THE PMI VECTORLINK PROJECT END OF SPRAY REPORT 2020 SPRAY CAMPAIGN: NOVEMBER 2 – DECEMBER 14, 2020 Recommended Citation: The PMI VectorLink Project. January 2021. Zimbabwe End of Spray Report 2020: Spray Campaign: November 2 – December 14, 2020. Rockville, MD. The PMI VectorLink Project, Abt Associates Inc. Contract: AID-OAA-I-17-00008 Task Order: AID-OAA-TO-17-00027 Submitted to: United States Agency for International Development/PMI Submitted on: January 28, 2021 Approved: March 16, 2021

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THE PMI VECTORLINK PROJECT ZIMBABWE END OF SPRAY REPORT 2020 SPRAY CAMPAIGN: NOVEMBER 2 – DECEMBER 14, 2020

CONTENTS

Acronyms ...... iv Executive Summary ...... 1 Country Background ...... 3 Technical Support ...... 5 2.1 Entomological Surveillance at Burma Valley and Vumba ...... 5 Implementation of IRS Activities in Mashonaland East Province ...... 6 3.1 IRS Planning and Partners Collaboration ...... 6 3.2 Trainings for IRS Operations ...... 7 IRS Trainings ...... 7 Other IRS Campaign Trainings ...... 8 3.3 Spray Operations and Supervision ...... 9 Spray Operations ...... 9 Supervision of the Spray Campaign ...... 10 Short Message Service-Based Job Aids For Spray Personnel ...... 11 IRS Campaign Vehicles ...... 11 Payment of Spray Teams and Vendors ...... 11 Cost-Efficiency of Spray Operations ...... 13 3.4 Insecticide Needs ...... 13 3.5 Insecticide Stock Management ...... 14 Inventory Assessment ...... 14 3.6 Post-Spray Conference ...... 14 3.7 Information Education and Communication Activities and Outcomes ...... 15 Information, Education and Communication Training ...... 15 Sensitization Meetings ...... 15 Provincial IRS Sensitization Meeting ...... 16 District Sensitization Meetings ...... 16 Community Sensitization Meetings ...... 17 Production and Distribution of IEC Materials ...... 17 Community Mobilizers And Guides ...... 17 Door-to-Door Mobilization ...... 17 3.8 Capacity-Building Efforts ...... 18 3.9 Gender Mainstreaming ...... 18 Entomology ...... 20 4.1 Insecticide Susceptibility Tests ...... 20 4.2 Residual Efficacy ...... 21 Environmental Compliance ...... 24 5.1 Pre-Season Assessment ...... 24

i 5.2 Pre-Season Environmental Compliance Assessment ...... 24 5.3 Final PSECA for IRS Campsites ...... 24 5.4 Pre-Contract Vehicle Certification ...... 25 5.5 Provision of Water at IRS Campsites ...... 25 5.6 Provision of Mobile and Permanent Soak Pits...... 25 5.7 Mid-season Environmental Compliance Assessments ...... 26 5.8 Post-season Environmental Compliance Assessment ...... 26 5.9 Incident Reports ...... 26 5.10 Waste Disposal ...... 27 Monitoring and Evaluation ...... 29 6.1 M&E Objectives ...... 29 6.2 Data Management ...... 29 6.3 Data Collection, Entry and Security ...... 29 6.4 Data Quality Assurance ...... 30 Data Collection Verification (DCV) ...... 30 Data Collection Supervision ...... 30 Campsite Data Quality Checks ...... 30 6.5 Data Reporting ...... 30 6.6 mHealth Results ...... 30 Storekeeper Performance Form...... 30 Morning Mobilization Form...... 30 Homeowner Preparation and Spray Operator Performance Form ...... 31 End-of-day Clean-up Form ...... 31 Transportation Vehicle Inspection Checklist ...... 31 Directly Observed Spraying ...... 31 6.7 Results of 2020 IRS Campaign ...... 33 Challenges and Recommendations ...... 37 Annex A. Monitoring and Evaluation Plan Indicator Matrix ...... 41 Annex B. Environmental Mitigation and Monitoring Report ...... 65

LIST OF TABLES

Table E-1. Summary of VL Supported IRS in Mudzi and Districts, 02 November to 14 December 2020 Zimbabwe at a Glance ...... 2 Table 1. Summary of 2020 IRS Trainings ...... 7 Table 2. Description of Other 2020 IRS-Related Trainings ...... 8 Table 3. Summary of Number of People Trained by Gender, 2020 ...... 9 Table 4. Positions Engaged for 2020 IRS Campaign, by District ...... 10 Table 5. Sensitization Meeting Participants, by Gender, 2020 ...... 16 Table 6. Females Hired During IRS, 2014-2020 ...... 19 Table 7. Results of Insecticide Susceptibility Tests on An. gambiae s.l. Conducted at Sites in Mashonaland East Province in 2020 ...... 20 Table 8. Results of Insecticide Susceptibility Tests on An. Funestus S.L. Conducted at Burma Valley and Vumba in Manicaland Province in 2020 ...... 21 Table 9. Summary of Wall Types Tested with Cone Bioassays in Mashonaland East, 2020...... 21

ii

Table 10: Solutions Deployed to Address Water Supply Gaps, by Site ...... 25 Table 11. Summary of Incident Reports During 2020 IRS Campaign...... 27 Table 12: IRS Waste Management Plan ...... 28 Table 13. CommCare and ODK Results by Form for Mudzi and Mutoko Districts ...... 32 Table 14. Non-Compliance Issues Observed on Directly Observed Spraying ...... 32 Table 15. Summary of the 2020 IRS Campaign Spray Coverage per District...... 35 Table 16. Summary of Insecticide Usage During the 2020 IRS Campaign per District ...... 35 Table 17. Challenges, Lessons Learned and Solutions from the 2020 Spray Campaign ...... 37

LIST OF FIGURES

Figure 1. Mosquito Mortality of Susceptible An. Arabiensis (KGB Strain) in Kawere and Dendera: Wall Bioassays Test Results ...... 22 Figure 2. Spray Quality and Residual Efficacy of DDT in Burma Valley, District, as Measured by An. Arabiensis (KGB Strain) ...... 23 Figure 3. Spray Coverage Mudzi and Mutoko Districts, 2020 IRS Campaign ...... 36 Figure 4. Spray Progress Mudzi and Mutoko Districts, 2020 IRS Campaign ...... 36

iii ACRONYMS

AIRS Africa Indoor Residual Spraying AU Africa University BMP Best Management Practices Manual COP Chief of Party DCV Data Collection Verification DDT Dichlorodiphenyltrichloroethane DEHO District Environmental Health Officer DHIS 2 District Health Information System 2 DOS Directly Observed Spraying EC Environmental Compliance ECO Environmental Compliance Officer EHT Environmental Health Technician GOZ Government of Zimbabwe HPO Health Promotion Officer IEC Information, Education and Communication IRS Indoor Residual Spraying ITN Insecticide-treated Net M&E Monitoring and Evaluation MEP Monitoring and Evaluation Plan MOHCC Ministry of Health and Child Care NIHR National Institute for Health Research NMCP National Malaria Control Program OP Organophosphate PEHO Provincial Environmental Health Officer PFO Provincial Field Officer PMI U.S. President’s Malaria Initiative PPE Personal Protective Equipment PSECA Pre-Spray Environmental Compliance Assessment RHC Rural Health Centre SBCC Social and Behavior Change Communication

iv

SEA Supplemental Environmental Assessment SOP Spray Operator TOT Training of Trainers USAID United States Agency for International Development VHW Village Health Worker WHO World Health Organization ZAPIM Zimbabwe Assistance Program in Malaria ZINWA Zimbabwe National Water Authority

v

EXECUTIVE SUMMARY

The U.S. President’s Malaria Initiative (PMI) has a long history of malaria vector control in Zimbabwe using indoor residual spraying (IRS), dating back to August 2011. Abt Associates first implemented PMI-supported IRS through the three-year Africa Indoor Residual Spraying (AIRS) projects, IRS 2 Task Orders 4 and 6. Task Order 4 provided technical support for IRS operations, environmental compliance activities, and entomological monitoring; the project ended in 2013. Task Order 6, which ended in 2018, was meant to showcase best practices for planning, implementing, monitoring, and evaluating an IRS program in selected high malaria- burdened districts of Manicaland Province (Chimanimani, Mutare, Mutasa, and Nyanga). These best practices would ultimately form a model IRS program for Zimbabwe. Abt Associates is currently implementing the PMI VectorLink (VL) Project in up to 24 African countries, including Zimbabwe, through a five-year contract launched in October 2017. VL Zimbabwe implements a full package of IRS support in two districts (Mudzi and Mutoko) in Mashonaland East Province, provides technical assistance to the Government of Zimbabwe IRS programs in Manicaland Province, and conducts entomological monitoring in Mashonaland East and Manicaland Province. The 2020 spray campaign in PMI-supported districts in Mashonaland East commenced on November 2 and ended on December 14, 2020 with a spray target of 147,636 structures and a target population of 324,685 across both Mudzi and Mutoko Districts. The project used the neonicotinoid and pyrethroid mixture clothianidin/deltamethrin (Fludora® Fusion) in both districts. The selection of Fludora® Fusion was guided by the country’s Insecticide Resistance Management Plan 2016-2020 and the results of the project’s insecticide susceptibility assays conducted in Mashonaland East Province. VL Zimbabwe implemented the 2020 IRS campaign during the COVID-19 pandemic with necessary mitigation measures in place. The project conducted entomological monitoring throughout the year in six sentinel sites in Mashonaland East and Manicaland Provinces. VL Zimbabwe continued to work with the National Malaria Control Program (NMCP), as well as the provincial and district health officials in two districts in Mashonaland East Province, to plan, implement, manage, and monitor the IRS campaign. The project also worked in collaboration with the provincial and district leadership to recruit and train seasonal staff prior to the spraying; procure insecticide, personal protective equipment (PPE), and IRS equipment; make logistical arrangements; and complete environmental compliance preparation and monitoring before, during, and after the IRS campaign to ensure that the standard operating procedures and protocols from the PMI Best Management Practices (BMP) Manual were consistently adhered to. In Manicaland, VL Zimbabwe’s support under the extended transitional plan was more technical than managerial. VectorLink supported the hiring of two lorries in Manicaland to ensure smooth transportation of spray teams during IRS operations in order to improve spray coverage. VL Zimbabwe held stakeholder and partner planning meetings in both provinces, as well as health worker sensitization meetings, which were cascaded to the communities in order to create the beneficiary awareness and service demand needed for successful spray operations. To improve uptake of the program, and social mobilization, VL Zimbabwe collaborated with the Mashonaland East provincial and district health officials and worked with community leadership, community mobilizers and community guides to assist in guiding spray operators (SOPs) and mobilizing the communities. Key results emerging from the 2020 campaign are summarized in Table ES 1.

1 Table E-1. Summary of VL Supported IRS in Mudzi and Mutoko Districts, 02 November to 14 December 2020 Zimbabwe at a Glance Number of districts covered by PMI- 2 districts: Mudzi, Mutoko supported IRS in 2020

Insecticide Clothianidin/Deltamethrin (Fludora Fusion)

Number of structures targeted by PMI-supported 147,636 IRS*

Number of structures found by SOPs during PMI- 136,774 supported IRS spray season

Number of structures sprayed by PMI supported 133,078 IRS

Spray coverage** 97.3%

Spray progress*** 90.1%

Targeted population for PMI-supported IRS in 324,685 2020 (based on 2019 IRS results)

Population protected by PMI-supported IRS in 315,403 (including 4,620 pregnant women and 49,029 2020 children under 5 years old)

Proportion of targeted population protected by 97.1% PMI-supported IRS in 2020

Total population found by SOPs in 2020 322,342

Population not protected 6,939

Length of campaign 36 days

Number of people trained with U.S. Government 319 (240 men, 79 women) funds to deliver IRS****

*The number of structures targeted during the 2020 campaign was adjusted following the Year 3 work planning process due to the cancellation of the data verification activity. This is further explained in Section 6.7. **Spray coverage is the percentage of sprayed structures out of those found by SOPs in 2020. ***Spray progress is the percentage of sprayed structures out of the targeted structures. **** Based on the definition for PMI indicator 1.2.2. This indicator includes only spray personnel such as SOPs, team leaders, and supervisors.

2 I. COUNTRY BACKGROUND

The U.S. President’s Malaria Initiative (PMI), funded by the United States Agency for International Development (USAID) and co-implemented with the U.S. Centers for Disease Control and Prevention (CDC), awarded Abt Associates two consecutive, three-year Africa-wide Indoor Residual Spraying (AIRS) projects, in August 2011 and September 2014. The projects supported the implementation of vector control activities for the prevention of mosquito-borne diseases. In 2017, PMI awarded Abt a five-year contract to continue the implementation of the vector control activities. This project, PMI VectorLink, is implemented in 24 different African countries, Zimbabwe among them. Malaria remains the most important vector-borne public health problem in Zimbabwe, with the major burden occurring in Manicaland, Mashonaland East, and Mashonaland Central Provinces. In Zimbabwe, indoor residual spraying (IRS) remains one of the most critical strategies for the reduction in malaria incidence, designated for malaria high-burdened areas. Spraying of structures with residual insecticides reduces the longevity of indoor-resting anopheline mosquitoes, greatly limiting the probability of malaria transmission in a geographical area. In 2017, AIRS Zimbabwe implemented IRS in four districts (Chimanimani, Mutare, Mutasa, and Nyanga) in Manicaland Province, covering areas previously sprayed in 2016. In line with the Zimbabwe Insecticide Resistance Management Plan 2016-2020, the National Malaria Control Program (NMCP) decided to rotate from pirimiphos-methyl to dichlorodiphenyltrichloroethane (DDT) in Manicaland in 2018. Following discussions with the NMCP, PMI agreed to transfer support for direct IRS implementation to other high burden areas, specifically Mudzi and Mutoko districts in Mashonaland East Province while maintaining technical assistance in Manicaland Province for a phased withdrawal and smooth transition of spray operations to NMCP management. In 2020, VectorLink Zimbabwe continued to work with the NMCP, as well as with the provincial and district health officials to plan, implement, manage, and monitor a full IRS package in Mudzi and Mutoko Districts in Mashonaland East Province and to support entomological surveillance in selected sentinel sites across the country. The support was guided by the following objectives: • Spray at least 85% of the 147,636 structures targeted in the two districts (Mudzi 72,443; Mutoko 75,193). • Protect at least 85% of the 324,685 persons found in the two districts in 2019. • Develop capacity for national, provincial, and district health staff to organize, plan, implement, monitor, and evaluate IRS through joint planning meetings, joint support and supervision, and monitoring and evaluation (M&E) activities during the IRS campaign, and data collection and analysis involving local counterparts in the IRS campaign. • Ensure spray campaign data are entered daily into Microsoft Excel spreadsheets in accordance with the NMCP’s data collection system, to allow VectorLink Zimbabwe to report on spray campaign progress weekly and to import data from the Microsoft Excel databases to the District Health Information System (DHIS) 2-based VectorLink Collect system on a weekly basis to allow for near real-time data analysis. • Complete longitudinal entomological monitoring and surveillance to ensure data are available for future IRS decision making, programming, and campaign planning. • Continue building environmental management capacity to ensure safety of IRS operations before, during, and after the campaign.

3 • Conduct advocacy and social and behavior change communication (SBCC) activities at provincial, district, ward, and community levels to create awareness and demand for IRS. Other important areas that the project supported during the 2020 campaign included: co-facilitation and logistics of trainings; procurement, distribution, and storage of insecticide, spray materials, and equipment; and monitoring of spray operations using the PMI VL project-wide supervision forms. Other Activities • VL Zimbabwe continued to provide technical assistance to the NMCP and partners on various national- level vector monitoring and control issues, as requested. This assistance included: • Technical support to shift from malaria vector control activities to an integrated vector management strategy in an effort to optimize use of resources for vector control • Increased capacity to plan, implement, and monitor vector control programs • Incorporating mapping data into IRS planning and implementation • Conduct training with a focus on IRS supervision, COVID-19 mitigation measures, and spray techniques to improve the overall quality of spraying • Technical support for forecasting insecticide requirements for the NMCP for the period 2018-2020 • Technical support to ensure EC for IRS activities • Participation in and support for malaria technical working groups and committees • Technical support for implementing malaria elimination activities • Support advocacy for the development of the national entomological monitoring plan • Technical support for rebranding the NMCP • Provided support for the distribution and review of IEC materials

4 2. MANICALAND PROVINCE TECHNICAL SUPPORT

2.1 ENTOMOLOGICAL SURVEILLANCE AT BURMA VALLEY AND VUMBA VL Zimbabwe provided technical support to Manicaland Province in the following areas: • Routine monthly entomological surveillance and cone bioassay tests. The monthly surveillance provided information on vector species occurrence, species density and behavior. • Bioassay tests to assess quality of spray and residual life of insecticide sprayed during routine IRS. • Monitoring insecticide resistance at Burma Valley and Vumba • On-the-job entomological training of MOH staff at provincial and district level. • Pre-contract vehicle inspections and recommendations on repairs done for transport safety • Hired two lorries and provision of fuel for the spraying campaign for 63 days. The lorries were deployed in Mutasa and Nyanga Districts of Manicaland Province • Monitoring solid and liquid waste management at IRS campsite • The Provincial IRS coordinator periodically monitored and advised on proper use of PPE during spraying.

