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Home , Burundi, Djibouti, Indoor residual spraying

ALGERIA PrivateCAPE VERDE Sector CENTRAL Opportunities AFRICAN COTE D’IVOIRE DJIBOUTIin Indoor Residual GABONSpraying GAMBIA IVORY MADAGAS- CAR MALIand Control in MOZAM- BIQUE West REPUBLIC OF CONGO SU- DAN SWAZILAND ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON VERDE CENTRAL AF- RICAN REPUBLIC CHAD COTE D’IVOIRE EGYPT ETHIOPIA GAMBIA GHANA GUINEA KENYA LESOTHO LIBERIA LIBYA MALAWI MAURITANIA MAURI- TIUS MOROCCO NAMIBIA NIGER NIGERIA REPUBLIC OF CONGO RWANDA SENEGAL SEYCHELLES SIERRA LEONE SOMA- LIA SOUTH AFRICA SWAZILAND TANZANIA TOGO TUNISIA UGANDA WESTERN SAHARA ZAMBIA ZIMBABWE ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHIOPIA GABON GAMBIA GHANA GUINEA IVORY COAST KENYA LESOTHO LIBERIA LIBYA MADAGASCAR MALAWI MALI A special thanks to our workshop co-hosts:

The West Africa Malaria Workshop was supported by:

About GBCHealth’s Corporate Alliance on Malaria in Africa (CAMA) The Corporate Alliance on Malaria in Africa (CAMA) is a coalition of companies from across industries and around the committed to decreasing the burden of malaria in Africa. CAMA brings the collective force and voice of the private sector to improve the impact of malaria control efforts in sub-Saharan Africa.

About GBCHealth GBCHealth represents private sector companies and top NGOs leading the business fight for improved global health. Through work that includes supporting community programs; leveraging core competencies; facilitating leadership and advocacy by business leaders; and brokering public-private partnerships, GBCHealth helps drive the achievement of global health goals. GBCHealth also manages the private sector delegation to the Global Fund to Fight AIDS, Tuberculosis and Malaria, serving as an entry-point for corporate col- laboration and engagement with the Fund and its recipients worldwide.

2 Private Sector Opportunities 2013 Table of Contents

Executive Summary & Recommendations...... 6

Workshop Overview and Objectives...... 8

Background: IRS in West Africa...... 9

How and Why Companies Should Implement an IRS Program...... 11

Models for Successful Partnerships...... 13

Addressing the Challenge of Resistance Management...... 15

Financing a Corporate IRS Program...... 18

Monitoring and Evaluating IRS Programs...... 20

IRS Research Updates...... 22

Country Sessions...... 23

Conclusion...... 25

Appendix I: Agenda...... 26

Appendix II: Workshop Participants...... 31

3 ACRONYMS & ABBREVIATIONS

AIRS africa Indoor Residual Spraying project anvr african Network on Resistance CAMa corporate Alliance on Malaria in Africa IRS indoor Residual Spraying ivcc innovative Vector Control Consortium IVM integrated Vector Management LLINs Long Lasting Insecticidal Nets M&e Monitoring and Evaluation MDGs Millennium Development Goals NMCP national Malaria Control Program PMi President’s Malaria Initiative RBM roll Back Malaria Warn West Africa Roll Back Malaria Network WHo World Health Organization WHO/AFRO World Health Organization Africa Regional Office

4 Private Sector Opportunities 2013 5 Summary & KEY Recommendations

Indoor residual spraying (IRS) is one of The event achieved the following results: the most effective malaria vector control • Promoted and increased private sector interventions and has played a key role engagement and investment in West in malaria elimination in around African workplace and community IRS the world. IRS remains a top priority and malaria control activities for controlling malaria in Africa. The private sector has initiated, funded and • Demonstrated the business case for IRS managed many successful IRS programs, and malaria control in West Africa most frequently led by the extractive • Highlighted best-in-class company IRS and agricultural industries and often programs in partnership with National Malaria Control Programs (NMCPs). Companies • Shared IRS and resistance management such as AngloGold Ashanti, Rio Tinto trends from international and - and the non-profit RTI International are level experts exercising leadership in IRS programming • Established connections among key and implementation, ensuring that their malaria control stakeholders across workforces and surrounding communities sectors, including NMCP officials, are protected from malaria through Coalition and WHO representatives, integrated and comprehensive programs. technical and academic experts and corporate leaders With less than 800 days remaining before the December 31st, 2015 deadline of At the workshop, companies developed attaining the Millennium Development Goal IRS knowledge and cultivated relationships (MDG) of zero malaria deaths, the time is with government and technical partners. right to increase private sector partnership Companies already managing IRS programs in IRS programming to achieve global improved technical expertise and knowledge malaria goals. of best practices, learning from cross- sector colleagues to push the boundaries of In this context, GBCHealth’s CAMA and the corporate excellence in IRS programming. Roll Back Malaria Partnership (RBM) held Companies considering new IRS programs a two-day workshop in September 2013 took the first steps to protect their in Ghana to examine the challenges and employees and communities and left the opportunities related to private sector IRS workshop inspired and committed. and malaria control activities. Recommendations across all sectors The workshop, “Private Sector included the following points: Opportunities in IRS and Malaria Control in West Africa,” brought together 60 regional COMPANIES CAN: participants including senior corporate agriculture executives and health managers • Work with governments to align from the mining, pharmaceutical, energy, corporate IRS programs with national food and beverage industries; Ministry malaria control strategies. Companies of Health/NMCP representatives from should reach out to NMCPs to 11 countries, World Health Organization understand priorities and gaps where technical experts and leading researchers they can assist and also keep NMCPs from the . informed of progress on corporate malaria programs.

