATEMALA VECTOR CONTROL INTERVENTION AREA 2018
As shown in Figure 2, the 2018 larvicide intervention reached 76,866 households and 159,157 beneficiaries.
FIGURE 2. REVIEW OF ZAP GUATEMALA LARVICIDING COVERAGE 2018
4 Table 2 breaks down the number of households that were treated with larviciding by department and municipality.
TABLE 2. ZAP GUATEMALA LARVICIDING CAMPAIGN SUMMARY 2018 Department Municipality # of Households Treated with Larvicide 1 El Progreso Sanarate 11,599 2 Sansare 2,521 3 San Antonio la Paz 3,097 4 El Jícaro 2,475 5 Chiquimula Esquipulas 6,242 6 San Jacinto 1,592 7 Quezaltepeque 2,639 8 Olopa 737 9 Concepción las Minas 2,296 10 Chiquimula 12,773 11 Camotán 2,753 12 Jocotán 2,357 13 Ipala 3,880 14 San Juan Ermita 1,427 15 San José la Arada 2,197 16 Zacapa Huité 1,961 17 Estanzuela 2,955 18 Cabañas 2,082 19 Usumatlán 2,283 20 Rio Hondo 4,196 21 San Jorge 2,083 22 Teculután 2,721 Total 76,866
The intervention model for larvicide application consisted of assigning a defined area to each technician who is responsible for conducting monthly visits. This allowed household owners to gain confidence in and get to know the technicians and allow them to enter their homes. This helped optimize the technicians time during the visit since they were familiar with the volume of the containers and where they were located. It also encouraged each technician to be responsible for their area and allowed homeowners to inform technicians of any issues in the area.
ZAP’s intervention model for larvicide application of Bti has had positive results with consistent reductions in the Bretaeu, household and pupae indexes since the start of larvicide application. The MOH has committed to continue the ZAP intervention approach in the MOH Health Area in Chiquimula. This Health Area is adopting the ZAP model using the MOH Chiquimula vector control team already in place. Because resources (financial and human) are limited in Guatemala, the ZAP team continues to explore sustainability with the MOH. 2.2.2 IRS
In 2018, ZAP Guatemala implemented a second IRS pilot to test the effectiveness of IRS for Aedes in an urban setting. ZAP selected Zacapa City as the intervention location as it was large enough for a sufficient sample and also free of other vector control interventions. Additionally, in assessing potential locations for the IRS pilot, ZAP received strong support from important local authorities and the MOH
5 Health Area. The pilot was designed and carried out in close collaboration with the Health Area authorities. Prior to the field intervention, ZAP Guatemala conducted insecticide resistance tests that showed that local Aedes aegypti populations were susceptible to bendiocarb (see Section 2.3). ZAP used carbamate, FICAM 80 WP (Bendiocarb) 100 grams, for this IRS pilot.
ZAP Guatemala targeted the entire city of Zacapa, which comprises approximately 9,000 households. It determined that 2,625 structures were non-eligible for IRS (for example, they were identified as businesses, or if households, they were ineligible for reasons such as having a sick occupant, or no clear designation between kitchen and other rooms). In the end, the 2018 pilot spray campaign was implemented from June 12 to July 3, 2018 and targeted 6,375 structures. A control site was established in Teculután, also in Zacapa Department, which showed the least difference with Zacapa City in terms of basic variables (population size, climate, business/household ratios, culture, etc.). Overall, ZAP hired 142 people (83 male, 59 female) to support the pilot. The team established an operations center in the MOH vector control facility in Zacapa City.
There were several distinct differences between the 2017 and 2018 IRS pilots. First, a two-village study design (with Zacapa City as the intervention site and Teculután as the control site) replaced the randomized cluster approach in a single locality used in 2017. Second, the team decided to increase the total area sprayed on the walls (from spraying up to 1.5 meters in 2017, to up to 3.0 meters in 2018). However, in the first week of IRS, spraying above 1.8 meters resulted in instances of spray operators being exposed to the insecticide spray. As a result, ZAP limited spraying to 1.6-1.8 meters. Also during the 2018 pilot, the spray team experienced increased cases of dehydration due to high temperatures during the spray period, requiring additional hydration support for the teams.
In general, the pilot highlighted the difficulty of implementing IRS for Aedes control in urban areas. Among the issues that contributed to refusals were: close proximity of homes and large amounts of personal effects made it difficult to safely remove personal effects from the walls; competing personal priorities of households; and, the perception that Zika is not a high risk. Based on the ZAP experience, IRS is not highly recommended for Aedes control in urban settings.
2.3 ENTOMOLOGICAL MONITORING
2.3.1 ENTOMOLOGICAL MONITORING FOR LARVICIDING AND SOURCE REDUCTION ZAP Guatemala continues to conduct entomological surveillance activities to monitor the impact of larviciding with Bti through the presence and density of Aedes aegypti in four sentinel sites. Entomological monitoring was conducted in Chiquimula and El Progreso where a Bti-based larvicide was applied monthly. Surveillance activities were also conducted in ZAP-designated control sites, Chiquimula City (Chiquimula) and Guastatoya City (El Progreso). (These sites, however, may be subject to MOH operational activities in the future, depending on local public health risks.) The entomological monitoring activities by ZAP are designed to measure the presence and density of Aedes aegypti as follows:
Ovitraps with hay infusion. Ovitraps were implemented in Chiquimula City and Guastatoya City. Ovitraps were placed in 100 sentinel houses in each sentinel site and recovered/redeployed every five days. Larval and pupal surveys. Approximately 200 houses per sentinel site were visited and searched for the presence of water-holding containers and the presence of larvae/pupae. Pupae were counted and brought to the laboratory for species identification. Adult mosquito surveys. ZAP Guatemala did not conduct adult mosquito surveys in sentinel sites where Bti was applied. It did survey adult mosquitoes in an IRS site (Zacapa City) and the
6 corresponding control site (Teculután). Adult collection is implemented with Prokopack aspirators three days a week in 105 structures, and BG-sentinel traps every 24 hours for 10 consecutive days per month in 21 structures.
ZAP Guatemala’s entomological results from 2018 showed that egg density was lower in the Chiquimula intervention site than in the Chiquimula control site. The number of eggs collected fluctuated in the three sentinel sites, showing a peak in August in Guastatoya City (Figure 3) and two peaks in July in both sites in Chiquimula (Figure 4). Those peaks can be explained as a consequence of the rainy season in the region.
FIGURE 3. AEDES SPP. EGG DENSITY IN OVITRAPS WITH HAY INFUSION IN GUASTATOYA (CONTROL SITE) FROM APRIL TO NOVEMBER 2018, CHIQUIMULA (CONTROL AND INTERVENTION SITES) FROM JANUARY TO NOVEMBER 2018
Note: The dates of the actual collection period vary by 1 to 2 days between Chiquimula and Guastatoya. To make the figure we used the dates from Chiquimula. In September there were no collections in some periods in each of the sites due to vacations, national and/or local holiday.
In 2018, the three standard entomological indices – House Index (HI), Container Index (CI), and Breteau Index (BI) – were calculated in the three sentinel sites for larviciding. In the Chiquimula intervention site and in Guastatoya, the HI and the BI increased in June, August, and September, and at the beginning of November. In the Chiquimula control site, the HI remained stable, while the BI showed an increase in September 2018. See Table 3. It is important to note that the ZAP control site in Chiquimula receives some operational vector control interventions from the MOH directly, which may influence the interpretation of ZAP control versus intervention results.
7 TABLE 3. TRADITIONAL AEDES INDICATORS (HI, CI, BI), JANUARY–NOVEMBER 2018 IN GUASTATOYA (CONTROL SITE) AND CHIQUIMULA (CONTROL AND INTERVENTION SITES)
Collection period 4 5
0
8 8 8 7 5 5 7 5 5 5 v 5 5 8 5 5 6 7 7 6 6 7 7 7 0 1 2 p 7 1 1 2 2 0 1 2 5 1 2 7 2 1 2 o 2 0 1 6 1 2 - - - - - 0 1 2 ------e ------
- - - 4 4 4 N 3 3 1 0 2 0 1 1 1 1 3 4 S 1 1 2 3 3 1 2 2
Site Index 3 3 3 3
0 1 2 - 1 - 1 2 r 0 1 2 1 2 2 1 2 2 r 0 1 1 2 t 2 0 1 2 b 1 1 a r r y y y c p t t v v l l l g g g e b b p p n n n 3 3 a n a a a c c p o o F A u u u u u u O e e e e a M u u t u J J J g J F F A J J O O S S M J A A A N N c M M M u O A HI 22 24 23 23 25 27 28 27 22 14 14 21 17 19 22 14 13 15 17 21 27 23 Guastatoya CI 101311101191098568767555571210 Control BI 26 28 25 23 25 25 30 27 25 15 16 24 21 25 34 15 15 15 17 24 29 24
Collection period 4 4
7 7 t 7 8 8 5 5 5 5 7 5 4 6 6 6 p 4 4 7 6 c 7 1 2 7 1 8 1 2 5 1 2 5 1 2 7 2 1 2 2 6 1 2 e 1 2 - - - - - 7 1 2 ------O - - - S 3 3 3 3 3 4 4 4 1 0 1 1 1 1 3 3 0 0 Site Index 2 2 2 2 - 0 0
- 2 2 2
1 2 1 1 2 r 1 2 1 2 2 1 2 2 r y 1 2 1 1 2 v l g 0 1 2 b n a r r a y y 3 p t t v v l l g g 3 o u u e b b p p n n n u a a a J c c p o o F A J u u u u e e g e e a M A N u u M p J J J F F A J J O O S S M A A u N N M M e A S HI 30 33 30 26 26 23 23 28 18 24 21 31 38 33 34 29 29 23 26 25 25 28 23 28 26 33 35 23 16 Chiquimula CI 911977669566810101087666653656854 Intervención BI 38 41 36 30 31 28 25 39 21 27 25 39 45 46 45 36 36 31 27 27 29 50 15 32 26 33 37 25 17 HI 26 26 29 25 20 18 17 13 16 17 17 21 15 24 21 22 17 18 24 24 20 17 24 23 17 25 22 35 25 Chiquimula CI 1191012766567694989769897795991312 Control BI 43 35 43 47 26 23 22 19 23 28 25 36 16 33 27 37 24 24 35 33 34 51 30 34 18 36 36 58 51 Red cells indicate the start of Bti application.
As shown above, the values of the HIs (HI: percentage of positive houses to larvae and pupae) are always higher than the Pupae Indexes (PI) (PI: percentage of positive houses to pupae) values in the three sentinel sites.
After careful revision of the data at hand, ZAP Guatemala noticed that the impact of the interventions aimed to reduce the mosquito populations in the target locations could be better tracked using pupae data (PI), see Figure 5. The scientific literature has extensively documented the limitations of the traditional indexes, as such indicators only measure the presence of mostly larvae, when the most informative developmental phase, still in aquatic environments, is the pupae.
