Uganda Indoor Residual Spraying Project Phase Ii Quarterly

UGANDA INDOOR RESIDUAL SPRAYING PROJECT PHASE II

QUARTERLY PERFORMANCE REPORT

January 1 – March 31, 2015

Contract No. AID-617-C-12—00004

April 2015 This publication was produced for review by the United States Agency for International Development. It was prepared by Uganda IRS Project Phase II, Abt Associates.

Recommended Citation: Uganda Indoor Residual Spraying (IRS) Phase II Project Quarterly Performance Report: January 1 through March 31, 2015 Uganda Indoor Residual Spraying Phase II Project, Abt Associates Inc.

UGANDA INDOOR RESIDUAL SPRAYING (IRS) PROJECT PHASE II QUARTERLY PERFORMANCE REPORT

Contract/Project No.: AID-617-C-12-00004

Submitted to: Mr. Joel Kisubi, Contracting Officer’s Representative United States Agency for International Development/Kampala, Uganda

Cover Photo: Spray operators in Tororo

Abt Associates  4550 Montgomery Avenue, Suite 800 North  Bethesda, Maryland 20814  Tel: 301.347.5000. Fax: 301.913.9061www.abtassociates.com

Abt Associates  Uganda IRS Project Phase II P.O.Box 37443 / Plot 3 Solent Avenue Kampala, Uganda.  Tel: 256 (0).414.251.300

Abt Associates Uganda IRS Project Phase II,Tororo  Plot 20 Masaba Rd, Tororo Municipality Tel: 256 (0).392.177.264

DISCLAIMER 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.

TABLE OF CONTENTS

Acronyms ...... iii Executive Summary ...... 1 1. Background ...... 2 2. Technical Management Including IRS Implementation, Capacity development and M&E ...... 3 2.1 Result 1: High quality, safe and effective IRS program implemented ...... 3 A. Spray operations ...... 4 2.2 Result 2: Capacity building and innovative approaches in IRS implemented ...... 11 B. Capacity development ...... 11 2.3 Result 3: Comprehensive monitoring and evaluation (M&E) of the IRS program performed ...... 12 C. Monitoring and Evaluation (M&E) ...... 13 3. Business Management ...... 15 4. Innovations ...... 15 5. Relationship building ...... 16 6. Project surveillance ...... 17 7. Cost considerations ...... 18 8. Challenges ...... 18 9. Lessons learned/recommendations ...... 19 10. Plans for next reporting period ...... 19 Annex 1: Summary maps of capacity dashboard scores by district ...... 21 Annex II: Map of Kibuku district showing proposed parish stores ...... 24

LIST OF TABLES

Table 1: Result 1: Summary of output indicators for quarter two January 1- March 31, 2015 ... 3 Table 2: TOT participants in group B districts ...... 5 Table 3: Spray teams recruited for round one in the group B districts ...... 6 Table 4: Number of parish stores by district ...... 7 Table 5: Summary of key IRS indicators for round one, new districts, December 2014 – February, 2015 ...... 10 Table 6: Result 2: Summary of output indicators for quarter two January 1- March 31, 2015 . 11 Table 7: Result 3: Summary of output indicators for quarter two January 1- March 31, 2015 . 12 Table 8: Comparison of the results of pre- and post-IRS PSCs in group A districts, October 2014 and February 2015 respectively ...... 14

LIST OF FIGURES

Figure 1: Uganda IRS project Phase II target districts ...... 2 Figure 2: Colored blocks by project area show progression from red (low) to green (high) capacity levels ...... 12

ACRONYMS

BCC Behavior Change Communication CAO Chief Administrative Officer CDC Centers for Disease Control and Prevention CDFU Communication for Development Foundation Uganda CHC Communication for Health Communities Project (USAID Funded) COP Chief of Party COR Contracting Officer’s Representative DFID-UK Department for International Development – United Kingdom DHE District Health Educator DHO District Health Officer DHT District Health Team DSO District Supplies Officer ECM Environmental Compliance Manager FAQ Frequently Asked Question FC Field Coordinator FY Fiscal Year GISO Gombolola Internal Security Officer IEC Information, Education and Communication IPC Interpersonal Communication IRS Indoor Residual Spraying IVM Integrated Vector Management LC Local Council MIS Malaria Indicator Survey M&E Monitoring and Evaluation MEO Mission Environment Officer MoH Ministry of Health MOP Malaria Operational Plan MP Member of Parliament NDA National Drug Authority NMCP National Malaria Control Program NU-HITES Northern Uganda Health Integration to Enhance Services (USAID-Funded) PMI President’s Malaria Initiative PMP Performance Management Plan PSC Pyrethrum Spray Catch RDC Resident District Commissioner

iii

SEA Supplementary Environmental Assessment SK Store Keeper SM Store Manager SMT Senior Management Team SO Spray Operator TOT Training of Trainers UMSP Uganda Malaria Surveillance Project USAID United States Agency for International Development VCO Vector Control Officer VHT Village Health Team WHO World Health Organization

EXECUTIVE SUMMARY

This quarterly report covers the period, January 1 – March 31, 2015 of the United States Agency for International Development/President’s Malaria Initiative (USAID/PMI), and the Department for International Development – United Kingdom (DFID-UK) funded Uganda Indoor Residual Spraying (IRS) Phase II Project. During this second quarter of project year three, the project completed spraying the seven group A districts of the Lango sub region: Alebtong, Amolatar, Dokolo, Kaberamaido, Lira, Otuke and Tororo, and prepared to spray the group B districts of: Budaka, Bugiri, Butaleja, Kibuku, Namutumba, Pallisa and Serere (round one, starting on April 20, 2015). Spraying in the five districts of Alebtong, Amolatar, Dokolo, Kaberamaido and Otuke is being funded by DFID- UK, while the remaining nine are funded by USAID/PMI. In all previous Phase II spray rounds, the October-November, spray round was completed within quarter one of that fiscal year (FY), however in year three, the project deviated from the norm, as the debut of spraying the new group A districts was delayed. Multiple factors which caused the delay are documented in the project’s quarter one, and the end of spray reports, which were submitted to the client. Briefly, the project was required to wait until the Malaria Indicator Survey (MIS) was completed in the new districts, and the approval of the Supplementary Environmental Assessment (SEA), secured. The holiday season also required a two week pause in the spraying activities, pushing the spray season into quarter two of FY 2015. The preparations for this particular spray season were also atypical for the project. The uncertainties of timing due to pending approvals, created a compressed time frame, and imposed limited mobilization of government officials, who are the gateway to community mobilization. Spray round one in the seven new districts commenced on December 08, 2015 and was completed on February 19, 2015. Initiating IRS in these Lango region districts, met with significant resistance from different factions, including local sub-county and political leaders, religious leaders, organic farmers, health workers, and community members. This significant and persistent resistance derailed spraying in many areas, and resulted in low spray coverage, which was uncharacteristic of the project during its entire history. Detailed actions taken to counter this resistance were documented in the ‘End of Spray Report, February 20151’, and a presentation to USAID/PMI dated February 10, 2015.2 In spite of these multiple challenges, the project, in collaboration with key stakeholders from the Ministry of Health (MoH)/National Malaria Control Program (NMCP), sprayed 429,562 houses in the new group A districts, and protected 81.5 percent of the population from malaria, of which 320,350 (20.7 percent) were children under five, and 53,688 (3.5 percent) were pregnant women. The project was also able to enlist the support of some of the initially resistant district leaders, including leaders from the resistant Lira District. With the support of the Minister of State for Housing, Honorable Sam Engola and Brigadier Oula (both residents of Lira district), the project was able to complete spraying in Agali and Amach sub-counties, which were initially opposed to IRS. On completion of spray round one in the group A districts, the project’s senior management team (SMT) met multiple times with these district leaders to discuss performance issues, and express concern about the strong resistance among the different cadres of district leaders. These leaders pledged their support for IRS and promised to help combat the initial resistance faced during spray round one. The project also conducted district sensitization of the group B districts that will initiate spraying in April 2015, and this, together with sensitization of local council (LC) I leaders in these districts, and sub-county level micro planning, is expected to yield positive outcomes for the upcoming spray round in quarter three.

