a global review of implementation of integrated vector...
TRANSCRIPT
Report by the Secretariat on the review of the current status of
implementation of integrated vector management
A Global Review of Implementation of
Integrated Vector Management
Developed by the Secretariat as part of the plan of action established by the
core-team of the thematic group on Strengthening of In-country Decision
Making on
Integrated Vector Management
Prepared by Dr. John Githure
International Centre of Insect Physiology and Ecology
Nairobi, Kenya
February 2011
Global Alliance for the development and deployment of products, methods and
strategies as alternatives to DDT for disease vector control
ii
Contents
1. Executive Summary ............................................................................................................... 1
2. Introduction .............................................................................................................................. 3
2.1 Evolution of Integrated Vector Management (IVM) ........................................ 3
2.2 Approach to the IVM survey ................................................................................... 3
3. Regional Profile of IVM Implementation ....................................................................... 4
3.1 WHO/AFRO ................................................................................................................. 4
3.2 WHO/EMRO ................................................................................................................ 5
3.3 WHO/SEARO .............................................................................................................. 6
3.4 WHO/PAHO ................................................................................................................ 6
3.5 WHO/Europe ................................................................................................................ 7
4. Regional and Sub-Regional Initiatives that Support IVM ......................................... 7
4.1 New initiatives on IVM ............................................................................................. 8
4.2 Departments and Entities that are Involved in IVM ......................................... 9
4.3. A Data Base of Experts in IVM toward Developing a Resource
Pool ............................................................................................................................... 10
5. Availability of IVM Related Information Exchange Mechanism with a
Strategy to Improve the System in Local, Regional and Global Level ................ 10
6. Current Status of Guidelines and Decision Support Tools Available for
IVM at Regional and Global Level ................................................................................. 11
7. Challenges and Knowledge Gaps on IVM Implementation .................................... 12
8. Strategies for Strengthening the Plan of Action of the Global Alliance
Thematic Group on IVM .................................................................................................... 13
9. Conclusion .............................................................................................................................. 15
10. References .............................................................................................................................. 16
11. Additional References cited in the Report .................................................................... 18
12. List of IVM Guidelines and Tools .................................................................................. 19
iii
Abbreviations
COP Conference of the Parties of the Stockholm Convention
CVC Comprehensive vector control
DDT Dichloro-diphenyl-trichloroethane
FAO Food and Agricultural Organization
GA Global Alliance for deployment of alternatives to DDT
GFATM Global Fund to fight Aids, Tuberculosis and Malaria
GEF Global Environment Facility
ICIPE International Centre of Insect Physiology and Ecology
IRS Indoor residual spraying
IVC Integrated vector control
IVCC Innovative vector control consortium
IVM Integrated vector management
LLINs Long lasting insecticide treated nets
MoH Ministry of Health
NMCP National malaria control programme
PMI US President‟s Malaria Initiative
POPs Persistent Organic Pollutants
RBM Roll Back Malaria
RTI Research Triangle International
SC Stockholm Convention
SVC Selected vector control
UNEP United Nations Environment Programme
USAID United States Agency for International Development
VBDs Vector borne diseases
VCNA Vector control needs assessment
WHO World Health Organization
WHO/AFRO World Health Organization for the African region
WHO/EMRO World Health Organization for the Eastern Mediterranean region
WHO/PAHO World Health Organization for the Pan American Health region
WHO/SEARO World Health Organization for the South East Asia region
WHOPES World Health Organization Pesticides Evaluation Scheme
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1. Executive Summary
Vector borne diseases account significantly for the disease burden with an estimated 80 to 90% of the 300
million global clinical malaria cases. Nearly one million malaria related deaths occur annually in Africa. The
widespread and unplanned population movement, poverty and poor sanitation in most disease endemic
countries continue to increase the breeding habitats of disease vectors. The situation is further compounded by
resistance of vectors to insecticides and environmental health impact of over-dependence on pesticides. Vector
control is an essential component of the control of vector borne diseases and forms the main part of preventive
measures to reduce or interrupt transmission.
Well planned and coordinated vector control interventions can help reduce the incidence and prevalence of
vector borne diseases. Although effective vector control methods such as LLINs and IRS exist, they tend to
address one disease at a time so that their implementation as part of an integrated diseases management
package is limited. In many countries, decentralization is providing opportunities for vector control with
community and key stakeholders participation. However, limited financial and human resources faced by many
disease endemic countries and the limited number of safe, cost-effective pesticides require selective and careful
application of pesticides. It is for this reason that integrated vector management (IVM) has been advocated as a
solution for sustainable vector borne disease control in all regions and in particular in those countries with
limited resources.
Although the WHO‟s definition of IVM is straightforward: “A rational decision-making process for the
optimal use of resources for vector control”, reports from several countries has indicated that IVM is still seen
as somewhat a philosophical concept or as a tool that has not yet been proven effective for disease control.
There is a clear inadequacy in IVM specific expertise. This is because the people who are supposed to drive the
IVM processes are not by default vector control experts but rather disease control programme managers who in
most cases have a clinical inclination.
It should be taken into account that IVM is not another programme with its own staff or structure, but rather, it
is a strategy that should be built onto the existing structures while strengthening linkages between partners and
systems. The lack of visibility of IVM in most disease control programmes underscores the emphasis that
should be given to advocacy strategy and how the packaging of the IVM initiative is crucial to ensure that the
principles are unambiguously communicated. There is therefore a need to mainstream vector control
departments/units to include entomologist/vector control specialists.
The following key challenges and gaps and possible strategies to address them were identified during the
survey. However, due to the diverse nature of IVM implementation globally, these strategies are not listed in
priority order of implementation at country level:
1. Gap: The number of persons with technical expertise in epidemiology and entomology, as well as the
available infrastructure for strengthening IVM operations is lacking;
Strategy: Governments should address capacity strengthening as a key element for effective
control of vector borne diseases and development partners should agree and work on a common
strategic plan, as a priority, on capacity strengthening with due consideration of malaria disease
burden and increased synergy.
2. Gap: Information on countries progress with IVM is generally with disease control programmes in the
form of reports, policy documents, annual operation plans, etc. Such information is difficult to get as it
is rarely published in journals or posted to the internet. The information accessible at regional or global
level is mainly from research articles in specific areas. Such information lacks the programmatic aspects
of IVM implementation at country level;
Strategy: Closer linkage should be established between researchers, communities and policy
makers to ensure adoption and utilization of research findings.
3. Gap: There is lack of coordinated one-stop-shop of information on IVM;
Strategy: Establish a national reporting system of case studies on IVM that is linked with regional
and global networks and other similar websites to showcase the power of IVM in disease control.
2
4. Gap: Most countries either lacking or weak IVM policy and as such cannot allocate adequate resources
for vector control;
Strategy: Advocate for restructuring of the health systems to establish IVM policy as part of
services targeted at communities should be strengthened.
5. Gap: The number and type of studies or pilot projects in the countries that generate new evidence for
decision making through operation research is largely lacking;
Strategy: The integrated use of vector control interventions in a multi-disease approach at the
district or village level that is based on evidence-based decision making arising from surveillance
data or operational research should be seen in the right direction towards IVM.
6. Gap: The IVM inter-sectoral coordinating mechanisms are generally lacking or weak in many countries;
Strategy: Sectors directly or indirectly involved in vector control should have active partnerships
on IVM and should be willing to allocate budgets for vector control.
7. Gap: Most countries concentrate their efforts on malaria control and are unaware of the impact of other
vector borne diseases and how the integration can have an added impact;
Strategy: Countries should conduct vector control needs assessment when allocating resources
towards IVM.
A recent WHO global survey of IVM implementation showed the number and percentage of countries with
national integrated vector management policy to be about 62% of the 113 countries. However, the extent of
implementation varies from country to country. It is suggested here that the WHO Regional offices expand on
this survey by documenting the countries that have IVM policy in place and those that need assistance. Overall,
clear indicators on the implementation of IVM at country level would be steps taken towards advocacy,
capacity building, collaboration, promotion of evidence based decision making, integrated approach to vector
control and allocation of funds from decentralized health budgets and from development partners to integrate
IVM within the health systems.
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2. Introduction
2.1 Evolution of Integrated Vector Management (IVM)
The emergence and re-emergence of vector borne diseases and the environmental concerns triggered by the
over reliance on insecticides invoked in WHO the importance of integrated vector control (IVC) in the early
1980s. The IVC approach was described as the utilization of all appropriate, safe and compatible means of
control to bring about an effective degree of vector suppression in a cost-effective manner. In 1992, a Global
Malaria Control Strategy was formulated, which provided for planning and implementation of selective and
sustainable preventive measures, including vector control. By the mid-1990s, the IVC further evolved into a
selective vector control (SVC) approach, which was considered as, the targeted use of different vector control
methods alone or in combination to prevent or reduce human-vector contact cost-effectively, while addressing
sustainability issues. It was essentially a unified plan that included use of one or more methods of control.