6 Private Sector Opportunities 2013 executive s u mm ary • Collaborate with research organizations Each country must initiate a vector to develop more effective—and cost- control strategy that incorporates effective— formulations for vector resistance management. IRS that are active against resistant • Provide concrete guidance and mosquitoes. recommendations for corporate • Contribute to national IRS interventions involvement in IRS beyond parallel beyond spraying, leveraging private spraying programs, including sector strengths in operations highlighting needed support in delivery, and logistics, communication, and funding, community outreach and other infrastructure development. key areas.

WEST AFRICAN GOVERNMENTS CAN: TECHNICAL PARTNERS CAN:

• Increase the number of companies • Develop an IRS Statement of Guidance involved by developing and promoting that will guide the implementation of the business case for corporate IRS programs. engagement in IRS. Governments should also develop strategies COALITIONS (E.G. RBM, CAMA) CAN: that build regional and national entomological capacity in collaboration • Enhance corporate engagement on IRS with the private sector. programs through increased advocacy and by convening representatives • Create an oversight committee that across sectors for partnership harmonizes nationwide malaria/IRS development. activities across stakeholders (e.g., Malaria Vector Control Oversight • Work with the government in removing Committee in Ghana). taxes and tariffs and rolling back import barriers on malaria products. • West Africa is the region with the highest insecticide resistance in Africa.

7 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHIOPIA GABON GAMBIA GHANA GUINEA IVORY COAST KENYA LESOTHO LIBERIA LIBYA WMADAGASCARorkshop OveMALAWIrv i e MALIw MAURITANIA MAURITIUS MOROCCOand MOZAMBIQUE Objective NAMIBIAs NIGER NIGERIA REPUBLIC OF CONGO RWANDA SENEGAL SEYCHELLES SIERRE LEONE SOMALIA SOUTH AFRICA SUDAN SWAZILAND TANZANIA TOGO

Indoor residual spraying (IRS) is one of the organizations, agriculture and food and primary malaria vector control interventions. beverage industries operating in West Africa, In recent years, countries have begun NMCP Managers from 11 countries, WHO implementing and expanding IRS efforts in representatives and leading researchers from conjunction with long-lasting insecticide the region. net (LLIN) distribution. This integrated vector control methodology, when The workshop agenda covered the following managed correctly, can be highly effective themes: at limiting interactions between • IRS Basics: How and Why your Com- and malaria vectors. Several countries in pany should Implement an IRS Program sub-Saharan Africa have added IRS to their comprehensive malaria control plan in line • Partnerships that Work: Models for with the Global Malaria Action Plan launched Successful Public and Private Sector by the World Health Organization (WHO) Collaboration for IRS and Roll Back Malaria (RBM) Partnership. • Addressing the Challenge of Resistance In 2010, IRS protected 185 million people (6 Management percent of the global population at risk)1. IRS investments are increasing globally but • Financing and Evaluating a Corporate the intervention is still often underutilized in IRS Program including West Africa. • Research Updates on IRS Many successful IRS programs have been • Country-focused Roundtables initiated, funded and managed by the private sector, most frequently in the extractive and agricultural industries and often in “[This event] has partnership with National Malaria Control Programs (NMCPs). Companies such as helped me meet and AngloGold Ashanti, Rio Tinto and Freeport McMoRan are exercising leadership in IRS network with insecticide programming, ensuring that their workforces companies and we and the surrounding communities are protected from malaria through integrated have agreed to conduct and comprehensive programs. a pilot study in one “Private Sector Opportunities in IRS and Malaria Control in West Africa” brought district in my country together 60 participants including senior corporate executives and corporate funded by the company” public health managers from the mining, pharmaceutical, energy, technical - Balla Kandeh, Gambia NMCP

8 Private sector opportunities 2013 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHI- OPIA GABON GAMBIA GHANA GUINEA IVORY COAST KENYABackgro LESOTHOund: LIBERIA IRS in LIBYAWest MADAGASCARAfrica MALAWI MALI MAURITANIA MAURITIUS MOROCCO MOZAMBIQUE NAMIBIA NIGER NIGERIA REPUBLIC OF CONGO RWANDA SENEGAL SEYCHELLES SIERRE LEONE SOMALIA SOUTH

Malaria is highly endemic in West Africa (see figure 1). According to the WHO, in all of West Africa, only Cape Verde has reduced malaria case incidence by more than 75 percent between 2000 and 2011, putting the country in a position to begin reducing the incidence of to zero2. All other countries in the region have high malaria transmission rates and the focus remains on reducing disease burden to a level at which it is no longer a public health concern.

Endemic countries can make considerable advances in malaria control by scaling up existing and appropriate interventions such as IRS for all populations at risk and sustaining these programs over time2. Currently the President’s Malaria Initiative (PMI)-financed and Abt Associates- implemented Africa IRS (AIRS) program is active in Senegal, Mali, Liberia, Burkina

Faso, Ghana, Benin and Nigeria. AIRS pilots Figure 1: Spatial Distribution of Plasmodium falciparum local IRS campaigns in partnership with malaria endemicity in 20101 country governments to build capacity for IRS implementation. However, countries relaxation of control over IRS activities. For have not yet been able to spread these example, in Zanzibar, IRS helped reduce campaigns for universal coverage under malaria prevalence from 76 percent in 1957 their NMCPs. to less than 5 percent in 1967. However, the program was suspended and by 1973 IRS has been largely responsible for the prevalence had returned to 32 percent and success of malaria elimination programs to over 60 percent by 19833. (notably in Europe, and the Americas from the 1940s to the 1980s3), but The number of people protected by IRS in it requires a long-term commitment the WHO Africa region increased from 10 without which any gains can quickly be million in 2005 to 78 million in 2010. We lost. Research shows that recent malaria cannot let these gains slip away, at country resurgence in Africa and Latin America or regional levels. It is vital that IRS is appears to be strongly correlated with the integrated and managed as complementary cessation of IRS programs and the to other malaria control methods, such as