8 FIGURE 4. HOUSEHOLD INDEX IN GUASTATOYA (CONTROL SITE) FROM APRIL TO NOVEMBER 2018 AND CHIQUIMULA (CONTROL AND INTERVENTION SITES) FROM JANUARY TO NOVEMBER 2018.
* Note: The dates of the collecting periods vary along the whole surveillance period for 1 to 2 days, between Chiquimula (control and intervention sites) and Guastatoya (control site).
FIGURE 5. PUPAE INDEX IN GUASTATOYA (CONTROL SITE) FROM APRIL TO NOVEMBER 2018, CHIQUIMULA (CONTROL AND INTERVENTION SITES) FROM JANUARY TO NOVEMBER 2018.
* Note: The dates of the collecting periods varies along the whole collecting period for 1 to 2 days, between Chiquimula (control and intervention sites) and Guastatoya (control site).
9 Based on the entomological survey data collected by the vector control technicians before applying the larvicide the impact of the Bti pilot in the municipalities can be stratified into low, medium and high. As seen in tables 4 and 5, the groups were obtained by dividing the reduction percentage (initial house/pupae index minus the average of house/pupae index of the last trimester of 2018) into thirds (low, medium and high). For the house index, 13 municipalities (n=18) show a reduction percentage ranging from 44.41 to 96.51 and can be categorized as showing medium to high impact. Concerning the pupae index, also 13 municipalities (n=18) show a reduction percentage ranging from 69.42 to 99.1 which allows those municipalities to be categorized as of medium to high impact as well (for more detailed information see Annex 8).
TABLE 4. COMPARISON OF HOUSE INDEX (HI) OF 18 ZAP MUNICIPALITIES AND THE DECREASE AVERAGE OF THE LAST TRIMESTER OF 2018.
Initial Average Number Reduction House HI (last Reduction Department Municipality of Percentage Tertile Index trimester impact localities (%) (HI) 2018) Chiquimula San Juan Ermita 9 19.20 20.64 0.00 Zacapa Cabañas 3 46.50 34.40 26.02 Chiquimula Jocotán 8 23.63 15.99 32.33 T1=44.05 Low Zacapa Usumatlán 5 25.00 16.83 32.67 Chiquimula Quezaltepeque 8 24.30 15.03 38.15 El Progreso El Jícaro 4 18.95 11.68 38.36 Zacapa Estanzuela 3 33.10 18.40 44.41 Chiquimula Ipala 10 19.32 10.55 45.41 Chiquimula San José la Arada 10 53.00 26.13 50.69 T2=68.37 Medium Zacapa San Jorge 15 56.30 25.97 53.88 Chiquimula Chiquimula 25 38.60 16.53 57.17 Chiquimula Camotán 11 36.54 13.77 62.32 Chiquimula Concepción 13 21.21 6.53 69.20 Chiquimula Olopa 1 38.31 9.82 74.36 El Progreso Sanarate 29 56.50 14.47 74.40 Chiquimula San Jacinto 8 26.81 6.73 74.88 High El Progreso San Antonio la Paz 12 55.60 13.37 75.96 Chiquimula Esquipulas 1 37.24 7.59 79.61 El Progreso Sansare 11 56.40 1.97 96.51
Based on the ZAP experience, larviciding with Bti in monthly applications is recommended for Aedes control in urban settings, but for MoH is limiting in terms of resources.
TABLE 5. COMPARISON OF PUPAE INDEX (PI) OF 18 ZAP MUNICIPALITIES AND THE DECREASE AVERAGE OF THE LAST TRIMESTER OF 2018.
10 Average Number Initial Reduction PI (last Reduction Department Municipality of Pupae Percentage Tertile trimester impact localities Index (PI) (%) 2018) Chiquimula San Juan Ermita 9 4.6 4.60 0 Zacapa Cabañas 3 14.6 13.00 10.96 Zacapa Usumatlán 5 8.5 5.33 37.25 T1=69.31 Low Zacapa Estanzuela 3 11.5 5.63 51.01 El Progreso El Jícaro 4 5.9 2.27 61.58 Chiquimula San José la Arada 10 18.9 6.13 67.55 Chiquimula Concepción 13 10.9 3.33 69.42 Chiquimula Quezaltepeque 8 12.9 3.83 70.28 Zacapa San Jorge 15 22.8 6.57 71.20 T2=86.00 Medium Chiquimula Ipala 10 6.29 1.71 72.76 Chiquimula San Jacinto 8 8.74 1.67 80.93 Chiquimula Chiquimula 25 15.2 2.57 83.11 Chiquimula Jocotán 8 12.5 1.70 86.40 Chiquimula Olopa 1 16.5 1.85 88.79 El Progreso Sanarate 29 20.3 2.07 89.82 Chiquimula Esquipulas 1 13.29 1.09 91.77 High Chiquimula Camotán 11 18.2 1.33 92.67 El Progreso San Antonio la Paz 12 24.7 0.53 97.84 El Progreso Sansare 11 18.8 0.17 99.11
2.3.2 ENTOMOLOGICAL SURVEILLANCE FOR IRS Entomological monitoring is done at three phases of the IRS campaign, as described below.
PRE-SPRAY SUSCEPTIBILITY TESTING Beginning in January 2018, before the IRS campaign, ZAP Guatemala used standard CDC bottle bioassays to determine the insecticide susceptibility of Aedes aegypti populations from Zacapa to the selected insecticide. ZAP used the first filial generation female mosquitoes of known age, reared from field larval collections in Zacapa City, and a susceptible strain of Aedes aegypti (Rockefeller strain) for the bioassays. ZAP conducted tests on deltamethrin and bendiocarb, because the vector control interventions regularly conducted by the MOH mainly use pyrethroids such as deltamethrin and alpha-cypermethrin. Deltamethrin has been used in Guatemala since 1979.) The CDC bioassays showed that the local populations of Aedes aegypti were susceptible to the insecticide selected for the IRS-2018, bendiocarb, and resistant to deltamethrin.
11 ENTOMOLOGICAL SURVEILLANCE DURING AND AFTER IRS As noted above, the intervention site was in Zacapa City and the control in Teculután. During and after the IRS intervention, ZAP Guatemala surveilled adult mosquito density, using two adult collection methods to monitor the local populations: Prokopack aspirators: The collections were done three days per week, and the original target was 105 household per study site (Zacapa vs. Teculutan). BG sentinel traps: These traps were deployed indoors and technicians collected trapped mosquitoes every 24 hours; BG trap monitoring was used for 10 consecutive days per month. The original target was 21 houses/businesses for each site. The distance between selected houses for Prokopack and BG trap collections was a minimum 100m. During the IRS campaign, both the intervention site and the control site were divided into three ‘color’ sectors, based on the local distribution of households versus businesses (Figures 6 and 7). The color codes are as follows: yellow indicates the sub-area with a higher proportion of households to businesses (residential zones), blue indicates a sub-area of mixed households and businesses (middle town), and green indicates a sub-area with a higher proportion of businesses (downtown area of each city). The average number of mosquitoes collected indoors in Teculutan (control site), in all subareas, showed a less abundant mosquito population than the density recorded in Zacapa city, even at baseline. Though the middle town (blue) had the highest density of Aedes mosquitoes during the baseline, once IRS started in Zacapa City, mosquito densities in both the green and blue subareas dropped drastically but the residential area of Zacapa City (yellow), remained the area with the highest mosquito density until the end of the campaign. Additionally, the commercial area or downtown (green), greatly added to the overall mosquito density. The BG collections are coherent with the mosquito density captured by the Prokopack collections, showing that in Zacapa City, the residential area (yellow) is the most challenging part of town, with the highest density of mosquitoes having a drastic peak during the rainy period in August.
FIGURE 6. AVERAGE NUMBER OF AEDES MOSQUITOES PER HOUSE, COLLECTED WITH PROKOPACKS, ZACAPA (IRS)
Data are presented by sub-area: downtown (green), middle town (blue), and residential (yellow).
12 FIGURE 7. AVERAGE NUMBER OF AEDES MOSQUITOES PER HOUSE, COLLECTED WITH PROKOPACKS, TECULUTAN (CONTROL)
Data are presented by sub-area: downtown (green), middle town (blue), and residential (yellow).
ENTOMOLOGICAL MONITORING AFTER IRS To monitor the insecticide residual effectiveness in the intervention site, ZAP Guatemala used standard WHO cone bioassays. It conducted the tests 24 hours after spray, as a quality test for the IRS (n=46 households) and then monthly in a sample of houses as part of the post-IRS entomological surveillance. Figure 8 shows the data on post-spray mortality (24 hours after spraying), and for the following months using both local and Rockefeller strains of Aedes aegypti. In these tests, a mortality rate above the “cut-off point” (80 percent mortality) indicates strong efficacy of the insecticide on the strain of mosquitoes tested. The residuality of bendiocarb in the intervention site lasted for only a month, with a drop of the average mortality in the cone bioassays to less than 80 percent in the second month. ZAP analyzed various factors that influence residuality, including wall material (brick, “repello,” water-based paint, other). Interestingly, in both the intervention and control sites, there were extensive collections of household belongings in the sprayed areas, including furniture, which may have influenced whether any insecticide accidentally removed (rubbed off) or influenced the indoor resting locations of the mosquitos.
13 FIGURE 8. INSECTICIDE RESIDUALITY BASED ON MOSQUITO MORTALITY, ZACAPA
2.4 ENVIRONMENTAL COMPLIANCE AND SAFETY ZAP Guatemala conducts environmental compliance activities in alignment with the PMI Best Management Practices (BMP) Manual, and the Environmental Mitigation and Monitoring Plan (EMMP). Annex 2 provides a detailed overview of the specific 2018 actions per the EMMP.
2.4.1 IRS CAMPAIGN ZAP Guatemala conducted several environmental compliance activities preparing for and during the 2018 IRS campaign, including: pre-campaign environmental compliance assessment; soak pits; training of personnel; daily spray operator health checks; supervision; incident reporting; post-spray environmental compliance assessment; and waste disposal.
2.4.2 LARVICIDE CAMPAIGN Warehouse Management and Larvicide Distribution. ZAP Guatemala managed the storage and distribution of Bti in accordance with environmental best practices. During 2018, ZAP closed one of its warehouses in Quezaltepeque due to high temperatures (up to 30°C). It then decided to permanently close the location for storage and use it only for distribution. It also opened additional distribution offices in Sanarate (El Progreso) and Huité (Zacapa).
Waste Disposal. In 2018, ZAP managed the disposal and recycling of empty Bti bottles, cardboard packaging, and implementation materials such as ovitrap papers. ZAP collects empty Bti bottles in the ZAP office in Chiquimula. From there, it sends the bottles to a storage center in Teculután (Zacapa) run by “Campo Lindo,” a program of the Association of the Agricultural Chemical Guild (AGREQUIMA) that manages the disposal of empty packaging. The recovered and crushed plastic is sent to different recycling companies, which transform it into plastic wood that the companies make into planks, benches, rubbish bins, and other goods. ZAP and Abt Associates received a certificate of participation from the Campo Limpio program in 2018. ZAP recycles cardboard boxes (Bti packing boxes) through a recycling center in Guatemala City. ZAP manages the disposal of ovitrap paper carefully. It collects the papers and sends them for incineration to ABC Biofert, a company certified by the ministries of Health and of Environment, in accordance with PMI BMP recommendations.