Later, selective vector control was redefined as, - application of targeted, site specific and cost-effective
activities to reduce malaria morbidity and mortality. Since it was considered that a unified management
structure could manage two or more vector borne diseases (VBD) prevalent in the same area, the concept of
comprehensive vector control (CVC) was adopted which was defined as, control of vectors of two or more
diseases through a unified managerial structure using similar or different methods. As such, it was recognized
that vector control is well suited for integrated approaches because some vectors are responsible for multiple
diseases while some interventions are effective against several vectors.
In May 2007, WHO organized a consultation meeting on integrated vector management in Geneva1. The
purpose of the meeting was to bring together experts in vector control from national, regional and global levels
to advance the development and promotion of IVM approach as set out in the Global strategic framework for
integrated vector management2 developed in 2004.
In December 2008, WHO organized another consultation on the development of a global action plan of IVM
for the period 2009 - 20113. The objective of the consultation was to develop a global action plan on IVM, to
identify the roles of partners and to review the status of IVM and develop a guidance document on national
IVM policy. Specific recommendations of that meeting included launching a global advocacy strategy;
strengthening capacity through development of a comprehensive modular training package; establishing a
network on IVM to strengthen the evidence base and data sharing for IVM, including the documentation of
case examples, and developing a system for evaluation of IVM.
In the same year, WHO issued a position statement on IVM to support the advancement of the concept in
vector-borne disease control (WHO/HTM/NTD/VEM/2008.2)4 and issued a simplified definition of IVM as, “a
rational decision-making process for the optimal use of resources for vector control”. The five key elements of
an IVM strategy are: i) advocacy, social mobilization and legislation, ii) collaboration within the health sector
and with other sectors, iii) integrated approach, iv) evidence-based decision making and v) capacity-building.
Member States were encouraged to accelerate the development of national policies and strategies to embrace
IVM.
To fast-track adoption of IVM by Members States, a number of WHO Working Group meetings on Advocacy
and collaboration; Capacity building and training; and Evidence base decision making and integrated approach
were held in 20095. As part of the global plan for 2008–2015 to combat neglected tropical diseases, the WHO
called for the strengthening of IVM and capacity building as one of the strategic areas for action
(WHO/CDS/NTD/2007.3)6. To add weight to the IVM initiatives, the fourth meeting of the Conference of the
Parties (COP4), in its decision SC-4/2: DDT Item 4, the COP requested the Stockholm Convention to lead the
implementation of a Global Alliance (GA) for the development and deployment of products, methods and
strategies as alternatives to DDT for disease vector control. The plan of action established by one of the five
thematic groups emphasizes the strengthening of in-country decision making on IVM as an alternative strategy
to the use of pesticides, including DDT. It is in view of the scattered information on IVM in various meeting
reports and articles that the Global Alliance took up the challenge to conduct a survey of IVM implementation
in order to identify challenges and gaps that needs attention by countries and development partners.
2.2 Approach to the IVM survey
To facilitate the decision by the Conference of the Parties to the Stockholm Convention on the establishment of
the Global Alliance for the development and deployment of products, methods and strategies as alternatives to
4
DDT for disease vector control, a plan of action was developed by the thematic group on strengthening of in
country decision making on IVM to conduct a preliminary survey of the global implementation status of IVM
so as to optimize resource mobilization and the output of identified interventions on strengthening for IVM
approach in national vector control programmes. A survey of global IVM implementation was undertaken in
November/December 2010 with particular emphasis in malaria endemic countries. A similar survey was
conducted recently conducted by the WHO whereby out of the 113 countries surveyed, 62% were found to
have an IVM policy. It would be necessary to examine the two surveys so as to come up with actual status of
IVM implementation. This survey was conducted through collection of information available from meetings
and project reports, published articles, regional and sub-regional programmes, research and training
institutions, public domain (web), national programme managers and local and regional representatives of the
WHO. In the online Google search, various key words were used singly or in combination. The following
sections describes the status of IVM implementation at the national, regional and global levels and points out
the challenges and key gaps that require strengthening by national governments, WHO, the Global Alliance
and other development partners.
While it is hoped that many of the key IVM reports, meetings and articles have been well represented in the
survey, it is worth noting that reviews of this nature can rarely be exhaustive due to the diverse nature of
country information and accessibility to relevant published information. The report will thus be updated from
to time.
3. Regional Profile of IVM Implementation
3.1 WHO/AFRO
The major burden of diseases in the Africa Region is attributed to vector borne diseases. An estimated 80-90%
of clinical malaria cases (300m) and malaria related deaths (1m) occur in the continent while an estimated
164m people are infected with schistosomiasis with 477m at risk. Other vector borne diseases such as
trypanosomosis, leishmaniasis, onchocerciasis, filariasis, guinea worm and plague also contribute to heavy
disease burden in Africa7.
Owing to the decline of vector control specialists in the 1990s, the WHO Africa Regional Office and its
partners initiated a programme to assess the vector control capability in African countries represented by
Uganda, Zimbabwe, Cameroon and Senegal. The report of that survey indicated that most of the personnel who
had been trained on vector ecology and control were not working in positions relevant to their training8. As
such, WHO/AFRO took steps to strengthen their capabilities by re-orienting the ministries of health to
emphasize on integrated vector management (IVM) as a new strategic approach to vector control. A workshop
for the development and implementation of vector control intervention in the African region took place in
Harare in Feb 2001. Participants of the meeting were experts in vector control and policymakers from the
Ministries of Health and Ministry of Environment from 14 countries. The meeting adopted IVM as the new
approach for vector control and a strategic framework for the African region was developed. The meeting also
recommended that WHO produce and disseminate as early as possible technical guidelines for the planning,
implementation, monitoring, and evaluation of IVM. The African region was the first to develop an IVM
framework for vector control in 20019.
With the strategic framework in place and countries introducing IVM, there was an urgent need to define
technical guidelines for planning, implementation, and monitoring and evaluation of IVM. In this regard,
WHO/AFRO developed two sets of guidelines: guidelines for the management of IVM10
and guidelines for
vector control needs assessment (VCNA)11
. Based on this plan of action and objectives, several IVM related
activities were planned and included organizing inter-country workshops to prepare national action plans for
IVM. In this regard, the Regional Office organized two regional IVM training workshops at ICIPE, Nairobi in
October 2002 and October 2004. where 38 senior level managers from 21 countries in Africa participated.
These participants were trained in planning, implementation, monitoring and evaluation of IVM interventions
using structured training modules developed by WHO.
Another regional training course on IVM targeting district health workers was developed and offered at the
Noguchi Memorial Institute for Medical Research in Accra, Ghana, in Oct. 2003. Participants in this course
included entomologists and environmental health workers dealing with vector control operations. Fourteen
participants drawn from Burkina Faso, Congo-Brazzaville, Madagascar, Namibia, Democratic Republic of
Congo, Senegal and Swaziland attended the course.
5
In July 2004, an awareness creation workshop on IVM was held at ICIPE for two weeks under the auspices of
UNEP Chemicals, in which 7 countries in eastern and southern Africa participated. The aim of this workshop
was to train disease control managers on IVM as an effective strategy in the control of vector borne diseases
and as a strategy to reduce reliance on DDT or not to revert to DDT for malaria control. Recently in July, 2010,
a five day training workshop on strengthening in-country capacities to implement IVM was again held at
ICIPE under the auspices of the Stockholm Convention Global Alliance for the development and deployment
of alternatives to DDT for disease vector control. Thirteen public health officers and environmental health
officers from seven countries (Ethiopia, Kenya, Malawi, Rwanda, South Africa, Tanzania, Uganda and
Zambia) participated in the workshop. A 2-weeks core curriculum on IVM12
recently developed by WHO was
pilot tested. As follow up action plan, the participants identified the priority needs for their countries and
developed plans of actions to facilitate implementation of IVM approach in their respective countries.
The expected outcome of all these workshops was to train managers at the national level on the IVM concept
who in turn would cascade the training to the district level as well as develop action plans for the
implementation of IVM as an effective strategy in the control of vector borne diseases and reduce reliance on
pesticides including use of DDT. WHO/AFRO provided financial and technical support to kick-start IVM in
these countries (see section 4.0). More recently in January 2010, a directory of 16 African institutions with
existing capacity to offer training on IVM was conducted under the auspices of RTI/USAID. The main
objective of the review was to prepare a directory from which suitable institutions can be selected and
supported to host IVM training in Anglophone and Francophone countries. In line with this, initiatives
currently involved in capacity-building for vector control is a five-year project supported by the Gates
Foundation. The project is aimed at strengthening systems for malaria vector control in seven African countries
including: Tanzania, Kenya, Mali, Madagascar, Mozambique, Cameroon, and Senegal. The main objective of
the project is to assess vector control and training needs, building consensus and developing work plans (see
section 4.1 for details).