5 3. IMPLEMENTATION OF IRS ACTIVITIES IN MASHONALAND EAST PROVINCE

3.1 IRS PLANNING AND PARTNERS COLLABORATION In May 2020, VL Zimbabwe began a series of regular micro-planning and communications with the NMCP, and the provincial and district health officials of Mashonaland East Province. The final micro-planning meeting was held during the second week of October 2020 at the district level with participants drawn from government health officials and relevant community leaders. The main purpose was to plan the spray campaign in the two target districts (Mudzi and Mutoko) together with provincial and district authorities, and community representatives, reach agreement with all partners on the specific operational approaches, sites, campaign and training dates, and government support on medical examination and pregnancy tests, as well as partners’ roles and responsibilities. VL Zimbabwe, in liaison with provincial and district health officials, and community leaders re-visited 2019 challenges and identified priorities and anticipated new challenges of Mudzi and Mutoko Districts for the upcoming spraying season. VL Zimbabwe shared the results of the IRS 2019 campaign, 2020 needed insecticide, quality personal protective equipment (PPE), gender equity, storerooms, soak pits, including mobile soak pits, and the IRS tools, including supervisory checklists and operational data reporting tools that the project regularly updates together with health officials to improve performance. New policies on travel safety and prevention of the coronavirus disease 2019 (COVID-19) were part of the discussions. Jointly, VL Zimbabwe and its government partners discussed and agreed on timelines and modalities for hiring seasonal staff and supervisors, including dates for procuring and distributing PPE and insecticide to the program warehouses at Kotwa Growth Point, as well as final distribution of the items to operations sites. Decisions were made on dates for hiring vendors to provide lorries and breakfast, dates for trainings and the start date for the IRS campaign. Also, determined and agreed upon were medical examinations and pregnancy tests as mandatory activities for IRS, the number of motorcycles and quantity of petrol required for the information, education and communication mobilizers (“warners”), and the level of effort required to provide joint quality supervision and monitoring of the campaign. VL Zimbabwe continued to work in collaboration with the NMCP, provincial and district Ministry of Health and Child Care (MOHCC) officials, the National Institute of Health Research (NIHR), the Environmental Health Directorate, Africa University (AU), and the Zimbabwe Assistance Program in Malaria (ZAPIM), another five-year USAID-funded project managed by Abt Associates and partners. PMI VectorLink, ZAPIM and MOHCC officials collaborated in the pertinent rapid assessment of a malaria outbreak in Mudzi and Mutoko Districts in March 2020. The aim of the rapid assessment was to identify major drivers associated with the epidemic. VL Zimbabwe continued to collaborate with the NIHR, the research department of the MOHCC, and with AU, a private university. NIHR and AU provided susceptible mosquito specimens for PMI VectorLink cone bioassays to monitor spray quality and insecticide decay rate. The two institutions analyzed mosquito specimens collected by the country program to identify the species, detect sporozoites and identify blood meal sources, as well as to disseminate and use data. VL Zimbabwe continued to provide technical and financial support for an insectary at AU. VL Zimbabwe worked closely with the NMCP to create a platform

6 for malaria partners to plan and discuss IRS and entomology activities in the country, as well as to engage communities to promote program acceptance and ownership, and joint implementation of interventions. Also, the project continued to work with Dimagi on mHealth activities in Zimbabwe, specifically, on the smartphone- based spray supervision system and bulk SMS job aids. 3.2 TRAININGS FOR IRS OPERATIONS VL Zimbabwe continued to support the well-established Levels 1, 2, and 3 spray campaign trainings (Table 1) as well as other trainings important for the success of IRS (Table 2). Trainings are summarized by gender in Table 3. Level 1 training was funded by the Global Fund, and the project provided technical inputs to ensure that IRS operations in Zimbabwe remain updated and standardized. For the levels 2 and 3 trainings, the country program updated relevant sessions to ensure continuous usage of PMI VectorLink tools and concepts by the government counterparts during the 2020 IRS campaign in Mashonaland East Province. These tools and concepts included the IRS performance tracking sheet; pre-mixing of insecticide; use of the control flow valve; gender inclusion, especially for higher-level IRS positions; and the various supervisory checklists.

IRS TRAININGS In collaboration with the NMCP and provincial and district health officials, VL Zimbabwe supported and conducted trainings from August through November 2020. The SOP manual guided all the trainings. Level 1 training was meant for IRS provincial managers, Level 2 was for IRS district managers and supervisors, while Level 3 was SOP training. VL Zimbabwe facilitated and provided technical support to Levels 1 and 2, while for Level 3, the country program provided both financial support and facilitation. One day before SOP training began, all SOPs and supervisors were medically examined by District Medical Officers to assess their health and fitness to participate in the IRS campaign. The examinations consisted of a thorough routine physical check-up. Also, before admission into the training, all SOPs and supervisors were assessed for signs and symptoms consistent with COVID-19. Although all SOPs and supervisors assessed were reported to have no signs and symptoms consistent with COVID-19, one SOP was not accepted in the IRS program after he was found with other medical conditions that are not suitable for IRS operations. In addition, all female seasonal staff who worked close to insecticides went for pregnancy tests twice during the campaign, one day before the first phase and second phase. One of the women tested positive for pregnancy before the first phase and she opted out as she was not prepared to be reassigned.

Table 1. Summary of 2020 IRS Trainings Type of Length Type of Training Dates (days) Participants Description of Training Level 1 31/8-4/9/20 5 PEHOs, Review challenges observed during the 2019 IRS training DEHOs, campaign, IRS targets and plans for 2020, insecticide (National PFOs, IRS management, community mobilization, spraying training of coordinators; techniques, data tools and collection, support and trainers personnel supervision, environmental compliance and safety (TOT)) from other issues, and entomological monitoring, transmission malaria and prevention of COVID-19. stakeholders Level 2 14-18/9/20 5 Team leaders, Handling of insecticides and sprayers, spraying training supervisors, techniques, environmental compliance and safety in (Provincial data manager IRS operations trouble shooting, effective community TOT) mobilization, management of callbacks, daily targets, data cleaning, analysis and utilization, importance of checklists in IRS, gender integration, IRS reporting

7 Type of Length Type of Training Dates (days) Participants Description of Training frequency, supervision of spray operations, the importance of EC in IRS, entomological monitoring and management of IRS resources, campsite hygiene, and transmission and prevention of COVID-19. Level 3 28/10- 5 SOPs Mixing insecticide, environmental compliance and training 1/11/20 safety in IRS operations, use of PPE, spraying (Training of techniques, dismantling and assembling of sprayers, SOPs) troubleshooting, maintenance and cleansing of sprayers, spray targets, data collection tools and recording data, community information before and after spraying, community mobilization, and transmission and prevention of COVID-19. Note: TOT=training of trainers, PEHO=provincial environmental health officer, DEHO=district environmental health officer, PFO=provincial field officer

3.2.2 OTHER IRS CAMPAIGN TRAININGS VL Zimbabwe conducted and completed several additional trainings for seasonal staff supporting the program that are important for the success of the IRS campaign, as shown in Table 2. To increase knowledge of first aid and emphasize the importance of morning health checks, the project organized orientation meetings on such assistance with seasonal workers grouped by positions in IRS.

Table 2. Description of Other 2020 IRS-Related Trainings No of No of Training Type of Participants Participants Issues Covered During Training Days Guards, drivers Guards, drivers, and 53 Roles of guards, drivers, and storekeepers in IRS, 1.5 and storekeepers Storekeepers vehicle management policies, standards and safety issues, and emergency procedures in case of a chemical spill in the vehicle. Stock-keeping system including management policies and standards, and emergency procedures in case of a chemical spill, poisoning, or theft of insecticide, environmental compliance and safety in IRS operations. Management of Environmental and 25 Orientation for environmental and clinical health 1.5 chemical clinical health workers workers on management of chemical poisoning and poisoning first aid. Management of dog, snake and scorpion bites and environmental compliance and safety in IRS operations. Mudzi: Data managers, 50 Training on IRS data entry and reporting of mHealth 1.5 IRS coordinator, team forms using phones; data verification and validation Data leaders, and supervisors techniques to ensure data accuracy and quality and management Mutoko: Data 53 environmental compliance and safety in IRS (mHealth) operations. training managers, IRS coordinator, team leaders, and supervisors

8 No of No of Training Type of Participants Participants Issues Covered During Training Days Information, PHPO, PEHO, PFOs, 12 Training and involvement of IRS mobilizers, review education and EHTs, warners and of key messages for ward sensitization and key 2 communication DEHOs messages on IRS warning, training on use of (IEC)/SBCC electronic loud hailers, and use of participatory approaches for IRS programming, IRS key messages, before, during, and after, myths and misconceptions of IRS. Note: EHT=environmental health technician

Table 3. Summary of Number of People Trained by Gender, 2020 Gender Job Function TOTAL M F PFO 1 0 1 DEHO/PEHO/PHPO 2 0 2 SOPs 189 50 239 Team leaders 11 6 17 Data Manager 4 5 9 Washers 5 12 17 Transport Officer 0 0 0 Storekeepers 5 6 11 Nurses/Clinicians 18 7 25 Pump technicians 9 0 9 IEC implementers, mobilizers 23 0 23 Field supervisors 40 23 63 IRS district coordinators 9 0 9 Drivers 11 0 11 Guards 13 7 20 TOTAL 340 116 456 *Total number of people trained to support 319 (240 males, 79 vector control in target areas with USG funds females) *Note: PHPO=provincial health promotions officer. Positions highlighted in light blue are reported in the PMI indicator 1.2.2 “Total number of people trained to support VC in target areas with USG funds”. 3.3 SPRAY OPERATIONS AND SUPERVISION

3.3.1 PRAY OPERATIONS In 2020, VL Zimbabwe sprayed two districts (Mudzi and Mutoko) in Mashonaland East Province. The campaign covered all 18 wards in Mudzi and 28 of 29 wards in Mutoko that the district health authorities prioritized for IRS based on the Annual Parasite Incidence (API) – only wards with API of more than 5 malaria cases per 1,000 population are eligible for IRS in Zimbabwe; those with less than 5 per 1,000 population receive ITNs. Only one ward in Mutoko was not included for IRS, as standard ITNs are distributed there. VL Zimbabwe organized the IRS campaign to be conducted by 17 teams comprising 239 SOPs, 63 field supervisors, and 17 team leaders. VectorLink sprayed for 35 days in eight of the nine operations sites in the two districts between November 2 and December 13 (inclusive), with a seven-day unpaid break in the middle. In the ninth site, the campaign was extended by one day at one operations site in as a lorry got

9 stuck in the mud for close to seven hours, resulting in a 36-day spray campaign for this site. A seven-day break after 21 operational days of spraying allowed SOPs and supervisors to physically recharge and enabled the project to replenish insecticide stocks at the campsite and address challenges encountered in Phase 1. After the break, SOPs returned for 14 days in 8 sites and 15 days in one site to complete the spray campaign. During the break, the team continued reviewing and entering data, assessed spray progress, addressed challenges, and identified callbacks needed from the first phase. Also, the team planned for the remaining period of spray, in coordination with district and provincial officials. Spraying was carried out in all nine operations sites in both districts simultaneously with all spray teams working from 6:00 a.m. to 2:00 p.m., seven days a week. SOPs and other spray teams were provided a daily breakfast before going to the spray areas. As part of scaling up a successful pilot assessment conducted in 2019 in five wards in Mutoko District, SOPs were led by community volunteers in most villages to assist SOPs in locating homes as well as help beneficiaries with homeowner preparation. VL Zimbabwe ensured that IRS campaign positions were filled by district and provincial health staff with a record of good performance from the 2019 spray campaign. VL Zimbabwe, under leadership of the district health officers and in close collaboration with the MOHCC Human Resources Department, recruited all seasonal positions. VL Zimbabwe emphasized increasing the number of women recruited for different positions to support the campaign (Table 3).

Table 4. Positions Engaged for 2020 IRS Campaign, by District Position Mudzi Mutoko Total % Female M F M F M F Total DEHOs 1 0 1 0 2 0 2 0.0% IRS district coordinator 4 0 5 0 9 0 9 0.0% Team leader 6 2 5 4 11 6 17 35.3% Field supervisor 20 10 20 13 40 23 63 36.5% SOP 97 21 92 29 189 50 239 20.9% Washers 3 5 2 7 5 12 17 70.6% Pump technician 4 0 5 0 9 0 9 0.0% Storekeeper 2 3 3 3 5 6 11 54.5% Guard 4 4 9 3 13 7 20 35.0% Mobilizer 11 0 12 0 23 0 23 0.0% Data manager 1 3 3 2 4 5 9 55.6% Driver 5 0 6 0 11 0 11 0.0% Total 158 48 163 61 321 109 430 25.3% For the areas where SOPs encountered a high number of locked houses or refusals, IRS coordinators, together with team leaders, field supervisors, warners, and data managers organized ‘callbacks’, where SOPs returned to the villages to spray the missed houses. As part of callback preparations, IRS coordinators communicated with village leaders to obtain a list of names and number of structures of those missed homes. Callbacks were only initiated in those wards where the spray coverage and spray progress were less than 85%. Houses that SOPs were unable to spray were recorded by SOPs in their data collection form and categorized according to the reason (locked or refused). This practice was mandated and monitored by supervisors and team leaders.

3.3.2 SUPERVISION OF THE SPRAY CAMPAIGN To maintain strict and consistent supervision of the campaign, VL Zimbabwe assigned one technical staff (Chief of Party (COP), Operations Manager, Environmental Compliance Office (ECO), or M&E Manager) to

10 each of the two districts each day throughout the campaign period. Team members used the mHealth phone- based checklists for each area of supervision and were responsible for on-the-spot trainings and corrective actions for any non-performance issues observed. Also, the PMI VectorLink IT consultant provided remote and field assistance to the smartphone users to ensure smooth phone-based IRS supervision. In addition, VL Zimbabwe provincial coordinator created a mHealth WhatsApp group for the supervisors, to facilitate quick sharing of mHealth field challenges and possible solutions. The information shared in this group was reviewed by provincial coordinators, the M&E Manager and IT consultant, and these officers were responsible for giving feedback to the group. The mHealth application provided the five main supervisory checklists, which seasonal staff supervisors were required to use when observing spraying. The checklists included: (1) morning mobilization, (2) SOP transportation vehicle inspection, (3) household preparation and SOP performance, (4) storekeeper performance, and (5) end-of-day clean-up. VL Zimbabwe developed a matrix with daily inspection targets and instructed supervisors to submit electronic forms to the main system daily to ensure close observation of the campaign. All the officers who were supposed to receive feedback reports were included in the list of recipients. This enabled quick response and timely resolution of any issues at the spray level, improving IRS performance in general.

3.3.3 SHORT MESSAGE SERVICE-BASED JOB AIDS FOR SPRAY PERSONNEL To strengthen spray performance, the PMI VectorLink IT consultant facilitated mHealth training and supported the field staff by strengthening and maintaining the established SMS-based job aid system. The project home office and country team reviewed the major challenges faced in 2019, as well as the type of messages and frequencies. The information gathered was helpful to prepare appropriate communications and more suitable schedules to maximize the use of broadcast messages by the SOPs and supervisors in 2020. Although SMS-based job aid system has not been subjected to any scientific evaluation, random and verbal routine checks with SOPs during 2020 IRS campaign has shown that this activity provided additional value to spray operations.

3.3.4 IRS CAMPAIGN VEHICLES VL Zimbabwe continued to rent vehicles for the 2020 campaign to transport seasonal personnel and supervisors, and to dispatch spray materials. VL Zimbabwe made certain that the final vendors selected modified their lorries to ensure that safety measures were in place to protect spray teams, IRS equipment, and insecticide. This included being fitted with benches, safety belts (where possible), roll bars, and purpose made shades, which were weatherproof. The PMI VectorLink team, MOHCC’s Administration Department and the Government of Zimbabwe Vehicle Inspection Department conducted pre-contract inspections for the vehicles, including ensuring that drivers for the selected lorries held valid driver’s license to ascertain safety and compliance prior to signing rental agreements. VL Zimbabwe procured transportation services (hired lorries and 4x4 lorries) through open competition and the selection of the lowest, technically acceptable offer. Additionally, VL Zimbabwe procured motorcycles for 23 warners to carry out community mobilization a day before an area was sprayed. MOHCC provincial health services administrators of PMI-supported districts provided motorcycles for IRS district coordinators who used them to manage IRS operations and communicate with team leaders, supervisors, and influential community leaders in the field. VL Zimbabwe funded the servicing of these motorcycles and supplied fuel.