9 LLIN distribution and use. According to the Effective use of IRS requires national RBM WARN report, 2008 IRS campaigns program capacity, structures and systems. in Nigeria have been carried out when the Together the public and private sector can funds were available, rather than in the continue to develop IRS best practices and context of broader strategic interventions5. strengthen IRS capacity. As a result, IRS programs may not be

t a f rica leveraged for maximum effect, and gains may be at risk over time. What is IRS? Challenges NMCPs face in implementing IRS5 include: Indoor residual spraying (IRS) is • Inadequate appropriate storage the process of spraying the inside facilities for and wall surfaces of dwellings with an equipment insecticide to kill mosquitoes that • Inadequate spraying equipment for spread malaria. Mosquitoes are killed IRS or repelled by the spray, preventing • Low capacity for IRS implementation disease transmission as insecticides within countries in the West African reduce contact between humans region

g roun d : ir s in w e and mosquitoes. IRS results in the • Inadequate awareness about IRS strategy within communities rapid reduction of a ’s ability to transmit malaria and, • Inadequate community involvement in

b ack the planning process subsequently, a reduction in malaria incidence. When more than 80 The private sector has an important role to play in reducing the malaria disease burden percent of structures in a defined in West Africa through IRS. Companies can are sprayed with an effective protect their workers and communities by insecticide, IRS is the most effective developing local IRS programs, and can leverage corporate strengths including method for reducing malaria logistics, distribution and communication transmission. to maximize the effectiveness of national programs and strategies.

10 Ghana Malaria Report 2013 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BU- RUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHIOPIA GABON GAMBIAHow GHANA and W GUINEAhy Compa IVORYn iCOASTes KENYA LESOTHO LIBERIASho uld LIBYA I mp MADAGASCARlement a n MALAWI MALI MAURITANIA MAURITIUS MOROCCO MOZAMBIQUE NAMIBIA NIGER NIGE- IRS PROgram RIA REPUBLIC OF CONGO RWANDA SENEGAL SEYCHELLES SIERRE LEONE SOMALIA SOUTH AFRICA SUDAN SWAZILAND

There is a sound business case in West and capacity-building for local Africa for corporate IRS programs as part of communities, creating a positive and a comprehensive malaria control strategy. stable social environment that supports Developing and executing IRS requires a company’s local operations and careful planning, adequate resources and relationships. ongoing monitoring and evaluation. To ensure sustained commitment, company stakeholders at all levels of the organization “Implementing an IRS must understand why this intervention is so essential. Best practice presentations campaign is like being from two mining companies—AngloGold Ashanti, Rio Tinto—and from HD Hudson pregnant: it is not Manufacturing Company offered insights into the business case and return on possible to be mostly investment, as well as the most effective ways to execute a corporate IRS program. or partly pregnant. HD Hudson Manufacturing Company: Manuel Once pregnant, you’re Lluberas, Executive Director for Public Health in for the long haul” AngloGold Ashanti: Frank Amoyaw, Deputy Program Director, Malaria Control - Manuel Lluberas, HD Hudson Manufacturing Company Rio Tinto Simfer SA: Cheick Ousmane Touré, Health and Safety Advisor

KEY TAKEAWAYS • IRS saves vulnerable lives that would have potentially been lost to a disease • IRS in West Africa is a good corporate that is preventable, curable and easy to and social investment, reducing medical manage. There is no replacement for life costs and absenteeism and increasing and that alone is significant reasoning productive output. It produces a to become involved in a program that healthy workforce and increases truly saves lives. employee satisfaction and community • There is abundant evidence that IRS is engagement. very effective in areas where malaria • IRS programs are a win-win situation transmission is year-round as well for the implementing company, as seasonal. In many areas, IRS has stakeholders and the community. proved crucial for the reduction or even Corporate IRS programs provide elimination of malaria. employment, economic empowerment

11 • An IRS campaign is a full commitment. • Technical partners like the World Health An efficient IRS program is: Organization (WHO) should develop an IRS Statement of Guidance that —— TOTAL: all dwellings (>85 percent) will guide the implementation of IRS are sprayed programs. —— COMPLETE: covering all sprayable • The NMCP managers of each country surfaces should create IRS awareness in —— SUFFICIENT: the selected schools. Malaria is the leading cause of insecticide must be applied school absenteeism, so educators and uniformly over all surfaces administration are likely to value malaria —— TIMED: residual effect should last education. Schools offer an efficient, through the malaria transmission cost-effective entry-point to reach local period community members. Students should be provided with educational materials • The basic entomological targets of on malaria prevention methods and IRS mosquito populations targeted by IRS that they can share with their families. are mosquitoes that: • Education and awareness is a critical —— Rest and/or bite indoors component of any IRS program. Residents of targeted areas need to be —— Are susceptible to the selected educated on IRS—how it contributes insecticide to reduction in malaria prevalence and • A successful IRS campaign requires what actions they can take to protect political will, awareness efforts to themselves and their families—including build acceptance and endorsement cooperation with spray teams, and from organizational and community other interventions (e.g. insecticide- stakeholders, as well as well trained and treated bed nets) that must be used in motivated spray teams. parallel with IRS activities. • Women should be involved in IRS RECOMMENDATIONS program implementation, especially anie s sh ou ld i mpl e m ent an ir p ro g ra • Companies should work with as educators at the community and governments to align corporate IRS household levels. programs with national malaria control strategies to ensure full support from the national government and NMCP. mp w an d wh y co h o

12 Ghana Malaria Report 2013 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BU- RUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHIOPIA GABON GAMBIA GHANA GUINEA IVORY COAST KENYA LESOTHO LIBERIAmoIIIdel LIBYAmosdel f or MADAGASCARs sfuorcc seusscc ful MALAWIess ful MALI MAURITANIA MAURITIUSpart partne MOROCCOrshipsnerships MOZAMBIQUE NAMIBIA NIGER NIGE- RIA REPUBLIC OF CONGO RWANDA SENEGAL SEYCHELLES SIERRE LEONE SOMALIA SOUTH AFRICA SUDAN SWAZILAND “Partnerships are necessary to achieve success in the fight against malaria; no one stakeholder can do it alone” - Jacob Williams, Director, Integrated Vector Management, RTI International