3.2 WHO/EMRO
The WHO Eastern Mediterranean Region comprises of 22 countries namely, Egypt, Libya, Morocco, Tunisia,
Djibouti, Somalia and Sudan, Afghanistan, Bahrain, Iraq, Iran, Jordan, Kuwait, Lebanon, Oman, Pakistan,
Palestine, Qatar, Saudi Arabia, Syria, United Arab Emirates and Yemen. Vector borne diseases such as
malaria, Rift Valley fever, dengue fever and leishmaniasis are quite prevalent in the region and account for
about 32% of the regional burden of disease, as assessed in disability-adjusted life years (DALYs).
Recognizing the importance of vector-borne diseases, Member States through a Resolution (EM/RC.52/R.6)
endorsed the Regional Strategic Framework for Integrated Vector Management. The strategy is based on
principles of strengthening inter-sectoral and intra-sectoral coordination, partnerships at all levels, decision-
making criteria at the lowest level and evidence-based interventions in addressing vector-borne diseases.
Member States committed themselves to develop national capacities to plan and implement IVM, make
specific budget allocations and establish functional intersectoral mechanisms to enhance in-country
coordination of all relevant sectors. To be able to develop national IVM strategies and plans of actions, each
country was required to carry out regular vector control needs assessment (VCNA) to identify needs, gaps and
opportunities for vector control. By Sep 2010, 10 countries had completed their VCNA. These are Djibouti,
Egypt, Iran, Jordan Morocco, Sudan, Syria, Yemen, Afghanistan and Oman. Four of these countries (Egypt,
Jordan, Morocco and Sudan), have vector control units while in the other six, the IVM mandate is undertaken
by the national malaria control programme due to the importance of malaria. However, this placement limits
the choice of the MoH and other sectors to efficiently exploit the prevention and control of other vector borne
diseases.
Dr Abraham Mnzava, the Vector Control Adviser in the region reported that a regional plan on IVM
implementation for 2010–2011 was already in place following a meeting of national focal points for vector
control that met in November 2008 in Jordan. In terms of scaling-up interventions within the framework of
IVM, eight countries (Sudan, Morocco, Yemen, Djibouti, Egypt, Syria, Jordan and Iran) are supported by the
GEF to promote cost-effective and sustainable alternatives to DDT.
In general, most of the EMRO countries have developed national IVM Plans of Action based on detailed
VCNA. Of particular significance is the strengthening of national capacity in vector control through
Postgraduate training at the MSc level. The region supports the MSc course in medical entomology and vector
control in Sudan and the National Diploma for district/provincial managers in Pakistan, in addition to technical
support to countries. The programme has trained 73 candidates from 10 countries in medical entomology
course.
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3.3 WHO/SEARO
In the South East Asia Region, malaria, dengue, filariasis, Japanese encephalitis and leishmaniasis are the main
vector-borne diseases. Malaria is a serious health and developmental problem in the region where 687 million
people are at high risk of the disease, with an estimated 90 -160 million infections and more than 120,000
deaths occurring each year. Vector control has been a strong component in the strategy to roll back malaria in
the region and depending on the epidemiological settings. All countries are implementing the two main vector
control measures (LLINs and IRS). The existing vector control strategy in the region evolved through a
number of inter-country consultations. A UNEP/WHO sub-regional workshop on the reduction/elimination
and management of pesticides in the context of the Stockholm Convention was held in Bangkok in May 2004
and recognizing the concerns of insecticide resistance, including environmental health, more emphasis on
vector control was placed on alternative control measures such as environmental management, biological
control and personal protection. These consultations have contributed to the development of a Regional
Framework for Integrated Vector Management Strategy for the South-East Asia Region. A Report of the
Regional Meeting on IVM held in Thailand in September 2010 where 10 countries (Bangladesh, Bhutan, India,
Indonesia, Nepal, Maldives, Myanmar, Sri Lanka, Thailand and Timor Leste) attended, the following
objectives were addressed: share and review status of IVM implementation in the Member States, identify
constraints, issues and training as well as research needs and prepare follow-up actions for implementation and
scaling up of IVM.
At the national level, India has developed comprehensive guidelines for the control of dengue and dengue
hemorrhagic fever by way of regular vector surveillance and integrated management of Aedes mosquitoes
through biological and chemical control methods that are safe and cost effective. Environmental management
and legislations as well as action at household and community levels are also implemented. To address the
dengue fever, Vietnam and Cambodia have conducted VCNA and identified capacity and facilities
requirements for vector control. These countries have the Vector Control unit under the Vector Borne Disease
Control Section in the federal Ministry of Health. Vector control decisions at national level are made by State
Deputy Director of Health and Senior Principal Assistant Director after discussions with the entomologist in
charge. At the district level, the decisions are made by the Medical Officer of Health in discussions with the
entomologist and the Assistant Environmental Health Officers. This structure reflects a well organized system
for IVM implementation.
3.4 WHO/PAHO
In the Americas, the most significant vector-borne diseases include malaria, dengue and Chagas‟ disease.
Malaria is a significant public health problem with an estimated 41 million people living in areas of moderate
to high risk of infection in 21 PAHO Member States. Dengue and dengue hemorrhagic fever (DHF) affect 34
countries in the region where over 900,000 clinical cases of dengue and over 26,000 cases of DHF resulting in
317 deaths were reported in 2007. Almost the entire population of Latin America and the Caribbean live in
close proximity to the domesticated mosquito vector, Aedes aegypti and as such are at high risk of dengue
transmission. Chagas‟ disease produces chronic complications in 2-3 million people throughout the Americas,
where an estimated 120 million persons are reported at risk. While Chagas‟ disease in Brazil and the Andean
countries has been the focus of most control programmes, the problem has largely been underreported in
Mexico and Central America.
Lack of effective medication for the treatment of Chagas‟ disease and lack of vaccines for dengue and malaria
make vector control a key component in the reduction of the burden of these and other vector-borne diseases.
At a resolution of the 60th Session of the Regional Committee in Sep 2008, PAHO region recognized that IVM
will allow countries to better respond to their specific needs and achieve better results with long-term impact. It
was also recognized that IVM will establish new modalities of technical cooperation and support the capacity
building of national institutions, promote horizontal cooperation between the ministries of health and national
and international training institutions, and share advances and best practices among countries. It also provides a
forum for operational research to develop new ideas, methodologies and technologies for vector control.
It was reported at the 142nd Session of the Executive Committee, in June 2008 that among the 27 member
states declared free of malaria transmission by WHO in previous years, an average of 1,300 cases are reported
annually since the year 2000. These imported cases occur among travelers from endemic countries in the
7
Americas and from other regions of the world. Outbreaks reported in two non endemic countries in 2006, the
Bahamas and Jamaica were controlled through expedient efforts of national authorities and effective
collaboration with PAHO and other international agencies. Intensive surveillance aimed at preventing future
outbreaks are in effect in these two countries. The Region continues to pursue a five-component strategy to
address the malaria challenges which are: a) malaria prevention, surveillance, and early detection and
containment of epidemics; b) integrated vector management; c) malaria diagnosis and treatment; d) enabling
environment for malaria prevention and control, and e) health systems strengthening/country-level capacity
building.
As a showcase for a successful IVM implementation, Mexico is always highlighted as one country that needs
emulation when it comes to use of integrated approach to vector control. Malaria was for a long time a public
health problem in Mexico, where climatic conditions in 60% of the country are favourable to malaria
transmission. In the 1940s and 1950s, malaria claimed an average of 24,000 lives each year with some 2.4
million people at risk. The government introduced a malaria-eradication programme that relied on extensive
household spraying with DDT and malaria treatment. Cases declined, but it proved impossible to completely
rid the country of the disease. Taking into account the 1997 North American Free Trade Agreement that
required Mexico to have reduced DDT use by 80% in 2000 and stop using it by 2002, researchers set about to
develop alternative strategies by addressing disease transmission determinants. An integrated approach was
used that showed a significant decrease of malaria cases from 15,121 in 1998 to 4,996 in 2001. This decrease
was realized without using DDT. As a result of this integrated approach, Mexico was able to abandon DDT
ahead of the scheduled time of 2002. The Mexican model of an integrated vector management strategy based
on community participation, inter-sectoral collaboration, prevention, and improved diagnosis and treatment
(Chanon et al 2003)13
proved that alternatives to pesticides are sustainable solutions to vector borne disease
control.