2.4.3 SECURITY ZAP Guatemala operates its core vector control and entomological surveillance activities in areas that have security risks. Some areas also have limited law enforcement, which can lead to general street crime
14 and drug-related violence. To address these security concerns and mitigate risks to project staff, in 2018, ZAP made several visits to the departmental police offices in Chiquimula, El Progreso, and Zacapa to collaboratively map and discuss areas of risk in each department. Local police stations and other local authorities, including COCODESs, participated in the risk mapping as well. ZAP used this information to develop and implement increased safety measures for technicians working in areas of greatest risk. In addition, it expanded the use of safety messages in its community mobilization efforts. It also ensured that all field technicians in seven higher-risk communities work in teams of two or more. During 2018, ZAP Guatemala trained 355 people in safety and security topics, including prevention of sexual harassment and violence, dog bites, theft, accidents, and traffic accidents. It also trained the Zacapa vector control team in general first aid.
In total in 2018, workers reported 48 security incidents during routine ZAP vector control and entomological monitoring activities across the three departments (Figure 9). The most common incident reported was dog bites (15) followed by traffic accidents (13) and assaults/thefts (8). The most serious incident was the murder of a security guard outside the ZAP office in Chiquimula. This case is under investigation but preliminary evidence has shown that it was a personal matter, unrelated to ZAP.
FIGURE 9. INCIDENTS REPORTED BY DEPARTMENT DURING THE LARVICIDE CAMPAIGN AND ENTOMOLOGICAL SURVEILLANCE, 2018
ZAP Guatemala analyzes incident reports to continually develop new approaches to mitigate safety and security risks. In 2018, the following tools were developed: Action guidelines for emergency attention: These guidelines include specific procedures and recommendations to be used per incident type. See Annex 4. Emergency focal points: The ZAP team created a cadre of emergency focal points (filled by the administrative assistants in Chiquimula, Sanarate, and Huité, as well as a field and a laboratory technician in Guastatoya) to assist with immediate response and action. Identification cards: ZAP field staff received identification cards with emergency contact information. Ongoing refresher/reminders about security and safety: All staff were provided with ongoing reminders about the importance of security and safety procedures. 2.5 MONITORING AND EVALUATION All ZAP Guatemala interventions continue to be monitored through a data capture system based on mobile phone technology. Mobile data capture activities have experienced continuous improvement, like the implementing of new platforms such as MySQL, which have been adapted not only to the processes of data
15 capture but also connected in real time and a dashboard for correct decision making. These systems support the project by routinely collecting a large amount of data. In 2018, ZAP collected over 827,800 data records.
ZAP Guatemala had previously rolled out a comprehensive mobile data collection process, based on Open Data Kit (ODK) platforms. Although ODK systems are relatively quick to implement, they can require manual data extraction and uploading processes into the data visualization platform, Tableau. In 2018, ZAP Guatemala tested an Android-based application to capture entomological data. This pilot demonstrated benefits of a MySQL platform that allows for a direct link and transfer of data into Tableau, which was not possible with the ODK application. Before the close of the project, ZAP Guatemala will provide a two-day training for the Health Area Director and MOH Epidemiology teams in the three departments were ZAP works. The training will focus on using Tableau for data analysis and programmatic decision making. These monitoring and evaluation (M&E) improvements have given the ZAP team access to timely information for operational and technical decisions. Figure 10 shows examples of how management decisions were supported by data and dashboards during the 2018 IRS campaign. FIGURE 10. EXAMPLES OF DECISIONS SUPPORTED BY M&E DATA AND DASHBOARDS Example Supported Action Concern/Question Verify if technicians achieved Direct supervision of low-performing daily goal of households technicians sprayed per day Verification of team operations Support logistical decisions
Distribution of sprayed and Allow for decisions based on geo- non-sprayed households referenced data on which sectors require recovery or revisit efforts Support design of more efficient sprayer routes Support logistical decisions
Identify and monitor the BCC campaigns to reasons behind refusals to address the reasons create effective BCC for not spraying were interventions implemented.
ZAP Guatemala’s M&E platform has elicited interest from the Health Areas, which have voiced their desire to continue collecting data for local decision making. The M&E system also was presented as a tool for broader management and programmatic decision making in Guatemala, and accepted for presentation at the 85th Annual Conference of the American Mosquito Control Association in February 2019.
16 3. IMPROVING ZIKA RESPONSE
3.1 TRAINING AND INSTITUTIONAL CAPACITY BUILDING ZAP Guatemala is building the MOH’s institutional capacity with specific vector control, entomological, and environmental compliance trainings to strengthen the ministry’s ability to plan, manage, and monitor vector control and entomological monitoring programs. In 2018, ZAP trained 1,284 persons (including ZAP seasonal workers and MOH staff) on a variety of topics related to vector control and entomology, as well as safety, environmental compliance, communications skills, M&E, and supervision. Approximately 41 percent of people trained were female. MOH-specific trainings focused on interventions and approaches not previously used by the MOH at the departmental level, such as Prokopack aspirators, BG traps, spatial placement for ovitraps, and cone bioassay testing for IRS residual effect. Throughout 2018, ZAP also made it a priority to decentralize entomological training opportunities to the departmental level. This introduced the MOH entomology staff to new tools and refreshed their knowledge and skills on entomology techniques and procedures. Additional training details are provided in Annex 5.
An important element of ZAP’s ongoing capacity strengthening of the MOH is its collaborative approach to supervision of ZAP teams. MOH staff are seconded to the project, to supervise routine field vector control and entomology teams. This offers hands-on skills building for MOH supervisors at the departmental level, and will leave a team of MOH staff ready to supervise and manage such work after ZAP ends. In 2018, ZAP continued to develop new, improved supervision tools and approaches, which will remain with the departmental vector control team at the MOH once ZAP ends. 3.2 GOVERNMENT ENGAGEMENT As above sections of this report have noted, ZAP Guatemala works closely with government counterparts in all of its efforts. In 2018, the following areas of collaboration were prioritized: Early in 2018, ZAP presented its proposed interventions to the national coordinator of vector control so they could discuss and jointly agree on ZAP’s overall work plan and scope. These coordination meetings, and subsequent decisions by the central-level MOH Vector Control Program unit, resulted in a coordinated approach, which was then cascaded down to departmental levels. Several instances of specific collaboration include the MOH’s provision of facility space as ZAP operations centers for the 2018 IRS campaign and other activities. ZAP Guatemala also made an effort to elevate the visibility of MOH engagement in ZAP efforts to ensure that beneficiaries in the communities saw the MOH actively engaged. Annex 7 provides additional examples of ZAP collaboration with stakeholders and other partners. 3.3 INNOVATIONS In 2018, ZAP Guatemala implemented several new innovations to enhance and improve the effectiveness of its interventions. Examples include:
M&E: As mentioned above, in 2018, ZAP continued improvements to its M&E system to improve the availability of high-quality and timely data to support decisions. This system has capitalized on low-cost information technology tools and was designed to provide project managers (and health authorities) with real-time access to vector control and entomology information. By exploring new and more efficient methods, ZAP M&E approaches support rapid data visualizations to support decision making.
17 BCC: In 2018, ZAP responded to the population’s relatively low risk perception of Zika, discovered during community meetings and social mobilization activities. To address this, ZAP explored alternative communication strategies to reach and inform communities. It opted to use entertainment methodologies to reach adults and children with simple, clear, and easy-to-recall messages. It was particularly interesting to test the strategy using children as “agents” for behavior change at their homes; ZAP designed and implemented puppet shows, songs, board games and dances for use at schools with information on the mosquito lifecycle and how to prevent breeding sites. ZAP participated in health fairs with a booth with magnifying glasses, ovitraps, and trays with larva, pupae, and adults, which allowed the audience to learn about the mosquito cycle and breeding sites at home. 3.4 INTEGRATION OF CROSS-CUTTING ISSUES
3.4.1 GENDER EQUALITY AND FEMALE EMPOWERMENT In 2018, ZAP made deliberate efforts to expand the number of women hired as seasonal workers. The number of women trained and participating in ZAP larvicide intervention increased from 31 in 2017 to 198 in 2018, the latter representing 50.3 percent of all 2018 vector control staff (larviciding and IRS). Among these new female staff, 11 were hired to fill supervisory positions. Similarly, ZAP hired and trained 33 women for its entomology team, bringing the proportion of female ZAP entomology staff to nearly 40 percent. In 2018, ZAP provided gender training to 182 participants (83 women and 99 men), and provided continual guidance on how to prevent and manage potential gender violence and/or sexual harassment situations, including mixed gender teams to reduce risks in selected neighborhoods.
18 4. LEARNING
4.1 CHALLENGES AND LESSONS LEARNED The following section outlines some of the challenges and lessons learned from 2018.
Vector Control and Community Engagement Low risk perception: ZAP found that its targeted populations have a low risk perception for Zika, which generated the need for additional efforts on the BCC components and vector control field interventions. Public health impact: ZAP teams continued to encounter closed households during vector control visits; approximately 17 percent of visited households are not treated each month because the homeowners are not at home when a team arrives. ZAP Guatemala attempted to revisit the closed homes at different hours and discussed the challenge of abandoned houses with local authorities with limited improvement. In addition to being an implementation challenge for the project, this also limits the overall coverage of communities. Also, inconsistent availability of water in some intervention areas forces households to collect and store water in multiple, often open containers and elevates the importance and complexity of the vector control intervention. The residents provided their phone numbers so that technicians could schedule visits and to help contact those that were not at home at the time of the visit. Field-level coordination works: In Camotan and Jocotan (Chiquimula Department), ZAP worked closely with the Guatemalan Red Cross’s ZICORE project. This collaboration allowed ZAP to focus on the household larviciding intervention while the Red Cross focused on environmental clean-up and elimination of mosquito breeding sites, thus enhancing the impact of both ZAP and ZICORE. BCC: ZAP made significant efforts to strengthen the BCC approaches aimed at increasing Zika awareness – including overall awareness of Zika as a health risk and understanding how mosquitoes transmit Zika and other arboviruses – and mobilizing community support/involvement. As mentioned earlier, new educational entertainment interventions for low-literacy audiences were developed in collaboration with PROEDUSA, who plans to use them after ZAP ends. ZAP also collaborated with ZICORE in the 8 communities in which the two projects overlapped and worked with Breakthrough Action on the development of shared BCC materials. Entomological Surveillance Insecticide resistance testing for Aedes: The MOH has not conducted insecticide resistance testing for Aedes in Guatemala in recent years. To address this gap and to build local capacity, in 2018 ZAP collaborated with the Universidad del Valle to conduct susceptibility testing of selected insecticides. ZAP has helped strengthen MOH entomology capacity through lab strengthening and training of entomology staff who will be able to continue conducting resistance testing after ZAP ends. Entomological surveillance at household level: ZAP Guatemala faced an interesting challenge in 2018 related to the households designated as control sites for entomological surveillance. After several weeks, these households complained about serving as a long-term surveillance site without intervention. As a result, ZAP developed plans to rotate its entomological surveillance sites, although doing so made comparison difficult. Since the MOH is unlikely to have the resources to conduct entomological surveillance with the same frequency as ZAP Guatemala, it is recommended that they implement periodic testing, however using the same tested methodology as ZAP. Inclusion of commercial locations for entomological surveillance: The IRS data showed that the commercial shops and business should be included in regular surveillance, as opposed of only
19 households, as these commercial areas have an important contribution when it comes to sustaining populations of adult Aedes mosquitoes. Monitoring and Evaluation Strengthening systems for timely data: ZAP Guatemala greatly benefitted from the use of technology-based M&E systems that allowed the technical team to analyze data and make timely programmatic adaptations to improve the effectiveness of field interventions.