3.3.5 PAYMENT OF SPRAY TEAMS AND VENDORS In 2020, the project paid the spraying team allowances and breakfast vendors in USD. The breakfast vendors and Phase 1 allowances for the spraying teams were paid through Nostro bank transfer while Level 3 Training and Phase 2 allowances were paid through the cash payment system, using a secure cash-in-transit company.

11 See below for a summary of how payments were made for each of the major payment phases during the campaign: Level 3 Training: Both MOHCC staff and seasonal workers received their allowances soon after training through the cash payment system. The cash-in-transit company paid all the spraying teams in the nine campsites. Because the spraying teams were paid by cash, spray team members received payment immediately. This method of cash payment was used to avoid a repeat of 2019 problem, where the payments were processed through the Ecocash platform and the spraying teams did not receive their allowances on time since the platform did not have cash to disburse to the recipients. Phase 1: Nostro bank transfer was used for phase one payments as the payment amount was so large it posed challenges for VectorLink to withdraw cash from the Central Bank due to daily withdraw limits. The MOHCC staff already held Nostro bank accounts, but DEHOs of the respective districts had to assist the seasonal workers to open Nostro bank accounts. The project successfully paid allowances for Phase 1 to all spraying teams in 2019 campaign using this method, however, in 2020, the project had issues with specific banks. Staff who banked with Steward Bank and Agri Bank received the USD payment without issues. Unfortunately, the spraying team members who banked with CBZ and First Capital had issues in that the banks would not disperse all the funds in USD to the recipients. Although these banks received the funds in USD from VectorLink, the banks have the authority to pay the funds partially in USD and partially in local currency. For example, CBZ paid only USD100.00 to seasonal workers out of the USD315.00 owed to the spray operator and paid the remaining converted to local currency. Although the project advocated with the bank to pay the full amount in USD, the efforts were unsuccessful. Therefore, staff with these banks received part of their payment in USD and part in local currency. Additionally, some spray team members provided local currency bank accounts numbers instead of Nostro bank account numbers and as a result, the funds were returned to the project bank account. After some follow ups with the respective team members, the correct bank account information was provided, and the project paid the recipients. These issues were resolved during the months of December 2020 and January 2021. Phase 2: The project sought and received authority from the Central Bank to withdraw a lump sum of cash to cover Phase 2 allowances for seasonal workers and MOHCC staff which was over the daily withdrawal limit of $10,000 USD. VectorLink paid Phase 2 allowances in cash during the second week of December 2020 using the cash-in-transit company. Vendor Payment: The breakfast vendors were paid in November and December 2020 for the two phases. Breakfast vendors were paid through Nostro accounts. Three of the breakfast vendors provided local bank accounts and funds were returned from the bank. The correct Nostro accounts were provided in January 2021 and the vendors were paid. Similar to the issue with the spray team and MOHCC staff allowance payments, some breakfast vendors received USD cash from their banks while others received partial USD and local currency disbursements from the bank. The IRS lorry vendors were paid in December 2020 and January 2021. Of the three lorry vendors, two vendors were paid through the home office since payment amounts were above the threshold for local payment. The third lorry vendor was paid by cash after the spraying campaign ended, in January 2021. The project paid one the vendor for the 4x4 truck in December 2020 by Nostro bank transfer and paid the other 4x4 truck vendor, who had also provided two lorries, in January 2021. The VL Zimbabwe team managed the following activities to support effective and efficient financial processes, to the greatest extent possible: • Conducted timely on-boarding of seasonal staff (SOPs, washers, storekeepers, security guards, and breakfast caterers), obtaining signed copies of associated on-boarding documents for the records. • Established and maintained daily log sheets for the IRS lorries, 4x4 trucks, and motorcycles.

12 • Maintained daily registers for all spraying teams, MOHCC staff, SOPs, washers, lorry drivers, security guards, storekeepers, and breakfast caterers that were approved by the IRS coordinators on a regular basis. They verified the daily registers for the breakfast caterers and IRS spraying teams to establish who was on duty on a particular day before preparing payrolls. • Signed fixed-price contracts with lorry service providers and 4x4 truck vendors. The motorcycle repairs were paid through the project bank Nostro account. The project made the final payments only after vendor log sheets had been verified and reconciled for the lorries. All payments were verified and approved by the VL Zimbabwe finance and administration staff and the COP.

3.3.6 COST-EFFICIENCY OF SPRAY OPERATIONS The project hired thirteen lorries from the private sector through a competitive bidding process. A total of five vendors responded to the call for a cost proposal. Eleven lorries were deployed in Mashonaland East while two lorries were deployed in two Manicaland districts (Mutasa and Nyanga). Before the final selection of lorry vendors, the VL Zimbabwe team negotiated with the service providers and managed to reduce the daily rate from $290 included in budget to $253. This was lower than the $290 daily rate charged in the previous campaign. The total savings from this budget line item was $21,924. Other cost saving in spray operations include: • VL Zimbabwe negotiated down the price of the plate of breakfast from $2.50 a plate to $2.20 a plate. The total savings from this budget line item was $4,525. • The project received 23 motorcycles from the MOHCC which only needed to be repaired for use during the campaign. The total budgeted for these repairs was $14,500 but the repairs came to $11,000, resulting in savings of $3,500. • The project negotiated less expensive accommodation rates at both hotels in both districts for the supervisory staff. The posted rate was $65 per night, but the agreed rate for both hotels was $55 per night, which fit within the budgeted cost. • The project negotiated the prices of tents. The budget included $34,600 for procurement of 32 tents but the final payment was $27,120, resulting in a savings of $7,480. 3.4 INSECTICIDE NEEDS VL Zimbabwe ensured the project procured adequate insecticide. Given the dangers that are associated with handling of insecticides without proper protection, the program ensured that all SOPs were adequately equipped to complete IRS and safely protected from the risks of using insecticides. The PMI VL Project completed quality local and international procurement in a timely manner and all materials and IRS equipment were delivered, stored, and distributed to designated sites before the start of the campaign. The total amount of insecticide required for the 2020 IRS campaign in Mashonaland East was calculated assuming 100% spray coverage of 149,470 structures found during the 2018 geo-mapping activities, with a 5% buffer. Although the final target structures were revised downwards to 147,636, this new target was not used in insecticide quantification since the revision came later than the purchase order. The revision of target structures for 2020 IRS campaign was necessitated by discrepancies between number of structures found during the 2018 geo-mapping activities and those found by SOPs in 2019 campaign in some of the wards. The discrepancy ranged between 3,000 and 6,000 structures in the two districts. The average number of structures sprayed per sachet in Mashonaland East Province in 2019 was 2.58, and the same rate was used for 2020 procurement estimates. Using this rate, the number of insecticide sachets needed was 59,958 including buffer. Given that the project had 17,452 leftover sachets of Fludora® Fusion, only 42,506 sachets of Fludora® Fusion were procured in 2020. To ensure no insecticide expired in the warehouses, first-expiry-first-out (FEFO) principle was applied to 17,542 sachets of Fludora Fusion® with 2021 expiry date that remained in stock after

13 2019 IRS campaign. Insecticide susceptibility tests performed by the VL Zimbabwe in 2020 in Mashonaland East indicated that An. gambiae s.l. is fully susceptible to both clothianidin and deltamethrin; hence the selection of Fludora® Fusion as insecticide of choice for 2020 IRS campaign. Independent and local laboratories were engaged to conduct pre-shipment inspections and quality analysis of all batches of insecticide that were imported. The insecticide was also subjected to quality control testing by the Zimbabwe Government Analyst’s Laboratory, a department of the MOHCC. The results of pre-shipment quality analysis and the Zimbabwe Government Analyst’s Laboratory assessment of all batches of insecticide were within the acceptable limits to allow the insecticide to be used in-country for malaria vector control. 3.5 INSECTICIDE STOCK MANAGEMENT Insecticide and other IRS materials and equipment were safely stored at provincial, district, and operational stores. All storerooms were manned by storekeepers, with security services provided by the security guards for 24 hours. The VL Zimbabwe team closely supervised and monitored the performance of the storekeepers and provided guidance and on-the-job training on the spot, when required. All storekeepers, the PMI VectorLink logistician and provincial coordinator at all levels regularly and consistently maintained and updated records including stock cards and ledgers with notations for each item including details of transactions, quantities, dates, and destination. They tracked insecticide sachets at the operations sites and district stores by recording the serial numbers of sachets issued to each team every morning, in the computer, and compared it with the serial numbers of empty and full sachets returned by each team at the end of a spray day. All returned empty and full insecticide sachets were reconciled and documented on stock cards, with the records safely kept at local levels before being transported to the provincial warehouse at the appropriate times and finally at the end of campaign for safe keeping and accountability. In addition, the storekeepers read and recorded temperatures of the storerooms twice daily, in the morning (around 10:00 a.m.) and afternoon (around 3.00 p.m.). To ensure temperatures in the storerooms were maintained at acceptable levels, the VL Zimbabwe procured and distributed fans for each storeroom. Before use of fans, there were other temperature control strategies, including keeping all windows open during the day and use of wet cloths. Since temperatures in some operational sites can go above 40 degrees Celsius at times, use of the two strategies alone were not good enough to reduce temperatures to required levels, hence, fans were procured and used together with wet cloths, which helped to lower temperatures.

3.5.1 INVENTORY ASSESSMENT Following the completion of the spray campaign, all IRS commodities and equipment (PPE, insecticide, tents, sprayers, barrels etc.) were counted, washed, and transferred from the campsites back to the main warehouse at Kotwa Growth Point, . Subsequently, the project conducted a review of inventory, internal financial and logistics audits, and inspection in compliance with storage and tracking requirements. Following the audit, the inventory was closed. Remaining usable commodities and equipment were noted and safely kept awaiting further PMI guidance moving forward. 3.6 POST-SPRAY CONFERENCE The post-spray conference is currently on hold due to Zimbabwe country-wide lockdown restrictions. VL Zimbabwe, together with the Provincial Medical Director of Mashonaland East Province and the NMCP, will organize a post-spray campaign conference for provincial stakeholders once COVID-restrictions allow. Participants will share feedback and lessons learned on the 2020 campaign, discuss tools used, share best practices, and exchange ideas and knowledge on improving operations in future campaigns. VL Zimbabwe and the provincial/district health office will complete several post-spray IRS reviews and planning meetings and conferences with provincial and district health officials. Separate community leaders and community beneficiaries’ meetings will be held to gather feedback on spray operations and answer questions about the IRS campaign. This will strengthen IRS operations in future campaigns.

14 3.7 INFORMATION EDUCATION AND COMMUNICATION ACTIVITIES AND OUTCOMES Information, Education, and Communication (IEC) is key to IRS programming because it improves the uptake and preparedness of IRS and ownership by the beneficiaries. PMI VL worked with the project core partner, the NMCP, and provincial and district health staff in Mashonaland East to disseminate information for the 2020 IRS campaign. IEC messages on IRS were transmitted through posters, community meetings, and door- to-door mobilization, before and during the IRS campaign, to ensure beneficiaries were aware of the importance and benefits of spraying and were ready to welcome SOPs for spraying. IEC messages clearly highlighted the importance of the IRS program, need to remove all goods from houses, need to provide adequate and clean water for SOPs to mix insecticide, proper management of dead pests following spray, and actions to take in the case of an adverse event following IRS. The 2020 IRS campaign was completed in a very difficult environment due to the ongoing COVID-19 pandemic. PMI VectorLink, in collaboration with MOHCC, agreed to include COVID-19 preventive measures in the IRS IEC materials. Although the sensitization meetings and IEC materials were effective in reaching many beneficiaries, the IEC activities could be strengthened through additional channels such as road shows, radio spots and community feedback meetings.

3.7.1 INFORMATION, EDUCATION AND COMMUNICATION TRAINING VL Zimbabwe led a training at Chibanguza Hotel from October 5-8, 2020, with a total of 13 communication specialists from MOHCC (Health Promotion Officers, National SBCC Officer, and District Environmental Health Officers) attending the training to review IRS IEC materials, which were originally developed in 2016, and integrate messaging to raise awareness of preventive behaviors for both malaria and COVID-19. VL worked with the district team to conduct a photoshoot in Ruze Village in Murewa District to update the visuals on IEC materials. Prior to finalizing updated IEC materials (poster and pamphlet), NMCP SBCC officers, HPOs, and DEHOs conducted a pre-test of the material through a focus group discussion with 20 people (10 females and 10 males) at Ruze Village. Before the focus group discussion, an HPO facilitated a COVID-19 awareness talk with focus group participants to review COVID-19 mitigation measure (wearing of face masks all the time, maintain physical distance, hand washing with soap and running water, and hand sanitizing). The participants contributed useful feedback on the messages, visuals and layout of the materials and some changes were incorporated. The team also developed a community guide to use whilst conducting community sensitization meetings so that there is a kind of uniformity in terms of the key messages to be shared by the HPOs and EHTs whilst doing community sensitization meetings. The guide was developed and was shared to all the members.

3.7.2 SENSITIZATION MEETINGS IRS sensitization meetings were conducted in three phases: provincial, district, and community level. These meetings targeted various stakeholders, especially influential leaders, sensitizing them on what they should and should not do prior to IRS and the role they were expected to play to ensure communities were ready for spray teams (Table 5). Key components to be discussed during the sensitization meeting include • Objectives of the IRS sensitization meeting • Type of chemical used in IRS • Goals of IRS • Role of community in IRS

15 • Previous IRS coverage • Challenges faced last IRS season and how to prevent those challenges from recurring this season • Community action plan development to support IRS

Table 5. Sensitization Meeting Participants, by Gender, 2020

Type of Meeting District Wards Female Male Total Province - - 14 16 30 District Mudzi - 7 33 40 Mutoko - 5 17 22 District Total 26 66 92 Community Mudzi 18 1330 1100 2430 Mutoko 28 1907 1466 3373 Community Total 46 3237 2566 5803

3.7.3 PROVINCIAL IRS SENSITIZATION MEETING The provincial IRS sensitization meeting was held on October 16, 2020, at Hopefay Hotel in . Participants were drawn from various government departments, NGOs, and the private sector. The main outcomes of the meeting are listed below: • Agreed that IRS sensitization meetings would be cascaded to districts. Districts were urged to cascade the sensitization meetings to ward and community levels. • Stakeholders agreed to help mobilize local resources, such as firewood and accommodation, for spray teams and to provide storage. • The MOHCC was urged to communicate IRS team schedules to all stakeholders in advance, to promote prepared households and minimize the number of locked rooms the teams would find. • The concept of an insecticide rotation plan, which the MOHCC is using as a way of managing insecticide resistance, was explained and all agreed that the same information was to be cascaded to lower levels. • Finalized the spray team recruitment plan and discussed the issue of gender balanced spraying teams.

3.7.4 DISTRICT SENSITIZATION MEETINGS Mudzi District IRS sensitization meeting was held on October 2, 2020 at Mudzi Rural District Council offices. The 30 participants who attended included MOHCC and other government officials, local authorities, and NGOs. The Mutoko District sensitization meeting was held on September 29, 2020 at the Mutoko Rural District Council offices and was attended by 51 stakeholders drawn from the same pool as in Mudzi District. The main outcomes of the meeting are as follows: • Local leadership to identify community guides to guide SOPs during implementation phase. • The stakeholders urged the MOHCC to share a tentative spray team movement schedule to allow for planning the ward sensitization meetings. • Both district leaderships developed a procedure on how to deal with people who refused to have their houses sprayed.

16 • Stakeholders advocated for post-spray feedback meetings, at which the coverage, challenges, and achievements were shared for program strengthening in future campaigns. • Both districts agreed that soon after a village has been sprayed all those households which would have been left unsprayed should be quickly reported to IRS Coordinator by the village head/VHW before the spraying team moves to another so that call backs are done as the team progresses to other wards. • Community roles were clearly spelled out and agreed upon. • Ward sensitization meetings schedules for both districts were shared.