3.5 WHO/Europe
While the number of vector borne diseases and their incidence in countries of the WHO European Region is
much less than that of the tropical developing countries, there are, nevertheless, a substantial number of
infections such as malaria and visceral/cutaneous leishmaniasis that have been on the rise. Other emerging and
re-emerging diseases such as Encephalitis, Crimean-Congo hemorrhagic fever and Chikungunya are also of
great concern in the region.Member States in the region have embarked on a GEF funded project to reduce
their reliance on the use of persistent insecticides, while strengthening national strategies based on sustainable
and cost-effective alternatives for vector control. To pursue this goal, a regional project to demonstrate and
scale up sustainable alternatives to DDT for the control of VBDs in the southern Caucasus (Georgia, Armenia
and Azerbaijan) and central Asia (Kyrgyzstan and Tajkistan) was developed with financial and technical
assistance from the Global Environmental Facility (GEF) of the UNEP for implementation in 2011 to 2015.
The project builds on countries‟ and WHO‟s efforts towards cost-effective and environmentally sound national
vector control, which relies less on pesticides such as DDT. As a means of achieving this, government support
was pledged for national capacity for planning and implementation of IVM.
4. Regional and Sub-Regional Initiatives that Support IVM
Due to the importance and heavy burden due to vector borne diseases, this section focuses on the African
region. WHO/AFRO has completed the development of: a) IVM guidelines to support countries in the process
of planning, implementation, monitoring and evaluation of IVM, b) Vector Control Needs Assessment
guidelines intended to support national authorities to assess capacity needs of countries to implement IVM, and
c) training modules to facilitate training on IVM. Different countries are at different stages of implementing
IVM14
. In Africa, at least 10 countries are implementing IVM action plans. Among the 16 countries
represented at the first regional training workshop on IVM at ICIPE, Nairobi, eight countries finalized their
national plans of action and submitted them to WHO/AFRO for funding of preliminary activities. These
countries are Burkina Faso, Congo-Brazzaville, Ethiopia, Nigeria, DRC, Senegal, Chad, Uganda and
Zimbabwe. Financial requests were made to fund three major activities:
1. Vector control needs assessment;
2. Organization of national consensus workshops on IVM;
3. Identification of districts suitable for IVM.
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WHO/AFRO provided financial support between 2003 and 2005 to Burkina Faso, Congo-Brazzaville, DRC,
Senegal, Chad, Uganda and Zimbabwe as follows:
1. Burkina Faso was awarded US $17,000 to conduct inventory of stakeholders, organization of national
consensus workshops, preparation of national training on IVM, selection of districts for implementation
of IVM and establishment of an entomology laboratory;
2. Chad received US $15,000 to organize a national consensus workshop on IVM, and to conduct VCNA
at the national level;
3. Congo-Brazzaville was provided US $11,000 to conduct a national consensus meeting and for VCNA,
to identify stakeholders, and to initiate national IVM training courses;
4. DRC received US $24,000 to organize a national consensus workshop on IVM, and to conduct VCNA
at national level;
5. Senegal was provided with US $17,000 to conduct a national consensus workshop on IVM and to
elaborate and distribute technical guidelines on IVM;
6. Uganda received US $17,000 to convene a national workshop on IVM, and to finalize the national IVM
framework;
7. Zimbabwe obtained US $8,000 to convene a national consensus workshop and to develop technical
guidelines on IVM.
A few countries in Africa have successfully conducted the VCNA either towards implementation of IVM or
indirectly through insecticide resistance surveys. These are: Uganda, Rwanda, Zanzibar, Ethiopia, Eritrea,
Zambia, Mali, Cameroun, Senegal, Kenya, Madagascar, Tanzania and Mozambique. Nigeria has adopted a
national strategic framework and guidelines (2006 – 2009) for the implementation of IVM targeting several
disease vectors15
. In line with the strategic intervention, the Nigeria national malaria control programme
(NMCP) has the following major units: Case Management, Integrated Vector Management, Behavioral and
Communication for Change and Monitoring and Evaluation.
In Kenya, IVM policy guidelines (2009-2015) have been developed but there is no designated focal point
specifically for IVM16
. Implementation of IVM in Kenya and Ethiopia is at a very rudimentary stage and is
mainly practiced in research projects where ICIPE conducts community based IVM demonstration projects. It
is worth noting that the government of Ethiopia decided to stop using DDT for malaria control and replaced it
with pyrethroids based on the evidence of widespread insecticide resistance. In Eritrea, a combination of
malaria control methods between 2000 and 2004 resulted in a steep decline of malaria morbidity and mortality
trends17
. Although the combination of intervention methods was not strictly according to IVM principles, this
decline underscored the importance of combining various strategies and methods in vector borne disease
control. In Dar es Salaam Tanzania, a successful urban malaria control programme that included IVM elements
was implemented in the 1980‟s through the 1990‟s18, 19
.
Although several countries might be said to be implementing some elements of IVM, there are very few
countries implementing IVM in its comprehensive package that cover the five key elements and attributes of
IVM. Rather, they employ a few of the elements of IVM and target only a few of the vector borne diseases and
in particular malaria. Zambia seems to be the only country in Africa that has been reported as a showcase for
implementation of IVM20
. Zambia has successfully introduced consolidated and expanded IVM activities. A
recent report by Chanda et al 200821
describes a comprehensive and highly successful IVM approach that has
been implemented by the Zambian national malaria control programme (NMCP). This approach has expanded
coverage of vector control interventions and leveraged additional resources to build national capacity to the
point where they have successfully reduced malaria related morbidity and mortality. Some of the notable
achievements in Zambia are: designation and training of a national IVM focal point, conducting a
comprehensive vector control needs assessment, development of country specific IVM guidelines and
constituting a national IVM steering committee. In many respects, the successful implementation of IVM and
integrated malaria control in Zambia serves as a prominent success story for all of Africa22
.
4.1 New initiatives on IVM
As the global trend is towards malaria elimination and eventual eradication, disease prevention will become
more important and hence IVM will take the centre stage in future disease control. As such, it is very important
that these partners‟ efforts are coordinated to achieve maximum benefits to the countries in need of assistance.
9
In 2008, WHO was awarded about US $5 million by the Bill and Melinda Gates Foundation to implement a
project entitled “Malaria Vector Control: Filling the Gap between Product Development and Effective
delivery” The project aims to strengthen national capacities for an effective delivery of vector control
interventions in order to safeguard the efficacy of current tools and to ensure a smooth introduction of newly
developed tools into malaria control packages. This project is being implemented in seven African countries
(Mali, Cameroun, Senegal, Kenya, Madagascar, Tanzania and Mozambique). A draft on standard procedures
for surveillance of disease vectors within the context of integrated disease surveillance and integrated vector
management have been developed and piloted in these seven countries23
.
In May 2009, UNEP and WHO in partnership with the Global Environment Facility announced a rejuvenated
international effort to combat malaria with an incremental reduction of reliance on the synthetic pesticide,
DDT. Ten projects, all part of the global programme “Demonstrating and scaling-up of sustainable alternatives
to DDT in vector management”, involving some 40 countries in Africa, the Eastern Mediterranean and Central
Asia are set to pilot non-chemical methods ranging from eliminating potential mosquito breeding sites and
securing homes with mesh screens, to deploying mosquito-repellent trees and fish that eat mosquito larvae. The
IVM strategy promoted by the WHO provides the framework to include these measures in combinations of
interventions adapted to differing local circumstances. Projects are now going global with several new, five
year regional demonstrations of sustainable alternatives to DDT launched in Eritrea, Ethiopia and Madagascar
and a larger regional initiative with Djibouti, Egypt, Jordan, Morocco, the Islamic Republic of Iran, Sudan,
Syria and Yemen. Another project is focusing on Kenya, Tanzania and Uganda in order to develop a Decision
Making Tool for governments allowing them to evaluate health, social and environmental impacts and policy
tradeoffs.
A number of development partners have taken up the task of supporting IVM initiatives. These include, the
USAID Integrated Vector Management Project (IVM), implemented by Research Triangle International (RTI)
which has supported WHO initiatives on IVM on several occasions. These project aims at supporting efficient
and sustainable vector control interventions. The IVM Project compliments the U.S. President‟s Malaria
Initiative (PMI) which aims at assisting national malaria control programmes in targeted countries to reduce
malaria related deaths by 50%, through the use of proven and effective prevention and treatment tools. Another
organization is the Biovision Foundation of Switzerland that is funding several community based IVM projects
in different eco-zones in Kenya and Ethiopia to obtain evidence base for decision making in vector control.
Recently, the Global Alliance of the Stockholm Convention working closely with WHO and ICIPE piloted
capacity building in IVM through pilot testing of an IVM Core Curriculum that will be made available to
countries to support in-country strengthening of IVM implementation. The curriculum is based on the IVM
Handbook that is also being developed by WHO in partnership with RTI International. A Policy Guideline for
IVM is also being developed by the two partners.