Successful public-private partnerships can • The public sector encounters advance IRS programs in West Africa. The partnership challenges including private and public sectors have unique instructional rivalry, bureaucracy strengths and by cooperating, partners can and partners who sometimes fold cost-effectively bolster IRS programs for up operations, ending IRS activities maximum impact. prematurely. Chirano Gold Mines Ghana: Joseph Stiles- Ocran, Medical Entomologist and Consultant, Cross-cutting lessons on partnerships Malaria Control Program include: Government of Ghana, National Malaria • Identify shared objectives Control Program: Godson Kofi Osae, and larger goals, including Monitoring and Evaluation Focal Point organizational priorities. RTI International: Jacob Williams, Director, • Ensure combined output that’s Integrated Vector Management greater than the sum of individual partner contributions; partnerships Moderated by GBCHealth Kenya: Neeta should add value for all, through Bhandari, Regional Director economies of scale and other synergies. KEY TAKEAWAYS • Anticipate and overcome • Governments recognize the key obstacles early in the partnership assets the private sector can bring by proactively developing to the malaria fight, including communication and mediation capital, geographical access, technical systems and agreeing on desired and logistics capacity, job creation outcomes and partner roles. potential and a shared vision for a healthy population. NMCPs can reach • Enable integration based on their goals faster by engaging private agreed criteria and common sector support in the development and goals; allow flexibility, tailored implementation of programs. partnerships and mechanisms to meet needs at different levels.

13 • Recognize the autonomy of each increasing insecticide resistance and individual entity: a partnership the slow market entry of new tools. does not mean the surrender of sovereignty • Organizations such as RBM and GBCHealth can enhance corporate • Appreciate and articulate the engagement on IRS programs through contribution of all partners. increased advocacy. Contributions must be seen as complementary, and successes Examples of successful Public sh i ps artner should be celebrated! Private-partnerships (PPPs):

Government/NMCP/NGOs/Private RECOMMENDATIONS Companies • Guinea NMCP/RTI/Rio Tinto. Visit the • Companies should reach out to NMCPs link here for more information to understand priorities and gaps where they can assist and keep NMCPs PMI/Government/NMCP/Academic Institute/ informed of progress on corporate Company/NGO malaria programs. • PMI/Ghana Health Service/Ghana • Governments have an opportunity to NMCP/Noguchi Memorial Institute

u l p ssf or s ucce increase corporate engagement in for Medical Research/Anglo Gold IRS by helping develop and promote Ashanti/RTI. Visit the link here for more the business case and identifying information specific opportunities beyond spraying (see Opportunities for Private Sector NGO/Company Engagement above). • IVCC/Bayer. Visit the link here for more • When developing new partnerships, information Mo d e ls f all stakeholders should keep abreast Company/Academic Institution of vector control trends and recognize related challenges, including changes • Syngenta/London School of Hygiene in the eco-epidemiology/ecosystem, and Tropical Medicine. Learn more here.

Opportunities for private sector engagement in priority activities for IRS: • Communication and public education/ • Logistics and procurement/ mobilization infrastructure development • Data management • Policy strategy development/ enhancement program planning and • Disease epidemiology and pesticide management management • Monitoring and evaluation • Financial management • Vector ecology and entomology • Human resource development • Proposal development

14 Private Sector Opportunities 2013 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHI- OPIAa dd GABONressi nGAMBIAg the cha GHANAllen GUINEAge IVORY COAST KENYAof r LESOTHOesistan c LIBERIAe man ag LIBYAem en MADAGASCARt MALAWI MALI MAURITANIA MAURITIUS MOROCCO MOZAMBIQUE NAMIBIA NIGER NIGERIA REPUBLIC OF CONGO RWANDA

Insecticide resistance poses a significant recommended on the label, etc.). threat to IRS programs. Over time, Agricultural spraying of insecticides insecticides lose effectiveness as mosquito is often a contributor to resistance in populations metabolically and genetically mosquitoes. adapt, limiting available IRS options and driving up costs. Making smart decisions to • Factors that reduce the efficiency of deal with resistance management requires insecticides and IRS programs include: thought, planning and the right knowledge. —— High precipitation that causes While insecticide resistance is a major solid particles to form from the challenge to IRS, there are new innovative insecticides. This can be avoided by approaches to address it within the context storing the insecticide in a secure, of a corporate IRS program. dry, cool (covered) storage and by Centre de Recherche Entomologique de constantly shaking when in use. Cotonou: Martin Akogbeto, Director —— Social and cultural realities such as Bayer Environmental Science: Adjo Mfodwo, community knowledge and beliefs, Regional Manager, West Africa perception and low acceptance Arysta Life Science: Rose Peter, Associate, of the intervention. Community Public Health Strategic Partnerships communication and education initiatives, including partnership Moderated by GBCHealth’s Corporate with community leaders, church Alliance on Malaria for Africa: Ochuko representatives and other Keyamo, Manager influencers, are key to ensuring IRS program success. KEY TAKEAWAYS • Larviciding—the use of insecticide to • Rapidly increasing insecticide resistance interrupt mosquito larvae development threatens to undermine recent gains —is a “new old” solution that has been against malaria in Africa. Resistance reconfirmed to be effective. A program development reduces effectiveness of can get better results by eliminating both IRS and LLINs and complicates the 90 percent of mosquitoes while they process of choosing an insecticide for are larvae than 10 percent that grow vector control. to become flying mosquitoes. Well- • The key causes of insecticide resistance concentrated larviciding efforts during are mosquito evolution, increased the cold/dry seasons can make a big tolerance and poor management of difference. available tools (continued, frequent use • There is an urgent need to develop of a single insecticide or closely related new insecticide active ingredients insecticides, the use of application and delivery systems (such as rates that are below or above those encapsulation). There are only four