5. SUSTAINABILITY AND EXIT STRATEGY
ZAP was not originally designed to promote sustainability – it was intended to be an emergency response, implementing field interventions that could quickly reduce the threat that Zika posed to public health. However, over the life of the project, ZAP has increased its efforts to transform the MOH’s vector control strategy at the departmental level, introducing procedures and methodologies that will remain with the MOH staff. In fact, the MOH is already adapting and implementing methodologies used by ZAP, as the following examples show:
Larvicide Intervention: The Chiquimula Health Area is piloting, independently from ZAP, a scaled- down version of the ZAP model in Chiquimula City.
ZAP BCC Methodologies and PROEDUSA: The MOH’s PROEDUSA department has participated in the design, validation, and approval of ZAP’s BCC tools and has clearly indicated its intention to continue using the ZAP approach and material once ZAP ends. Furthermore, PROEDUSA also has indicated its intention to use adapt the materials to the MOH malaria program. Additionally, PROEDUSA is interested in implementing the ZAP methodologies to integrate community leadership and other community stakeholders (police, private sector) to support vector control interventions.
Entomology and Insectary: ZAP has benefited from MOH staff seconded as full-time entomology supervisors on ZAP teams. The MOH staff have received theoretical and hands-on training on newly introduced entomological techniques and procedures and will be ready to continue ZAP entomological activities at the insectary that ZAP will support in Chiquimula in 2019. Further, a proposed insectary will receive equipment and supplies and will function as the first regional insectary for the MOH in Guatemala’s eastern region.
M&E: At this time, all MOH staff participating as ZAP supervisors are proficient in the use of the M&E system ZAP developed for vector control and entomology. At its end, ZAP will transfer all data sets, equipment, and analytic tools to the MOH, which will allow the ministry to continue collecting, analyzing, and using data for making vector control decisions in Chiquimula, El Progreso, and Zacapa. The ministry also will be able to compare old and new data to measure progress and make further decisions.
20 ANNEX 1A. MONITORING AND EVALUATION: ZIKA FRAMEWORK
Indicator INDICATOR FY 2017 FY 2018 Cumulative results Number to date Year Q1 Q2 Q3 Q4 End 1a Percent (%) of communities where physical vector 59% 87% 96% 96% 100% 100% control activities are being implemented 1b Percent (%) of communities in which vector 100% 75% 100% 100% 100% 100% monitoring activities are being implemented 1c Number of people trained in vector control 85 79 77 35 21 301 1d Percent (%) change in mosquito egg density, from N/A 39.3% 5.6% -48.8% 13.7% baseline, in targeted geographic areas (Baseline- Current/Baseline)% 1e % change in mosquito frequency, from baseline, in N/A 58.2% 59.8% 20.0% 37.3% targeted geographic areas
5a # communities with members actively participating in 13 20 22 27 30 30 Zika monitoring, prevention, and/or support activities
Additional information Definition of community in the country: Municipality is the definition for Community in Guatemala, Guatemala has departments and municipalities. Approximate number of people in each community (i.e. municipality/ region): Average 9,000 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
21 ANNEX 1B. MONITORING AND EVALUATION: ZAP M&E PLAN (MEP)
Data Source(s) Performance Year 1: Results Year 2: Results and Reporting Disaggregate Indicator Frequency (October 26 - December 21, 2017) (January 1 2018- December 31 2018)
Component 1: Implement safe and high-quality vector control (VC) programs and provide operational management support 1.1.1 Percentage Data source: Total (All reduction of Vector Control Department/ region/ 63% 75.25% breeding sites technician data municipality testing positive collection form combined) for pupae in Chiquimula 74.79% permanent Reporting By Department/ Camotán 75.80% water sources frequency: region/ municipality Chiquimula_mun 74.81% Monthly ConcepciónlasMinas 90.00% Esquipulas 90.17% Ipala 81.56% Jocotán 74.86% Olopa 62.73% Quezaltepeque 64.75% San Jacinto 59.92% San José la Aranda 73.22% San Juan Ermita 74.74%
Zacapa 70.70% Cabañas 68.10% Estanzuela 80.28%
22 Huité 72.61% Rio Hondo 74.84% San Jorge 68.67% Teculután 55.42% Usumatlán 74.97%
El Progreso 88.56% El Jícaro 61.58% SanAntonioLaPaz 98.92% Sanarate 95.12% Sansare 98.61% 1.1.2 Number of Data source: Total (All 98,420 285,261 people residing Vector Control Department/ region/ in households technician data municipality visited by vector collection form combined) control By Gender Male 49,906 145,206 technicians Reporting frequency: By Gender Female 48,514 140,055 Annually By Pregnant 1,488 3,553 Women By Women of 32,894 91,784 Reproductive Age
By Children <5 10,873 30,146
1.1.3 Number Data source: Total (All 26.82% 44.99% and percentage Vector Control Department/ region/ of households technician data municipality receiving one collection form combined) vector control visit per Collection intervention frequency: cycle1 Monthly Quarterly
1The “intervention cycle” is defined as the frequency with which one household is visited. Typically for vector control activities this is once per month
23 By Department/ Chiquimula 7,614 (26.82%) Chiquimula 13,899 (32.32%) region/ municipality Camotán 1,642(77.60%) Camotán 934 (31.51%) Chiquimula_mun 103(0.82%) Chiquimula_mun 1,967(14.16%) Concepción las minas 1,270 (52.87%) Concepción las Minas 995 (37.95%) Esquipulas 2,131(37.73%) Esquipulas 2,861(41.35%) Jocotán 24 (2.17%) Ipala 547 (34.02%) Olopa 403(55.13%) Jocotán 1,483(59.06%) Quetzaltepeque 1,460(60.11%) Olopa 464(59.95%) San Jacinto 581 (40.54%) Quetzaltepeque 1,269 (42.30%) SanJacinto 1,025(57.46%) San José la Arada 967 (38.70%) San Juan Ermita 387 (25.85%)
Zacapa 17,326 (74.58%) Cabañas 2,293(94.60%) Estanzuela 3,548(94.74%) Huité 2,040 (79.56%) RioHondo 5,184(91.49%) San Jorge 1,247 (52.88%) Teculután 827 (22.47%) Usumatlán 2,187(78.27%)
El Progreso 8,093 (38.26%) ElJícaro 1,136(43.41%) San Antonio la Paz 2,046 (60.53%) Sanarate 3,540 (28.42%) Sansare 1,371 (50.70%)
Data Source(s) Target 2017 Accomplished 2017 Target 2018 Accomplished 2018 Performance and Reporting Disaggregate Indicator Frequency
24 1.2.1 Number of Data source: By Spray Campaign 12,000 10,947 6,375 5,500 structures targeted Previous spray (5,100 x 1.25) (4,400 x 1.25) for spraying3 campaign data, enumeration data (targets); Daily Spray Operator Forms (results)
Reporting frequency: Daily per spray campaign 1.2.2 Number of Data source: By Spray Campaign 12,000 10,947 6,375 5,500 structures sprayed Daily Spray (5,100 x 1.25) (4,400 x 1.25) with IRS3 Operator Forms
Reporting frequency: Daily per spray campaign 1.2.3 Percentage Data source: By Spray Campaign 100% 89% 100% 66% of total structures Daily Spray targeted for Operator Forms spraying that was sprayed with a Reporting residual insecticide frequency: Daily (Spray Coverage) 3 per spray campaign 1.2.4 Number of Data source: By Spray Campaign N/D 30,010 N/D 14,026 people residing in Daily Spray structures sprayed Operator Forms (Number of people By Gender Male N/D 14,778 N/D 7,171 protected by IRS) 3 Reporting frequency: Daily By Gender Female N/D 15,232 N/D 6,876
25 per spray By Pregnant N/D 226 N/D 110 campaign Women
Women of N/D N/D 3,763 Reproductive Age By children <5 years N/D 3,272 N/D 1,181 old 1.2.5 Number and Data source: By Spray Campaign 1, 100% 1, 100% percentage of soak Project records – By Soak Pit pits and Reports By Storehouse storehouses submitted by inspected and district approved prior to environmental spraying3 officers
Reporting frequency: Each spray season
Component 2: Contribute to the collection and analysis of Routine entomological data 2.1 Number of Data source: N/A 54 clusters for IRS 54 clusters for IRS 5 clusters in 3 5 entomological Entomological and 3 sentinel sites and 2 sentinel sites sentinel sites (Chiquimula control and sentinel sites reports and ZAP intervention, Guastatoya, supported by ZAP country work plan Zacapa,Teculutan) Guatemala monitoring species Reporting composition frequency: Annually 2.2 Number of Data source: N/A 3 2 5 clusters in 3 5 entomological Entomological sentinel sites (Chiquimula control and sentinel sites reports intervention, Guastatoya, supported by ZAP Zacapa,Teculutan) Guatemala monitoring egg density, larval
26 density, and pupal Reporting density frequency: Annually
2.3 Number of Data source: N/A 54 clusters for IRS 54 clusters for IRS 2 clusters in 2 2 entomological Entomological sentinel sites (Teculuan and Zacapa) sentinel sites reports supported by ZAP Guatemala Reporting established to frequency: monitor adult Annually density 2.4 Number and Data source: N/A 54 clusters for IRS 54 clusters for IRS 5 clusters in 3 5 percentage of Entomological and 3 sentinel sites and 2 sentinel sites sentinel sites (Chiquimula control and entomology reports intervention, Guastatoya, monitoring Zacapa,Teculutan)) sentinel sites Reporting measuring all frequency: seven Annually entomological indicators 2.5 Number and Data source: N/A 3 6 sentinel sites were 3 3 sentinel sites were percentage of Entomological included for all consistently included for all sentinel sites reports insecticide testing insecticide testing (El that tested at (five from El Progreso Progreso, Zacapa, and one from least one Reporting Chiquimula) Chiquimula) Additional sites were for insecticide from frequency: Annually Additional sites were specific tests. each of the three considered for specific classes of tests. insecticides recommended for vector control
27 2.6 Number and Data source: N/A 3 sites (2 from El 3 3 sentinel sites were percentage of Entomological 3 Progreso and 1 from consistently included for all sentinel sites that reports Chiquimula); insecticide testing (El tested at least one percentages of Progreso, Zacapa, larvicide from Reporting mortality were Chiquimula) each of the three2 frequency: variable classes of Annually larvicides recommended for vector control 2.7 Number and Data source: By Spray Campaign 44 households 24 hours post IRS (58 30 households 24 hours post IRS (53 HH= percent of homes Entomological (HHs) HH= 100%) (HHs) 100%) receiving wall reports 1 month post IRS (44 1 month post IRS (47 HH= bioassays HH= 100%) 100%) conducted after Reporting 2 months post IRS (39 2 months post IRS (44 HH= the completion of frequency: HH= 88.64%) 100%) spraying at Monthly 3 months post IRS (25 3 months post IRS (42 HH= monthly intervals HH=56.82%) 100%) to evaluate (42 HH= 100% insecticide decay3 percentages were received continuous wall variable bioassays) Component 3: Capacity Building and Human Resources
3.1 Number of Data source: By Campaign N/D 165 N/D 152 people trained to Project records – 3 deliver IRS in Training reports By Gender Male N/D 131 N/D 90 target departments Reporting By Gender Female N/D 34 N/D 62 frequency: Annually Percentage of N/D 26% N/D 40% Women Trained
2 These three classes include: organophosphates, insect growth regulators, and biopesticides 3 Only for countries implementing IRS
28 3.2 Total number Data source: Total (All 156 157 168 197 of people trained Project records – Department/ to conduct vector Training reports region/ municipality control in target combined) departments Reporting By Gender Male N/D 122 N/D 121 frequency: Annually By Gender Female N/D 35 N/D 76