4.2 Departments and Entities that are Involved in IVM
At country level, IVM is mainly spearheaded by the national malaria Control programmes that mainly, plan,
coordinates, monitors and evaluates activities. However, other stakeholders including government departments
both in the health and non health sectors, development partners (multilaterals and bilateral), civil society
organizations, research and academic institutions are supposedly required to take part in the planning and
decision making. In Zambia, for example, the entities involved from the health sector are: National Malaria
Control Centre (NMCC), Medical Stores Limited, Provincial Health Office and District Health Office. The
other ministries involved include, defense, environment, housing & local government and academic/scientific
institutions. The private sector includes, mining and agricultural companies, chemical companies, while the
NGOs include both social marketing and non-profit making organizations. The community members are
involved through the community health workers. The bilateral and multilateral partners include USAID, WHO,
RTI, IVCC, Global Fund. In Kenya, there are notable additions of departments and entities including Division
of Vector Borne and Neglected Tropical Diseases, Division of Environmental Health; Pest Control Products
Board; Other ministries (education, agriculture, water, tourism and livestock). In the bilateral and multilateral
list, UNEP and UNICEF are included.
At the regional and global level, the IVM approach has been embraced by WHO and the UNEP as well as by
other partners and countries. UNEP which administers the Secretariat for the Stockholm Convention on
Persistent Organic Pollutants (POPs) is developing IVM plans, programmes, and strategies in partnership with
WHO with the aim of reducing reliance on POPs in developing countries.
10
The Roll Back Malaria (RBM), a global partnership in WHO, development agencies, banks, the private sector
and NGOs, have placed renewed emphasis on malaria elimination. A central feature of RBM is the
strengthening of local capacities and local health systems to deal with malaria. Its Vector Control Working
Group is spearheading vector control strategies including IVM implementation.
The GEF, UNEP and the Global Alliance of the Stockholm Convention are keen to support countries to
develop and deploy alternatives to POPs. A menu of options for the best-practice design of dams and
agricultural irrigation projects to control vector breeding sites, while minimizing the disruption to ecosystem
services has been detailed in the joint WHO/FAO/UNEP/UNCHS Panel of Experts on Environmental
Management for Vector Control (PEEM) series. However, the extent to which these documents are utilized for
vector control is not clear and some efforts should be made to document this. Other players at the global and
regional levels include Global Fund to fight Aids, Tuberculosis and Malaria (GFATM), CropLife and USAID
through RTI International which is implementing IVM in some of the African PMI target countries.
4.3. A Data Base of Experts in IVM toward Developing a Resource Pool
Through a human resource and training facility survey recently conducted by the RTI International in16
African countries, it was observed that the information currently available on IVM in Africa is mainly inferred
from research projects on vector behaviour and population dynamics, or evaluation of single vector control
interventions in different ecological settings. It was noted that the objective of such projects is to generate
knowledge that may ultimately contribute to development of IVM, most notably for malaria vectors. However,
the projects are often short-lived and dwell on only a few aspects of IVM without clearly articulating how the
results can be incorporated into a programmatic framework of vector control strategy. And although there are
many entities involved in IVM related activities, there is a clear lack or inadequacy in IVM expertise. This is
because the people driving the IVM processes are not vector control experts but rather disease control
programme managers who in most cases are medical doctors with limited knowledge on vectors. There is
therefore a need to mainstream vector control departments/units to include entomologist/vector control
specialists. An attempt in this direction has been done by WHO, UNEP and ICIPE through training of decision
makers on IVM at the national level. ICIPE as Regional Centre that conducts research and training in tropical
disease vectors and agricultural pests has conducted several training workshops on integrated pest and vector
management. The Centre was in July 2010 nominated as a Regional Centre for the Stockholm Convention on
capacity building on alternatives to pesticides including DDT for disease control. A such, data base of trainees
from the African region is available within the Capacity building department where a list of senior level
disease control managers trained on IVM as trained as trainers of trainers (ToTs) is presented in Annex 1.
Thirteen of these participants were part of the pilot testing of the WHO IVM core curriculum that was
conducted for 7 AFRO countries in June 2010. A parallel pilot testing of the curriculum was conducted in
SEARO region where 25 senior level managers from 10 ACTMalaria member countries, 6 Pacific island
countries and 10 Philippines countries were trained on IVM in Oct 2010. In EMRO, 73 participants from 10
countries graduated in medical entomology in an effort to boost IVM capacity in the region. However, during
this survey, it was noted that other regions have conducted training did not provide names of trainees and as
such are not presented here.
5. Availability of IVM Related Information Exchange Mechanism
with a Strategy to Improve the System in Local, Regional and
Global Level
At the regional and global level, IVM related information sharing platforms include consultation meetings and
workshops and various task forces and working groups. WHO has organized several meetings for development
of guidelines and action plans that Members States endorse and adopt for implementation. The Conference of
the Parties of the Stockholm Convention on POPs is another biannual forum where information exchange on
IVM and alternatives to DDT is discussed. To facilitate this process, ICIPE was recently nominated as a
Regional Centre for technical assistance on IVM approach as alternative to DDT for malaria control in eastern
and southern African countries.
At the local/national level, vector control and different IVM related information is relayed through policy
documents and technical working groups. For instance, the National Malaria Strategic Plan (NMSP 2006–
2011) in Zambia, the National Malaria Strategy (NMS 2009-2017), the National Malaria Policy (2010) and the
IVM Policy Guidelines (2010) in Kenya and the Plan of Action for Integrated Vector Management (2006 –
11
2009) in Nigeria are well articulated documents on malaria control. Information on IVM is also exchanged
through training, e.g. workshops to build capacity for sustainable approaches to pest and vector management
that are periodically staged under the auspices of FAO, UNEP and WHO and regional IVM training workshops
held at ICIPE.
It is noted that information on IVM remains limited at the implementation level in many countries and success
stories on IVM implementation are not documented and almost non-existence except for a few countries such
as Zambia and Mexico highlighted above. Information on countries progress with IVM is generally with
disease control programmes in the form of reports, policy documents, annual operation plans that are not
readily accessible. Such information is difficult to get as it is rarely published in journals or posted to the
internet. The only information available is mainly from research articles in specific projects in restricted
geographical areas. Such information lacks the programmatic aspects of IVM implementation at and do not
reflected the scalability of research findings at national level.
The print media (journal articles, bulletins) serves as another method of sharing IVM related information. The
internet also has extensive IVM related information with WHO and USAID hosting sites for IVM resources.
The proposed IVM websites by the Global Alliance and RTI International will also improve the information
sources and flow on IVM. However, for the IVM implementers, it would be ideal to have a one-stop-shop
where all the IVM information is available. It is therefore suggested here that such websites be coordinated
and cross-linked to satisfy the IVM needs of decision makers.
6. Current Status of Guidelines and Decision Support Tools
Available for IVM at Regional and Global Level
Several guidelines and decision support tools for IVM have been and are still being developed (see item 12 for
list of guidelines). The Global Strategic Framework for Integrated Vector Management (2004)2 provides a
basis for strengthening vector control in a manner that is compatible with national health systems. It sets out
new and broad principles and approaches to vector control that is applicable to all vector borne diseases. This
Framework is intended to provide orientation to policy-makers within WHO and Member States on the
development and implementation of IVM, and to strengthen collaboration with donors and other United
Nations agencies, notably FAO and UNEP.
The draft Guidelines of Integrated Vector Management (2003) produced by WHO/AFRO, are intended to
help policy makers, vector control and environmental health workers (both at central and operational levels)
and all stakeholders in their effort to introduce IVM. These guidelines are generic and can be used to develop
country-specific IVM guidelines. The implementation of IVM strategy requires evaluation of technical and
capacity needs of implementing countries to identify barriers and gaps in order to improve vector control
programmes. In response to this IVM prerequisite, WHO/AFRO developed Guidelines for Vector Control
Needs Assessment (2003)11
that are intended to guide public health authorities to identify the technical, policy,
managerial and human needs for the effective implementation of vector control programmes. VCNA helps
countries to adequately identify the gaps in policy, strategies and resources for vector control. As a result of
conducting VCNA, Burkina Faso, Congo and Chad were able to form a new vector control unit while
Swaziland and Namibia realized they lacked policy on pesticide registration. VCNA helps countries to
adequately identify the gaps in policy, strategies and resources for vector control.
There are other decision support tools that are related to the implementation of IVM. For example, the
Decision Making Criteria and Procedures for Judicious Use of Insecticides (2003) published and updated
regularly by WHO/WHOPES. The purpose of these publications is to help ensure the safe and effective use of
insecticides in vector borne disease control. The choice of the methods to use should be preceded by decisions
on the composition of a selective approach to vector control that is specific in time and space and may or may
not require the application of insecticides.