1 End of Spray Report, Round Five for the Previous IRS Districts and Round One for the New IRS Districts October 2014 – February 2015. 2 Uganda Indoor Residual Spraying Project, Phase II, Presentation to PMI, FY 15, February 10, 2015, presented by J. B. Rwakimari, Chief of Party.

1. BACKGROUND The Uganda IRS Phase II project is a continuation of the PMI IRS program in Uganda, building on the achievements attained in Phase I (July 2009 – July 2012). The Phase II, five-year project commenced on June 26, 2012, and will end on June 25, 2017. The overall objective of the project is to achieve the PMI Uganda targets in IRS. In particular, the Uganda IRS project contributes to USAID/Uganda’s Development Objective 3, a comprehensive effort to improve outcomes in health, HIV/AIDS and education in Uganda through the following project objectives:

a. High quality, safe and effective IRS program implemented;

b. National capacity to conduct IRS developed;

c. Comprehensive monitoring and evaluation (M&E) of the IRS program performed.

PMI/Uganda has a five-year strategic plan (2015-2020) and an annual Malaria Operational Plan (MOP) which guides the implementation and scale-up of activities. IRS is one of the key components of the MOP, and is one of the four key interventions of the PMI/Uganda program. The aim is to reduce malaria-related mortality in Figure 1: Uganda IRS project Phase II target districts children under five and pregnant women.

Abt Associates, Inc. as the prime contractor of this program manages and directs all technical component activities in support of IRS planning, procurement, implementation, monitoring, and capacity building. Two subcontractors support the project: Communication for Development Foundation Uganda (CDFU) provides support for information education and communication (IEC)/ behavior change communication (BCC) activities. EnCompass provides assistance in developing and upgrading IRS training materials.

Building on the projects’ ongoing successes and ability to deliver innovative IRS programming that helped reduce the malaria burden in the north, the project has gradually transitioned out of the 10 northern districts that it previously covered, to the 14 new high-prevalence and high-malaria burden districts in the northern and eastern regions (see Figure 1).

2. TECHNICAL MANAGEMENT INCLUDING IRS IMPLEMENTATION, CAPACITY DEVELOPMENT AND M&E

2.1 RESULT 1: HIGH QUALITY, SAFE AND EFFECTIVE IRS PROGRAM IMPLEMENTED Table 1 shows the targets and actual results for selected monitoring indicators for result 1, according to the project’s Performance Management Plan (PMP).

Table 1: Result 1: Summary of output indicators for quarter two January 1- March 31, 2015 January – March , 2015 INDICATOR Target Actual Number of district level planning and introductory 14 14 meetings conducted with NMCP support

Number of district assessments conducted by DHTs and 14 14 NMCP with the support of project staff

Number of spray personnel trained to deliver IRS in the 174 1652 IRS target districts1

Number of IRS print materials disseminated in the IRS 25,000 15,5103 target communities

Number of radio talk shows conducted 25 304

Number of radio spots aired 400 275

Number of community members mobilized and 8,500 49685 sensitized about IRS

6 Number of households sprayed with IRS 725,092 429,562

1Spray personnel include the SOs, supervisors, teams leaders, wash persons, clinicians, environmentalists, and any others. 2In this quarter, only clinicians in group B districts were trained. 165 clinicians attended the training of the expected 174 from the seven group B districts 319,010 IEC materials were printed this quarter; more will be printed in quarter three to make 25,000. 15,510 were disseminated in group B districts to LCIs and sub-county members during the sensitization meetings. The remaining 3,500 will be disseminated in the group A districts together with the additional prints. Number disseminated refers to delivery to the community members/target group 4 Five extra radio shows were conducted as need arose to counteract the rising resistance in group A districts 5This number includes 2098 LCIs and 2870 sub-county stakeholders. Sensitization of community members by the LCIs from the group B districts crossed over to quarter three and is therefore still ongoing. 6This target was based on data from the 2014 census

A. Spray operations Engagement with the district leadership In February 2015, the project made preliminary visits to the district leaders in the seven group B districts that are on track to start spraying on April 20, 2015. The team also held preparation meetings with the LC V Chairpersons, Resident District Commissioners (RDCs), Chief Administrative Officers (CAOs) and District Health Officers (DHOs), to discuss the schedule of activities. These leaders pledged their support for IRS, introduced the team to the IRS Focal Person in their district, provided free district stores, and helped identify office space for IRS data clerks.

In response to the sub-optimal performance of the round one spray in group A districts, the SMT, including the Chief of Party (COP) and the Field Operations Manager, made several visits to each of seven districts in the Lango sub-region to discuss the spray results, and discuss strategies for improving compliance during the upcoming spray round.