15 classes of insecticides currently available (, carbamates, organochlorides, ); Integrated Vector Management additional insecticide types are needed. Principles Encapsulation—a method of wrapping Integrated vector management (IVM) g e m ent a core substance (e.g. insecticides) in walls formed by a covering substance is a rational decision-making process —allows controlled delivery to for the optimal use of resources for targets with greater specificity. An vector control. IVM includes LLIN, IRS, encapsulated form of an insecticide larviciding, repellents and environmental is efficacious at lower doses than the management. The principles of IVM are: conventional formulation, which results • Strategic and focused treatments in lower environmental burden. • Environmental control of breeding • The African Network for Vector

tance m ana tance sites (e.g. get rid of puddles) Resistance (ANVR), managed by WHO/ AFRO, is available to help countries • Disease management that need resistance management • Reproduction interference—any support. kind of interaction that occurs between different species during “Taking steps to prevent the process of mating that the development of adversely affects the fitness of at least one of the species involved. resistance increases the Some specific plants, bacteria cost of IRS programs and genetic control can interfere with mosquitoes in all stages of BUT addressing reproduction. resistance after it has • Modification of vectoral capacity— strategies that result in significant developed is even reductions in the capacity of a mosquito population to transmit more costly.” disease. One example is to shorten - Adjo Mfodwo, the life span of adult mosquitoes. Bayer Environmental Science

Strategies to overcome or mitigate the development of resistance: • Before ordering insecticides, establish varying mosquito sensitivity to insecticides in g t h e c a ll en o f re s i a dd re ss at each location • Avoid single insecticide approaches: rotate products, use mosaic spraying and consider combining insecticides • Improve the skills of spray operators to make sure mosquitoes are being killed and malaria cases are decreasing • Diligently implement a monitoring and evaluation (M&E) program to track the results of spray rounds • Ensure good quality control of the spray program and products • Collaborate with and support local research institutions

16 Private Sector Opportunities 2013 a dd re ss in g t h e c a ll en o f re s i RECOMMENDATIONS • West Africa is the region with the Africa and reserve pyrethroids for LLINs highest insecticide resistance in Africa; in areas of insecticide resistance. each country must initiate a vector • Given the significant cost of “second- control strategy that incorporates line” insecticides for resistant areas, vector resistance management. companies and governments should • Governments must monitor the coordinate to pool insecticide orders. evolution of vector resistance; they Insecticide companies can provide should work with companies and better discounts when order volume partners to expand and consolidate and/or predictability is increased. existing networks of surveillance sites. • Companies and research organizations • Government and companies should should collaborate to develop more create an environment that encourages effective insecticide formulations innovation and the development of for IRS. Companies should also ethical research-based products (Use of partner with research organizations the WHO Pesticide Evaluation Scheme to study the possibility of insecticide is recommended.) combinations for LLINs and to develop the technology of big molecule • Give priority to the use of non- insecticides to increase IRS efficacy on pyrethroids (e.g. or mud walls. pirimiphos methyl) for IRS in West tance m ana g e m ent

17 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLICFinan ci CHADng a COTE Corporat D’IVOIREe DJIBOUTI EGYPT ETHIOPIA GABONIRS P rogramGAMBIA GHANA GUINEA IVORY COAST KENYA LESOTHO LIBERIA LIBYA MADAGASCAR MALAWI MALI MAURITANIA MAURITIUS MOROCCO MOZAMBIQUE NAMIBIA NIGER NIGERIA REPUBLIC OF CONGO RWANDA SENEGAL

IRS program costs can be maximized pyrethroids have been rotated to with partner collaboration that leverages the more expensive carbamate or unique strengths and contributions. insecticides. Further, When creating an IRS program budget, when dealing with resistance, multiple it is important to localize to the context, spray rounds per year may be required. including key decisions about the program size, appropriate insecticides (given • The cost per person protected is lower resistance patterns) and potential partner in larger spray programs (over 150,000 contributions. structures sprayed) than in smaller ones, due to economies of scale (as Abt Associates: Peter Mumba, Africa IRS studied by PMI). Costs range from Chief of Party for Ghana approximately $2 per person in large programs to almost $7 per person in President’s Malaria Initiative: Philip Ricks, small programs. Resident Malaria Advisor, Ghana RECOMMENDATIONS Moderated by HD Hudson Manufacturing Company: Manuel Lluberas, Executive • When budgeting for an IRS program, Director for Public Health companies must account for all technical areas, including logistics, KEY TAKEAWAYS procurement of supplies, technical • Program costs vary significantly staff trainings and monitoring and based on the frequency of insecticide evaluation. application (number of spray rounds • Leverage co-financing: NMCPs and per year), the type of insecticide used, companies do not need to bear the the size of the program, the number of whole cost of IRS programs. The personnel and management structures costs may be shared with other (e.g. ratio of spray staff to team leaders ministerial departments or programs, to supervisors), and as malaria control is an issue of national (the distance between structures to be importance. sprayed). • RBM should work with the government • The insecticide is often the largest share in removing taxes and tariffs and of the budget. While funding for IRS rolling back import barriers on malaria has increased over the years and IRS products. will continue to be seen as a valuable investment for donors, insecticide resistance is driving up the costs of IRS programs. In many cases, due to rising insecticide resistance, the inexpensive

18 Private Sector opportunities 2013 Financin g a cor p orate ir s p ro g ra m

Spotlight: Africa IRS (AIRS) Program • AIRS manages IRS operations and logistics in 13 endemic countries in Africa and conducts entomological monitoring in Burundi and the Democratic Republic of Congo. • A guiding principle of the project is to develop local capacity to lead IRS. In every country where AIRS sprays, the project assesses the capacity of the Ministry of Health and the NMCP to implement IRS without foreign technical assistance. • AIRS is funded by PMI and implemented by Abt Associates. • Find out more at www.africairs.net.