For the global implementation of IVM, a Global Action Plan (2009–2011) for IVM has been drafted. The
action plan aims at transforming the IVM framework and policies into actual implementation including
partners‟ roles and responsibilities. Detailed activities and timelines for implementing each of the five key
elements of IVM are spelled out in this action plan. At a recent meeting of WHO and RTI held in Washington
DC in Oct 2010, an IVM Handbook, a Core training curriculum on IVM with training modules that target non-
professionals, public health officers and academics, and, an IVM policy guidelines were developed and will be
ready for circulation in 2011.
12
Other decision support tools under development include Malaria Decision Analysis Support Tool (MDAST)
being developed by a team of researchers from the Duke University, UK with African counterparts. The main
objective is to improve malaria control through an approach that integrates health delivery and decision-
support modeling, to promote joint optimization of vector control and disease management strategies. The
Vector Control Decision Support System (VCDS) being developed by WHO/AFRO aims at helping local
disease control managers plan and take decisions about future vector control operations.
Recent advances in geographical information and mapping technologies have created new opportunities for
public health administrators to enhance planning, analysis, monitoring and management of health systems. GIS
provides excellent means for visualizing and analyzing epidemiological data, revealing trends, dependencies
and inter-relationships. It can acquire, store, manage, and geographically integrate large amounts of
information from different sources, programmes and sectors24
. GIS serves as a common platform for
convergence of multi-disease surveillance activities. Following the events of the 2006/ 2007 outbreak of Rift
Valley fever in East Africa, decision-makers assembled their collective experiences in the form of a risk-based
decision support tool to help guide responses in future emergencies.
Using West Nile virus (WNV) as an example, Allen and Wong, (2006)25
demonstrated how geographic
information system and remote sensing, and spatial statistics, can be used for the surveillance and control of
disease vectors in general, and specifically mosquitoes. Data supporting the analyses consist of local field
surveillance data, population demographic data, and remote sensing data for habitat characterization and
environmental conditions affecting mosquito vector breeding. The results provide evidence that these
technologies, integrated in scientific methods, can provide valuable information to formulate risk management
policies and actions. ICIPE in collaboration with the Biovision Foundation, Switzerland and the Millenium
Institute, USA are developing a dynamic IVM model for decision makers in malaria control26
.
7. Challenges and Knowledge Gaps on IVM Implementation
Lack of policy on IVM
While vector control is indicated as a key strategic approach in the control and prevention of VBDs in most
countries, there is an absence of a well articulated overarching policy on vector control. Relevant policies are
fragmented and embedded across different programmes and agency mandates. Consequently, there is very little
cross-sector efforts and accountability among the major stakeholders whose actions or inactions contribute to
local disease burdens. Furthermore, the impact of environmental and agricultural policies on VBDs are not
adequately recognized within the health sector, thus opportunities to link vector control with environmental
and agricultural policies and practices are being missed.
Lack of efficient management system for vector control
The greatest hurdle to the promotion of IVM may not lie in any technical weaknesses, but rather in good
management. IVM requires the overhauling of vertical management structures that rely solely on one or few
methods of vector control. The lack of knowledge and experience of mainstreaming management issues in
IVM is a major challenge. Responsibilities must be allocated for various essential functions to the optimal level
in the overall system (e.g. national, provincial, district, community levels). In parallel, decision-making on
resources needed to finance operations must also be allocated to the optimal level. Also, a good understanding
of how health and environment objectives may be incorporated into good management design should be
addressed.
Inadequate convincing evidence on IVM
Perhaps the most important challenge is the cost-benefit analysis of IVM compared to other single
interventions. Many countries have not experienced the power of IVM implementation and there are few
examples of success stories. There is often a misconception that IVM is an integration of intervention tools.
This is either due to lack of national guidelines for universal overage and clear indicators of IVM
implementation or lack of convincing evidence by the ministries to adopt IVM. There is a need to design a
13
comprehensive cost-benefit analysis model for evaluating IVM against other vector control approaches and
showcase IVM if it has to be widely accepted through evidence-based decision making process.
Weak institutional arrangement for IVM implementation
The other challenge is in the implementation arrangements. Most of IVM programmes are initiated and
implemented by the national malaria control programmes and therefore tend to focus more on malaria, thus
compromising the „integrated‟ and intra- and inter- sectoral mechanisms for collaboration and coordination that
are components of a true IVM process. The malaria control programmes lay claim on ownership of vector
control activities even when other structures and entities exist. In Kenya for example, the IVM activities,
including the drafting of the IVM policy guidelines, were spearheaded by the Division of Malaria Control
despite the presence of a well established Division of Vector Borne and Neglected Tropical Diseases that has
satellite laboratories and staff well distributed in the country. This could be partly explained by the fact that
malaria is well funded compared to other vector borne diseases. There is therefore a need to re-vamp vector
control units/divisions in the ministries of health to take charge of IVM activities.
Ineffective interaction between researchers and programme implementers
The information on countries progress with vector control and IVM process is generally with the ministries in
form of reports, policy documents, annual operation plans that are not unavailable in the public domain. The
only information available is mainly from research articles in specific areas and taking into consideration that
there is minimal interaction or dialogue between researchers and programmatic implementers, such
information ends up in scientific journals and is not adopted by ministries for implementation in vector control
at national level.
Lack of structured career path for entomologists
There is lack of structured career path for public health officers and environmental officers and as such, low
motivation and high attrition rate of entomologists occurs in the ministries who, due to financial constraints are
not able to replace them through training.
Inadequate financial support for vector control
The lack of a comprehensive policy on vector control prevents appropriate placement and cross-sectoral
mobilization of resources for vector control within the Ministry of Health. With the exception of malaria, there
is virtually no vector control policy or effort linked to other vector-borne diseases. Compounded by the lack of
national capacity for entomological and eco-epidemiological evaluations of other VBD, it becomes difficult to
convince decision makers to allocate resources for VBD they consider less of a priority. In addition, although
there has been significant success at mobilizing external (donor) funding for malaria vector control, these funds
are however mandated for single interventions and does not provide flexibility for the national programme to
mix appropriate major and supplementary interventions towards IVM that will maximize impact.
8. Strategies for Strengthening the Plan of Action of the Global
Alliance Thematic Group on IVM
Support vector control needs assessment (VCNA)
A first step for national transitioning to IVM is to undertake a detailed review of the current framework and
status of vector control; to identify and understand the root causes of existing constraints to the achievement of
set goals, identify opportunities and requirements for addressing those constraints and recalibrating operations
to increase efficiencies and maximize sustainable reductions in disease burdens. Such information can be
obtained through conducting a Vector Control Needs Assessment (VCNA) whose objectives are to: a) review
policy framework and institutional arrangements for vector control b) review the burdens of vector-borne
diseases and the status of their control, including the planning, implementation and management of operations
and existing constraints, and c) identify opportunities for addressing identified constraints and facilitating
national transitioning to IVM, including processes to utilize the findings of this report for the development of a
national IVM strategy and work plans.
14
In this regard, it would be necessary to develop a questionnaire (see examples in Annex 2 and 3) for countries
and regions to review the current status of vector control and IVM implementation at country level and later
invite those that respond to a consultative meeting to develop consensus on country priority needs for IVM. A
meeting with national disease control managers to agree and establish national IVM focal points would be an
important step towards implementation and strengthening of the process. WHO and the Global Alliance can
convene such meetings with national programme managers and national IVM focal points towards assessment
of present status and needs for IVM implementation.
Documentation of success stories on IVM
While most countries have a misconception that IVM is a combination of a number of intervention tools, and
that IVM is another programme, there is need to clarify this by coming up with clear guidelines on coverage
and clear indicators of stages of IVM implementation so that a uniform reporting on the achievements can be
made. This can be partly achieved by documenting success stories of those countries that have seen the
importance and impact of IVM implementation through focused group meetings with case examples and
practical implementation by all stakeholders. WHO and GA should support the review and documentation of
success stories through web based instruments to showcase the power of IVM in vector borne disease control.
These partners should facilitate sharing and flow of information related to IVM, by developing and improving
on the advocacy materials to be disseminated to key stakeholders and uploading and linkage of information on
an interactive IVM website for countries to learn and be encouraged to also post their achievements. The
information should attempt to give clarity and simplicity on IVM interpretation for the lay persons and
decision makers.
Capacity strengthening on IVM
While there is urgent need to strengthen human, technical, financial and infrastructural capacities, actions
should be informed by a clear understanding of the functional roles and responsibilities of the various levels of
operations linked with the politico-administrative levels within a highly decentralized environment. There
should be deliberate efforts at building critical competencies and national capacities to, among others (i) clarify
on an ongoing basis, the eco-epidemiology and transmission of local VBDs, particularly malaria, (ii)
continually enhance the efficient targeting of a mix of interventions that delivers and sustain maximal
reductions of local disease burdens, and (iii) mainstream regulatory frameworks that safeguards human and
environmental health from potential negative impact of the use of public health insecticides.