By Type of Vector Larviciding Larviciding Larviciding Larviciding Control Activity 4 79 trainees 77 persons 90 trainees 116 persons 68 technicians 113 persons (38 male, 30 female) (72 male, 41 female) 9 technicians from 3 technicians from MoH (3 MoH (9 male) male)
IRS IRS IRS IRS 86 89 78 84 (84 male, 5 female) (49 male, 35 Female) 10 technicians from 12 technicians from MoH MoH (10 male) (12 male) 3.3 Total number Data source: By Year N/D Total 114 persons N/D Total 78 persons of people trained Project records – 5 technicians from 9 Trainers to conduct Training reports MoH for susceptibility 45 for ento surveillance for Entomological tests IRS Surveillance in Reporting 56 for ento 15 for ento surveillance for target frequency: Semi- surveillance for IRS larviciding departments annually 5 technicians for 9 from MoH for (sentinel sites) residuality tests susceptibility and residuality 10 technicians for tests laboratory 4 technicians for insectary 34 technicians for ento surveillance for larviciding By Gender Male N/D 70/114 N/D 45/78
29 By Gender Female N/D 44/114 N/D 33/78
By Position4 N/D 5 N/D 9 Trainers/supervisors technicians/supervisor 60 field and lab technicians s from MoH 9 technicians and 109 technicians for supervisors from MoH field and lab for ento surveillance By Department/ 80 from El Progreso 58 from Zacapa region/ municipality 34 from Chiquimula 15 from El Progreso 5 from Chiquimula 3.4 Number and Data source: Total (All percentage of Project records – Department/ women hired in Contracts signed region/ municipality supervisory roles combined) 3 8 in non-IRS target Reporting departments frequency: Annually By Department/ 4 region/ municipality Chiquimula Chiquimula 3 1 El Progreso 3 Zacapa
3.5 Number and Data source: Total (All percentage of Project records – Department/ women hired in region/ municipality Contracts signed 1 3 supervisory roles combined) in IRS target Reporting 5 departments frequency: Annually By Department/ region/ municipality El Progreso 1 Zacapa 3
4 This includes entomological team leaders and entomological technicians 5 For countries implementing IRS
30 ZAP Guatemala Summary of M&E Records Collected in 2018 Intervention Area Tool Name Records Collected (Data Points) IRS Vector ONA Control of FICAM 19 Control IRS 9,267 Entomological Larvae and Pupae 5,302 Monitoring Identification of Pupae 608 Identification of Larvae 306 Cones 188 Monitoring of Technicians with GPS 18,056 Android development Entomological Monitoring 380 MySQL Platform Entomological Monitoring Laboratory 38,772 Larvicide Vector Kobo Collect Larvicide Chiquimula 421,350 Control Larvicide Zacapa 187,636 Larvicide El Progreso 80,484 Entomological Ovitrap 28,091 Monitoring Larvae and Pupae 17,440 Identify Species 2,573 Record of Eggs 17,329 TOTAL OF RECORDS: 827,801
31 ANNEX 2. ENVIRONMENTAL MITIGATION AND MANAGEMENT REPORT
Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
1a. Pre-contract inspection and 2 vehicles were inspected and approved on No outstanding issues relating to One bus rented for the transport of certification of vehicles used for 06/11/2018. required conditions. the Spray Operators (SOs), and one pesticide or spray team transport. truck rented to transport the pumps. 1b. Driver training Drivers were trained on 06/11/2018. Training No outstanding issues relating to included: good driving practices, PPE, required conditions. decontamination procedures, and symptoms of insecticide exposure. 1c. Cell phone, personal protective All drivers had a cell phone, personal No outstanding issues relating to equipment (PPE) and spill kits on protective equipment, first aid kit, fire required conditions. board during pesticide extinguisher. One spill kit was in the pumps transportation. truck and another one in the ECO´s car for supervision 1d. pregnancy testing for female 15 female operators of the project did their No outstanding issues relating to candidates for jobs with potential pregnancy test on 06/11/2018. All tested required conditions. pesticide contact. negative. 1e. Health fitness testing for all All the team members did their medical No outstanding issues relating to operators evaluation before the campaign. required conditions. The evaluations were made on 06/11/2018 and include: 1. Personal and family background: diabetes, hypertension, disability, tuberculosis, nephropathy, malnutrition, mental illness, STI/HIV /AIDS.
32 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
2. physical examination: Cough or shortness of breath. Ear and throat Oral health Diarrhea Fever Skin ITS Nutritional supplementation Warning Signs in Diabetes Warning signs in Hypertension / Heart Failure Warning signs for the early diagnosis of Cancer 1f. Procurement of, distribution to, 51 team members were trained on 06/08/2017 No outstanding issues relating to and training on the use of PPE for all on the best practices using the insecticide, the required conditions. workers with potential pesticide importance, and use of PPE, symptoms of contact. insecticide exposure, how to reach emergency contacts, and the best steps to take after exposure was identified. 1g. Training on mixing pesticides and The sprayers were trained on mixing the Problems with the pumps, such as the proper use and maintenance of insecticide and avoiding spills on soil or in the leaks and deterioration of some parts spray pumps. environment. They were provided with plastic were reported to the pumps keeper sheets to place the pumps on the ground, and for repair. plastic bags to keep insecticide empty sachets. Training included pumps care. 1h. Provision of adequate facilities Every day the facilities for the end of day clean- No outstanding issues relating to The ECO inspected the facility to and supplies for end-of-day clean-up, up were inspected to ensure adequate required conditions. guarantee that all supplies were suppliers for available for end-of-day clean-up. available for end-of-day clean-up The washing area had 3 stations for the procedures. progressive rinse of the pumps and one extra barrel to clean their PPE. The area had one station to clean the nozzles and drying helmets.
33 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
1i. Enforce clean-up procedures. Every day the procedures of the end of day All non-compliance issues, such as The washing system was a success. clean up were supervised by the ECO and two entering the wash area without a face supervisors and reinforced as it was needed. shield, were immediately corrected. 2a. IEC campaigns to inform The actions done by the information, education No outstanding issues relating to homeowners of responsibilities and and communication (IEC) team were: required conditions. precautions. Meetings with the Governor, Health Area Director, Major, local leaders (COCODEs), Education Authorities, communication media to inform about the project and the responsibilities and precautions to be taken. Tours with loudspeakers in the afternoon one day before spraying and two hours before the spraying Two songs were written by Iris Burgos (VC Departmental Coordinator in Chiquimula) and were recorded using two well-known tracks (the songs used in the last campaign were used as well). One video was made with the instructions to follow and was transmitted by private cable channels and social networks. One video was made by the municipality. Flyers were handed to the owners by the SOs to reinforce the information about the steps before spraying and the precautions and steps after spraying. One poster about shared responsibility between ZAP project and owners. Community assemblies in the afternoon to reinforce information with residents. 2b. Prohibition of spraying houses In many cases, the houses were not prepared After an evaluation by the supervisor, that are not properly prepared. and had to be evaluated to see if it was possible ECO, and VC manager houses were to spray. In most of the cases, the mobilizers not sprayed if rooms had small had to prepare the houses before spray, spaces with furniture impossible to
34 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
sometimes supported by supervisors, move, rooms which did not have departmental coordinators, VC Assistant, ECO, closed windows or doors, or when and VC manager. the houses did not have full walls dividing other rooms from the kitchen, 2c. Two-hour exclusion from house The owners were informed to wait two hours No outstanding issues relating to after spraying. before entering the home after the spray and required conditions. about the steps to follow to avoid insecticide exposure. The SOs handed to every owner one flyer to reinforce the information. 2d. Instruct homeowners to wash The owners were instructed to wash itchy skin No outstanding issues relating to itchy skin and go to health clinic if and to visit health clinic if exposure symptoms required conditions. symptoms do not subside. do not subside. 3a. Indoor spraying only. The instruction for the SOs was the prohibition No outstanding issues relating to of spray outside the houses, even if the owners required conditions. ask for that. SOs only sprayed inside of the house. 3b. Training on proper spray The SOs were trained and supervised daily on No outstanding issues relating to technique the proper spray technique. This supervision required conditions. was done by the VC assistant, Departmental Coordinators, VC manager, and Supervisors. 3c. Maintenance of pumps The pumps were maintained as needed and The pump keeper checked for spills, reviewed every day when the SOs handed nozzle not in good condition, or them to the pump keeper. when parts needed to be lubricated 4a. Choose sites for disposal of liquid The liquid wastes were disposed into one fixed No outstanding issues relating to wastes according to PMI BMPs. soak pit according to PMI BMPs. The leftover required conditions. pesticide and rinse-water in barrels 1, 3, 5, and 7 were used to fill spray tanks for the next day of operations. The rinse-water of the uniforms cleaning was disposed on the soak pit and all the water that could have contact with the insecticide.
35 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
4b. Construct soak pits with charcoal The soak pit was constructed according to PMI No outstanding issues relating to to adsorb pesticide from rinse water. BMPs inside the washing area. required conditions.
4c. Maintain soak pits as necessary The soak pit was inspected two times during No outstanding issues relating to The source of water and waste during the season. the campaign to ensure all the filtrating required conditions. water entering the soak pit during materials were in place. the campaign were season rains and the rinse water used for the uniforms cleaning. 4d. Inspection and certification of In the case of the ordinary waste, it was No outstanding issues relating to solid waste disposal sites before spray disposed of in the municipal landfill of Zacapa. required conditions. campaign. The PET bottles used for supply with water to the SO´s during the spraying were sent to a recycling center in Teculután. The empty insecticide sachets, masks and sawdust were collected and sent to ABC Biofert, a certified company by the Ministry of Health and Ministry of Environment, for incineration, according to the PMI BMP recommendations. 4e. Monitoring waste storage and Weekly supervision included the Storekeeper No outstanding issues relating to management during campaign. Operation Checklist to verify: required conditions.