3.7.5 COMMUNITY SENSITIZATION MEETINGS The community is the major beneficiary of the IRS program; therefore, community sensitization meetings were another strategy that was used for information dissemination. For the program to succeed, a high percentage of community members must accept spraying. This requires proper communication. For this reason, Iocal EHTs conducted three community sensitization meetings per ward in Mutoko and Mudzi to inform the communities about the IRS program. Following COVID-19 prevention guidelines, a limited number of people per meeting were included (50 per meeting). Mutoko District conducted community sensitization meetings in 28 wards from September 8-26, 2020 and a total of 3,373 people were reached. Mudzi conducted community sensitization meetings in 18 wards during the same period as Mutoko and a total of 2,430 were reached. The sensitization meetings mainly focused on malaria transmission, signs and symptoms of malaria, preventive measures with emphasis on IRS as well as COVID-19 precaution measures. An explanation was conducted on tentative dates for spray, type of insecticide to be used, roles of community leaders in IRS, roles of household owner /beneficiary pre- and post-spray, selection of volunteers to guide movement of SOPs in the villages, need to closely monitor SOPs in the field to minimize insecticide pilferage and need to report any unsprayed structures.

3.7.6 PRODUCTION AND DISTRIBUTION OF IEC MATERIALS VL Zimbabwe produced 1,000 IRS posters and 3,000 IRS pamplets. EHTs distributed the materials during the ward sensitization meetings and the warners distributed materials during village mobilization. Messages on the posters aimed to increase community acceptance of IRS and to explain the role of households during the campaign as well provide COVID-19 mitigation measures.

3.7.7 COMMUNITY MOBILIZERS AND GUIDES Volunteer community mobilizers played a crucial role in ensuring that all the households were sprayed within their areas of jurisdiction. The community mobilizers visited communities a day prior to the planned spray and following the spray to ensure that all of the names of households that were not sprayed were compiled so that call backs could be arranged before moving to another ward. This strategy was successful in that spray teams could quickly address areas with low spray coverage, as well avoid traveling long distances to return back to the wards at a later date to spray unsprayed households. Given the success of the community guides used during the 2019 campaign, , VL Zimbabwe scaled up the program across all spray areas. The guides assisted SOPs to locate homes, especially in areas where homes were isolated or covered by thick vegetation or on/behind mountains as well as to help beneficiaries to remove household goods to facilitate smooth spray operations.

3.7.8 DOOR-TO-DOOR MOBILIZATION As in previous IRS campaigns, warners visited every household in the spray areas the day before spraying took place to remind villagers of the upcoming spraying exercise, household preparation, and the overall IRS process. Following visits to each household, the warners marked all structures visited with chalk, noting the date of the visit, the initials of the warner, and if the structure was mobilized or locked. In addition, the warners recorded in their notebooks the name of the head of the household, number of structures, and the population. The

17 information was used by the IRS coordinators and team leaders to deploy spray teams the following day. The VL Zimbabwe team and provincial and district MOHCC staff verified, where possible, that the number of households mobilized was adequate for each SOP to meet the following day’s target. To complement the door-to-door mobilization campaign, the warners made announcements and informed stakeholders at local Rural Health Centers, schools, and churches to ensure that the area(s) to be covered the following day were well sensitized. The warner’s used loudhailers around the communities to help deliver key messages to community members. 3.8 CAPACITY-BUILDING EFFORTS VL Zimbabwe project continued to build national, provincial and district capacity to plan, implement, and monitor and evaluate IRS operations. It achieved this by exposing MOHCC staff to the innovations and tools developed and tested by the AIRS global project over the years and updated regularly under PMI VectorLink. Selected personnel with influential roles from other campsites within PMI supported districts were invited to visit other campsites to share IRS best practices. Also, selected Mashonaland East provincial personnel was supported to visit and experience some of PMI VectorLink‘s best practices in IRS for wider adoption and scale up of proven and tested tools and approaches to non PMI-supported districts within the province. The project continued to share technical knowledge and best practices in malaria control interventions with partners during national malaria quarterly review meetings, provincial health team meetings, IRS Level 1 Training, and other ad hock national, and provincial malaria meetings. During Level 2 Training for both Manicaland and Mashonaland provinces, the VL Zimbabwe staff shared best practices with district leaders in non-PMI supported districts. PMI VectorLink continued to provide on-the-job training for ministry staff at both sites in Mashonaland East and in Manicaland provinces. The local EHTs at Dendera, Kawere, Makarara and Burma Valley received hands- on training during routine entomology surveillance. Training covered aspects on adult mosquito collections indoors and outdoors, mosquito behavior and cone bioassay tests, were applicable. 3.9 GENDER MAINSTREAMING The PMI VL Project supports gender equality and female empowerment as independent development objectives as well as approaches to improve vector control activities. The trained Zimbabwe Gender Focal Person, with support from the other members of the project team, leads the country-level gender mainstreaming agenda for Zimbabwe. This agenda is based on USAID’s Gender Equality and Female Empowerment Policy and the PMI VectorLink Project Gender Strategy. VL Zimbabwe mainstreams gender throughout its project operations, with a focus on women’s economic empowerment through seasonal employment with the project. In 2020, the Mashonaland East provincial coordinator was responsible for gender mainstreaming in Mashonaland East. The Manicaland provincial coordinator was responsible for gender mainstreaming in that province. Specific action items are listed below: • Training: To strengthen the support of gender equality in IRS, the project conducted gender integration trainings, which started in Level 1 training and cascaded to Level 2 and 3 trainings, and other trainings like drivers, guards, and storekeepers training. Also, the VL Zimbabwe gender focal persons trained provincial and district MOHC leaders on gender during provincial team meetings held in Mashonaland East and Manicaland provinces. • Increased women’s recruitment: VL Zimbabwe continued to integrate gender and non-discrimination practices into the spray operations personnel recruitment, TOTs, and community mobilization (Table 6). In 2020, PMI VL hired 26.1% women across all positions, which was the highest proportion of women since AIRS started supporting IRS in Zimbabwe in 2014.

18 Table 6. Females Hired During IRS, 2014-2020

Supervisory Roles Other Roles

Province Year

al

Total FemalesTotal Hired % of Total of % Staff Hired IRS coordinator leaderTeam supervisor IRS Storekeeper Total Sub manager Data SOP Washer Warner Guard Tot Sub 2014 0 5 11 0 16 0 2 0 0 0 2 18 5.6% 2015 0 1 26 0 27 1 10 9 1 0 21 48 14.2% Manica-land 2016 0 8 32 0 40 1 22 20 1 0 44 84 15.9% 2017 1 7 33 0 41 1 29 19 1 0 50 91 13.7% 2018 0 6 21 1 28 2 36 3 0 3 47 72 20.1% Mash East 2019 0 4 27 3 34 2 47 8 0 1 58 92 24.4% 2020 0 6 23 6 35 5 50 12 0 7 74 109 26.1%

• Gender-friendly work environment: VL Zimbabwe provided well-demarcated accommodations and washing facilities for females and males at campsites, as well as provision of adequate and safe water supplies in most campsites. Also, the project provided feminine hygiene products to female seasonal workers to eliminate menstruation as a possible barrier to women’s participation in the spray campaign.

19 4. ENTOMOLOGY

4.1 INSECTICIDE SUSCEPTIBILITY TESTS Insecticide susceptibility test results completed at five sites in three districts in Mashonaland East and Manicaland Provinces are shown in Table 7 and 8, respectively. Deltamethrin and clothianidin were tested for susceptibility tests in anticipation of the use of Fludora® Fusion in Mutoko and Mudzi Districts during the 2020 IRS campaign. All tests were done using the CDC bottle bioassay protocol except for clothianidin, for which the World Health Organization (WHO) tube test was used. Tests on An. gambiae s.l. were performed on adult female mosquitoes raised from larvae collected from the field whereas for An. funestus s.l. test mosquitoes were on F1 generation raised by forced oviposition of blood-fed female collected resting indoors at Vumba and from pit shelters at Burma Valley. Pit shelters were used since no adult female mosquitoes were collected indoors at Burma Valley which is under routine IRS whereas blood-fed mosquitoes were collected at Vumba which is not sprayed. The current vector control intervention determined the choice of insecticide that was tested at each site. Alpha-cypermethrin was tested in since the nets distributed in the district are treated with this pyrethroid.

Table 7. Results of Insecticide Susceptibility Tests on An. gambiae s.l. Conducted at Sites in Mashonaland East Province in 2020 Total # Resistance Status Larval Date of Insecticide Mosquitoes (Mosquito District Sentinel Site Collection Site test Tested (Dose) Test Tested Mortality) Mudzi Dendera Dendera Feb and Clothianidin (2% WHO 51 S (100%) Spillway, Meza, May 2020 or 13.5mg) Musau and Nyamapanda Dam Dendera Feb and Deltamethrin (1X) CDC 184 PR (95%) Irrigation, Mar 2020 Musau and Nyamapanda Dam Musaruro May 2020 Clothianidin WHO 11 S (100%) village and (13.5mg) Karonga Dam Mutoko Kawere Kawere Pool, Feb and Deltamethrin (1X) CDC 235 S (98%) Hunda and March Ndemera 2020 Lot Highway Feb 202 Deltamethrin (1X) CDC 13 S (100%) stream Chitora May 2020 Clothianidin WHO 8 S (100%) (13.5mg) Wedza Makarara Samurivo, Mar, May Alpha- CDC 70 R (69%) Makuwaza and and June cypermethrin (1X) Chakanyuka 2020 S = susceptible; PR = possible resistance; R = resistant

20 Table 8. Results of Insecticide Susceptibility Tests on An. Funestus S.L. Conducted at Burma Valley and Vumba in Manicaland Province in 2020

Total Number Resistance Sentinel Date of Insecticide District Collection Site Test of Mosquitoes Status (Mosquito Site test Tested (Dose) Tested Mortality)

Mutare Burma Brandhill Farm June DDT (1X) CDC 52 S (100%) Valley and and Zonwe 2020 Vumba Dam

S = susceptible; PR = possible resistance; R = resistant

4.2 RESIDUAL EFFICACY The standard WHO cones bioassay method was followed to measure the quality of spraying and insecticide decay rate of deltamethrin + clothianidin combination (Fludora® Fusion WP) following the routine spraying of walls at Kawere (Mutoko) and Dendera (Mudzi). All villages selected for quality assessment near Dendera entomological sentinel site in Mudzi District, and near the Kawere site in Mutoko District were sprayed on November 2, 2020. To assess the spray quality of the IRS application, bioassays were conducted within 24 hours after spraying followed by monthly tests at T1. Teams will conduct further bioassay tests at the two sites at monthly intervals until mosquito mortality falls below 80% for two consecutive months. For testing, teams used susceptible Anopheles arabiensis (KGB strain) from the National Institute for Health Research’s (NIHR) insectary in during the quality of spray tests in November and from AU in Mutare for the residual efficacy test in December. The airborne effect of the insecticide was also assessed concurrently with wall cone bioassays in all the test houses at both sites. Ten rooms were tested at each site with wall types summarized in Table 9 below.

Table 9. Summary of Wall Types Tested with Cone Bioassays in Mashonaland East, 2020 Number of Houses Wall surface type Kawere (Mutoko District) Dendera (Mudzi District) Mud 4 2 Brick 1 2 Cement 4 3 Paint 1 3 Total 10 10 For the WHO cone bioassays, 10 unfed, 2‒5-day-old female mosquitoes were exposed on the treated walls per cone. Three cones were fixed per room at 0.5, 1.0, and 1.5 meters above the floor. Mosquitoes were exposed for 30 minutes, after which they were aspirated to a holding paper cup, provided with 10% sugar solution before recording the mortality after 24-hours as well as recording after a 48-hour, 72-hour, 96-hour holding period for the slow-acting clothianidin, when necessary. Knockdown rates were also recorded at 30 minutes and 60 minutes. Mosquitoes exposed to unsprayed surfaces were run concurrently as controls, one cone in each per room for the wall bioassay tests and one cup per every two rooms for the airborne effect. Temperature and relative humidity were recorded during the exposure and subsequent 24 to 96-hour holding period. Mortality for the Fludora® Fusion was observed up to 96-hour holding period. To assess the airborne or fumigant effect, bioassays were conducted in each room where wall cone bioassay tests were done.

21 The quality of spray was satisfactory with 100% mosquito mortality observed at T0 on all wall surfaces at both sites that was observed 24 hours post exposure. Mosquito mortalities were still at 100% on all wall four surface types at Kawere and Dendera sites one month post-spray (Figure 1).

Figure 1. Mosquito Mortality of Susceptible An. Arabiensis (KGB Strain) in Kawere and Dendera: Wall Bioassays Test Results

The mortality rate due to the fumigant effect per wall type ranged between 85 – 100% at Kawere and 63.3 – 86.7% 24 hours post spray at Dendera, respectively at T0 (November) and 100% mortality was observed within 96 hours holding period at T1 (December) at both sites. No mosquito mortality was recorded in the controls at the two sites during the tests, hence it was not necessary to use Abbott’s formula. Similar bioassay tests were done at Burma Valley as part of the technical support to Manicaland Province. Burma Valley was sprayed using DDT on October 21, 2020. WHO cone bioassays were conducted using susceptible colony mosquitoes of Anopheles arabiensis (KGB strain) in ten sprayed houses and ten controls. The quality of spray was assessed through bioassays one day post-spray. The insecticide decay rate was assessed at T1 and T2, one month and two months after spraying, respectively (Figure 2). Africa University provided mosquitoes used in the bioassays. Ten sprayed houses, consisting of one cement, three painted cement and six painted brick were randomly selected for the bioassays. For controls, ten mosquitoes were exposed on uncontaminated paper and monitored in a similar way for knockdown and mortality. Results show that the application of insecticide was satisfactory at T0 (with 100% mosquito mortality) on all three types of wall surfaces. At T1, mosquito mortality declined on painted brick and painted cement wall surfaces but met the minimum criteria of efficiency (>80% mortality). At T2, mosquito mortality was below 100% on all three wall surfaces especially painted brick (88% mortality). Insecticide decay rate will continue to be assessed monthly until the average mortality falls below 80% for two consecutive months.

22

Figure 2. Spray Quality and Residual Efficacy of DDT in Burma Valley, , as Measured by An. Arabiensis (KGB Strain)

23 5. ENVIRONMENTAL COMPLIANCE

VL Zimbabwe operates under a Supplemental Environmental Assessment (SEA) that was developed and approved in 2017. The SEA, which is valid for the period of 2017-2022, covers the use of pyrethroids, carbamates, organochlorines, organophosphates, and clothianidin, in addition to chlorfenapyr (when approved by the WHO Pre-qualification Team (PQ), and for IRS in Zimbabwe. In 2018, PMI approved an amendment to the SEA to authorize technical assistance for DDT (organochlorine) use by the Government of Zimbabwe and the clothianidin/deltamethrin combination for IRS. A Letter Report was approved in 2020 to fulfill the requirement of the SEA for an annual report rationalizing the continued use and choice of pesticides for IRS, and to report on the preparations and readiness for the IRS campaign in Zimbabwe for 2020. 5.1 PRE-SEASON ASSESSMENT Successful implementation of IRS includes having EC procedures in place that ensure the safety of the SOPs as well as beneficiary communities, and that protect the environment through the appropriate use and disposal of insecticides and other waste. Prior to the start of any IRS program, an environmental assessment should be conducted to inform the environmental mitigation plan. 5.2 PRE-SEASON ENVIRONMENTAL COMPLIANCE ASSESSMENT The 2020 initial Pre-season Environmental Compliance Assessment (PSECA) was conducted in Mudzi and Mutoko districts of Mashonaland East Province from June 15 to19, 2020. The exercise was conducted by teams comprising of Provincial Field Officer (Mashonaland East), VL Zimbabwe Environmental Compliance Officer (ECO), and District Environmental Health Officers (EHOs) for Mudzi and Mutoko. From the two districts visited, 10 sites were inspected, recording geocodes for all the proposed campsites. Data were collected through observation and inspection of the proposed IRS campsites. Also observed was the general geographical environment of the proposed spray areas, to assess accessibility during the spraying. The VectorLink PSECA Checklist on Open Data Kit (ODK) was used for the inspections at all proposed campsites. The broad aim of the PSECA was to assess the level of IRS preparedness for 2020 in the two PMI-supported IRS districts in Mashonaland East Province. The following campsites and storerooms were inspected during the period under review (eleven, including nine campsites, one district store and a provincial warehouse): • Mutoko District: Chindenga, Kawere, Chidye, Kapondoro, Nzira, and Mutoko District storeroom • Mudzi District: Makaha, Suswe, Shinga, Dendera, and Mudzi Provincial storeroom 5.3 FINAL PSECA FOR IRS CAMPSITES The final PESCA was conducted in the two districts from October 21 to 25, a week before the start of 2020 IRS campaign. The assessment covered nine operations sites and one district storeroom. The PESCA aimed to confirm that environmental compliance gaps that were identified during the initial PESCA had been addressed to allow for the implementation of 2020 IRS operations. With these gaps addressed, it was recommended that the insecticides be distributed in both districts to support the 2020 IRS campaign. However, provision of adequate first aid kit consumables and partitioning of one storeroom in Mudzi District was needed before the start of the campaign. This did not result in any delays in getting insecticide to the operation sites.

