SPEED Uganda - Elimination of Malaria

Several efforts to contain malaria have been undertaken in Uganda. For example, the deployment of Long Lasting Insecticide Treated Nets (LLITNs) as a key vector control method. However, this preventive measure has not resulted in eradication. Malaria has remained the most frequently diagnosed disease in Uganda, with over 9 million new cases per year, thereby undermining efforts towards achieving Universal Health Coverage in the country. Indoor Residual Spraying (IRS) has been applied in the northern region of the country to compliment malaria control efforts and led to marked reductions in the malaria burden of the region.

The SPEED project in Uganda performed a study[1] to understand the financial implications and requirements of the national scale -up for this effective intervention. Evidence from this study indicated that IRS is inexpensive if existing district systems are mobilised to implement it, instead of using a vertical programme. IRS should be done using an insecticide (such as actellic) that has long lasting effects. Behaviour change communication for IRS should be part of the activity.[2] Further research into cost-effectiveness showed that the investment in spraying would easily pay back in 1) savings on curative health services and 2) reductions on workdays lost due to malaria.

SPEED project advocated for strengthening the malaria control programme with IRS. Scientists and activists met with communities, district authorities, and national stakeholders  to lobby together for IRS in heavily endemic areas.

The advocacy group met several times with parliamentarians on the Health Committee   and discussed fears and concerns such as: use of fake insecticides, high costs of spray equipment, and contamination of household foodstuffs. Together they reached consensus on the  following conclusions:

• The implementation of IRS in a phased manner would be best approach. Starting with the most burdened eight sub-regions would require total financing of 106.7 Billion Shs (29 million US$).
• Key cost-saving strategies that the government can adopt include: use of existing spray logistics on a rotational basis, Exploring the use of Village Health Teams (VHTs) or Community Health Extension Workers (CHEWs), men in uniform and idle youth to do the spraying and subsidization and/or giving fiscal incentives to local chemical manufacturing firms to manufacture insecticides domestically.
• National IRS scale up is feasible, but government needs to take a lead in financing for its implementation rather than relying on development partners.

Supporting Policy Engagement for Evidence  based Decisions  (SPEED) for  Universal Health Coverage  in Uganda; a project funded by European Union and hosted by Makerere University School of Public Health, in collaboration with the Uganda National Health Consumers Organisation, the Economic Policy Research Centre, the National Planning Authority, the Human Sciences Research Council in South Africa, the Institute of Tropical Medicine in Belgium

[1] Odokonyero. T, Ahaibwe. G, Ssengooba. F ( 2019) Financing Indoor Residual Spraying for Malaria Prevention in Uganda: Options for Cost Minimization. https://tinyurl.com/y3hsq623

[2] Tugume, A., Muneza, F., Oporia, F. et al. Effects and factors associated with indoor residual spraying with Actellic 300 CS on malaria morbidity in Lira District, Northern Uganda. Malar J 18, 44 (2019) doi:10.1186/s12936-019-2681-6