Micro planning In March 2015, the project, in collaboration with the District Health Team (DHT) members from each of the seven group B districts, conducted micro-planning meetings in each sub-county. The project adopted this innovative sub-county level micro planning approach as opposed to the previous district level micro planning to solicit the support and buy-in of the sub-county officials for IRS activities. This strategy was adopted following complaints from the sub-county leaders about the poor trickling down of information by the district leaders, as well as their lack of involvement in the recruitment of competent store keepers (SKs). During this micro-planning activity, the project’s SMT, field coordinators (FCs) and store managers (SMs), in collaboration with the sub-county officials, identified, interviewed and recruited competent parish SKs, and supervisors to be trained as trainers during the Training of Trainers (TOT). District sensitization meetings The project’s IEC/BCC partner, CDFU, together with project staff and MoH officials, conducted meetings to sensitize the district leaders from all group B and two group A districts (Lira and Alebtong) on IRS activities. During spray round one in the Lango region, the then existing USAID policy, precluded the project from conducting these meetings which are vital for garnering political support for IRS. Recognizing this as a major gap, during this quarter, the project secured USAID permission to conduct these meetings which helped create awareness among the district leaders about the IRS strategy. The project used these meetings to: solicit the support and resources from the district leaders needed for the smooth implementation of IRS activities in their districts, equip district leaders with IRS facts for effective sensitization and mobilization of their communities during the IRS campaign, and to share IRS work plans with the district leaders, thus creating a sense of ownership of the program among the district leaders. During these meetings, district leaders were urged to use all available resources and channels, such as the free radio talk show airtime allocated to them, to communicate IRS information to their communities. A sub-county task force (composed of LCIII Chairperson, Sub-county Chief, Gombolola Internal Security Officer (GISO), Secretary for Health, Community Development Officer (CDO) and the Health Assistant) was formed in each of the seven group B districts to monitor IRS implementation at the sub-county level, and conduct mobilization and sensitization of their communities. During the upcoming spray round, this task force will hold weekly meetings, discuss the spray progress and provide updates to the District Health Educators (DHEs), who will in turn inform the district task force during their weekly meetings. This reporting channel will keep the district stakeholders up-to-date with the IRS progress, and will enable them to act promptly where issues arise.

Training of Trainers (TOT) In collaboration with the DHTs and MoH staff, the project conducted TOTs for DHTs, sub-county supervisors and SKs, in all the seven group B districts. This four day training, which started on March 30, 2015 helped build the capacity of the participants to train the recruited spray personnel at the sub- county level, to plan and implement quality IRS.

Table 2: TOT participants in group B districts Supervisors Store Keepers DHTs Overall District Female Male Total Female Male Total Female Male Total Total Budaka 3 10 13 7 20 27 0 7 7 87 Bugiri 4 7 11 10 21 31 4 12 16 116 Butaleja 4 8 12 9 17 26 6 9 15 106 Kibuku 3 8 11 6 20 26 3 8 11 96 Namutumba 1 6 7 4 14 18 1 4 5 60 Pallisa 5 14 19 13 27 40 2 8 10 138 Serere 8 2 10 12 15 27 1 7 8 90 Total 28 55 83 61 134 195 17 55 72 700

Recruitment of spray teams and parish mobilizers On completion of the sub-county sensitization meetings, the project, in collaboration with DHT members, and sub-county officials, recruited spray personnel for the group B districts. The recruitment of the spray team was held concurrently with the sensitization at sub-county level. Given the proximity and influence of the village health teams (VHTs) to the communities, they were given priority for being recruited as spray operators (SOs), SKs, and wash persons. As shown in Table 3, 3311 (91 percent) of the total 3639 recruited were VHTs. The project also recruited one parish mobilizer per parish store, to help with the mobilization of the community at the village level. Women were encouraged to apply to join the spray team. The project recruited a total of 4,132 spray team members (including supervisors and security guards) of which 1,393 (33.7) percent were female and of the total SOs recruited, 876 (28.9 percent) were female. Compared to spray round one in group A districts where 1166 (26.7 percent) of the total recruits and 716 (22.2) percent of the SOs were women, there was a19.5 percent increase in the total female recruits, and 22.4 percent increase in the female SOs in the group B districts.

Table 3: Spray teams recruited for round one in the group B districts Wash Persons VHTs (SOs, SKs Spray Operators Supervisors Store Keeper Security Guards District (WPs) and WPs) Female Male Female Male Female Male Female Male Female Male VHTs Non- VHTs Budaka 100 212 3 10 20 7 37 37 2 54 290 123 Bugiri 214 464 4 7 10 31 80 0 4 82 777 22 Butaleja 123 246 4 8 9 17 34 10 0 52 327 112 Kibuku 71 227 3 8 9 17 36 0 3 49 289 71 Namutumba 128 258 1 6 4 14 46 0 15 19 450 0 Pallisa 149 448 5 14 13 29 68 0 35 41 707 0 Serere 91 304 8 2 12 15 49 0 3 51 471 0 876 2159 28 55 77 130 350 47 62 348 3311 328 TOTAL 3035 83 207 397 410 3639

Identification of district and parish stores The project’s Environmental Compliance Manager (ECM) together with the District Environment Officers (DEOs) conducted district store identification and assessment, as well as siting and construction of district soak pits and bath shelters in preparation for spray round one in the seven group B districts. The purpose was to ensure that environmental compliance standards were in place prior to delivery of insecticide to the district stores, and commencement of spraying in these districts. The project’s staff in collaboration with the district staff also sited parish stores in the seven group B districts from March 9 - 13, 2015. The project strictly followed the new SEA guidelines, which precludes the use of stores located at schools. In line with this new guidance, all IRS stores in group B districts are located in health centers, sub-county headquarters, and private residences. The project will relocate the group A IRS stores to meet the SEA requirements before commencement of the next spray round.

Table 4: Number of parish stores by district No. of No. of Group District Group District Parish stores Parish stores Group A Tororo 53 Group B Pallisa 42 Kaberamaido 27 Namutumba 18 Lira 44 Kibuku 26 Amolatar 27 Butaleja 26 Alebtong 25 Bugiri 41 Otuke 21 Budaka 27 Dokolo 28 Serere 27 Subtotal 225 Subtotal 207 Grand Total 432

Inspection of district stores in group B districts The project’s ECM together with inspectors from the National Drug Authority (NDA) regional offices inspected all the seven group B district stores to ensure that the stores were suitable for storage of IRS supplies. Pallisa and Bugiri district stores needed some repairs, which were completed, and a report submitted to NDA.

Identification of entomological sites The project’s Entomologist, with assistance from the district Vector Control Officers (VCOs) and Health Inspectors selected villages for pyrethrum spray catches (PSCs) and wall bio-assay sentinel sites in the seven group B districts. Based on specific criteria, the project selected 14 villages in the seven districts (two villages per district) as sentinel sites; seven for conducting PSCs, and seven for wall bio-assays.