The barrels or containers for the empty sachets and the used masks were available and clearly labeled; The used sachets are counted and stored carefully in labeled containers; and The number of empty bags is equal to what the storekeeper indicates as the number of shares issued to date. 4f. Monitoring disposal procedures The post-spray environmental compliance No outstanding issues relating to post-campaign. inspections took place between 9 and 11 July required conditions. 2017. All sites have been well cleaned and closed according to PMI BMP standards.
36 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
The leftover insecticide was resting for 4 days for its decomposition and subsequent disposal in the soaking pit. The solid waste was disposed of as described in the section 4.d. 5a. Maintain records of all pesticide All the records of receipts, issuance, and return No outstanding issues relating to receipts, issuance, and return of of empty and full sachets were maintained and required conditions. empty sachets/bottles. are available at Abt office in Guatemala City. 5b. Reconciliation of the number of From the last campaign in 2017 ZAP Guatemala No outstanding issues relating to houses sprayed vs. number of stored 4459 unused sachets that expired in required conditions. sachets/bottles used. June 2018. ZAP asked Bayer to make validation of the lot of FICAM and the results showed that the insecticide is effective until November 2019. In the campaign 2018, each SOP sprayed an average of 7.4 structures per day, using an average of 1.9 bendiocarb sachets per structure and sprayed a total of 140 structures over a 19 day campaign period. 5c. Visual examination of houses Visual examination of houses sprayed to No outstanding issues relating to sprayed to confirm pesticide confirm pesticide application was done during required conditions. application. daily supervision and accompaniment of all groups by the supervisors, Departmental Coordinators, VC manager, VC Assistant, and the ECO. 5d. Perform physical inventory counts All physical inventory was performed during No outstanding issues relating to during the spray season. and in the post-campaign activities. required conditions. Research and Development The manuals for resistance and susceptibility No outstanding issues relating to ZAP GT has internal SOPs for the Implement laboratory tests have been shared by the ZAP Regional required conditions. entomology laboratory. environmental, health, and safety entomologist for use in local insectaries and (EHS) manuals with standard laboratoires. The environmental compliance plan operating procedures (SOPs), or is a standard operating procedure use existing SOPs, for laboratory An environmental compliance plan was which is being implemented operations in accordance with elaborated, which details the following currently. procedures:
37 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
country-specific compliance A. Proper administration of storage No outstanding issues relating mechanisms. areas to required conditions. Compliance with the established B. Proper management of solid wastes requirements Implement SOPs for the safe Field security storage, transport, and use of equipment, chemical reagents, No outstanding issues relating pesticides, and supplies in New vector control technicians were trained in to required conditions. conformance with international 2018 on the standard operating procedures for best practices (e.g., WHO, FAO) properly handling and disposing of waste. The and host country requirements. training included the triple washing of Bti bottles and proper disposal. Provide training to workers on the approved SOPs or Waste Management Plan (WMP) developed for properly handling and disposing of wastes (i.e. waste generated from insecticide resistance testing). Small-Scale Construction Not applicable Not applicable. Not applicable.
1. Ensure construction activities are in conformance with international best practices and host country laws and regulations. Refer to the “Small- Scale Construction” chapter of the USAID Sector Environmental Guidelines (www.usaidgems.org/sectorGuideline s.htm) 2. Ensure contracted company Not Applicable Not Applicable Not Applicable complies with international best practices and host country laws/regulations.
If a contractor or contracting company was not hired: Implement WMP, or equivalent SOPs, for properly disposing of construction waste. Follow international best management
38 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
practices and host country laws and 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 ZAP selected Bacillus thuringiensis israelensis (Bti) No outstanding issues relating to Compliance with the established Campaigns: as the larvicide, this product is biologic and required conditions. requirements 1. Health and Environmental approved in the PERSUAP. Impacts Larvicide selection for any USAID- Bti was imported complying with the supported Zika program is subject regulations established by “Ministerio de to the criteria listed in the Zika Agricultura,Ganadería y Alimentación” Programmatic PERSUAP and host Guatemala and MoH to be used in Vector country requirements. Control activities.
The storage facility complies with Bti's storage Procurement and inventory logs requirements, must be maintained. The amount distributed is determined by the Ensure storage facility and PPE are estimated larvicide usage rate for in a specific appropriate for the active area.
39 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
ingredient used and in accordance with approved SOPs. All technicians have been trained in the proper Distribute insecticides to facilities storage and handling of Bti. 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.
2. Occupational Risk The vehicles used to transport Bti where Inspect and certify vehicles used inspected by the ECO No outstanding issues relating to Compliance with the established for larvicide team transport prior required conditions. requirements to contract. Two driver were retrained in security Train drivers of certified vehicles guidelines in 2018, the main topic was field Provide cell phone and appropriate security. personal protective equipment (PPE) during larvicide Cell phones were provided to all technicians. transportation. The ZAP project field staff have been trained Procure, distribute, and train all and retrained in personal and occupational workers with potential larvicide security (508 technicians) contact on the use of PPE. The personal and occupational security training were focused to prevent dog bites, traffic accidents, occupational accidents, thefts, Ensure health and safety testing as threats, harassment, and sexual violence. First appropriate for the campaign aid training was done with the VC field team in larvicide (i.e. pregnancy testing if Chiquimula. Additional training have been not using Bti) done depending on the reinforcing necessities.
Train operators on mixing ZAP GT is using Bti as its larvicide. E-mail pesticides and the proper use and communication dated between June-July 2017 was received with two documents stating that
40 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
maintenance of application the type of Bti to be used was non-toxic and equipment. not hazardous during pregnancy (Safety Data Sheet and “Panfleto VectoBac”)
Enforce application and clean-up The hired staff are in good physical condition. procedures. Not applicable
3. Health and Safety Risk The IEC strategies include: No outstanding issues relating to Compliance with the established Implement Information, Education Family empowerment through monthly required conditions. requirements and Communication (IEC) campaigns household visits to inform homeowners of Public announcements promoting ZAP’s responsibilities and precautions activities including source reduction by Educational booklets with Zika and vector eliminating or covering standing control information are used by water. technicians to train families
4. Storage No outstanding issues relating to Compliance with the established Storage facilities and The storage facilities are physically secured to required conditions. requirements transportation vehicles must be prevent theft. The facility in Chiquimula was physically secured to prevent theft. located by the side of a court office building (that has permanent security) and it was provided with cameras and security 24/7, its door is secured with pins and padlocks. The storage facility in Guatemala city was located in in a warehouse park with alarm system and security 24/7
The vehicles are locked and parked at ZAP’s office which is in a secure location. Maintain records of all larvicide receipts, issuance, and return of The delivery of Bti bottles per technician were empty containers. recorded in the control and distribution cards of larvicide is. This same form is used when empty bottles were returned.
Each household where Bti is applied, is properly recorded as well as the number of Bti bottles used per technician.
41 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
Reconcile number of houses treated vs. number of containers Monitoring visits are done to households to used. verify the application of Bti.
Physical inventory is updated weekly. Examine houses treated to confirm application All technicians carry the larvicide in a backpack while working, at the end of the work day, they Perform physical inventory counts store it in their house in a secure location during the application season.
Technicians should store larvicide in a locked bag within a secure location. 5. Ecological Risk No outstanding issues relating to Train applicators on the Zika All technicians have been trained in required conditions. Programmatic PERSUAP environmental compliance plan: Storage operational requirements, SOPs, management procedures, solid waste PMI BMPs, and approved WMP, management plan and field safety. developed for the safe and effective storage, distribution, application, and disposal of insecticides VC techs wear short and long sleeve t-shirts and closed toed shoes during operations. Ensure application equipment and PPE are appropriate for the active We do not have specific equipment for Not Applicable ingredient used and in accordance larviciding, we use spoons so the technicians with approved SOPs, and maintain avoid direct contact with the larvicide and equipment. guarantee the larvicide’s exact amount is applied No application of larvicides within 30 yards of beekeeping sites VC techs do not operate near beekeeping sites 6. Environmental Risk No outstanding issues relating to Compliance with established Handling, treatment, and disposal The solid waste management plan has been required conditions. requirements of nonhazardous (general waste) written and is being implemented. and hazardous wastes must be in accordance with the approved The Association AGREQUIMA is the WMP/SOPs, in accordance with responsible of recycling empty Bti bottles
42 Outstanding issues relating to Mitigation Measure Status of Mitigation Measures Remarks required conditions
the PMI BMPs. The WMP, which outlines SOPs for managing waste The batteries were brought to Acumladores processes, must be in accordance España where they are recycled. with international best practices (i.e. WHO, FAO) and host country ZAP GT has established procedures for solid requirements waste management. In the storage facility, the office administrator keeps record of the empty Monitor waste storage and bottles that will be delivered to AGREQUIMA management during campaign for recycle.
Monitor disposal procedures post- AGREQUIMA supports the recycling of empty campaign bottles Through the empty packaging management program "Campo Limpio". 7. Disposal Wastes will only be disposed in The project does not generate hazardous Not Applicable Not Applicable incinerators that comply with PMI wastes, therefore incineration is not applicable BMPs and international standards (i.e. WHO and FAO guidelines). The waste boxes were dismantled and tied in Collect and maintain treatment bales and then transferred to the collection No outstanding issues relating to Compliance with the established and disposal documents and center located in Chiquimula where is sent to a required conditions requirements records on file recycling center in Guatemala City.
The USAID operating unit The cleaning train of Chiquimula performs the financing the activity must prepare collection and separation of the different types an amended SIEE pertaining to the of ordinary waste, and then be taken to specific site and circumstance as collection centers for recycling so that in the part of the decision to procure or ZAP office in Chiquimula had been placed manage incineration services. The dumps for each type of waste and facilitate the GH COR must approve the handling of them. amended SIEE with concurrence by the GH BEO prior to detailed In the case of the other ZAP offices, where the design, procurement, or operation. Municipalities don´t have a system of ordinary For incinerators with capacities to waste separation for recycling, the waste was burn >100kg of waste per hour, this collected by the cleaning train and transported will result in a Positive to the municipal landfill. Determination and require a scoping study, and potentially, an Not Applicable EA.
43 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
Research and Development Implement laboratory environmental, health, The manuals for resistance and susceptibility tests No outstanding issues relating to required ZAP GT has internal and safety (EHS) manuals with standard have been shared by the ZAP Regional entomologist conditions. SOPs for the entomology operating procedures (SOPs), or use existing for use in local insectaries and laboratoires. laboratory. SOPs, for laboratory operations in accordance with country-specific compliance mechanisms. An environmental compliance plan was elaborated, No outstanding issues relating to required which details the following procedures: conditions. C. Proper administration of storage areas The environmental D. Proper management of solid wastes compliance plan is a Implement SOPs for the safe storage, Field security standard operating transport, and use of equipment, chemical procedure which is being reagents, pesticides, and supplies in implemented currently. conformance with international best practices New vector control technicians were trained in No outstanding issues relating to required (e.g., WHO, FAO) and host country 2018 on the standard operating procedures for conditions. requirements. properly handling and disposing of waste. The training included the triple washing of Bti bottles and proper disposal. Compliance with the established requirements Provide training to workers on the approved SOPs or Waste Management Plan (WMP) developed for properly handling and disposing of wastes (i.e. waste generated from insecticide resistance testing).