Spotlight on the President’s Malaria Initiative • Launched in 2005, the President’s Malaria Initiative (PMI) began as a five-year, $1.2 billion expansion of U.S. Government resources to reduce the intolerable burden of malaria and help relieve poverty on the African . • The initiative expanded in 2008 to reduce malaria morbidity and mortality by 70 percent in 19 high burden countries, compared to the 2004 baseline, with 30 million people protected by IRS in 2012. • PMI provides significant commodity support and data-driven IRS program support with a focus on capacity building. • Approximately 25 percent of annual country budgets have supported IRS program activities, with a recent expansion of PMI funding for IRS from $75 million to $90 million. • The Lantos-Hyde Act of 2008 extended PMI’s original scope and funding for an additional five years (FYs 2009—2013) • Visit http://pmi.gov/technical/irs/ IRS_economic_analysis.pdf for more information. 19 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CAPE VERDE CENTRAL AFRICANMonitori REPUBLICng and CHAD Eva lu COTEatin D’IVOIREg DJIBOUTI EGYPTIRS P ETHIOPIArograms GABON GAMBIA GHANA GUINEA IVORY COAST KENYA LESOTHO LIBERIA LIBYA MADAGASCAR MALAWI MALI MAURITANIA MAURITIUS

A monitoring and evaluation (M&E) plan —— Indicators of interest may differ based is necessary to track and demonstrate IRS on program objectives but should program results and is key to articulating align with national goals. For example, the business case within a company or private industry may be particularly partnership. When creating an M&E plan interested in measures such as for an IRS program, it is important to define decreased sick days, while NGOs may clear objectives and commit to robust, be aiming for an increase in school comprehensive surveillance and standard attendance for children. All partners procedures. should clarify objectives early in program development and incorporate MosquitoZone: Cole Church, Program national indicators and goals into M&E Manager, Vector-borne Disease Prevention systems. KEY TAKEAWAYS Private-Public Opportunities for • When data is collected frequently, Collaboration Around M&E monitoring is consistent and data is tracked well. M&E can provide feedback • Sharing resources (finances, on a successful program or can facilities) and expertise serve as an early warning of a failing intervention, allowing for real-time • Standardizing malaria control course correction. measures and resourcing across the country • Measures of IRS success include: • Coordinating and standardizing —— Outcome measurements such as monitoring, evaluation and the number of illnesses/deaths planning of IRS prevented and the reduction in anemia —— Process indicators such as RECOMMENDATIONS intervention processes, blood parasitemia and economic benefits • Before starting a corporate IRS program, companies must collect —— IRS program indicators including baseline data. In order to provide a the number of structures sprayed comprehensive context for M&E, data and the cost per person protected collection should occur during both by IRS low and high transmission seasons, and include vector identification and —— Entomological indicators such as an estimation of vector population reductions in the vector population dynamics.

20 Private sector opportunities 2013 Monitorin g an d E val • Companies should adapt M&E approaches to the program’s “Our company is geographic context: already planning to —— In moderate to high malaria transmission areas, where there do a case study on is frequently a low per capita healthcare expenditure and the having another IRS population has poor access to medical care, M&E should focus team in place and the on reductions in mortality and morbidity. information received —— In low malaria transmission areas where there is increased access from this workshop to medical care and diagnostic tests and data collection allows

on budgeting will be uatin g IR S Pro ra m identification of geographic and seasonal transmission trends, M&E used. Statistical data should focus on hotspots, rapid response, entomological vigilance will be used in our (such as insecticide resistance) and tracing cases to specific reports.” geographic areas. - Rio Tinto Simandou

21 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHIOPIA GABONIRS Re GAMBIAsearch GHANA Updat GUINEAes IVORY COAST KENYA LESOTHO LIBERIA LIBYA MADAGASCAR MALAWI MALI MAURITANIA MAURITIUS MOROCCO MOZAMBIQUE NAMIBIA NIGER NIGERIA REPUBLIC OF CONGO RWANDA SENEGAL

IRS is a highly effective means of malaria RECOMMENDATIONS control but remains underutilized and can be logistically complex. The planning and • Government and the private sector implementation of IRS program must be should collaborate on research activities based upon epidemiological analysis and to develop new vector control products entomological surveys for specific localities or approaches and on the management or countries. All stakeholders involved in of insecticide resistance. malaria control need to be equipped with • Governments should develop a the most current knowledge to enable smart strategy to build regional and national decision making around IRS program. entomological capacity in collaboration Nigerian Institute of Medical Research: with the private sector. Samson Awolola, Head of Department, • Companies can call upon in-country Public Health Division university experts for assistance. The Noguchi Memorial Institute for Medical Nigerian Institute of Medical Research, Research: Samuel Dadzie, Research Fellow Noguchi Memorial Institute for Medical Research and Université Cheikh Anta Noguchi Memorial Institute for Medical Diop, , Senegal are all open to Research: Benjamin Abuaku, Research Fellow consultation. Université Cheikh Anta Diop, Dakar, Senegal: Ousmane Faye, Professor, Medical Entomologist, Laboratoire d’Ecologie “Create an effective Vectorielle et Parasitaire data management of all PRESENTED STUDIES & RESOURCES current IRS programs; • Baseline Information for the Implementation of Indoor Residual communicate to Spraying: The Nigeria Experience. For more information visit this link here. employees on the • Entomological and Epidemiological benefits of IRS; Monitoring of Indoor Residual Spraying Program in Northern Ghana. For more implement continual information click here. surveillance • Impacts of Indoor Residual Spraying in Senegal (French article). Visit here for of the ongoing more information. IRS program” - Tullow Oil, Ghana

22 Private sector opportunities 2013 ALGERIA ANGOLA BENIN BOTSWANA BURKINA FASO BURUNDI CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CHAD COTE D’IVOIRE DJIBOUTI EGYPT ETHI- OPIACo GABONuntry BrGAMBIAeakf astGHANA Se ssio GUINEAn IVORY COAST KENYA LESOTHO LIBERIA LIBYA MADAGASCAR MALAWI MALI MAURITANIA MAURITIUS MOROCCO MOZAMBIQUE NAMIBIA NIGER NIGERIA REPUBLIC OF CONGO RWANDA