IEC/BCC activities During this quarter, project partner, CDFU spent time strategizing with project and district staff on preparing the group B districts for spraying. Based on the multiple lessons learned from group A districts on community mobilization and sensitization, CDFU, in collaboration with the district task force members, and other stakeholders, made all possible efforts to sensitize the communities in the group B districts. Key strategies included: interpersonal communication (IPC) by LCIs, engaging religious leaders at churches and mosques to advocate for IRS, active presence during market days, in shops and town centers to encourage IRS acceptance among communities.

 Community dialogues: CDFU conducted 60 community dialogues in the six districts of Alebtong, Amolatar, Dokolo, Kaberamaido, Lira, and Otuke, with a special focus on communities

which significantly resisted IRS and had low coverage. The ‘question and answer’ format at these dialogues, enabled participants to ask questions about IRS, understand its benefits and allay some of their fears about the insecticide and IRS in general. For instance, in Abowa village, in Kangai sub-county in Dokolo, a few SOs could not clearly explain the advantages of IRS, and this caused many community members to refuse spraying their houses. However, during a community dialogue meeting, these community members had a chance to ask questions, and clear their doubts about the safety of the insecticide, and in the end agreed to have their houses sprayed.

 Orientation of sub-county task force and LCIs: CDFU together with the DHEs concurrently conducted the the orientation of the sub-county task forces and the LCI Chairpersons in the group B districts. Orientation of the LCI Chairpersons, who are leaders at the village level, is a new strategy that the project decided to implement based on lessons learned from the group A districts. LCI Chairpersons have significant influence on their communities, and for the upcoming spray round, these LCIs will be involved in door-to-door IPC and sensitization of their communities, thereby leading to increased IRS acceptance levels.

CDFU also adopted a new communication strategy of conducting sub-county sensitization meetings in the 82 sub-counties of group B districts. Each sub-county was represented by 35 influential community members at these meetings including community leaders, cultural opinion and religious leaders, head teachers, health facility in-charges, Health Assistants, heads of community organizations, LCIII councilors, sub-county chiefs, parish chiefs, Secretary for Health, GISO, and CDOs. The objective of these meetings was to empower the sub-county leaders with correct IRS information. Leaflets with ‘frequently asked questions (FAQs)’ on IRS were distributed to all participants to use as reference points while sensitizing and mobilizing the communities.

 District leaders and media orientation: During this quarter, the project oriented 21 district leaders from group B districts including DHEs, District Information Officers, and Secretary for Health, as well as radio presenters from six media houses on IRS. Keeping in mind the lessons learned from the group A districts where radio presenters were not sensitized on IRS, in group B districts, the district officials and media presenters were oriented on presenting correct information about IRS on radio and other media, and addressing any negative questions/issues about IRS raised by their audiences.

 Radio activities: Following the significant IRS resistance from the group A districts during spray round one, in January 2015, CDFU conducted additional IRS interactive radio talk shows with technical and political leaders to encourage households that had not sprayed in December 2014, to do so. Various IRS related questions including health implications of the insecticide, and IRS benefits were also addressed during the radio talk shows. In the group B districts, the project conducted pre-IRS radio talk shows with distinguished speakers including LCVs, DHOs and RDCs. Additionally, CDFU, tried to maximize the utilization of the free air time provided to districts for talk shows by the Uganda Communications Commission. This increased the number of IRS radio talk shows without increasing the actual costs incurred.

 Distribution of IEC materials: During this quarter, CDFU printed and distributed posters translated in the districts’ local dialect in the group B districts. The posters highlight the role of the community during spraying. CDFU also printed and distributed an updated version of FAQs on IRS. Dissemination of the IEC materials was done during the sub-county orientation, where each participant was given IEC materials, along with clear instructions for displaying them in strategic places in the community. The LCIs were also given posters which show IRS steps at the household level, for displaying in their communities as well as for using as reference material for community sensitization. A total of 19,010 IEC materials were printed and 15,510 were disseminated; the balance will be disseminated in the group A districts.

Logistics distribution and retrieval From January 12-15, 2015, the project’s logistics team supervised by the Logistics Manager, distributed logistics to the two sub-counties of Amach and Agali which had initially resisted spraying. The team also carried out retrieval of logistics from the seven group A districts from February 16-23, 2015. The project’s logistics team in collaboration with the district staff, including the District Supplies Officer (DSO), the DEO, and the IRS Focal Person, also sited parish stores in all the group B districts.

Supervision of spray operations Project staff, in collaboration with MoH and DHT members, conducted support supervision in the seven group A districts. The FCs received spray data summaries through short message service from all the group A districts on a daily basis, and analyzed the results to guide spray operations, enabling field teams to focus their support supervision efforts on poorly performing spray personnel and/or communities. Since these districts were implementing IRS for the first time and the spray teams needed to adopt proper spray techniques, this intensive supervision and diligent monitoring of spray activities helped the FCs monitor key indicators like spray coverage, insecticide usage rate and the spray progress on a daily basis during the spray round, and immediately address any upcoming issues.

IRS implementation-results from spray round one-group A districts During spray round one in the group A districts, the project sprayed 429,562 households, of the total 639,173 households found in the seven districts (Table 5). The project attained overall coverage of 67.2 percent, which is below the World Health Organization (WHO) recommended coverage, as well as the project’s target. This spray round protected a total population of 1,551,123, which is 81.5 percent of the total 1,902,426 population found in the seven new districts. Acquiring accurate data for the unprotected population was challenging, as most of the unsprayed households were locked, with no one available to provide information on the household occupants. Of the total population protected, 792,434 (51 percent) were female, while 758,689 (49 percent) were male; 289,423 (19 percent) were children under five, and 35,772 were pregnant women. The project used a total of 185,877 insecticide sachets to spray a total of 429,562 households, with an overall insecticide usage rate of 2.3 houses sprayed per sachet. All the seven districts completed spraying within the project’s set target of 30 day; with an overall average of 25 days. On average, a SO sprayed five (5) houses per day which was below the project’s target of 10 houses per day. This was due to the resistance/refusals, and locked houses found in the districts. Detailed results and reasons for sub optimal coverage during this spray round, are included in the ‘End of Spray Report, Round Five for the Previous IRS Districts and Round One for the New IRS Districts October 2014 – February 2015’, which was submitted to USAID.