Small-Scale Construction Not applicable 1. Ensure construction activities are in Not applicable. conformance with international best practices Not applicable. and host country laws and regulations. Refer to the “Small-Scale Construction” chapter of the USAID Sector Environmental Guidelines (www.usaidgems.org/sectorGuidelines.htm)
44 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
2. Ensure contracted company complies with international best practices and host country Not Applicable laws/regulations.
If a contractor or contracting company was not hired: Implement WMP, or equivalent SOPs, for properly disposing of construction waste. Follow international best management practices and host country laws and 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.
45 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
Vector Control for Larviciding Campaigns: 3. Health and Environmental Impacts ZAP selected Bacillus thuringiensis israelensis (Bti) as Larvicide selection for any USAID-supported the larvicide, this product is biologic and approved in Zika program is subject to the criteria listed in the PERSUAP. the Zika Programmatic PERSUAP and host country requirements. Bti was imported complying with the regulations established by “Ministerio de Agricultura,Ganadería y Procurement and inventory logs must be Alimentación” Guatemala and MoH to be used in maintained. Vector Control activities.
Ensure storage facility and PPE are appropriate for the active ingredient used and in The storage facility complies with Bti's storage accordance with approved SOPs. requirements, No outstanding issues relating to Compliance with the required conditions. established requirements Distribute insecticides to facilities that can The amount distributed is determined by the manage such commodities safely in storage, estimated larvicide usage rate for in a specific area. use, and disposal (i.e. in a manner generally equivalent to Implementing Partner’s own SOPs/WMP). All technicians have been trained in the proper storage and handling of Bti. 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.
46 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
4. Occupational Risk Inspect and certify vehicles used for larvicide The vehicles used to transport Bti where inspected team transport prior to contract. by the ECO
Two driver were retrained in security guidelines in Train drivers of certified vehicles 2018, the main topic was field security.
Provide cell phone and appropriate personal protective equipment (PPE) during larvicide Cell phones were provided to all technicians. transportation.
The ZAP project field staff have been trained and Procure, distribute, and train all workers with retrained in personal and occupational security (508 potential larvicide contact on the use of PPE. technicians)
The personal and occupational security training Ensure health and safety testing as appropriate were focused to prevent dog bites, traffic accidents, No outstanding issues relating to required Compliance with the for the campaign larvicide (i.e. pregnancy occupational accidents, thefts, threats, harassment, conditions. established requirements testing if not using Bti) and sexual violence. First aid training was done with the VC field team in Chiquimula. Additional training have been done depending on the Train operators on mixing pesticides and the reinforcing necessities. proper use and maintenance of application equipment. ZAP GT is using Bti as its larvicide. E-mail Enforce application and clean-up procedures. communication dated between June-July 2017 was received with two documents stating that the type of Bti to be used was non-toxic and not hazardous during pregnancy (Safety Data Sheet and “Panfleto VectoBac”)
The hired staff are in good physical condition.
Not applicable
47 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
3. Health and Safety Risk
Implement Information, Education and The IEC strategies include: No outstanding issues relating to required Compliance with the Communication (IEC) campaigns to inform Family empowerment through monthly conditions. established requirements homeowners of responsibilities and precautions household visits including source reduction by eliminating or Public announcements promoting ZAP’s covering standing water. activities Educational booklets with Zika and vector control information are used by technicians to train families
48 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
4. Storage Storage facilities and transportation vehicles The storage facilities are physically secured to must be physically secured to prevent theft. prevent theft. The facility in Chiquimula was located by the side of a court office building (that has Maintain records of all larvicide receipts, permanent security) and it was provided with issuance, and return of empty containers. cameras and security 24/7, its door is secured with pins and padlocks. The storage facility in Guatemala Reconcile number of houses treated vs. city was located in in a warehouse park with alarm number of containers used. system and security 24/7
Examine houses treated to confirm application The vehicles are locked and parked at ZAP’s office which is in a secure location. Perform physical inventory counts during the No outstanding issues relating to required The delivery of Bti bottles per technician were application season. conditions. recorded in the control and distribution cards of Compliance with the larvicide is. This same form is used when empty Technicians should store larvicide in a locked established requirements bag within a secure location. bottles were returned. Each household where Bti is applied, is properly recorded as well as the number of Bti bottles used per technician.
Monitoring visits are done to households to verify the application of Bti.
Physical inventory is updated weekly.
All technicians carry the larvicide in a backpack while working, at the end of the work day, they store it in their house in a secure location
49 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
5. Ecological Risk Train applicators on the Zika Programmatic All technicians have been trained in environmental No outstanding issues relating to required PERSUAP operational requirements, SOPs, compliance plan: Storage management procedures, conditions. PMI BMPs, and approved WMP, developed for solid waste management plan and field safety. the safe and effective storage, distribution, application, and disposal of insecticides
Ensure application equipment and PPE are VC techs wear short and long sleeve t-shirts and No outstanding issues relating to required appropriate for the active ingredient used and closed toed shoes during operations. conditions. in accordance with approved SOPs, and maintain equipment. We do not have specific equipment for larviciding, we use spoons so the technicians avoid direct Not Applicable No application of larvicides within 30 yards of contact with the larvicide and guarantee the No outstanding issues relating to required beekeeping sites larvicide’s exact amount is applied conditions.
VC techs do not operate near beekeeping sites 6. Environmental Risk Compliance with Handling, treatment, and disposal of The solid waste management plan has been written No outstanding issues relating to required established requirements nonhazardous (general waste) and hazardous and is being implemented. conditions. wastes must be in accordance with the approved WMP/SOPs, in accordance with the The Association AGREQUIMA is the responsible of PMI BMPs. The WMP, which outlines SOPs for recycling empty Bti bottles managing waste processes, must be in accordance with international best practices The batteries were brought to Acumladores España (i.e. WHO, FAO) and host country where they are recycled. requirements ZAP GT has established procedures for solid waste management. In the storage facility, the office No outstanding issues relating to required administrator keeps record of the empty bottles conditions. Monitor waste storage and management that will be delivered to AGREQUIMA for recycle. during campaign AGREQUIMA supports the recycling of empty bottles Through the empty packaging management No outstanding issues relating to required program "Campo Limpio". conditions. Monitor disposal procedures post-campaign
50 Description of Mitigation Measures for these Outstanding Issues Relating to the activities as required in Section 2.6 of ZAP IRS 2 Status of Mitigation Measure Remarks Required Conditions Task Order Six
7. Disposal Wastes will only be disposed in incinerators The project does not generate hazardous wastes, Not Applicable Not Applicable that comply with PMI BMPs and international therefore incineration is not applicable standards (i.e. WHO and FAO guidelines).
The waste boxes were dismantled and tied in bales Collect and maintain treatment and disposal and then transferred to the collection center No outstanding issues relating to required Compliance with the documents and records on file located in Chiquimula where is sent to a recycling conditions established requirements center in Guatemala City.
The cleaning train of Chiquimula performs the The USAID operating unit financing the collection and separation of the different types of Not Applicable Not Applicable activity must prepare an amended SIEE ordinary waste, and then be taken to collection pertaining to the specific site and circumstance centers for recycling so that in the ZAP office in as part of the decision to procure or manage Chiquimula had been placed dumps for each type of incineration services. The GH COR must waste and facilitate the handling of them. approve the amended SIEE with concurrence by the GH BEO prior to detailed design, In the case of the other ZAP offices, where the procurement, or operation. For incinerators Municipalities don´t have a system of ordinary waste with capacities to burn >100kg of waste per separation for recycling, the waste was collected by hour, this will result in a Positive the cleaning train and transported to the municipal Determination and require a scoping study, landfill. and potentially, an EA. Not Applicable
51 ANNEX 3. SELECTED ENVIRONMENTAL COMPLIANCE RESOURCES
Poster designed to create awareness and response to Bendicoarb intoxication
52 Participation Certificate in the “Campo Limpio Program”
53 ANNEX 4. ZAP SECURITY RESOURCES
This Annex includes examples of safety and security resources that ZAP developed during the year. Action Guides for Emergency Attention
Emergency Numbers Cards
54 Security while visiting households
Dog Bite prevention
Advice to prevent assaults
Advice on how to handle sexual harassment risks
55 Occupational Accidents Prevention
Traffic Accidents Prevention
Security Booklet
56 ANNEX 5. TRAINING REPORT
ZAP Guatemala Training Summary: January to December 2018
Name and Description of Total Participants Total Women Total Men Training # Vector Control Larvicide (field operations, M&E, 208 83 125 BCC, ECO) MOH Supervisors for Larvicide 22 22 IRS (field operations, M&E, BCC, 152 62 90 ECO) (see table below) MOH Supervisors for IRS 12 12 Entomology Larvicide Ento Surveillance(field 15 8 7 implementation, M&E, BCC) IRS Ento surveillnace (field 54 25 29 implementation, M&E, BCC) Susceptibility and residuality 9 0 9 tests Community Engagement Community leader 128 Not recorded Not recorded Gender ZAP seasonal workers, talks, 170 75 95 pamphlets, ZAP staff 12 8 4 Safety and Security General safety and security 252 109 143 Use of vehicles 30 2 28 Dog bite 142 62 80 First aid 84 36 48
57 Staff trained for IRS 2018 campaign
s g s e g g n n r p n
i n t g i i o y o i n n t n n y n t O i n g i t i
i o r n e a S i o a n y t a a
l e i r t r r r a n m o a a & e T Categories of Persons r m e T r E T c
p
t s i p
g m Total y s T a c e a x ' t S
a o
Trained i O i t
c r e
o t : t n r a C r t e n y s n a i T u v a a n C D T i E c g I r n m O r B e i o p T S F D L S
SPRAY CAMPAIGN M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F M/F
1 Field Supervisors 12/0 12/0 12/0 12/0 12/0 12
2 Spray operators 26/8 26/8 26/8 26/8 26/8 34
3 Vector Control mobilizers 14/21 14/21 35 4 BCC Assistants 3/1 3/1 4
5 Data Assistants 0/1 0/1 0/1 0/1 1 6 Administrative Assistant 0/1 0/1 0/1 0/1 1 7 Store Assistants 2/2 2/2 2/2 4 8 Laundry Assistants 0/4 0/4 4 9 Drivers 2/0 2/0 2/0 2 10 Medical Assistants/ Prescribers 3/2 3/2 5 11 Guards 3/0 3/0 3 12 Practical Entomological training 36/33 36/33 36/33 36/33 69 Field Supervisors 13 (Entomological training) 5/0 5/0 5/0 5/0 5/0 5 63/3 TOTAL M/F 12/0 26/8 2/3 68/40 3/2 50/16 2/0 0/1 25/22 90/62 1 1 TOTAL/ training 34 94 5 108 5 66 2 1 47 152 2 152
58 ANNEX 6. BCC INTERVENTIONS IN 2018
Summary of ZAP BCC interventions implemented for both 2018 IRS campaign and larvicide interventions.