24 5.4 PRE-CONTRACT VEHICLE CERTIFICATION Initial pre contract inspection was done during the period 22 – 25 September 2020 in Harare and Mutare for compliance with requirements of BMP manual. A total of 18 of these vehicles were found to be suitable for IRS operations based on the Vehicle Inspection Department (VID) recommendations, mechanical assessment reports and physical inspections that were conducted using the prescribed checklist by the VectorLink team and MoHCC officials. VectorLink only needed 11 of the 18 lorries to support operation. Final certification of the vehicles was conducted from October 29 to 31, 2020, where 11 lorries were approved to support 2020 IRS in Mudzi and Mutoko districts. 5.5 PROVISION OF WATER AT IRS CAMPSITES The project provided water supply facilities at various IRS campsites after noting challenges during PSECAs were conducted at the nine sites in Mudzi and Mutoko districts (Table 10).

Table 10: Solutions Deployed to Address Water Supply Gaps, by Site

District Site Solution

Shinga Provided with a new 5,000-litre water tank, and the supply of water to the health center was supplemented by water trucking from nearby private service provider.

Dendera A new electric water pump was fitted.

Mudzi Suswe The site received trucked water from a service provider.

Makaha Provided a water tank to increase the capacity of the health center reservoir as the existing tank could not fully cater for both health center and IRS operation’s needs.

Chidye Installed a 5,000-liter water tank as the existing tank could not fully cater for both health center and IRS operation’s needs

o Chidenga Connected pipes from local school to facilitate water reticulation to the health center as the health center borehole was yielding low

Mutok water supply

Kaware Installed a solar-powered water pump as the old one was having operational challenges

5.6 PROVISION OF MOBILE AND PERMANENT SOAK PITS For the 2020 spray campaign, the project provided three new large capacity mobile soak pits and a new permanent soak pit at some select sites in both Mudzi and Mutoko Districts in Mashonaland East Province, as the PSECA had shown that the existing wash areas at all the IRS sites in the two districts were not adequate to support the number of SOPs working from the sites. In Mutoko District, one large-capacity mobile soak pit was provided at Chindenga IRS site as the existing wash area could not accommodate the number SOPs at the site. Also, in Mutoko, an additional permanent soak pit was provided at Chidye, a new IRS site established in 2020. In Mudzi, two large-capacity mobile soak pits were installed at Makaha and Shinga IRS sites, to accommodate the increased number of SOPs at those sites. At the Dendera IRS site, an additional existing permanent soak pit was used.

25 5.7 MID-SEASON ENVIRONMENTAL COMPLIANCE ASSESSMENTS The PMI VectorLink ECO, Operations Manager, COP, M&E Manager, Provincial Coordinator, as well as the DEHOs visited all nine campsites to conduct EC assessments using supervisory checklists and address any gaps in compliance. Assessments focused on proper storage of insecticides, stock control and inventory management procedures, proper IRS effluent disposal, proper spill response procedures, sprayer maintenance, availability, and usage of PPE by spraying teams, and homeowner preparation. The purpose of these assessments was to ensure the safety of the IRS workers, community members, and the environment. In total, the supervisors observed usage of all seven permanent soak pits on a daily basis. It was observed that during IRS operations, implementation personnel adhered to environmental, health and safety requirements for IRS. Appropriate PPE was issued to spray personnel and others who could be exposed to insecticides including coveralls, gloves, boots, helmets, face shields, neck protection, and dust masks. However, some shortage of PPE for supervisors including face shields and gloves were identified during the early stages of the exercise and this was addressed as the campaign progressed. The team encountered challenges in maintaining the recommended temperature ranges at most of the IRS sites due to harsh environmental temperatures in Mudzi and Mutoko Districts. The most affected sites were: Makaha, Shinga, c Suswe of Mudzi District whilst Chidenga and Kapondoro were affected in Mutoko District. Electric fans were installed at all the highlighted campsites whilst aluminum cushions were installed at Chiwenga and Dendera s campsite storerooms in order to mitigate against high temperatures. These interventions proved to very effective as temperatures drops to acceptable ranges of below 35 degrees Celsius. There was an observed improvement in household preparation as SOPs found most of the homes fully compliant, however some few villages and households (0.07%) were seen to be experiencing some challenges in home preparation as they sometimes had to remove household goods on arrival of spray operators. The situation was aided by the continued use of village volunteers as community guides, and intensified support and supervision. The supervision team observed also that almost all IRS sites met the standards for IRS operations Various EC monitoring activities as described in the EMMR (Annex B) were conducted to mitigate against non-compliance incidents that were observed during the spraying. 5.8 POST-SEASON ENVIRONMENTAL COMPLIANCE ASSESSMENT Post-spray EC inspections were conducted in January 2021. The exercise covered eight of the nine IRS sites that were used in 2020 season. The exercise involved officially closing out the IRS campsites and cleaning of IRS storerooms that were used during the 2020 season. The project could not officially close out the Makaha IRS site as the area was marooned by flooded streams and slippery roads. However, the local EHT for Makaha confirmed that all the waste has since been removed from the campsite and the storeroom and the soak pit were cleaned and locked. Once the rains have subsided, the project will physically confirm this report. The soak pits at the campsites in Mudzi and Mutoko were cleaned and locked according to BMP standards. The soak pits were covered with the specially designed soak pit covers in order to prevent unauthorized access to pits by the general public and animals. 5.9 INCIDENT REPORTS One major incident was recorded during the 2020 IRS campaign. See Table 11 below for a summary of this incident.

26 Table 11. Summary of Incident Reports During 2020 IRS Campaign

Incident ID Brief Description of Incident Location

ZIM-112120-001-Theft Theft and misappropriation of six Fludora Fusion sachets by a Chindenga IRS campsite, female spray operator and two male supervisors. Six inner Mutoko District sachets without outside packaging were recovered from two supervisors’ bags upon a random search that was triggered by a whistle blower and the DEHO’s Office. The female spray operator was dismissed from spraying operations and the two MOHCC staff were suspended from IRS operations by the District Medical Officer. The incident was also reported to the police for further investigations. VectorLink staff and the DEHO for Mutoko continued with surveillance and increased oversight of Chidenga camp to identify any other cases of insecticide theft and to improve field supervision of spray operators. A follow-up investigation was also done by a team of VL and MOHCC officials to find out if there was manipulation of data on structures, which found no data manipulation by the implicated spray operator.

5.10 WASTE DISPOSAL All IRS solid waste materials that were generated during the 2020 IRS season was disposed of in accordance with the PMI BMP (Table 12). Five types of solid waste were generated during the 2020 IRS campaign: • Empty cardboard boxes • Used disposable respirators • Used mutton cloth • Well-washed, damaged gloves, boots, contaminated and damaged PPE and plastic sheets • Empty Fludora Fusion sachets Fludora Fusion waste (empty sachets and uncontaminated cardboard boxes) from Mudzi Provincial warehouse were thoroughly sorted out according to levels of contamination. The project then transported waste to Southern Incineration Services in for incineration. The incineration of the contaminated waste, which included Fludora Fusion empty sachets, used disposable face masks, used mutton cloth, contaminated empty cardboard boxes, and damaged PPE, such as overalls in very poor condition, was done at Southern Incineration Services during the week 22-26 February 2021. The process was witnessed by Environmental Management Agency officials and MOHCC officials. PPE such as overalls and gumshoes that are no longer useable for IRS operations were cleaned and issued to spray operators as a token of appreciation. In 2021, only damaged rubber gloves and face shields were recycled. Recycling was done at Recycle Today in Harare and the process was witnessed by Officials from Environmental Health (MOHCC) and Environmental Management.

27 Table 12: IRS Waste Management Plan

Wastes types Disposal site Method of Disposal Date of Disposal

Contaminated empty insecticide Southern Incineration packages, used mutton cloth and used Incineration respirators Services, Bulawayo

Torn overalls and Gumshoes IRS camp sites Donated to spray December 2020 operators after cleaning up

Uncontaminated, empty Fludora Recycle Today Recycling February 2020 Fusion boxes Recycling Agent, Harare

Damaged rubber gloves, gumshoes Recycle Today Recycling February 2020 and face shields Recycling Agent, Harare

28 6. MONITORING AND EVALUATION

6.1 M&E OBJECTIVES The objectives of the M&E activities laid out in the Year 3 work plan were as follows: • Emphasize and supervise accurate data collection and data management, through comprehensive trainings and supervision at all levels • Continue to streamline and standardize data flow and facilitate timely reporting to all stakeholders • Ensure IRS data security and storage through the establishment and enforcement of proper protocols • Continued use of the VectorLink Collect data management system for IRS data to allow for near-real time data use • Performing an exploratory activity into the data discrepancies identified between the total number of structures targeted and structures found in selected wards from the 2019 IRS campaign, including mapping of data (Activity cancelled due to COVID-19 pandemic) 6.2 DATA MANAGEMENT In 2020, VectorLink Collect, the DHIS-2 based global data management system for the PMI VectorLink Project, continued to serve as the central place to house VectorLink Zimbabwe IRS data, following approval from the Zimbabwe NMCP. Approval was also granted to accommodate the use of VectorLink Collect for reporting data to PMI and for key visualizations to be created to monitor campaign progress within VectorLink Collect. Data flow and operations within the country remained the same as in previous years, using a modified approach in which ward-level IRS data is imported into the VectorLink Collect system on a weekly basis, rather than the direct entry of structure-level data that is standard across other PMI VectorLink countries. Data managers continued to use the campsite-specific Microsoft Excel spreadsheets originally developed under the PMI AIRS project to enter and aggregate at the ward level data at the end of each week during the IRS campaign. Once finalized by the campsite data manager, the VL Zimbabwe M&E Manager would collect data weekly, review it for quality and analyze the data before sending to the Home Office M&E Specialist who imported data into the VectorLink Collect System. This system allowed for near real-time analysis using the robust DHIS2 functionalities. The data managers also submitted spray data into the weekly IRS summary sheet via the Frontline SMS system, which auto integrated this data into the national DHIS2 system hosted by the MOHCC. Hard copies of spray data were sent to DEHOs, PEHO, and the NMCP after the data were submitted via Frontline, but these staff members also had access to the national DHIS2 and could view IRS data electronically at any time. 6.3 DATA COLLECTION, ENTRY AND SECURITY The same data collection tools used for the PMI VectorLink project in the 2019 IRS campaign (Daily Spray Operator Form, Daily and Weekly Team Leader Summary Forms, and Daily and Weekly Data Manager Summary Forms) continued to be used in 2020 to record and document IRS campaign data, as these forms have been successful in prior campaigns and fully capture relevant PMI and NMCP data elements. To ensure the secure storage of all data collected, all paper forms submitted were filed by geographical area and date in binders shelved at the campsite. Electronic data were secured and backed up to the VectorLink Collect

29 servers, cloud-hosted by the BAO Systems team. The data manager and IRS coordinator safeguarded the laptop password by preventing others’ access to spray data and campaign hardware (laptop). Laptops were transferred to the Harare office for safe storage during the offseason. 6.4 DATA QUALITY ASSURANCE

6.4.1 DATA COLLECTION VERIFICATION (DCV) The DCV tool is used to verify data accuracy by ensuring that the data recorded on Daily Spray Operator Forms matches the information reported by households. In 2020, the DCV tool was not used due to the COVID-19 restrictions, as recommended in PMI VectorLink guidance. This activity was not completed in an effort to prevent any additional and unnecessary exposure to households. However, data collection supervision and field spot checks were conducted as part of the measures to strengthen data quality.

6.4.2 DATA COLLECTION SUPERVISION Data collection supervision was conducted to ensure data quality. Field spot checks were conducted to verify the data collected by SOPs and to identify where inaccuracies occurred. This allowed for immediate identification of errors and corrections to the collected data. Supervisors, team leaders and data managers also reviewed the SOP data collection forms and signed off on the data collection forms to indicate that they had reviewed the data and inaccuracies had been corrected.

6.4.3 CAMPSITE DATA QUALITY CHECKS Data quality checks were conducted at all campsites. This included checking SOP data collection forms for completeness and ensuring that arithmetic checks were performed on all relevant data elements or indicators. 6.5 DATA REPORTING Mid weekly data and weekly IRS progress reports were produced and shared with the Home Office, PMI, provinces, and districts. Pre-programmed standard dashboards created in the VectorLink Collect database continued to provide information on key IRS indicators to allow for near real-time tracking of progress by stakeholders. Stakeholders such as PMI and provincial and district officials had access to the VectorLink Collect database and could monitor campaign progress and make informed decisions about IRS operations. 6.6 MHEALTH RESULTS During the 2020 IRS campaign, the two PMI-supported districts (Mudzi and Mutoko) continued EC monitoring using mHealth tools. SOPs were randomly sampled for observations on a daily basis. Smartphone- based EC checklists were used for data collection. The checklists were administered by IRS field supervisors, team leaders, IRS coordinators and PMI VectorLink staff. All smartphone-based checklists were supported by the CommCare and ODK applications for data collection.

6.6.1 STOREKEEPER PERFORMANCE FORM Storekeeper performance inspections were conducted to ensure that storekeepers were following the prescribed best warehousing practices and can account for stocks and equipment in their stores all the time. The plan was to inspect all nine campsite storerooms used concurrently on a daily basis. The team achieved close to 100% storekeeper inspections.

6.6.2 MORNING MOBILIZATION FORM The objectives of morning mobilization were to ensure spray teams left for the day fed, healthy, and well prepared, and with adequate and appropriate PPE, insecticide, and supplies for the day’s work. Coordinators,

30 team leaders and VectorLink staff were responsible for carrying out the inspections on a daily basis. The team successfully accomplished the goal of daily completion of morning mobilization forms at each campsite.

6.6.3 HOMEOWNER PREPARATION AND SPRAY OPERATOR PERFORMANCE FORM The aim of the homeowner preparation and spray operator performance form was to ensure that SOPs perform IRS on households that have been properly prepared for spraying and that SOPs use correct spraying techniques to ensure beneficiary safety. Coordinators, team leaders and VectorLink staff were responsible for completing the homeowner preparation and spray operator performance forms. A total of 3,136 forms were completed by both Team leaders and IRS Coordinators (MOHCC) and VectorLink staff. Few homeowners (0.07%) were not well prepared for IRS and would wait until an SOP /Supervisor /community guide arrived especially during the rainy season. This affected EC and IRS operations as SOPs would assist in homeowner preparation leading to some delays. This information also helped in strengthening homeowner preparation. The goal of completing the homeowner preparation and spray performance form was successfully accomplished.

6.6.4 END-OF-DAY CLEAN-UP FORM To ensure spray teams correctly follow EC standard procedures for cleaning IRS equipment, and account for insecticide stocks and safe storage of equipment, the end-of-day clean-up checklist was used. 479 forms were completed by the two districts, achieving more than 70% of the campaign’s target. Competing activities affected completion of the end of day clean up form. Some team leaders who had the task of completing the end of day clean up form ended up doing other activities such as screening their bubble for COVID-19 symptoms as well as checking daily temperature and that affected the completion of end of day clean up form. However, this activity was achieved through the use of IRS coordinators.

6.6.5 TRANSPORTATION VEHICLE INSPECTION CHECKLIST The aim of using this checklist was to assess and ensure safe transportation of spray teams and IRS commodities and supplies. Both districts had a total of eleven lorries that were supposed to be inspected on a daily basis. A total of 552 inspections were recorded and submitted, thus accomplishing the goal of the transportation vehicle inspection form.

6.6.6 DIRECTLY OBSERVED SPRAYING The aim of the Directly Observed spraying (DOS) checklist is to ensure that SOPs are following the prescribed spray techniques, ensure household preparation for safety, ensure proper spraying techniques and skills for high quality spraying, and to ensure proper protection of spray operators through proper use of adequate PPE. Field supervisors were responsible for the completion of the DOS checklist. Each field supervisor was expected to complete one form with at least six observations (two per SOP) each day. A total of 11,942 observations (90% of target) were submitted by the two districts (Table 13). There were some technical challenges experienced with the ODK platform which affected completion and submission of the DOS forms. Some of the phones were logged out of the Google account and needed to be verified every time, which affected submission of forms. At one point during the campaign all phones were retrieved from supervisors so that the IT manager could work on them. However, the problem was persistent throughout the campaign. The supervisors were advised to keep collecting data and submit when the problem was solved. The project reported the technical issues to the platform administrator and discussed solutions to ensure these glitches do not happen again in future. Forms were completed on a daily basis. Both CommCare and ODK applications do not allow the user to proceed without filling in all the required information. Completeness was therefore at 100% for all forms submitted. The quality of responses was also verified to ensure the responses were correct. The challenge was the timeliness for submission of forms. Users were not able to submit their forms on a daily basis as required

31 as they sometimes failed to sync with the server due to poor internet connectivity at most of the campsites. However, whenever the teams were in an area with better signal all the hanging forms were then sent to the server. For the CommCare application, this push was done automatically; however, for ODK this push had to be done manually, once a strong enough signal was available.