Table 5: Summary of key IRS indicators for round one, new districts, December 2014 – February, 2015 DISTRICTS INDICATOR TOTAL Alebtong Amolatar Dokolo Kaberamaido Lira Otuke Tororo Targeted households (based on the 2014 census) 91 110 55 770 69 562 77 042 178 330 44 546 208 732 725 092 Total households found* 70 825 57 316 77 623 70 069 148 626 33 803 180 911 639 173 Total households fully and partly sprayed 39 746 31 362 41 850 49 785 90 477 21 895 154 447 429 562 Households not sprayed 31 079 25 954 35 773 20 284 58 149 11 908 26 464 209 611 Percentage of households partly or fully sprayed 56.1 54.7 53.9 71.1 60.9 64.8 85.4 67.2 Percentage of households not sprayed at all 43.9 45.3 46.1 28.9 39.1 35.2 14.6 32.8 Targeted population (based on the 2014 census) 225 327 146 304 182 577 213 374 410 516 105 617 526 378 1 810 093 Total population found 201 877 141 640 206 028 192 466 481 730 83 022 595 663 1 902 426 Total population protected 129 269 96 395 143 299 152 287 389 953 66 525 573 395 1 551 123 Total population not protected 72 608 45 245 62 729 40 179 91 777 16 497 22 268 351 303 Percentage of population protected 64.0 68.1 69.6 79.1 80.9 80.1 96.3 81.5 Percentage of population not protected 36.0 31.9 30.4 20.9 19.1 19.9 3.7 18.5 No. of children under five protected 24 861 20 005 27 579 33 128 56 912 14 443 112 495 289 423 No. of pregnant women protected 2 689 2 089 3 317 3 848 9 090 1 544 13 195 35 772 No. of insecticide sachets used 16 694 13 500 16 685 19 856 46 678 8 325 64 139 185 877 Average number of households sprayed per sachet 2.4 2.3 2.5 2.5 1.9 2.6 2.4 2.3 Number of SOs 346 251 457 366 918 177 706 3 221 Average number of households sprayed per 5 5 3 6 4 5 9 5 SO per day Average number of spray days 24 27 27 23 27 25 25 25

2.2 RESULT 2: CAPACITY BUILDING AND INNOVATIVE APPROACHES IN IRS IMPLEMENTED Table 6: Result 2: Summary of output indicators for quarter two January 1- March 31, 2015 January-March 2015 Performance Indicator Title Target Actual Dashboard charts populated with district data 5 5

National and district staff receiving in-service training 14 141

Large private companies trained on IRS to expand their on-going IRS 0 0 activities

114 district biostatisticians from the 14 IRS districts were trained B. Capacity development Training of technical staff In March 2015, the project trained clinical and laboratory personnel from hospitals and health centers III and IV in the group B districts. This training which was attended by 165 participants (of which 53 , 32.1 percent were female), focused on managing the adverse effects of carbamates, as well as handling emergencies arising from insecticide poisoning. The clinicians were also trained on examining and screening spray team personnel to prevent the recruitment of expectant mothers, and sick people who may be at-risk or ineffective during spraying.

From March 23-26, 2015, the project’s M&E and capacity building team conducted a three day training of district biostatisticians from the 14 group A and B districts. The training focused on review of the revised M&E tools and IRS data management. All the 14 district biostatisticians, 11 males and three females, attended the training.

IRS materials In this quarter, the project handed over the six IRS technical manuals to the MoH for conducting trainings for the different cadres of support personnel involved in spray operations, and also to act as reference guides containing IRS technical and management information. Additionally in this quarter, the project shared with USAID pocket guides on BCC, spray operations, parish store management, environmental compliance, supervision, and entomological monitoring, all of which will be used as reference materials by the different cadres involved in spray activities.

Capacity dashboard The project’s capacity dashboard assesses the capacity of the IRS districts in managing and implementing IRS, on six key parameters: logistics, environmental compliance, entomological competence, spray operations, M&E, and IEC/BCC. Preliminary results from spray round five (the last round) in the five previous IRS districts showed significant increase in overall capacity for each district, in comparison to the previous spray round (see detailed maps of individual districts in Annex 1). Gulu had a 66.7 percent increase in overall capacity across the six key areas, followed by Kole at 32.8 percent, Oyam at 22.3 percent, Pader at 15.6 percent, and finally Agago at 14.3 percent. For ease of understanding, the dashboard showcases results using color coding, with red denoting low capacity to green being high capacity (see Figure 2 below). Environmental compliance scores in particular helped account for these increases, since districts prioritized cleanliness and security of soak pits, as observed during field visits. It is important to note that since the onset of the capacity dashboard in May 2013, the project has increased the capacity of each project areas across all districts by 40 percent or more with the exception of logistics. The districts have continued to struggle with logistics, as DSOs continue to be overstretched with multiple responsibilities.

The capacity dashboard results have enabled project staff to better understand key areas where capacity growth is needed, and these will be handed over and shared with MoH and NMCP for helping them better understand the current capabilities of these districts, and existing gaps for future government implemented IRS programs.

Figure 2: Colored blocks by project area show progression from red (low) to green (high) capacity levels Round two (April-May 2013) Round five (Oct-December 2014)

In March 2015, the project provided support to MoH/Vector Control Division staff, as well as VCOs from the previous IRS districts to collect data for populating the capacity dashboard for the seven newly phased in group A districts. Results from these districts will be reported in the next quarter. Meeting with private companies on IRS support In quarter two, the project identified six big companies, Kakira Sugar Works, Hima Cement Factory, Kijuura Tea Estate, Tullow Oil Ltd, and Kinyara Sugar Factory to support their IRS activities in their workers premises and neighboring communities. The project held some initial meetings with some of these companies to discuss their IRS activities and over the next few months, will ramp up efforts to engage in detailed discussions with these companies, analyze existing gaps, and prioritize the support needed for efficient and effective spraying of their own and neighboring communities.

2.3 RESULT 3: COMPREHENSIVE MONITORING AND EVALUATION OF THE IRS PROGRAM PERFORMED Table 7: Result 3: Summary of output indicators for quarter two January 1- March 31, 2015 January - March, 2015 INDICATOR Target Actual PMP developed and submitted 0 0 Updated PMP submitted quarterly to USAID/PMI 1 1 Annual work plan developed and approved 1 1 Number of district-level IRS digital maps prepared 7 7 Number of parish level IRS digital maps prepared 0 0 Number of sub-county level IRS digital maps prepared 0 0 Number of progress reports prepared and submitted 5 51 IRS entomological monitoring plans developed and implemented 1 1 Number of spray teams inspected by supervisors per spray round 0 18502 Percentage of IRS operational units (washing bays and soak pits) inspected according to IEEs/SEAs guidance 0 100%

January - March, 2015 INDICATOR Target Actual IEEs and/or SEAs completed as required 0 0 Number of independent environmental compliance inspections conducted 0 23 Number of national insecticide susceptibility tests conducted 0 0 Number of CDC bottle bioassays conducted 0 0 Number of wall bioassay tests conducted according to WHO standards 90 90 Number of PSCs carried out in the previous IRS districts 216 216 Number of pre- and post-PSCs carried out in the 14 new IRS districts 84 84 Number of bionomic studies conducted 0 0 1Progress reports submitted this quarter include two monthly reports, one quarterly report, one revised annual work plan and one end of spray cycle report. 2Supervisors are project staff, MoH staff and district staff. The start of spraying was delayed resulting in the spray round spilling over to quarter two 3Two independent environmental compliance inspections were conducted by the USAID mission’s Environment Officer C. Monitoring and Evaluation Progress reports During this quarter, the project compiled and submitted five reports to the project’s Contracting Officer’s Representative (COR) as detailed in the reporting section under business management. Data management In March 2015, the project’s M&E team completed data cleaning and analysis for the group A districts following the end of spray round one. The data was incorporated in the end of spray report which was submitted to USAID. Environmental compliance monitoring During spray round one in the group A districts, the project’s ECM with the support from district officials and other project staff, conducted environmental supervision throughout the spray period to ensure that all required environmental guidelines were followed.