Coordination events with local counterparts: a. Institutions (intervention, allies, communication spaces) IRS Larvicide Total Health Centers 01 49 50 Communitarian Leaders (COCODES) 14 363 377 COMUDES 01 18 19 COMUSANES 0 01 1 Community 01 78 79 Partners 0 156 156 DAS 04 03 07 Local Government 01 01 02 Mass media 07 29 36 Municipality 01 106 107 Policeman 0 10 10 Education Sector 6 398 528 Private sector 02 0 02
Main BCC interventions: Interventions IRS Larvicide total Talks 02 151 202 Face to face communication n/a* 24 24 Group Communication 0 31 31 Mass Media communication 09 12 21 Coordination with local counterparts 08 148 156 Playful Learning 02 95 97 Scheduling coordination 03 247 250 Promotion 0 98 98 Awareness meetings 05 328 333 Free broadcast 08 12 12 Diffusion with loudspeaker 38 42 80 Communication skills for ZAP seasonal 35 180 215 workers
59 Production of Educational Material IRS Larvicide Total Printed Flyers: “Entomology”, “Hoy es el Día” and “5 pasos post 3 2 5 rociamiento”; Poster: “Acción Habitacional”; Bti Campaign and mosquitoes breeding sites; All can contribute to control the mosquito´s breeding sites in the cemeteries (November 1st) Roll ups 03 03 TV Video: “Más allá del Rociamiento” 1 0 1 TV spots “Invitame a tu Casa” (recorder and edition) 6 0 6 Radio Radio spots 2018 (edition IRS) 4 0 4 DVD (songs and spots for diffusion IRS) 01 0 01 Campaing spot´s “ Campaign "A daily task to control 0 07 07 transmitter mosquito of Zika" Entertainment Puppets sets ( life cycle of the mosquito)* 0 04 04 Piñatas ( life cycle of the mosquito) 0 04 04 07 songs (Zacapa –Ya llegaron los rociadores-,* Pican los 01 03 04 mosquitos, Huevitos*, La Larva Rapera*, Zancuda Ingrata*)
Topics IRS Larvicide total Presentation of the ZAP / USAID project to counterparts 15 194 209 (authorities, communities) BTI application 6 06 Campaign "A daily task to control transmitter mosquito of 04 Zika" 4 “We can interrupt the cycle of the mosquito” 52 52 Identification of mosquito breeding sites 119 119 Participation of the family and the community 03 19 19 Personal Security n/a 01 01 Clarification and answering doubts n/a 01 01 Others 0 21 21
60 COMMUNITY ADVOCACY MEETINGS JULY 24 - AUGUST 31, 2017
Decision Private COCODES MOH Media Total makers* Sector No. of Meetings 14 8 4 6 2 34 Total Number of 20 13 2 90 3 128 Attendees
* Decision makers include: City Major, Head of Police Department, headof the local MOH office, Zacapa Governor’s office
COMMUNITY EDUCATION/COORDINATION EVENTS Activity Total Institution Attendees Departmental Education Support to inform at schools about the 3 campaign Educational Supervision Principals meeting (urban area) 25 Juan Pablo II School “Dancing la rociadita” contest 30 Pedro Nufio School Parent meeting 20 Luterano School Director´s meetings (private schools) 32 School for Boy II Contest 20
SUMMARY OF ZAP GUATEMALA BCC MATERIALS 2018
Material produced Number Flyers: “Entomology”, “Hoy es el Día” and “5 pasos post rociamiento” 3 Poster: “Acción Habitacional” 1 Video: “Más allá del Rociamiento” 1 Radio spots 2017 (edition) 4 TV spots “Invitame a tu Casa” (recorder and edition) 6 USB distributed to COCODES president 4 DVD (songs and spots for diffusion) 100 News release 1
61 DIFFUSION AND COMMUNICATION FOR THE 2018 IRS CAMPAIGN
Media
Information meeting to Directed to the local media communicators to provide space to the media exchange suggestions and solve questions on the subject before to the campaign and to get a strategic alliance Media conference Multi-sector launch “Spraying Campaign” to the Zacapa central area.
Radio Advertising schedule 11 days in Station Radio Grupo Alius, Exa y Radio Novedad
Interviews 1 SOP and community mobilizer in Radio Station Brisa
2 Interviews with Zap communication specialist (Brisa and Caliente radio station)
Breaking news in Radio Station Novedad TV 2 hr report: Program Participants: Dr. Jaime Guerra, Health Area Director and Julio “Personajes, con Romero, CV ZAP/USAID Theme: “Más allá del Rociamiento” Nehemías Castro” Messages: Show the process before, during and after daily Spraying (Thursday from 6 to 8 (Julio Romero) pm) The benefit to Zacapa from the Spraying Campaign (Dr. Guerra) Advertising schedule Program: “Personajes (Thursday, June 21 and 28 from 6 to 8 pm, 6 spots every day) News: “Impacto Informativo” 21 a 22:30 hrs. (June 20, 22, 25, 27 and 29) Bonificación 25% (2 additional ads in advertising schedule)
Strategic Alliances
Telecom (local cable) Dissemination: 4 days Infomercial of 8.30 minutes of duration " Más allá del Rociamiento ", 3 times daily; The Telecom boss supported ZAP Project to get free spaces in other local radios
Sabrosita Company Unit mobile diffusion with a loudspeaker
Mobile loudspeaker Mobile loudspeaker worked 2 tours in each neighborhood
62 ANNEX 7. COLLABORATION
COLLABORATION WITH OTHER USAID OR USG ACTIVITIES
PASMO With USAID Mission support, PSI/PASMO implements a communication and behavior/change project which aims to strengthen the population’s knowledge about ZIKA risks during pregnancy. To this end, PSI/PASM has developed and implements a national media campaign. This campaign was launched in Guatemala City and later in each of the targeted regions. In three of these events, ZAP participated with an information booth which allowed media and attendants to identify the different phases of the Aedes mosquito.
MCDI: MCDI implements in Guatemala a USAID- funded community mobilization project aimed to reduce the risk for Zika (called ZICORE). In two municipalities in Chiquimula (Camotan and Jocotan), ZAP and ZICORE work in synergy to expand the impact of USAID’s Zika programming. In these two locations, ZAP implements the monthly home visit to apply Bti while ZICORE implements the community mobilization to reduce breeding sites through an environmental clean-up approach.
US Embassy: The US Embassy Department of Defense units based in Guatemala periodically organizes Health Fairs implemented in coordination with local Municipalities. ZAP was invited to participate by the USAID Mission, and organized informational booths with magnifying glasses and samples of pupae, larvae, and mosquitos for attendants to learn more about mosquitos and identify different ways that vector control helps to interrupt the mosquito lifecycle.
USAID Zika Consortium: The Zika consortium brings together 8 USAID-funded Zika- projects to monthly meetings were all projects share progress and information aiming for better coordination and synergy.
Collaboration and/or knowledge sharing with Partner Entities in Host Government and other Donor Agencies
National Vector Control Program: As stated earlier, all ZAP activities are first coordinated with the MOH through the VC National program office. Additionally, ZAP has sponsored field trips for MOH staff at the VC National Program office aiming to familiarize MOH staff with the VC models implemented by ZAP. In addition, in November 2018, ZAP supported the MOH Malaria Program by providing information about the BMP manual and background on incineration options.
Health Area VC Programs: ZAP has maintained constant and close coordination with the VC teams in each of the three departments where ZAP implements field activities. Point in fact, the supervisors for the larvicide model implemented
63 by ZAP are MOH VC staff seconded to the ZAP project 5 days a week. This way, ZAP complies with the normative aspects for VC and share project information.
PROEDUSA: The MOH implements a health communication program implemented by an internal Unit called PROEDUSA. ZAP has coordinated and provided technical assistance to PROEDUSA for the design, production, and dissemination of communication techniques to reduce the risk for ZIKA. Many of the material produced by ZAP has been adopted by the MOH.
In addition to the above examples, ZAP supported collaboration and coordination with the National Surveillance Laboratory in the MOH in Honduras. In October 2018, ZAP shared information on fixed and mobile soak pits, pump progressive rinse, container disposal and the BMP Manual.
64 ANNEX 8. AEDES INDICES FROM LARVICIDING CAMPAIGN IN 2018
House Index
Municipalities with low impact in the percentage of decrease in House Index 50 s e 45 u l a 40 v x e 35 d n
I 30 25 20 15 10 5 0 8 8 8 8 8 8 7 7 8 8 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 l t r r c c v v y g n b n p u c a p e e a o o a u e e u J J J O A F S D D A N N M M - t c O Time (Approx. 1-month per round of Bti application)
San Juan Ermita Cabañas Jocotán Usumatlán Quezaltepeque El Jícaro
65 Municipalities with medium impact in the percentage of decrease in House Index 60 s e u l
a 50 v
x e
d 40 n I
30
20
10
0 8 8 7 8 8 8 8 8 8 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 l r r t c c y v g n b n p u c a p e e a o a u e e u J J J O A F S D D A N M M Time (Approx. 1-month per round of Bti application)
Estanzuela Ipala San José la Arada San Jorge Chiquimula Camotán
Municipalities with high impact in the percentage of decrease in House Index
s 60 e u l a v 50 x e d
n 40 I
30
20
10
0 8 8 8 8 7 7 8 8 8 8 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 l t r r c c v y v g n b n p u c a p e e a o o a u e e u J J J O A F S D D A N N M M - t c O Time (Approx. 1-month per round of Bti application)
Concepción Olopa Sanarate San Jacinto San Antonio la Paz Esquipulas Sansare
66 Pupae Index
Municipalities with low impact in the percentage of decrease in Pupae Index
s 25 e u l a v x
e 20 d n I
15
10
5
0 Mar18 Apr18 May18 Jun18 Jul18 Aug18 Sep18 Oct18 Nov18 Dec18 Time (Approx. 1-month per round of Bti application)
San Juan Ermita Cabañas Usumatlán Estanzuela El Jícaro San José la Arada
Municipalities with medium impact in the percentage of decrease in
s Pupae Index e u l a 25 v x e d n
I 20
15
10
5
0 8 8 8 7 7 8 8 8 8 8 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 l r r t c c v y v g n b n p u c a p e e a o o a u e e u J J J O A F S D D A N N M M - t c O Time (Approx. 1-month per round of Bti application)
Concepción Quezaltepeque San Jorge Ipala San Jacinto Chiquimula
67 Municipalities with high impact in the percentage of decrease in Pupae Index
s 30 e u l a v 25 x e d n I 20
15
10
5
0 8 8 8 8 7 7 8 8 8 8 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 l t r r c c v y v g n b n p u c a p e e a o o a u e e u J J J O A F S D D A N N M M - t c O Time (Approx. 1-month per round of Bti application)
Jocotán Olopa Sanarate Esquipulas Camotán San Antonio la Paz Sansare
68