Table 13. CommCare and ODK Results by Form for Mudzi and Mutoko Districts Targeted Number of Form/Checklist Number of Forms Filled Percent Coverage Forms Storekeeper 385 382 99 % Performance Morning Mobilization 415 484 116 % Homeowner 2,400 3136 130 % Preparation and Spray Operator Performance End-of-Day Clean-up 645 479 74 % Transportation Vehicle 485 552 114 % Inspection DOS 13,230 11,942 90%

Of the total 11,942 observations, non-compliance was identified in 160 (1.3%) of observations. The most common reasons for non-compliance were leaking sprayers and incorrect insecticide mixing with 73 and 31 observations recorded constituting 45.6% and 19.4%, respectively. (Table 14).

Table 14. Non-Compliance Issues Observed on Directly Observed Spraying Observation Non-Compliant Compliant Total Observations 1 Did the SOP mix the insecticide to 31 11,911 11,942 form a 7.5l solution? 2 Did the SO triple rinse the empty 7 11,935 11,942 insecticide bottle? 3 Is the SOP in full PPE 11 11,931 11,942 4 Is the SOP spraying with a pump 4 11,938 11,942 fitted with a CFV? 5 Have all belongings, food items, 8 11,934 11,942 animals/sick persons been removed? 6 Have all items that cannot be 7 11,935 11,942 removed been covered with plastic sheeting? 7 Are there any leaks from the 73 11,869 11,942 pump? 8 Is the SOP spraying with the tip of 9 11,933 11,942 the nozzle 45cm away from the wall? 9 Is the SOP maintaining the correct 6 11,936 11,942 speed of spray? 10 Is there a 2cm overlap with each 4 11,938 11,942 successive swath? Total 160 11,782 11,942

32 There was a great improvement in terms of navigating through the smartphone applications compared to the last two IRS campaigns. • There were no reports of phones running out of power in the field as all phones used for 2020 campaign were relatively new and had a better battery life. Power banks were provided to campsites that previously had power challenges. Solar powered systems were installed at most camps therefore phone charging was not interrupted even when there was no electricity due to load shedding or faults caused by rains during phase 2 of the campaign. • All phones had adequate data bundles for syncing with the server. A portable Wi-Fi modem was provided at Chindenga Campsite to improve internet connection and submission of forms. The ECONET network which was used for the phones had very poor reception in that area so the NETONE operated router came in handy. Network connectivity was erratic at some campsites resulting in some forms being submitted a day or two later. • There was a challenge with the ODK application where some supervisors would temper with the Google account and logout most of the users from the application. It was difficult and time consuming to verify and log in users back into ODK. This hiccup however only affected form submission, so supervisors were advised to continue filling out their forms and submit when they were logged in again. 6.7 RESULTS OF 2020 IRS CAMPAIGN VL Zimbabwe sprayed 133,078 structures out of the 136,774 eligible structures found, resulting in a 97.3% spray coverage. The campaign protected 315,403 people (151,668 males and 163,735 females) in the two supported districts. This included 4,620 pregnant women and 49,029 children under 5 years old. A breakdown of the 2020 IRS campaign results by district is shown in Table 15. The VL Zimbabwe team intended to conduct an exploratory data verification activity during Year 3 to verify targets for the number of eligible structures in targeted areas. This activity intended to target key wards in which discrepancies were identified between the number of structures found in the previous 2019 campaign by SOPs and the targets provided by the 2018 geo-mapping activity. However, due to the COVID-19 pandemic, the activity was cancelled given the increased exposure risk. Because of this, a mixed approach was used to determine structure targets for the 2020 IRS campaign, resulting in an adjustment of the spray target from what was used in the insecticide procurement estimation. In order to generate the 2020 IRS spray targets, the following criteria were used: 1) for all wards, where SOPs during the 2019 campaign identified 85-100% of the structure target identified by geo-mapping, the geo- mapping target was used, 2) for all wards where SOPs during the 2019 campaign found greater than 100% of the structure target identified by geo-mapping, the actual number of structures found in 2019 was used and 3) for wards where SOPs during the 2019 campaign found less than 85% of the structure target identified by geo- mapping, the 15% difference between the geo-mapping target and 2019 structures found was used. For example, in Charehwa B ward, the 15% difference was calculated as follows: 1675 [structures found in 2019] + (2180 [2018 geo-mapping target] - 1675)*0.15 = 1751 structures targeted for the 2020 IRS campaign. The adjusted spray targets were agreed upon with PMI Zimbabwe before the beginning of the 2020 IRS campaign. Table 16 shows insecticide usage from the 2020 IRS campaign. A total of 7,230 sachets of insecticide (Fludora Fusion) were left over – VL is currently working with PMI to identify how this insecticide will be used in 2021. The average structures sprayed per SOP per day was 15.4 against a target of 18. A breakdown of the spray coverage and spray progress by district is shown in Figures 3 and 4. Overall spray coverage and spray progress were 97.3% and 90.1%, respectively. Spray coverage remained high throughout the extent of the campaign. In order to maintain high spray coverage throughout the IRS campaign, PMI VL

33 worked with community mobilizers and community guides to assist in guiding SOPs and mobilizing the communities. Rainfall experienced in both districts during week 4 and 5 of the spry campaign contributed to delayed spray progress. Callbacks were conducted to improve spray progress throughout the campaign.

34 Table 15. Summary of the 2020 IRS Campaign Spray Coverage per District

Non-sprayed Overall Structures Population Protected Population

nd in 2020 nd in

% of Population ldren <5 Years

District Structures Target Fou Structures Sprayed Structures Coverage Spray % Progress Spray % Protected Refused Locked Total Males Females Pregnant Women Chi ProtectedNot Total Found

Mudzi 72,443 67,473 66,001 97.8% 91.1% 621 851 161,521 77,541 83,980 2,477 25,688 2,211 163,732 98.6%

Mutoko 75,193 69,301 67,077 96.8% 89.2% 877 1,346 153,882 74,127 79,755 2,143 23,341 4,728 158,610 97.0%

Total 147,636 136,774 133,078 97.3% 90.1% 1,498 2,198 315,403 151,668 163,735 4,620 49,029 6,939 322,342 97.8%

Table 16. Summary of Insecticide Usage During the 2020 IRS Campaign per District

Avg # of Avg # of Total Avg # of Structures Total Sachets Total Lost/ Total Sachets # of Days Avg # of Structures Sachets District Sachets Structures Sprayed Received Damaged Remaining Worked SOPs Sprayed/SOP/ Used/SOP/ Used Sprayed/Sachet Day Day

Mudzi 66,001 28, 658 23,769 0 4,889 35 118 2.8 15.9 5.8

Mutoko 67,077 31,300 28,959 0 2,341 36 121 2.3 15.2 6.6

Total 133,078 59,958 52,728 0 7,230 36 239 2.5 15.4 6.1

Note: The 2020 insecticide balance of 7,230 bottles has expiration date of May 2022. The project plans to hand over the insecticide to the MOHCC for use during the 2021 IRS campaign.

35 Figure 3 Spray Coverage Mudzi and Mutoko Districts, 2020 IRS Campaign

Figure 4. Spray Progress Mudzi and Mutoko Districts, 2020 IRS Campaign

36 7. CHALLENGES AND RECOMMENDATIONS

The following challenges, lessons learned, solutions and recommendations were identified during the 2020 spray campaign:

Table 17. Challenges, Lessons Learned and Solutions from the 2020 Spray Campaign

Challenge Solution/Recommendation

Zimbabwe, as all other countries around VL Zimbabwe implemented mitigation measures established with the world, was affected by the COVID-19 home office guidance: increased number of campsites to nine pandemic with approximately 12,000 cases (versus four in 2019) reducing the number of staff per site; spray accumulated by December 2020. teams worked in “bubbles,” reduced the seasonal workers per tent by using schools for accommodations, social distancing, use of face coverings and hand sanitizers at all times, instead of homeowners signing forms their cell phone numbers were written by the SOPs, handwashing during household preparation, daily health checks, clear procedures in case of suspected cases or outbreak.

Accommodation challenges for spray teams VL Zimbabwe made use of nearby schools and churches as due to COVID-19 physical distance. accommodation for spray teams. The project also purchased additional tents for the spray teams. These additional tents were used to reduce tent capacity by 50% as well as for use as isolation tents in the case of any suspected infection.

Inadequate homeowner preparation The project worked with VHWs and community leaders, delayed spray progress in some instances in community guides and community mobilizers to continuously all campsites. As a result, spray operators engage communities to improve uptake of IRS and adequately spent additional time working with prepare for IRS. VL and MOHCC officials also increased their homeowners to adequately prepare homes supervision efforts in order to attain some improved degree of to receive IRS. The delays did not heavily compliance. impact the overall campaign progress.

Persistent rainfall affected spray progress in To mitigate this challenge, the team rescheduled IRS to start very Week 4 and 5 of the IRS campaign. SOPs early in the morning before rains start (most rain occurred around had less time available to be in the field. mid-morning) and before people are out in the fields. The team also Homeowners were not keen on preparing continued to work with community volunteers and leaders to their homes for IRS due to the rains. In engage communities and improve program uptake. Call backs were some cases when homeowners did not conducted where necessary to improve spray progress. want to put their belonging in the rain, belongings would instead be put in the freestanding kitchen which are considered eligible structures. These freestanding kitchens, could not be sprayed and were thus, recorded as not sprayed structures.

37 Challenge Solution/Recommendation

Due to the heavy rainfall received in In order to improve spray progress and meet the target of spraying Mutoko District, a lorry at Nzira Campsite 85% of the targeted structures in the area, one additional operation became stuck in mud on day 33 on its way day was added to the Nzira Campsite. to deploy spray teams in the morning. This resulted in approximately 7 hours of downtime in activities.

Farming activities delayed spray progress as To mitigate this challenge, the team rescheduled IRS to start very some of the homeowners were out in their early before people are out in the fields. Call backs were conducted fields resulting in some locked structures. where necessary. However, the farming activities did not result in major delays in spray progress.

Food handouts and seed distribution Spray teams rescheduled IRS upon consultation with the village affected spray progress in most campsites heads and IRS was conducted on days when villagers were not as homeowners were away from home receiving food handouts and agricultural inputs. In some cases, when spray operators arrived, resulting in teams also managed to reschedule IRS to start very early in the some locked structures. mornings before the handouts gatherings and seed distribution began.

VL sought approval from the Central Bank The payment was originally scheduled for December 14, 2020 and to withdrawal cash from the bank which was delayed until December 18, 2020 following the approval from exceeded the daily limit of $10,000 to allow the Central Bank on December 16, 2020. for payment of Phase 2 payment. The review and approval took longer than anticipated which delayed the Phase 2 allowance payment.

When paying spray campaign allowances to The project worked to advocate with the banks that the funds spray staff and MOHCC staff, those who should be paid as USD in full. But efforts were unsuccessful, so used CBZ and First Capital Bank were those team members who banked at CBZ and First Capital Bank disbursed funds in USD and local currency, received partial USD and local currency disbursements. despite VectorLink transferring funds to VectorLink followed up with the respective team members who the banks in USD. had provided local currency bank accounts and received the correct Some payments were also returned by the bank accounts. Using this updated account information, the project banks because the seasonal workers had managed to pay the recipients. provided local currency bank accounts instead of Nostro bank accounts.

Most of the IRS sites had adequate water VL Zimbabwe project activated a contingency plan of procuring supply for use by spray operators except trucked water to both Suswe and Shinga. This plan worked well and for Suswe and Shinga campsites. The water continued throughout the campaign. supply at Shinga campsite in Mudzi District was inadequate due to low yield resulting from the low water table. At Suswe campsite in Mudzi District, the challenge was mainly due to the obsolete ZINWA system which could not sustain the high water demands at the campsite.

38 Challenge Solution/Recommendation

Frequent breakdown of motorcycles The project engaged the service provider to attend to the which are used by IRS mobilizers was motorcycles’ service during the one-week break before the second reported across all campsites. The phase of IRS. breakdowns did not impact IRS mobilization. IRS mobilizers in most cases used motorcycles assigned to the IRS coordinator instead. In some cases, one mobilizer would visit the whole area alone but would take more time than when there are two.

Rough terrain and mountainous areas in Callbacks were conducted to improve spray progress above the Shinga Ward (Mudzi District) delayed spray expected 85% threshold. The project will improve on planning and progress. SOPs had to walk long distances deployment by increasing SOPs coverage in areas with rough of not less than a kilometer to reach terrain and long distances between households. homesteads which are sparsely distributed in these areas. This did not impact the overall spray progress of the campaign.

Community water challenges delayed spray To mitigate this challenge, affected communities were mobilized progress in some areas. Water shortages are two or more days in advance for them to source and reserve 10 a hardship for many of the communities liters of water to mix insecticide. that the campaign targets, many areas had not received enough rains and the water table was still low.

Electricity outages were reported across VL Zimbabwe encouraged CommCare and ODK users to collect campsite towards the end of the campaign. and save data in their phones. The collected data were submitted The electricity outages resulted from when the phones were retrieved from the users following the end electric poles which were damaged by the of the campaign. heavy rains received in both districts. The outages resulted in limited cellphone connectivity to submit CommCare and ODK supervision forms.

Some areas such as Chindenga Campsite VL Zimbabwe purchased a portable Wi-Fi modem for the campsite had limited network connectivity for to enable submission of supervision forms and IRS data to the supervisors to submit CommCare and M&E Manager. ODK supervision forms and for the data managers to send the data on time to the M&E Manager.

There were challenges with temperature VL Zimbabwe installed portable solar kits at Chidye and Nzira regulation in storage facilities due to lack of campsite storerooms to facilitate the use of fans for temperature electrical connections for fans at Nzira, control. For clinics with electricity, extension cables were installed Chidye, Kapondoro and Chindenga from the clinics to provide electricity to Kapondoro and Chindenga storerooms. campsite storerooms. The project also encouraged stores personnel to open storeroom windows during the day to ensure natural cross- ventilation.

39 Challenge Solution/Recommendation

Mobile phones were continuously logged VL Zimbabwe advised supervisors using ODK to continue out of the Google Account which affected collecting and saving data in their phones. The saved ODK forms submission of ODK forms. were then submitted soon after the IRS campaign.

Challenges, on behalf of NIHR, in the VL Zimbabwe coordinated with Africa University to supply the provision of mosquitoes to complete needed number of mosquitoes to do the bioassays. bioassays.