Intra- and inter-sectoral collaboration
Advocacy for political commitment, resource mobilization, intra/intersectoral coordination and community
mobilization are essential for IVM. As such an appropriately mandated inter-agency coordinating committee
(ICC) or national inter-sectoral steering committee (NISC) for IVM is proposed to coordinate joint action,
enable informed review of relevant policies and strategies, orient national vector control goals/targets and
oversee implementation and stakeholder accountability. This committee should facilitate national review and
adoption of the VCNA, and oversee the development of a national IVM strategy and work plan. The countries
should be encouraged to establish and strengthen national units for IVM and allocate adequate financial and
human resources for capacity building. WHO and the GA should support capacity for and accessibility of
training on IVM related activities at regional level in collaboration with regional training and academic
institutions and selected universities. This should be expanded by seeking other donor support and
collaboration to enhance in-country capacity on IVM including policy development and resource mobilization
for vector control.
Develop tools and guidelines for M&E of the impact of IVM on VBDs
Although a number of documents exist on IVM, the WHO and GA should continue to support development of
decision support tools and guidelines for implementation of IVM at country level and indicators to assess the
implementation and impact of IVM for VBDs control.
15
9. Conclusion
A significant progress has been achieved since the WHO published a position paper on IVM in 2008. Although
several countries are implementing some elements of IVM, there are very few countries implementing IVM in
its comprehensive package that cover the five key elements and attributes. Rather, they employ a few of the
elements of IVM and target only a few of the vector borne diseases and in particular malaria. There is as such,
confusion between integrated vector control and integrated vector management.
For those countries with IVM implementation, they lack information on the evaluation of IVM as a whole and
have no basis to evaluate the incremental effect of a component of this strategy. Although WHO is in the
process of developing guidance tools for monitoring and evaluation of IVM implementation, there are very few
cases that show-case the power of IVM. The only country with documented impact is Mexico where they
showed reduction and stoppage of DDT by implementing IVM (Chanon et al 2003)13
and Zambia where they
enumerated the process of IVM implementation (Chanda et al 2008)21
. It is apparent that in most of the
countries that were reported to have undertaken some form of IVM implementation, it was evident that either
due to lack of government commitment or due to lack of funds, there has not been a follow up survey to assess
the implementation of IVM. It would be worthwhile to conduct a follow up study to find out the current status
of IVM implementation or the constraints and challenges of implementation in these countries. For instance, if
IVM policy has been established, what aspects of IVM are being pursued and for how long and what are the
short-term, medium term and long term goals of vector control programme. A number of challenges which are
by no means exhaustive and the way forward are listed below:
Challenges
1. Lack of policy guidelines on vector control and IVM in most countries;
2. Inadequate skilled personnel to take charge of IVM implementation;
3. Need for most countries to conduct vector control needs assessment;
4. Need to allocate sufficient budgets for vector control;
5. Need for intra and inter-sectoral collaboration on IVM;
6. Lack of indicators for implementation of IVM strategy.
Way Forward
1. Develop a questionnaire and conduct a regional and country level surveys on IVM Implementation;
2. Review and document success stories on IVM in partnership with stakeholders;
3. Organize meetings with national programme managers and national IVM focal points towards
assessment of present status and needs for IVM implementation;
4. Develop and improve advocacy materials and disseminate to key stakeholders;
5. Seek support and collaboration of key entities involved in IVM;
6. Improve capacity for and accessibility of training on IVM related disciplines at regional level in
collaboration with regional training and academic institutions;
7. Develop and maintain a reference IVM website with cross linkages to existing websites;
8. Develop guidance tools for assessment of IVM implementation at national level;
9. Seek donor support and collaboration to enhance in-country capacity on IVM including policy
development and vector control needs assessment.
To achieve universal coverage of IVM implementation, more commitments by governments and development
partners including WHO and GA need to address and support, policy development for vector control and IVM,
vector control needs assessment, capacity building, management and organization, funding and community
engagement at local level.
16
10. References
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headquarters, Geneva, Switzerland 1–4 May 2007. WHO/CDS/NTD/VEM/2007.
2. WHO (2004) Global strategic framework for integrated vector management. Geneva, World Health
Organization, 2004 (WHO/CDS/CPE/PVC/2004.10).
3. WHO (2009) Development of a global action plan for integrated vector management (IVM). Report of a
WHO Consultation. Geneva, Switzerland 1–3 December 2008 (WHO/HTM/NTD/VEM/2009.1)
4. WHO (2008) WHO position statement on integrated vector management. Geneva, World Health
Organization, (WHO/HTM/NTD/VEM/2008.2).
5. WHO (2009) Integrated Vector Management: First Working Group meeting reports on advocacy,
evidence based and capacity building. (WHO/HTM/NTD/VEM/2009.2)
6. WHO (2007) Global plan to combat neglected tropical diseases, 2008–2015. Geneva, World Health
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studies in Uganda, Zimbabwe, Cameroon and Senegal. WHO /AFRO and EHP report. January 2001.
9. WHO (2001) Workshop on a framework for the development and implementation of vector control
interventions in the African region, Harare, 6-9 February 2001.
10. WHO (2003) Guidelines for Integrated Vector Management. Harare, World Health Organization
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11. WHO (2003) Guidelines for Vector Control Needs Assessment. Harare, World Health Organization
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12. WHO (2010) Core training curriculum on Integrated Vector Management (Draft). Neglected Tropical
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13. Chanon, K.E., et al. (2003) Cooperative actions to achieve malaria control without the use of DDT.
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African Region: Progress Report 2000–2003. Washington DC: U.S. Agency for International
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15. Federal Ministry of Health of Nigeria (2005) Plan of Action for Integrated Vector Management for
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16. Republic of Kenya, Ministry of Health (2009). Integrated Vector Management Policy Guidelines For
Kenya.
17. Nyarango P.M., Gebremeskel T., Goitom Mebrahtu G., MufundaJ., Abdulmumini U., Ogbamariam A,
Kosia A., Gebremichael A., Gunawardena D., Ghebrat Y. and Okbaldet Y. (2006). A steep decline of
malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of
control methods. Malaria Journal, 2006, 5:33
18. Utzinger, J. et al. (2001) Efficacy and cost-effectiveness of environmental management for malaria
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17
19. De Castro, M et al. (2004). Integrated urban malaria control: a case study in Dar es Salaam, Tanzania.
American Journal of Tropical Medicine Hygiene, 71(2 suppl): 103-117.
20. Utzinger J. Tozan, Y., Doumani, F. Singer, BH. (2002). The economic payoffs of integrated malaria
control in the Zambian copper belt between 1930 and 1950. Tropical Medicine and International Health,
7(8):657–677.
21. Chanda E, Masaninga F, Coleman M, Sikaala C, Katebe C, Macdonald M, Baboo KS, Govere J, Manga
L: (2008). Integrated vector management: the Zambian experience. Malaria Journal, 7:164.
22. Beier, J., Keating, J., Githure, J., Macdonald, M., Impoinvil, D., Novak, R. (2008). Integrated vector
management for malaria control. Malaria Journal, 7: Suppl 1. S4.
23. WHO (2009) Standard procedures for surveillance of disease vectors within the context of integrated
disease surveillance and integrated vector management (draft report).
24. Decision-Support Tool for Prevention and Control of Rift Valley Fever Epizootics in the Greater Horn
of Africa (Decision support tool for prevention and control of RVF epizootics in the greater horn of
Africa, (2010). Consultative group for RVF decision support. American Journal of tropical Medicine
and Hygiene, 83, 75-85.
25. Thomas R. Allen and David W. Wong. (2006). Exploring GIS, spatial statistics and remote sensing for
risk assessment of vector-borne diseases: a West Nile virus example, International Journal of Risk
Assessment and Management 6, 253-275.
26. Matteo Pedercini, Eric O. Momanyi, Josephat Shililu, Charles M. Mbogo, John Githure. A decision-
making support tool for formulating effective integrated vector management strategies (Draft report).
18
11. Additional References cited in the Report
Integrated vector management:
1. Working group meeting reports, 2009.
http://whqlibdoc.who.int/hq/2009/WHO_HTM_NTD_VEM_2009.2_eng.pdf (2009) meetings
2. Strategic Framework for the Eastern Mediterranean Region 2004-2010.
http://www.emro.who.int/rbm/ivm2004.pdf).