District maps For planning purposes, in preparation for the spray round one in group B districts, the project’s Geographical Information System Specialist developed seven district level maps for each of the seven group B districts showing the district sub-counties and parishes, and the proposed parish stores locations. These maps will be updated with the actual store locations once these have been finalized. Factors like availability of infrastructure and environment issues are considered when deciding on the store location. The FC will capture the location of every store using smartphones, which will be updated in the parish stores database, and reflected on the map. An example of the map is included in Annex 2.

Entomological monitoring activities  Pre and post IRS pyrethrum spray catches (PSCs): In February 2015, the project conducted 84 post–IRS PSCs in the seven group A districts. A total of three indoor resting female vectors (0 female Anopheles gambiae s.l. and 3 female An. funestus) compared to 923 that were caught during the pre-IRS PSCs conducted in October 2014 in the same districts (Table 8). No other female Anopheline mosquito species was caught in the seven new IRS districts. Follow-up by the district VCO of the house where the three female An. funestus mosquitoes were caught in Kaberamaido, established that the house had not been sprayed. The post-PSC results, and the very

few vectors found indicate that IRS was well conducted in all the group A districts despite the challenges faced during IRS implementation in these districts.

Table 8: Comparison of the results of pre- and post-IRS PSCs in group A districts, October 2014 and February 2015 respectively An. gambiae s.l. An. funestus Total vectors District Sub-county Pre-IRS Post-IRS Pre-IRS Post-IRS Pre-IRS Post-IRS Kaberamaido Aperikira 21 0 141 3 162 3 Dokolo Dokolo T.C. 22 0 70 0 92 0 Amolatar Aputi 20 0 54 0 74 0 Alebtong Aloi 26 0 4 0 30 0 Otuke Orum 59 0 48 0 107 0 Lira Adekokwok 62 0 105 0 167 0 Tororo Nagongera 278 0 13 0 291 0 TOTAL 488 0 435 3 923 3

 Monthly entomological monitoring of the malaria vector situation in the previous IRS districts: During this quarter, a total of 216 monitoring PSCs were conducted in six of the 10 previous IRS districts of Amuru, Apac, Gulu, Kitgum, Oyam and Pader. A sample of 12 houses was selected in each of the sentinel site in each district where PSCs were conducted in each month of the reporting period. A total of 68 female malaria vectors (59 An. gambiae s.l. and nine An. funestus) were caught, 33 in Amuru, 28 in Kitgum, 6 in Apac, 1 in Pader and none (zero) in Gulu and Oyam. In addition, a total of 898 female Culex and 3 female Mansonia mosquitoes were also caught in the six sentinel districts. This indicates that the malaria vectors have primarily increased in Amuru and Kitgum, since the closure of IRS in these districts. The project will analyze the vectors for sporozoite rates to determine the infection rates in these vector populations, and work with the Uganda Malaria Surveillance Project (UMSP) to assess the burden of malaria in the health facilities. The project will use this information to determine the impact of the increase in the malaria vectors on the burden of malaria in these previous IRS districts.

 Post IRS wall bio-essays: In February 2015, the project conducted a total of 63 cone tests in the seven group A districts to assess the quality of spraying with Bendiocarb. In all the districts, all the mosquitoes exposed to plastered and painted, mud and wattle and plain brick wall surfaces were knocked down within 20-40 minutes post-exposure, with the exception of Alebtong, where the mosquitoes exposed to plain brick wall surfaces were knocked down within 60 minutes post- exposure. This indicates excellent spraying quality in most districts except for the sentinel site in Alebtong, which needs improvement through closer supervision during the next spray round. This being the first spray round in Alebtong, the new SOs may have had issues with ensuring even and adequate distribution of insecticide on the almost exclusively mud and wattle walls. However, all the mosquitoes exposed to the three wall surfaces in the seven districts died after the 24-hour holding period.

In March 2015, the project conducted 27 other cone tests in the three sentinel sites in Kaberamaido, Lira and Tororo (group A districts), to assess the residual efficacy of Bendiocarb. In all three districts, all the mosquitoes exposed to plastered and painted wall surfaces were knocked down within 30 minutes post-exposure. However, the mosquitoes exposed to mud and wattle and plain brick wall surfaces in the three sentinel districts had variable knockdown times, ranging between 30 and >60 minutes post-exposure. All the mosquitoes exposed to the different wall surfaces in all the three sentinel districts, died after the 24-hour holding period indicating that the insecticide used for spraying was residual and effective.

Rehabilitation works for Gulu University insectary and establishing the Tororo Insectary The rehabilitation works for Gulu University insectary was completed by the end of February 2015. The insectary is already operational with two newly recruited insectary technicians who started work in March 2015. The project is negotiating with Tororo District authorities on rehabilitating the former Tororo Hospital theatre for use as an insectary, while at the same time, conducting exploratory talks with authorities of the Nagongera Campus of Busitema University as an alternative site for establishing this insectary, in case the first option does not materialize.

3. BUSINESS MANAGEMENT Key and other project personnel During this quarter, all key personnel were in place. With the transition to 14 new districts, to meet the growing needs, the project also recruited nine new staff: one M&E Manager, one FC, one dispatch agent, three SMs, two insectary technicians, and one driver. In March 2015, the project conducted interviews for the Environment Compliance Officer position, and identified a suitable candidate.

Reporting During this quarter, the project developed and submitted five reports to the project’s COR: monthly reports for January and February, one annual work plan, one quarterly report, and one end of spray report.

Property control In this quarter, the project acquired equipment from the USAID funded Stop Malaria Project which closed in March 2015. This includes a fax machine, two telephone handsets, an inverter system with 20 batteries and a server rack. The project also procured a microwave, located in Tororo, for the entomology department. The project has updated its inventory list. No property was lost or damaged in this quarter.