40

ANNEX A. MONITORING AND EVALUATION PLAN INDICATOR MATRIX

MEP Table 1. Performance Indicators Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Objective 1: Implementation of Malaria Vector Control (VC) Interventions 1.1 Successfully Execute IRS and Other Integrated Malaria VC Activities Number and percentage of completed annual 1.1.1 Country country work plans developed and submitted on-time Number of eligible 1.1.2 structures targeted Total (All) 125,068 125,249 149,645 139,636 147,636 136,774 for spraying Number of eligible 1.1.3 structures sprayed Total (All) 106,308 112,805 127,199 131,191 125,491 133,078 with IRS[1] Percentage of total structures targeted for spraying that 1.1.4 were sprayed with Total % 85% 90.10% 85% 93.90% 85% 97.30% a residual insecticide (Spray Coverage) Number of people 1.1.5 Total (All) 271,608 276,343 297,070 307,209 324,685 315,403 protected by IRS

41 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of vector control project country programs 1.1.6 submitting an Country EOSR within 45 days after the end of spray (including completing MEP and EMMR) Number and percentage of IRS country programs that conduct a 1.1.7 Country Post-Spray Data Quality Audit within 90 days of spray completion Number of Insecticide Treated 1.1.8 Nets (ITNs) Channel N/A N/A N/A N/A N/A N/A distributed, by channel Number and percentage of countries completing ITN 1.1.9 durability Country monitoring data collection as planned in a given project year

42

Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of PMI- funded durability monitoring surveys 1.1.10 Country with reports submitted within 90 days of the end of data collection 1.2 Strengthen Capacity of NMCPs, VC Personnel, and Other Institutions to Implement and Manage IRS and Other VC Activities Total 402 385 324 400 430 456 VC IRS IRS IRS Total number of Intervention people trained to 1.2.1 Sex: Male 232 301 340 support VC in target areas Sex: Female 153 99 116 See Table Job Function See Table 2 See Table 2 2 Total NA 295 315 315 315 319 VC Total number of IRS IRS IRS people trained to Intervention 1.2.2 support VC in Sex: Male 232 237 240 target areas with Sex: Female 63 78 79 USG funds[2] See Table Job Function See Table 2 See Table 2 2 Number of people Total 50 29 75 50 50 55 trained during the Sex: Male 29 36 37 Master (National) 1.2.3 Training and/or IRS Sex: Female 0 14 18 Training of Type of TOT TOT TOT Trainers. Training

43 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Total 365 357 402 377 398 417 VC IRS IRS IRS Total number of Intervention people hired to 1.2.4 Sex: Male 285 285 308 support VC in target areas. Sex: Female 72 92 109 See Table Job Function See Table 2 See Table 2 2 Total 4 8 8 7 8 7 Number of VC Ops (1), mHealth Ops (1), project training Ops (1), M&E Technical (1), M&E M&E (2), workshops (2), EC (3), 1.2.5 Area (1), EC (3), EC (3), targeting NMCP SBCC (1) and other host Ento (1), SBCC (1) country staff SBCC (1) See Table Job Function See Table 2 See Table 2 2 Number of NMCP and other vector Total N/A N/A 15 3 15 20 control host country 1.2.6 staff who have See Table logged into Job Function See Table 2 2 VectorLink Collect Number and percentage of Country technical assistance requests to support Technical 1.2.7 ITN distribution Area planning and/or implementation completed on time as planned in a Channel given project year

44

Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of technical Country assistance requests to support operational routine 1.2.8 monitoring systems for continuous ITN distribution Channel completed on time as planned in a given project year 1.3 Environmental Compliance and Safety Number of Total 385 363 416 385 399 422 seasonal vector Sex: Male (#) 293 295 318 control personnel Sex: Female trained in 70 90 104 environmental (#) 1.3.1 compliance and Sex: Male (%) 81% 77% 75% personal safety Sex: Female 19% 23% 25% standards in vector (%) control See Table Job Function See Table 2 See Table 2 implementation 2 Total 30 22 30 18 30 25 Number of health Sex: Male (#) 15 11 18 workers receiving insecticide Sex: Female 1.3.2 7 7 7 poisoning case (#) management Sex: Male (%) 68% 61% 72% training Sex: Female 32% 39% 28% (%)

45 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number of adverse reactions to Total 0 0 0 0 0 0 pesticide exposure 1.3.3 documented that resulted in a Type of N/A N/A N/A referral for medical Exposure care Number of SEAs and Letter Reports submitted at least 1.3.4 Country 60 days prior to the commencement of VC campaigns Number and percentage of Total Number 8 8 8 8 7 16 permanent and mobile soak pits 1.3.5 inspected and approved prior to Percent 100% 100% 1 IRS campaigns or 229% before first use Total Number 11 11 11 9 9 11 Number and Percent 100% 82% 122%2 percentage of Type: storehouses 1 1 1 1.3.6 Provincial inspected and Type: District approved prior to 2 1 1 Warehouse IRS campaigns Type: 8 7 9 Campsite

1 Target was exceeded due to: (i) compliance with the new PMI BMP manual requirements where each soak pit should not be used by>25 SOPs, (ii) increased number of campsites as a COVID-19 mitigation measure. 2 Target was exceeded due to the increased number of campsites as a COVID-19 mitigation measure to reduce the number of people at campsites

46 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result 1.4 Promote Gender Equality in all Facets of Planning and Implementation Number and Number 75 72 35 92 40 109 percentage of 1.4.1 women hired to Percent 20.1% 24.40% 26.13% See Table support VC Job Function N/A See Table 2 campaigns 2 Number and Number 24 28 28 34 28 35 percentage of Percent 37% 37% 32.10% women hired in VC 1.4.2 IRS IRS IRS supervisory roles in Intervention target areas for VC See Table activities Job Function See Table 2 See Table 2 2 Total 418 385 420 417 420 471 Number and Sex: Male (#) 306 313 339 percentage of Sex: Female trainees 79 104 132 (permanent and (#) 1.4.3 seasonal) who Sex: Male (%) 79% 75% 72% have completed Sex: Female 21% 25% 28% gender awareness (%) training See Table Job Function See Table 2 See Table 2 2 Number and percentage of Country women in senior 1.4.4 leadership roles in VectorLink country Sex (# and %) offices 1.5 Implement and Support SBCC and Mobilization Activities Total 2 33 66 0 0 0 Number of radio VC IRS IRS IRS 1.5.1 spots and talk Intervention shows aired Talk Show or Radio Spot Radio Spot

47 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number of print materials Total 103,880 22,984 103,880 1,400 4,000 4,000 1.5.2 distributed to or VC targeted at IRS IRS IRS beneficiaries Intervention Number of people Total 102,546 74,268 102,546 87,164 102, 546 136,750 reached with vector VC control and/or IRS IRS IRS 1.5.3 Intervention SBCC messages Sex: Male 29,707 41,838 67,007 via door-to-door messaging Sex: Female 44,561 45,325 69,743 2. Entomological and Epidemiological Data to Drive Decision-Making 2.1 Vector Control Activities Monitored via Entomological and Epidemiological Data Number of project- supported entomological Total 4 4 6 6 4 4 sentinel sites established to monitor vector 2.1.1 bionomics (vector species, distribution, VC Ento Ento Ento seasonality, Intervention feeding time, and location)

48

Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of vector bionomics Total Number 2 2 3 3 4 4 monitoring sites measuring all basic entomological 2.1.2 indicators (species Percent 100% 50% 100% composition, indoor and outdoor human biting rates, hourly VC human biting rates, Ento Ento Ento indoor resting Intervention densities) Number and percentage of Total Number 2 2 6 6 4 4 vector bionomics monitoring sites measuring the following all 2.1.3 Percent 100% 100% 100% advanced entomological indicators: IRS or sporozoite rates Entomology IRS IRS IRS and entomological Only Program inoculation rates Number and percentage of Total Number 21 7 6 4 6 5 insecticide resistance monitoring sites 2.1.4 Percent 33% 67% 83% that tested all priority insecticides for the relevant VC Ento Ento Ento local vector control Intervention intervention

49 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of Total Number 20 20 30 30 30 30 houses in which WHO cone bioassays were conducted within 2.1.5 Percent 100% 100% 100% two weeks of spraying with greater than 98% Pirimiphos- test mortality Insecticide Pirimiphos- Fludora methyl, Fludora recorded for IRS Type methyl Fusion Fusion countries Number and percentage of sites that conducted Total Number 3 3 3 3 3 WHO cone bioassays after the completion of 2.1.6 spraying at monthly Percent 100% 100% 100% intervals until test mortality drops below 80% for two Pirimiphos- Insecticide Pirimiphos- Fludora consecutive methyl, Fludora Type methyl Fusion months for IRS Fusion countries Number of countries with an integrated vector 2.1.7 control analytics Country dashboard created by PATH, available for decision-making

50

Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Total 20 35 35 41 10 7 Number of people Sex: Male (#) 29 33 4 trained (VectorLink and non VectorLink Sex: Female 2.1.8 6 8 3 staff) in (#) entomological Sex: Male (%) 83% 80% 57% monitoring Sex: Female 17% 20% 43% (%) Number and percentage of sites Total Number N/A N/A N/A N/A N/A N/A in which WHO cone 2.1.9 bioassays were conducted to evaluate bio- Percent efficacy of bed nets Number of nets in which WHO cone bioassays were 2.1.10 Total N/A N/A N/A N/A N/A N/A conducted to evaluate bio- efficacy of bed nets 2.2 NMCPs Develop Country-Level IRS and Other Malaria VC Strategies Number and percentage of countries with an integrated malaria vector control strategy, including 2.2.1 a plan for Country monitoring and managing insecticide resistance supported by the project

51 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of countries with a data and visualization dashboard 2.2.2 Country complete for IRS and/or entomology data in VectorLink Collect for vector control decision making

Number of countries that 2.2.3 implement sub- Country national insecticide rotation

2.3 Build capacity of NMCPs and local institutions to collect, analyze, and use data for strategic malaria control decision-making Number of individuals trained Total N/A N/A N/A N/A N/A N/A from NMCPs and national institutions 2.3.1 to review and Job Function interpret data for integrated vector control decision Organization making

52

Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percent of targeted Total N/A N/A N/A N/A N/A N/A individuals that report using new analytical tools 2.3.2 and/or skills in their Job Function planning, resourcing, implementation, or measurement Organization activities 3. Procurement and Logistics 3.1 Cost-Effective Procurement Mechanism Established Number and percentage of insecticide Country procurements that 3.1.1 had a pre-shipment QA/QC test, done Insecticide by a third party, at least 60 days prior Type to spray campaign Number and percentage of Total Number 1 1 1 1 1 1 insecticide procurements 3.1.2 received on-time to Percent 100% 100% 100% allow for the initiation of spray Insecticide Pirimiphos- Fludora operations as Fludora Fusion Type methyl Fusion scheduled

53 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of targeted countries Country with international equipment procurements, 3.1.3 including PPE, received on-time to allow for the VC

initiation of vector Intervention control campaigns as scheduled

Number of VectorLink staff 3.1.4 Country trained on procurement

3.2 Robust Inventory Management and Logistics Systems Established Total Number 6 6 6 6 6 11 VC Number and IRS IRS IRS percentage of Intervention logistics and Sex: Male (#) 5 3 5 warehouse Sex: Female 1 3 6 3.2.1 personnel (#) (seasonal and full- Sex: Male (%) 83% 50% 46% time) trained in VC Sex: Female supply chain 17% 50% 55% management (%) See Table Job Function See Table 2 See Table 2 2

54 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result Number and percentage of Total Number 8 7 7 7 7 11 operations site 3.2.2 warehouses where physical inventories can be verified by Percent 88% 100% 157%3 daily stock records Number and percentage of IRS Country countries that successfully 3.2.3 completed spray operations without Insecticide an insecticide Type stock-out 4. Innovation 4.1 Conduct operational research or monitoring to scale up new tools, methods, and approaches Number of operational research studies on Total Number N/A N/A N/A N/A N/A N/A promising new 4.1.1 tools or new methods/approach es to existing tools Type of that are Innovation implemented

3 Target exceeded due to the increased number of campsites as a COVID-19 mitigation measure to reduce the number of people at campsites

55 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result 4.2 Create and share knowledge through dissemination of best practices and lessons learned

Number of innovations, best practices, and other Country data or lessons learned shared with 4.2.1 other partners or international institutions for Technical global reporting on Area the Vector Learning Exchange Number of individual members 4.2.2 N/A who use the Vector Learning Exchange Number of symposia and/or Total 0 0 1 0 1 0 presentations 4.2.3 submitted to and Technical accepted at global Area conferences Number of success stories written or videos produced 4.2.4 Total 1 0 1 0 1 0 and shared on the VectorLink project website Number of peer- reviewed journal Technical 4.2.5 articles submitted Area and accepted

56

Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result

Number of Total 1 1 1 1 1 2 contributions to vector control 4.2.6 global or country NMCP policy and/or Strategic guidance Technical Plan and documents Area National COVID-19 Guidelines 4.3 Develop and deploy cost-savings approaches Number of innovative or novel approaches Total 1 1 1 3 2 2 implemented to 4.3.1 achieve cost savings in IRS and VC integrated malaria IRS IRS IRS vector control Intervention programs Number of cost effectiveness assessments of Total 1 1 1 0 1 0 existing 4.3.2 approaches in the implementation of VC IRS and integrated IRS IRS malaria vector Intervention control programs

57 Annual Targets and Results Performance Dis- # Indicator aggregation Year 1 Year 2 Year 3 Year 4 Year 5

Target Result Target Result Target Result Target Result Target Result 4.4 Cultivate public-private partnerships Number of private sector entities engaged with to establish public private partnerships 4.4.1 Total 2 11 11 10 15 1 to increase the quality and coverage of malaria vector control activities globally [1] Target based on 85% of estimated eligible structures in indicator 1.1.2 [2] For IRS program, this includes spray operators, team leaders and supervisors

58 MEP Table 2. Job Function Annual Targets and Results Selected Indicators with Job # By Job Function Year 1 Year 2 Year 3 Year 4 Year 5 Function Disaggregates Target Result Target Result Target Result Target Result Target Result 1.2 Strengthen Capacity of NMCPs, VC Personnel, and Other Institutions to Implement and Manage IRS and Other VC Activities Total 402 385 324 400 430 456 District /Provincial 2 3 3 Officers Sector 4 4 9 Coordinators Sector IECs 22 22 23 Supervisors 56 60 63 Spray Operators 224 239 239 Team Leaders 15 16 17 Total number of people trained 1.2.1 to support VC in target areas Clinicians 18 11 25 M&E Asst, Data 4 4 9 Clerks Pump 4 4 9 Technicians Driver 8 9 11 Storekeepers, 6 6 11 Logistics Security Guards 12 10 20 Washers 10 12 17 Total NA 295 315 315 315 319 Total number of people trained Supervisors 56 60 63 1.2.2 to support VC in target areas with USG funds[2] SOPs 224 239 239 Team Leaders 15 16 17

59 Annual Targets and Results Selected Indicators with Job # By Job Function Year 1 Year 2 Year 3 Year 4 Year 5 Function Disaggregates Target Result Target Result Target Result Target Result Target Result Total 365 357 402 377 398 417 District IEC Asst 0 0 0 Data Clerks 4 4 9 M&E Assistants 0 0 0 Data Cleaners 0 0 0 District 6 6 11 Storekeepers Sector 0 0 0 Storekeepers Logistics 0 0 0 Assistants Finance 0 0 0 Assistants Sector 4 4 9 Total number of people hired to Coordinators 1.2.4 Sector support VC in target areas. 56 60 63 Supervisors Sector IEC 0 0 0 Assistants SOPS 224 239 239 Team Leaders 15 16 17 Cell IEC 0 0 0 Mobilizers Village IEC 22 22 23 Mobilizers Security Guards 12 10 20 Washers 10 12 17 Pump 4 4 9 Technicians Cleaners 0 0 0

60 Annual Targets and Results Selected Indicators with Job # By Job Function Year 1 Year 2 Year 3 Year 4 Year 5 Function Disaggregates Target Result Target Result Target Result Target Result Target Result Number of 8 7 7 Number of VC project training workshop 1.2.5 workshops targeting NMCP and other host country staff

Total N/A N/A 15 3 15 20

AU 5 Number of NMCP and other vector control host country staff 1.2.6 Health Director 1 who have logged into VectorLink Collect VL 1 5 NMCP/MOHCC 2 9 Staff 1.3 Environmental Compliance and Safety Total 385 363 416 385 399 422 District/Provincial 2 3 3 officers Sector 4 4 9 Coordinators Sector IECs 22 22 23

Number of seasonal vector Supervisors 56 60 63 control personnel trained in SOPs 224 239 239 1.3.1 environmental compliance and personal safety standards in Team Leaders 15 16 17 vector control implementation Pump 4 4 9 Technicians Drivers 8 9 11 Storekeepers, 6 6 11 Logistics Security Guards 12 10 20 Washers 10 12 17

61 Annual Targets and Results Selected Indicators with Job # By Job Function Year 1 Year 2 Year 3 Year 4 Year 5 Function Disaggregates Target Result Target Result Target Result Target Result Target Result 1.4 Promote Gender Equality in all Facets of Planning and Implementation Total 75 72 35 92 40 109 District IEC Asst 0 0 0 Data Clerks 2 2 5 M&E Assistants 0 0 0 Data Cleaners 0 0 0 District 1 3 0 Storekeepers Sector 0 0 6 Storekeepers Logistics 0 0 0 Assistants Finance 0 0 0 Assistants Sector 0 0 0 Number and percentage of Coordinators 1.4.1 women hired to support VC Sector 21 27 23 campaigns Supervisors Sector IEC 0 0 0 Assistants SOPs 36 47 50 Team Leaders 6 4 6 Cell IEC 0 0 0 Mobilizers Village IEC 0 0 0 Mobilizers Security Guards 3 1 7 Washers 3 8 12 Pump 0 0 0 Technicians Cleaners 0 0

62 Annual Targets and Results Selected Indicators with Job # By Job Function Year 1 Year 2 Year 3 Year 4 Year 5 Function Disaggregates Target Result Target Result Target Result Target Result Target Result Total 24 28 28 34 28 35 Sector 0 0 0 Coordinators Number and percentage of Sector women hired in supervisory 21 27 23 1.4.2 Supervisors roles in target areas for VC Team Leaders 6 4 6 activities Storekeepers, 1 3 6 Logistics M&E Assistants 0 0 0 Total 418 385 420 417 420 471 Permanent Staff 0 15 15 District /Provincial 2 4 3 Officers Sector 4 4 9 Coordinators Pump 4 4 9 Technicians Sector IECs 22 22 23 Number and percentage of Drivers 8 9 11 trainees (permanent and Storekeepers, 1.4.3 6 6 11 seasonal) who have completed Logistics gender awareness training Guards 12 10 20 Transport officer 0 1 0 Washers 10 12 17 Supervisors 56 60 63 Data Managers 4 4 9 Clinicians 18 11 25 SOPs 224 239 239 Team Leaders 15 16 17