These sessions provided a platform for • It is important for governments to NMCP representatives to discuss country- present a business case to companies specific best practices, lessons learned and for private sector engagement. challenges and opportunities for private sector engagement on IRS and malaria • Companies can engage in IRS and control. malaria control gradually but should do so in alignment with national strategies. KEY TAKEAWAYS RECOMMENDATIONS • The private sector must seek more financial and political commitment from • Governments can create an oversight the government. committee that harmonizes all malaria control and IRS activities in the country, • IRS remains under-implemented across stakeholders. A best-practice in West African countries due to example is that of the Malaria Vector perceived high costs. Control Oversight Committee in Ghana, which reaches out to stakeholders, • The malaria control challenges faced providing guidance, coordination and most by West African countries include: support. country size (e.g. large geographic area to cover), lack of adequate resources • Ministries of Health and NMCPs (e.g. funding and human capital), must allocate resources to support insecticide resistance that increases IRS management positions at both program costs and lack of knowledge district and national levels in order to on how to engage the private sector. promote skills transfer and program sustainability.

23 24 Ghana Malaria Report 2013 CONCLUSION

The 2013 Private Sector Opportunities in IRS and Malaria Control in West Africa workshop demonstrated the value of IRS as part of a comprehensive malaria control approach and the importance of business involvement in IRS programming. Partnership has been critical to past successes in IRS and must continue to sustain recent gains. More importantly, opportunities abound for new and deeper partnerships and corporate contributions. GBCHealth’s CAMA and RBM continue to be at the forefront of collaborative malaria control efforts and have called on the private sector and the public sector to intensify the fight against malaria. Building national capacity in key areas such as entomology, research and program management will be critical to ensure that countries are firmly in the driver’s seat.

The workshop provided a unique platform for leaders within the public and private sectors to convene and outline necessary actions for meaningful impact on malaria control. Participants agreed on the need to intensify political commitment, financial resources and research and development to achieve the 2015 targets. Several companies made commitments to begin malaria control collaboration with government NMCPs, NGOs, council chiefs and other stakeholders and to join with private sector peers in supporting the CAMA partnership.

Defeating malaria is possible if the West African community stays together and stays focused, looking past perceived differences to focus on shared goals.

WORK CITED

1. Gething, P.W.*, Patil, A.P.*, Smith, D.L.*, Guerra, C.A., Elyazar, I.R.F., Johnston , G.L., Tatem, A.J. and Hay, S.I. (2011). A new world malaria map: Plasmodium falciparum endemicity in 2010. Malaria Journal. 10: 378. *indicates equal authorship.

2. World Health Organization. (2013). Indoor residual spraying: An operational manual for IRS for malaria transmission control and elimination. Available online .

3. Cohen, J., Smith, D., Cotter, C., Ward, A., Yamey, G., Sabot, O., Moonen, B. (2012). Malaria resurgence: a systematic review and assessment of its causes. Malaria Journal. 11(122).

4. RBM (2008). Gambia RBM needs assessment. RBM WARN. Available online .

5. RBM (2008). Roll Back Malaria country needs assessment: Nigeria report. RBM WARN. Available online .

25 APPENDIX I AGENDA

West Africa Malaria Workshop: Private Sector Opportunities in IRS and Malaria Control

September 12th-13th, 2013 Fiesta Royale Hotel, , Ghana

WOKSHOP OBJECTIVES: • Promote and increase private sector engagement and investment in workplace and community IRS and malaria control activities in West Africa • Demonstrate the business case for IRS and malaria control in West Africa • Highlight best-in-class private sector driven IRS programs • Share updates on IRS and resistance management trends from international and country level experts • Establish connections between key malaria control stakeholders, including National Malaria Control Program (NMCP) officials, RBM/WHO representatives, technical and academic experts and the corporate sector

AGENDA

SEPTEMBER 11th, 2013 7:00-8:00 PM registration and Welcome Cocktail 8:00 PM Dinner on your own

SEPTEMBER 12th, 2013 8:30-9:00 AM registration and Breakfast 9:00-9:30 AM WELCOME REMARKS • Naa Korkor Allotey, Program Officer, National Malaria Control Program, Government of Ghana presenting remarks from Dr. Constance Bart-

26 Private Sector Opportunities 2013 Plange, Director, National Malaria Control Program, Government of Ghana • Pam Bolton, Vice President, Membership and Advisory Services, GBCHealth New York

9:30-10:00 AM OPENING PRESENTATION: MALARIA CONTROL IN THE WEST AFRICAN REGION—OVERVIEW AND UPDATES • Jan van Erps, Coordinator Supply Chain Support, RBM Secretariat, World Health Organization

10:00-10:15 AM tea BREAK

10:15-11:30 AM IRS BASICS: HOW AND WHY YOUR COMPANY SHOULD IMPLEMENT AN IRS PROGRAM Session Objectives: Demonstrate the business case for implementing an IRS program within a company; Share the “nuts and bolts” of IRS program implementation. • Manuel Lluberas, Executive Director for Public Health, HD Hudson Manufacturing Company (Moderator) • Frank Amoyaw, Deputy Program Director, Malaria Control, AngloGold Ashanti • Cheick Ousmane Touré, Health and Safety Advisor, Rio Tinto Simfer SA

11:30-12:45 PM PARTNERSHIPS THAT WORK: MODELS FOR SUCCESSFUL PUBLIC AND PRIVATE SECTOR COLLABORATION FOR IRS Session Objectives: Showcase successful government- private sector partnerships that advance IRS programs within the region; Highlight the ways in which organizations can create, nurture and sustain cross-sectoral collaborations • Neeta Bhandari, Regional Director, GBCHealth Kenya (Moderator) • Joseph Stiles-Ocran, Medical Entomologist and