Payment of spray teams The project’s Finance and Administration team used mobile money to pay 4,640 spray team members in the group A districts, following the end of spray round one.

4. INNOVATIONS Based on the lessons learned from spray round one in the group A districts, the project came up with specific innovative measures to address the challenges faced in the spray round.

 Initiation of micro planning at the sub-county level: Under the previous model, micro planning was held at the district level, but this sometimes resulted in alienating the sub-county leaders, who were not involved in recruiting the parish SKs and often denounced them. Instead of the centralized micro-planning approach, the project decided to roll out micro-planning at respective sub-counties in all the group B districts. The project in each sub-country together with a DHT member briefed the sub-county leaders, shared the IRS activity schedule, solicited their support and involvement in recruiting SKs, and identifying competent supervisors. This helped streamline the implementation process, and recruit competent spray team members with the support of sub- county officials.

 LCI sensitization: In the previous spray rounds, LCI Chairpersons were oriented on IRS at respective stores, but were not given an opportunity to sensitize the villages, despite them being key influencers at the community level. For the group B districts that are going to start spraying on April 20, 2015, the LCIs were oriented and equipped with BCC materials, and they were

involved in conducting door-to-door IPC and sensitization of their communities to create IRS awareness and demand at the village level.

 Recruitment of a parish store mobilizer: From the last spray round, the project realized that there was a gap in communicating and reminding the LCI and the community about the upcoming spray dates. The project therefore identified a SO to take up the role of a parish store mobilizer, notify the LCIs at respective villages, and village communities, about the spray dates and remind them that the SOs were coming to spray the houses. This approach will help improve IRS acceptance, as the community members can stay home and prepare for the SOs, instead of being taken by surprise.

 Stamping of spray cards: In order to facilitate community mobilization at village level, the sub- county supervisors in Agweng sub-county, Lira District, mobilized and involved all the LCI chairpersons in the stamping of spray cards after spraying, as proof that the SOs had sprayed existing houses in their villages. This encouraged the LCIs to be more active and take ownership of the program and also acted as a reminder to SOs that they are being monitored closely at different levels. The project will roll out this innovation to other districts in the upcoming spray rounds.

 Sensitization of radio presenters: To minimize airing false information about IRS, radio presenters were sensitized on how to answer IRS related questions while on air, and were given FAQ sheets which provide detailed answers to common IRS issues. This empowered the presenters and gave them an ability to inform callers about IRS, reversing what could otherwise be a source of myths and negative rumors into positive information sharing with the communities.

 Involvement of prominent political leaders: In order to address the resistance in the Lira District, the project secured the support of prominent political leaders like members of parliament (MPs) who had their houses sprayed publicly, and also assured the people from their own and surrounding districts about the benefits of IRS. This not only gave the MPs a chance to directly lead their constituents in IRS, but it also gave confidence to the community members where IRS had been initially rejected to embrace IRS.

 Involvement of VHTs: To enhance IRS mobilization, the project together with CDFU, has planned to involve all the VHT members, four per village, in IRS mobilization, in addition to the LCIs. CDFU has started developing talking points that can be used by these VHTs for IRS door to door mobilization during the upcoming spray round.

 Mobile money: The project continued to use the innovative and effective mobile money system to pay all spray team members after conclusion of spray round one.

5. RELATIONSHIP BUILDING The project is committed to building quality relationships with key malaria stakeholders in Uganda, both for the current success of the project, and long term sustainability of the IRS program. In quarter two, the project worked together with MoH staff to conduct entomological monitoring in the six sentinel sites in the previous IRS districts. In the seven new group A districts, the project continued to collaborate with MoH representatives and staff including VCOs, DHTs, DEOs, to conduct IRS activities, including supervision of spraying, entomological monitoring and environmental compliance monitoring. To counter the resistance in the Lango sub-region, the project sought the support of IRS focal persons, DHOs, and RDCs from their respective districts to help temper the unrealistic remuneration expectations of district leaders, and with time, several of these leaders became proponents of IRS. The project also enlisted MPs in some of these districts, to spray their homes publicly, and to appeal to their constituents to open their homes for spraying.

In the seven new group B districts, the project forged strong ties with the district leadership, sensitized them on IRS, and worked closely with the DHT members to implement IRS, from conducting sub- county level micro planning, recruiting spray team members, and providing support supervision during spraying. IRS district task forces comprised of various cadres of district staff were also formed to monitor spray progress during the spray round. The project also worked closely with the DHEs to conduct BCC activities including community mobilization. Prior to spraying these districts, the project also engaged LCIs at the ground level to lead mobilization activities, and help with sensitization in their communities.

The project also engaged with other USAID projects like Communication for Healthy Communities (CHC), and Applying Science to Strengthen and Improve Systems to coordinate malaria prevention activities in the former Northern Uganda – Health Integration to Enhance Services (NU-HITES) districts. The project attended the implementing partners (IP) meeting held on March 12 in Kampala to discuss and coordinate efforts on the NU-HITES bridge activities. Since then the project along with CHC has been providing inputs to communication strategies for malaria prevention in these NU- HITES districts.

The project is a member of the Malaria M&E Technical Working Group, which is chaired by the UMSP, and meets on a monthly basis to discuss malaria M&E issues. On March 6, 2015, the project also chaired the Integrated Vector Management (IVM) Thematic Working Group which was attended by the Roll Back Malaria partners to guide the NMCP on the national IVM strategy in Uganda.

6. PROJECT SURVEILLANCE Project site visits From January 13-16, 2015, Joel Kisubi, the USAID COR for the project, and Robinah Lukwago, the DFID-UK Health Advisor, visited the project. They conducted joint field visits in the new IRS districts of Kaberamaido, Lira and Tororo, and inspected parish stores and soak pits. Accompanied by the project’s Deputy Chief of Party and ECM, the delegation met with the CAOs, RDCs, IRS Focal Persons, and DHEs of Kaberamaido, Lira and Tororo. During these meetings, the district officials expressed gratitude to the American and British governments for supporting IRS, and pledged their full cooperation and support to the project.

From February 8- 13, 2015 the project received visitors from PMI Uganda and USAID/Washington. The objective of the visit was to assess the performance and impact of all PMI funded projects. The team held meetings with project staff and made field visits to the community including visits to Bendo village in Iyolwa sub-county of Tororo District. From February 23- 16, 2015 Joel Kisubi, the project’s COR, and Jessica Okui, the Mission Environment Officer (MEO) also visited the project, and together with the project team conducted joint field visits to assess the districts stores of Tororo, Kaberamaido and Amolatar.