3. A comprehensive response to vector borne diseases. 48th Directing Council. Washington D.C. 2008.
http://www.paho.org/English/GOV/CD/cd48-13-e.pdf,
Regional Integrated vector management:
4. WHO African region, Steps towards implementation, WHO 2004.
http://www.afro.who.int/vbc/framework-guidelines/ivm-steps-implementation.pdf
5. Regional framework for an integrated vector management strategy for South-east Asia region, WHO 2005.
http://www.searo.who.int/LinkFiles/Kala_azar_VBC-86.pdf
Malaria:
6. Progress Report, 142nd Session of the Executive Committee. Washington D.C. 2008.
http://www.paho.org/English/GOV/CE/ce142-16-e.pdf
7. Malaria control, the power of integrated action, WHO/UNEP 2010.
http://www.who.int/heli/risks/vectors/malariacontrol/en/index6.html
8. Case study, Mexico (Malaria) - Fighting malaria without DDT. IDRC publication.
http://web.idrc.ca/ev_en.php?ID=29136_201&ID2=DO_TOPIC
9. Action plan for the reduction of reliance on DDT in disease vector control. WHO 2001.
http://whqlibdoc.who.int/hq/2001/WHO_SDE_WSH_01.5.pdf
19
12. List of IVM Guidelines and Tools
10. Guidelines for integrated vector management, Harare, WHO Regional Office for Africa 2003.
http://www.afro.who.int/vbc/framework
11. Guidelines for vector control needs assessment, Harare, WHO Regional Office for Africa 2003.
http://www.afro.who.int/vbc/framework
12. Guidelines for diagnosis, treatment, prevention and control of Dengue, WHO 2009.
http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf
13. Guidelines for integrated vector management for control of dengue/dengue hemorrhagic fever in India.
http://nvbdcp.gov.in/Doc/dengue_1_.%20Director_Desk%20DGHS%20meeting%20OCT%2006.pdf
14. Integrated vector management programs for malaria vector control, Programmatic Environmental
Assessment, USAID January 2007.
http://www.ehproject.org/PDF/ehkm/ivm-env_assessment.pdf
15. Van den Berg, H. and Takken, W. (2007) A framework for decision-making in integrated vector
management to prevent disease. Tropical Medicine &International Health 12, 1230-1238.
16. Van den Berg, H. and Takken, W. (2009) Evaluation of integrated vector management. Trends in
Parasitology 25, 71-76.
17. Handbook on integrated vector management, WHO 2010 (Draft)
18. Core Curriculum on integrated vector management, WHO 2010 (Draft)
19. Policy Guidelines for Integrated vector management, WHO 2010 (Draft)
20
Annex 1to the Report developed by the Secretariat on the review of the
current status of implementation of integrated vector management
Participants at the IVM training workshops held at ICIPE, Nairobi, Kenya, 2002-2010
Name Institution Country Email Addresses
1 Gotulweng K.
Katholo
Ministry of Local
Government Botswana [email protected]
2 David M.
Dekoker Mr Ghanzi District Council Botswana
3 Dieudonne P.
Sankara Dr Ministry of Health
Burkina
Faso
4 Thierry
Quedraogo Dr
Programme National de
Lutte contre le Paludissme
Burkina
Faso [email protected]
5 Solomon
Patchoke Mr Ministry of Public Health Cameroon [email protected]
6 Peka Mallaye Mr Ministere de lajante Chad [email protected]
7 Patrick Bitsindou Dr DGRST B.P Congo [email protected]
8 Mansinsa D.
Philemon Mr
National Program of
Human Trypanosomiasis Congo [email protected]
9 Ngoran Koffi Mr INHP Abidjan Cote
d'Ivoire [email protected]
10 Germaine C.
Metannou Ms CREC DRC [email protected]
11 Zawadi Bifuko Ms National Program of
Onchocerciasis of DRC DRC [email protected]
12 Mesfin Haile
Assfaw Mr Federal Ministry of Health Ethiopia [email protected]
13 Abdrie Seid
Hassen Mr
Environmental Protection
Authority Ethiopia [email protected]
14 Sheleme Chibsa Mr Ministry of Health Ethiopia [email protected]
15 Teshome Gebre-
Michael Dr Addis Ababa University Ethiopia [email protected]
16 Fekede Balcha Mr Institute of Pathobiology Ethiopia [email protected]
17 Amadou Wurie
Jallow Mr Ministry of Health Gambia [email protected]
18 Paul Kiptoo Mr Division of Malaria
Control Kenya [email protected]
19 Mercy Ingosi Ms Pest Control Products
Board Kenya [email protected]
20 Dunstan Mukoko Mr Ministry of Health Kenya [email protected]
21 Eric Muchiri Dr Ministry of Health Kenya [email protected]
22 Joseph Njagi
Kiambo Mr Ministry of Health Kenya [email protected]
23 Samuel Muiruri Mr Ministry of Health
(DVBD) Kenya [email protected]
24 Philip Kangethe Mr Ministry of Health
(DVBD) Kenya [email protected]
25 Emmanuel M.
Rakotontaibe Mr Ministry of Health
Madagasca
r
26 Juwo Juwish
Sibale Mr
Ministry of Energy, Mines
and Environment Malawi [email protected]
27 Shadreck Mr Nkhotakota District Malawi [email protected]
21
Name Institution Country Email Addresses
Mulenga Hospital
28 Lutho Innocent
Zungu Mr
Ministry of Health
(CHSU) Malawi [email protected]
29 Alwin Mbene Mr Ministry of Health, Mzuzu
central hospital Malawi [email protected]
30 Doreen Ali Mrs Ministry of Health
(NMCP) Malawi [email protected]
31 John
Chiphwanya Mr
Ministry of Health,
community health science
unit
Malawi [email protected]
k
31 Iita Erastus
Amukushu Mr Ohanngwina Region Namibia
33 Choma N.
Amajoh Mrs Federal Ministry of Health Nigeria [email protected]
34 Ordu Donald Mr Federal Ministry of Health Nigeria [email protected]
35 Emmanuel
Hakizimana Mr NMCP Rwanda [email protected]
36 Eliezer N.
Rusakana Mr
Rwanda Environment
Management Authority
(REMA)
Rwanda [email protected]
37 Diouf Mame
Birame Dr Ministry of Health Senegal [email protected]
38 Sarr Moussa
Dieng Mr Ministry of Health Senegal [email protected]
39 Mogale John
Khutamo Mr Malaria Centre
South
Africa
40 Charles Swai Mr Vice President's Office-
Div. Of Environment Tanzania [email protected]
41 Jubilate Minja Ms MOHSW-Preventive
department Tanzania [email protected]
42 Winfred J.
Mwafongo Mr
National Malaria Control
Centre Tanzania [email protected]
43 Charles Dismas
Mwalimu Mr Ministry of Health (HQ) Tanzania [email protected]
44 Tom
Byembabazi Mr Ministry of Health Uganda [email protected]
45 Tom Lakwo Mr Ministry of Health Uganda [email protected]
46 Michael Eluga
Okia Mr Ministry of Health Uganda [email protected]
47 Joseph Okello-
Onen Dr
Livestock Health Research
Institute Uganda [email protected]
48 Maxwell
Mwewankoya Mr
Environmental Council of
Zambia Zambia [email protected]
49 Chadwick H
Sikaala Mr
National Malaria Control
Centre Zambia [email protected]
50 Wambinji
Kapelwa Dr
National Malaria Control
Centre Zambia [email protected]
51 Paul Banda Mr National Malaria Control
Centre Zambia [email protected]
52 Chadwick
Sikaala Mr
National Malaria Control
Centre Zambia [email protected]
53 Emmanuel
Chanda Mr
National Malaria Control
Centre Zambia [email protected]
54 Macdonald
Kadzatsa Mr Ministry of Health Zimbabwe [email protected]
22
Name Institution Country Email Addresses
55 Moses Chimbari Dr University Lake Kariba
Research Station Zimbabwe [email protected]
56 Elijah Chirebvu Dr Ministry of Health &
Child Welfare Zimbabwe [email protected]
23
Annex II to the Report developed by the Secretariat on the review of
the current status of implementation of integrated vector
management
Questionnaire Example at Country Level
A country profile on vector control and status of integrated vector management (IVM) Name of respondent: ____________________ Designation: ________________________
Institution: ____________________________ Country: __________________________
1. Main vector borne diseases in your country (tick)
2. Name(s) of Institution/Ministry involved in vector control
_________________________________________________________________
3. Presence of vector control Unit/Department in your country
4. Availability of vector control policy
5. Availability of IVM policy guidelines
6. Availability of IVM focal point
7. Future plans to implement IVM in your country
8. If yes in 7 above, tick one key element of IVM which is a priority in your country
Integrated approach
Evidence based decision making
9. List the Key challenges/constraints your country faces in IVM implementation
_________________________________________________________________
10. Describe briefly how these challenges can be tackled
_________________________________________________________________
24
Annex III to the Report developed by the Secretariat on the review of the
current status of implementation of integrated vector management
Questionnaire Example at Regional Level
WHO Regional Offices
Country Have conducted VCNA Have IVM policy Are implementing IVM