27 Consultant, Malaria Control Program, Chirano Gold Mines Ghana • Godson Kofi Osae, Monitoring and Evaluation Focal Point, National Malaria Control Program, Government of Ghana • Jacob Williams, Director, Integrated Vector Management, RTI International

12:45-2:00 PM netWORKING LUNCH

2:00-3:15 PM ADDRESSING THE CHALLENGE OF RESISTANCE MANAGEMENT Session Objectives: Discuss innovative approaches to address the challenges of insecticide resistance within the context of a corporate IRS program; Equip corporate managers with the knowledge to enable smart decision-making around resistance management • Ochuko Keyamo, Manager, Corporate Alliance on Malaria in Africa, GBCHealth New York (Moderator) • Martin Akogbeto, Director, Centre de Recherche Entomologique de Cotonou • Mark Edwards, Head of Product Development and Regulatory Affairs, Bayer • Rose Peter, Associate, Public Health Strategic Partnerships, Arysta LifeScience

3:15-4:00 PM tea BREAK

4:00-5:00 PM INTERACTIVE EXHIBIT: DEMONSTRATION OF IRS APPROACHES BY ANGLOGOLD ASHANTI Experience a mini exhibition displaying activities that normally constitute an IRS program (e.g. IEC materials, M&E, spray logistics, spray operations, entomology lab)

5:00-5:15 PM DAY 1 SUMMARY • Shuma Panse, Director, Membership and Advisory Services, GBCHealth New York

28 Private Sector Opportunities 2013 5:15-5:30 PM GROUP PHOTO

6:00-8:00 PM netWORKING DINNER

SEPTEMBER 13th, 2013 8:00-9:00 AM COUNTRY-FOCUSED Meet and engage NMCP managers, who will lead informal discussions on country-specific malaria and IRS issues and high-impact partnership opportunities for private sector

9:00-9:15 AM DAY 1 SUMMARY AND DAY 2 OVERVIEW • Ochuko Keyamo, Malaria Manager, Corporate Alliance on Malaria in Africa (CAMA), GBCHealth New York

9:15-10:30 AM FINANCING AND EVALUATING A CORPORATE IRS PROGRAM Session Objectives: Discuss monitoring and evaluation strategies for an IRS program; Discuss funding trends and challenges; Discuss cost-effectiveness of IRS • Manuel Lluberas, Executive Director for Public Health, HD Hudson Manufacturing Company (Moderator) • Peter Mumba, Africa IRS Chief-of-Party for Ghana, Abt Associates • Cole Church, Project Manager, Vector-borne Disease Prevention, MosquitoZone International • Phillip Ricks, CDC Resident Malaria Advisor

10:30-11:00 AM tea BREAK

11:00-12:15 PM RESEARCH UPDATES ON IRS Session Objectives: Provide a platform for regional research institutes to share current areas of work and share opportunities for private sector partnerships • Samson Awolola, Head of Department, Public Health Division, Nigerian Institute of Medical Research (Moderator)

29 • Benjamin Abuaku, Research Fellow, Noguchi Memorial Institute for Medical Research • Samuel Dadzie, Research Fellow, Noguchi Memorial Institute for Medical Research • Martin Akogbeto, Director, Centre de Recherche Entomologique de Cotonou • Ousmane Faye, Professor, Medical Entomologist, Laboratoire d’Ecologie Vectorielle et Parasitaire, Université Cheikh Anta Diop (UCAD), Dakar, Senegal

12:15-12:30 PM WRAP-UP AND SUMMARY OF WORKSHOP • Neeta Bhandari, Regional Director, GBCHealth Kenya

12:30-14:00 PM netWORKING LUNCH

PHOTO CREDITS: Cover: Arne Hoel / Page 5: Arne Hoel / World Bank Page 7: John Rae / The Global Fund Page 10: Maxwell Tetteh Page 12: Maxwell Tetteh Page 17: Nate Miller Page 19: USAID Page 21: Nate Miller Page 23: Maxwell Tetteh Page 24: Nate Miller

30 Private Sector Opportunities 2013 APPENDIX II WORKSHOP PARTICIPANTS

Abt Associates National Malaria Control Program - Mali AngloGold Ashanti National Malaria Control Program - Niger Arysta LifeScience SAS National Malaria Control Program - Nigeria Bayer AG National Malaria Control Program - Senegal Benelux Afrocenter National Malaria Control Program - Sierra C Zard Company Leone Centre de Recherche Entomologique de National Malaria Control Program Nigeria Cotonou National Malaria Control Program- Togo CEPICI Nigeria LNG Ltd. Chirano Gold Mines Nigerian Institute of Medical Research CIELS Noguchi Memorial Institute of Medical Dow Chemical Company Research Drugmart Ltd Novartis FHI 360 Palutech Releve Company Benin GBCHealth PMI/CDC Ghana General Electric Company (GE) Rio Tinto Golden Exotic Roll Back Malaria Partnership Harvestfield NG RTI International Health Authority - Rural Builders Organisation HEINEKEN Santé En Entreprise Hudson Pumps & Equipment Saphyto Jhpiego SC Johnson Lafarge Speak Up Africa MosquitoZone International Syngenta Crop Protection National Malaria Control Program - Benin Tullow Oil plc National Malaria Control Program - Burkina Université C.A.D. , Labo. Ecologe Vestorielle Faso & Parasitaire - Faculté des Sciences & National Malaria Control Program - Côte Techniques, Dakar - Sénégal d’Ivoire Vestergaard Frandsen National Malaria Control Program - Gambia Vodacom National Malaria Control Program - Ghana

31 We would like to acknowledge the following GBCHealth staff who contributed to the writing and production of this report.

Project Lead: Ochuko Keyamo Writing and Editing Team: Ochuko Keyamo, Margaret Arbogast, Shuma Panse, Eve, Heyn, Pamela Bolton Design and Layout: Nisa Patel, Helene Coulson, Surabhi Bhatt

We would also like to thank Casey Levine-Beard of The Acuity Project for writing and editing support.

32