63 Annual Targets and Results Selected Indicators with Job # By Job Function Year 1 Year 2 Year 3 Year 4 Year 5 Function Disaggregates Target Result Target Result Target Result Target Result Target Result 2. Entomological and Epidemiological Data to Drive Decision-Making 2.3 Build capacity of NMCPs and local institutions to collect, analyze, and use data for strategic malaria control decision-making Number of individuals trained from NMCPs and national Total N/A N/A N/A N/A N/A N/A 2.3.1 institutions to review and interpret data for integrated Category/Function vector control decision making Number and percent of targeted individuals that report Total N/A N/A N/A N/A N/A N/A using new analytical tools 2.3.2 and/or skills in their planning, resourcing, implementation, or Category/Function measurement activities 3. Procurement and Logistics 3.2 Robust Inventory Management and Logistics Systems Established Total 6 6 6 6 6 11 Central Number and percentage of Warehouse 1 1 1 logistics and warehouse Storekeeper District Logistics 3.2.1 personnel (seasonal and full- 0 0 0 time) trained in VC supply Asst District chain management 1 1 1 Storekeepers Sector 4 4 9 Storekeepers

[2] For IRS program, this includes spray operators, team leaders and supervisors

64 ANNEX B. ENVIRONMENTAL MITIGATION AND MONITORING REPORT

Implementing Organization: Abt Associates Geographic location of USAID-funded activities: Mashonaland East (Mudzi and Mutoko) Period covered by this Reporting Form and Certification: 1 March 2020–28 February 2021 Outstanding Issues Relating Mitigation Measure Status of Mitigation Measures Remarks to Required Conditions 1a. Insecticide selection for any VL Zimbabwe operates under a Supplemental Environmental Assessment (SEA) USAID-supported malaria program that was developed and approved in 2017. The SEA, which is valid for the period is subject to the criteria listed in the of 2017-2022, covers the use of pyrethroids, carbamates, organochlorines, and USAID Programmatic organophosphates, in addition to clothianidin and chlorfenapyr (when approved Environmental Assessment, by the WHO Pre-qualification Team (PQ)), for IRS in Zimbabwe. In 2018, PMI country SEAs, and host country approved an amendment to the SEA to authorize technical assistance for DDT requirements. (organochlorine) use by the Government of Zimbabwe and the clothianidin/deltamethrin combination for IRS. A Letter Report was approved in 2020 to fulfill the requirement of the SEA for an annual report rationalizing the continued use and choice of pesticides for IRS, and to report on the preparations and readiness for the IRS campaign in Zimbabwe for 2020. 1b. Procurement and inventory Logistics Coordinator, Provincial Coordinator, storekeepers, operations manager, logs must be maintained. ECO and COP performed regular inventory counts throughout the spray campaign across all the operations sites. All storekeepers were advised to regularly update their inventories and improve on compliance. A total of 382 storerooms inspections were done with 2 incidences of non-compliance noted 1c. Ensure storage facility and Storerooms for insecticide management were provided from health centers and personal protective equipment are private service providers. The storerooms at all the 9 sites were then refurbished appropriate for the active to meet the BMP requirements. Each IRS site was then given a supply of PPE for ingredient used and in accordance insecticide handling. with approved SOPs.

65 Outstanding Issues Relating Mitigation Measure Status of Mitigation Measures Remarks to Required Conditions 1d. Distribute insecticides to Both international and local procurements for PPE were done on time. All the facilities that can manage such sites were certified ready before delivery of the insecticides after refurbishment of commodities safely in storage, use, the storerooms. and disposal (i.e., in a manner PPE for the storekeepers was ready for use during delivery of the insecticides. generally equivalent to However, first aid kits components were not adequate for accidents management Implementing Partner’s own during this early stage though the situation improved as the time progressed SOPs/Waste Management Plan 2a. Inspect and certify vehicles Pre-contract inspection and certification of vehicles was conducted in October used for insecticide or team 2020. Initial inspections were done by the VectorLink ECO, Ops Managers, transport prior to contract. Logistician and Ministry of Health officials and Government of Zimbabwe Vehicle Inspection Department and found defects on all vehicles during the initial stage which were later fixed to meet all certification criteria. A total of 11 lorries were certified for the 2020 spray operations. 2b. Train drivers All 11 drivers, IRS coordinators, and DEHOs were trained in Mudzi in October 20-21, 2020. Topics included safety measures for transporting insecticides, accident and spills response procedures, and safe driving techniques. Drivers, guards, and storekeepers were trained together. 2c. Ensure availability of cell All 11 drivers had cell phones as a pre-requisite to their vehicles being rented. All phone, personal protective were given a set of PPE to use when transporting insecticides and/ or spray team equipment, and spill kits during members. Each vehicle used for the transportation of pesticides was equipped insecticide transportation. with a spill kit. A total of 552 morning mobilization vehicle inspections were conducted during the 2020 spray campaign. On 552 occasions, the vehicle had all required PPE and spill kits. The few major noncompliance issues noted during the spraying included inadequate components of first aid kits components and fire extinguishers without service and expiry dates 2d. Initial and 30-day pregnancy Before Level 3 training, 109 females (SOPs, washers, team leaders and testing for female candidates for supervisors) were screened for pregnancy during the last week of October 2020. jobs with potential insecticide A second screening was done before the second phase of IRS began in the first contact. week of December2020 2e. Health test all spray team All 428 spray personnel candidates had the required pre-spray general physical/ members for duty fitness. medical examination in October 29-30, 2020. All 427/428(99%) spraying candidates passed the medical examination and were declared to be medically fit for training as spray team members. The medical examination included checking blood pressure, respiratory system, pulse, vision, ear nose and throat, chest condition, allergies to OPs Locometer system and temperature for Covid-19 checks. The exam was conducted by qualified Medical Officers from government health facilities

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Outstanding Issues Relating Mitigation Measure Status of Mitigation Measures Remarks to Required Conditions 2f. Procure services of, distribute, Both international and local procurements for PPE were done on time. The PPE and train all workers with potential was received and distributed to all operations sites on timeously though some few insecticide contact on the use of shortages were witnessed during the early stage of IRS operations. Shortages were personal protective equipment. experienced on overalls, face shields for supervisors and rubber gloves. However, shortages were addressed during the first phase of the program. All candidates with potential pesticides contact were fully trained on correct PPE use 2g. Train operators on mixing At district-level 3 SOP trainings, trainers demonstrated the proper mixing of insecticides and the proper use and pesticides (Fludora Fusion). The trainings also demonstrated the proper use and maintenance of application maintenance of sprayers. All supervisors, IRS coordinators, team leaders, SOPs, equipment. and government officials (field officers and DEHOs in the targeted districts) were trained, and a total of 337 people were covered. 2h. Provide adequate facilities and A total of 9 (100%) campsites were used. Each IRS campsite was provided with supplies for end-of-day cleanup. adequate storage facility that was either provided by the MOHCC or health centers or rented from an individual at local business centers. Each IRS campsite had latrines and bathing facilities for both sexes of spray operators and supervisors. All facilities were compliant, and had the materials required for clean-up. A total of 479 end-of-day inspections were conducted, and one episode of non-compliance was noted, and this was that of spray operator. Also, 428 SOPs and supervisors were issued soap for bathing and handwashing. Additional handwashing stations were provided at each and every bubble within the campsite. Improvements in water supply situations were done at all IRS sites. All spraying team members were issued with surgical face masks and hand sanitizers for use at the campsite as part of the Covid-19 Mitigation measures 2i. Enforce application and clean- All clean-up procedures were inspected as scheduled. Sprayer clean-up up procedures. procedures were done in the soak pits as required and supervised by the IRS coordinators every day throughout the spray campaign. Washing or bathing of spray operators were supervised by team leaders and field supervisors. ECOs, COP, DEHOs, operations managers and the IRS coordinators supervised clean- up procedures when present at any operations site. A total of 479 end-of-day inspections conducted and some incidences of non-compliant during clean-up procedures were identified. Appropriate advice regarding identified defects was given to SOPs. No major defects noted during end of day clean-up, with the exception of the need to clean the visors and gumshoes after collecting water from the bucket instead of cleaning them inside the bucket as this practice caused contamination of the cleaning water. Decongestion of spray operators was enforced as part of the normal end of day procedure and as a covid-19 mitigation measure.

67 Outstanding Issues Relating Mitigation Measure Status of Mitigation Measures Remarks to Required Conditions 3a. Implement Information, Homeowners were fully informed about their roles, responsibilities, and Household Education and Communication precautions mainly through house-to-house mobilization. In addition, community preparation was (IEC) campaigns to inform meetings and discussions highlighted the roles, responsibilities, and precautions still a challenge homeowners of responsibilities and for homeowners before, during, and after their homes are sprayed. The VL which needed a precautions, including washing Zimbabwe continued to use of local community village volunteers to help the lot of attention itchy skin and going to health clinic beneficiaries to remove household goods to facilitate smooth spray operations for full if symptoms develop and do not during spraying compliance subside. 3b. Ensure health facility staff are Training for environmental and clinical health workers on management of aware of insecticide poisoning chemical poisoning and first aid, Management of dog, snake and scorpion bites management. was done to 25 cadres. The training was done over a period of 1.5 days 4a. Storage facilities and Each of the eleven IRS sites had secured insecticide which had been refurbished transportation vehicles must be to PMI BMP requirements which included: fencing, burglar bar provision, physically secured to prevent theft. thermometer for temperature monitoring, locks and keys for double locking, and danger warning signs. Pre-contract inspection and certification of vehicles was conducted in October 2020. Initial inspections were done by the VectorLink ECO, Provincial Coordinator and Ministry of Health officials and Government of Zimbabwe Vehicle Inspection Department found defects on all vehicles during the initial stage which were later fixed to meet all certification criteria. A total of 11 lorries were certified for the 2020 spray operations. 4b. Maintain records of all Records of all pesticides’ receipts, issuance, and returned empties were kept on insecticide receipts, issuance, and stock cards with a backup in a ledger books at the regional, district, and return of empty containers. operations site-level. A total of 382 storerooms inspections were done with 2 incidences of non-compliance noted. Remedial action was done to prevent reoccurrences of noncompliance incidence identified in the field. 4c. Conduct analysis comparing In Zimbabwe, the average number of structures sprayed per bottle is 2.2. This number of houses sprayed vs. indicator was calculated daily throughout the spray campaign to ensure that number of containers used. insecticides usage was consistent with number of structures sprayed 4d. Examine houses sprayed to Team leaders, field supervisors, senior supervisor, operations manager, and/or confirm application. the COP performed a total of 15078 spot checks in sprayed houses to verify/confirm insecticides application. This was mainly done through an observation checklist which included visual examination of sprayed walls, eaves, and ceilings.

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Outstanding Issues Relating Mitigation Measure Status of Mitigation Measures Remarks to Required Conditions 4e. Perform physical inventory The ECO, logistics Coordinator, Provincial Coordinator, storekeepers, operations counts during the application manager, and COP performed regular inventory counts throughout the spray season. campaign across all the operations sites. All storekeepers were advised to regularly update their inventories and improve on compliance. A total of 382 storerooms inspections were done with 2 incidences of non-compliance noted. 5a. For shipments of insecticide N/A over water, sachets/bottles will be packed in 220 liter open top barrels with a water-tight top and a locking ring, or in a similar durable container. Waterproof labeling must be affixed to the barrel, with the identity of the pesticide, number of bottles inside, the weight, the type of hazard posed by the contents, and the personal protective equipment to be worn when handling the barrel. 5b. Train applicators on the SEA During Level 1, 2, 3 training to various levels of IRS implementers were trained operational requirements, SOPs, on the SEA requirements to ensure compliance. An approved waste management PMI BMPs, and approved Waste plan was available for use during and after the IRS program. Management Plan, developed for the safe and effective storage, distribution, application, and disposal of insecticides. 5c. Ensure application equipment Each spray operator was given a Hudson sprayer for operations. All 239 SOPs Some leaking of and personal protective equipment and 89 team leaders were also trained on standard spray techniques during Level sprayers was are appropriate for the active 3 training. This included emphasizing standing one meter away from the observed during ingredient used and in accordance “sprayable” surface, keeping the nozzle tip 45 cm from the spray able surface, spraying and with approved SOPs and maintain and spraying at the correct speed. There was constant supervision in the field to these were equipment to avoid leaks. ensure that SOPs adhered to all BMP standards. attended to Also11 incidences of spraying with inadequate PPE were recorded – the majority immediately. were due to in adequate use of the flashlights and 73 cases of spray leaks were observed, and appropriate action was taken due the spraying.

69 Outstanding Issues Relating Mitigation Measure Status of Mitigation Measures Remarks to Required Conditions 5d. Maintain application The 386 SOPs, supervisors, and team leaders were trained in Hudson sprayer Some leaking of equipment. maintenance during Level 3 training. Sprayer were checked daily before use by sprayers was the spray pump technician. During the supervision of SOPs, 73 incidences of observed during leakages were observed and the parts of sprayer that were found to be faulty were spraying and replaced. these were attended to immediately. 5e. No application of insecticides Spraying was only done indoors only and also at least 30 meters away from within 30 yards of beekeeping sites. sensitive areas including beehives. 6a. Handling, treatment, and Each of 9 IRS campsites was provided with a fixed soak pits for every 25 spray disposal of nonhazardous (general operators. Mobile soak pits were provided at IRS sites were spray operators waste) and hazardous wastes must exceeded 25 in number. be in accordance with the approved Solid waste at IRS Sites was packed, labelled and stored in the storeroom at a Waste Management Plan /SOPs corner safe from prevention of contamination. Regular waste collection was done and the PMI BMPs. The WMP, from operations sites to the district and provincial warehouses. which outlines SOPs for managing All waste management operations were guided by the approved waste waste processes, must be in management plan. accordance with PMI best practices and host country requirements 6b. Choose sites for disposal of All 9 IRS campsites were provided with both permanent and large mobile soak liquid wastes, including fixed and pits for disposal of IRS liquid waste. All operations sites were inspected to ensure mobile soak pit sites according to that they meet BMP standards before they were certified for use. Also, SOPs’ PMI BMPs washing slabs were provided at all campsites to facilitate their decent bathing. 6c. Construct fixed and mobile One new soak pit was constructed at Chidye IRS site for use during the soak pits with charcoal according campaign. The other 8 sites had soak pits which were functional according to to the BMPs to adsorb insecticide BMP manual and were refurbished to maintain a good state of functionality. All from rinse water. the 9 soak pits had adequate aggregate which included charcoal for insecticide adsorption and absorption 6d. Maintain soak pits as necessary During the course of the spraying season all 9 IRS sites soak pits were functional during season. according to the requirements of the BMP guidelines 6e. Monitor waste storage and All waste materials were stored and managed according to PMI BMPs during the management during campaign. spray campaign. Generally, there was clear labeling of sacks/ boxes for storing used nose masks, hand gloves, and all other waste that was generated. A total of 382 storekeeper performance monitoring visits were done during the course of the IRS season and only 2 incidences of non-compliance were noted in storage and stock management.

70 Outstanding Issues Relating Mitigation Measure Status of Mitigation Measures Remarks to Required Conditions 6f. Monitor disposal procedures All combustible solid waste generated will be incinerated in Bulawayo at Southern post-campaign Incineration Services Company. The mentioned facility is certified by Environmental Management Agency. Incineration will be done in January 2021or after the national Covid-19 lockdown 7a. Wastes will only be disposed in IRS waste from campsites was collected and stored at district storerooms and incinerators that comply with PMI later transferred to at the Mudzi Provincial warehouse. The waste will be sorted BMPs Collect and maintain according to the level of contamination and type in preparation for recycling and treatment and disposal documents incineration. Waste disposal incineration will be done at Southern Incineration and records on file. Services Company which has already been inspected and meets WHO requirements for waste disposal. The ECO and MOHCC officials will monitor the post-spray campaign solid waste management procedures 7b. Country-level USAID EC There is an approved IRS waste management plan which was developed during documentation must contain the course of year. guidance on proper disposal of All combustible solid waste generated will be incinerated in Bulawayo at Southern wastes Incineration Services Company. The mentioned facility is certified by Environmental Management Agency. Incineration will be done in January 2021. Recycling of waste will be done at Recycle Today based in Harare and this exercise will be done in January 2021or after the national Covid-19 lockdown

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