Meetings and conferences In January 2015, the project’s Field Operations Manager attended the USAID-organized District Operational Plan (DOP) meetings in Dokolo and Lira. These DOP meetings are attended by all USAID-funded implementing partners in Lango sub-region in northern Uganda. These meetings provide an opportunity for partners to share past and future planned to strengthen coordination and minimize overlap.

Staff retreat The project staff attended a staff retreat in Mbale Resort Hotel from February 23-25, 2015. The objective of the retreat was to: introduce and orient staff to the contract modification, new scope of work, objectives and targets; reinforce team work, integrate new staff in the existing structure; and most importantly to discuss challenges and lessons learned from the new districts and agree on the

way forward for the upcoming spray rounds. Joel Kisubi, the project’s COR, and Jessica Okui, the MEO also attended selected sessions of the retreat.

Gender consultancy In March 2015, the project engaged a team of two consultants to examine gender roles and behaviors in the new IRS districts in relation to malaria prevention, and better understand how gender has been integrated and can be promoted through the project’s ongoing activities. The consultants visited five new districts: Amolatar, Dokolo, Lira, Tororo and Namutumba, met with key stakeholders, held focus group discussions and key informant interviews to gather qualitative gender related data. Based on the gender analysis report and recommendations, the project will adapt its strategies to ensure gender balance and equity, tailor its BCC messages to make them gender sensitive.

7. COST CONSIDERATIONS During the quarter under review, the project ensured that all cost considerations were met in a timely and effective manner. The project ensured that all quarterly expenditures were on track, quarterly accrual reports were completed and submitted on time, and that there were no unallowable expenditures in this quarter.

8. CHALLENGES  There were varying degrees of resistance to IRS in the seven group A districts which derailed spray activities and resulted in sub-optimal IRS coverage. In many cases, resistance to IRS by different segments of the district personnel was due to unrealistic expectations regarding their remuneration for their involvement in IRS activities while in some localities, IRS was politicized and alleged to be a campaign strategy for amassing votes for the ruling National Resistance Movement party. Journalists and radio presenters published myths, misinformation and rumors about IRS which contributed to greater resistance among communities. Some VHTs who did not qualify to participate in the IRS program also de-campaigned the program in their localities.

 Besides the persistent resistance, the project also had to wait for the SEA and MIS to be completed in the new districts before spraying could commence. This also created uncertainty as to when spraying was going to start, and adversely impacted the time allocated for mobilization and sensitization of the community members. In some communities, IRS implementation was ahead of mobilization activities, leading to poor community acceptance rates and inadequate coordination between the project and the district teams.

 The project was unable to conduct district sensitization of political leaders for spray round one. This created a major gap, since district sensitization is key for garnering the support of the new district leaders and securing their buy-in, especially in a region that historically has a tendency to be initially resistant to government-sponsored activities. District sensitization meetings also provide an opportunity for discussing and agreeing on remunerations for involvement of district officials in IRS activities, to avoid misunderstandings and confusion in the future.

 The project was understaffed during spray round one, while waiting for approval of the contract modification to hire and deploy additional personnel to cover the new districts. This placed an additional burden on the existing project staff who were stretched thin with multiple demands and additional workload.

 In the group B districts, the project has identified pockets of resistance including religious sects that are against spraying their houses. These groups are hard to mobilize since they think it is anti- religious to open their houses for spraying. The project has done an initial assessment of these

groups and is trying to get a sense of their magnitude. The resistance is especially significant in Budaka District and the project will make all efforts to negate these resistant forces.

9. LESSONS LEARNED/RECOMMENDATIONS  The significant resistance to IRS in the group A districts highlighted the importance of starting sensitization and mobilization activities early, with adequate time on-hand to negate resistance, and to dispel the myths and concerns about IRS among communities. In this quarter, the project had sufficient time to sensitize district leaders, local politicians; religious and cultural leaders on IRS before spraying began in the group B districts.

 In order to enhance IRS acceptance and boost mobilization, the project needs to continue to involve prominent political leaders from the districts, local councils as well as community members in mobilization activities. The project also needs to sensitize all MPs from the catchment area to enlist their support for IRS activities, and prevent any negative rumor- mongering about IRS.

 The project should also sensitize media presenters, journalists on IRS, and equip them with the knowledge and information on how to answer IRS-related questions in order to minimize publicizing false information, myths and rumors.

 Conducting the recruitment of spray teams concurrently with the sub-county leaders’ sensitization ensures that there is ample time for training and mastering spray techniques, as well as community mobilization.

 Involvement of LCI chairpersons in IRS mobilization is essential for enhancing community acceptance of the program. LCI chairpersons need to be sensitized and equipped with appropriate information and BCC materials to conduct door-to-door mobilization. They will also be involved in verifying sprayed houses by stamping the spray cards after confirming that the recorded houses belong to their area, to minimize misrepresentation and ensure accurate recording of data by SOs.

 The project needs to work closely with other USAID-funded projects especially CHC in the new districts, and closely coordinate BCC activities to help spread the word about IRS to the target communities.

 The involvement of additional supervisors from the MoH/NMCP in the different IRS activities: district leaders’ sensitization, micro-planning, sub-county leaders sensitization and spray team recruitment, and TOT, ensured a critical mass of personnel needed to provide support supervision during spraying to ensure it is done properly and that the SOs record the spray data accurately.

10. PLANS FOR NEXT REPORTING PERIOD The major activity for the next quarter (April 1 – June 30, 2015) is to spray the group B districts, starting on April 20, 2015. Key activities include: training spray personnel to implement IRS, ensuring that soak pits and parish stores are environmentally compliant, conducting intensive BCC and mobilization in the group B districts, supervision of the spray round to minimize insecticide pilferage and inaccurate recording of spray data. On completion of spraying, the project will retrieve the supplies to ensure that the group A districts start spraying on-time, on June 8, 2015.

Under capacity building, the project will consolidate its relationships with the five big companies it has identified to support their IRS activities in their own and neighboring communities. The project’s capacity building team will lead this activity and conduct in-person meetings with representatives of these big companies to figure out next steps and make a detailed plan for providing support. After spraying in group B districts is completed, the capacity building team will lead the dashboard data

collection process in these districts. It will also share the initial baseline results from the group A districts with project senior management and key district and MoH stakeholders. The project will also carry out scheduled entomological monitoring activities to assess the quality and impact of spraying in the new districts, and share results from its routine entomological activities in the previous IRS districts. Finally on the operational and administrative front, the project will continue to draft and submit the required reports, including an updated PMP.

ANNEX 1: SUMMARY MAPS OF CAPACITY DASHBOARD SCORES BY DISTRICT

ANNEX II: MAP OF KIBUKU DISTRICT SHOWING PROPOSED PARISH STORES