IRS

What happened to the IRS campaign in the fight against malaria?

BY GEORGE KAGAME

The Indoor Residual Spray campaign launched late last year as a very effective measure in controlling malaria in Rwanda was stopped on 14th February this year by the Ministry of Health. RTI Rwanda who were charged with the spraying cried foul at the intentions of the National Malaria Control Programme. GEORGE Kagame finds out what happened.


The highly publicized national indoor residual spray campaign which was launched last year in August has been described as a successful initiative among a handful that Rwanda has adopted in her drive to reduce malaria related health problems in the country.

Speaking to The New Times, Professor Michael Kramer, the director General of TRAC Plus said; “we are on top of fighting Malaria in Africa, we are model country in regard to reducing the threat of malaria to the population.”

With funding from US President George Bush Presidential Malaria Initiative; Rwanda has adopted several techniques to reduce to reduce malaria which is the leading cause of death in Rwanda. These techniques include, rolling out of insect treated mosquito nets, provision of water purifying tablets and this week will see the official launching of Coartem drugs in the private sector.

With a budget of over 100 million US dollars according to Dr Corine Karema the director general of the National Malaria Control Programme, the fight against malaria in Rwanda has been largely successful and is considered a model to other countries upstaged by the leading public health problem in developing countries malaria.
Health officials state that Malaria is the leading cause of death and illness in Rwanda.

The latest attack technique against malaria was launched last year in August. With the launching of the Indoor Residual Spraying, all the homes in the country were to be sprayed, with ICON an insecticide manufactured in the US to be sprayed on all the interior halls.

The project was highly successful when it was started in Kigali, where 159000 homes were sprayed i\with ICON, however on 14th Feb 2008, IRS was halted by the Ministry of Health and the National Malaria Control Programme.

By December 2008, the IRS campaign which was started in Kigali had posted good results, spraying implementers, donors and policymakers agreed.

Malaria related complications Professor Michael Kramer the director of TRAC PLUS says; “what was thought to be impossible in the fight against Malaria 20 or even 5 years ago has been successfully implemented in Rwanda, but by 2007, the use of health centres for malaria related illnesses had reduced in the country.” Kramer further states that at CHUK, there are no more malaria complicated cases and that in the whole country; “the distribution of mosquito bed nets and our change of malaria treatment cases has reduced ,malaria case n the country by 60 percent and its related deaths by 64 percent. This is a significant success considering that malaria was leading the cause of death in Rwanda before, currently it’s the fourth.”



However on 14th February 2008, IRS campaign was suspended by the Ministry of Health citing lack of enough preparations by all stakeholders involved in controlling malaria in the country.
RTI Rwanda the US based experts charged with implementing the task of spraying inside residential houses across the country have since taken offence at the decision to suspend the exercise. They accuse the National Malaria Control (PNILP) office for sabotaging the exercise; Dr Corine Karema the director General of PNILP says the allegations are “unprofessional and absurd”.

Kramer adds that the fight against malaria in Rwanda had registered a lot of success in a very short time and therefore we needed to reflect on our various approaches. He says the postponement of IRS was because of the need; “to address issues that developed during the first phase of the campaign, we needed to increase community sensitization, use of ICT, and train more sprayers because we were are also lacking in capacity.”


RTI officials cited that PNLIP was jealous because IRS funding was not channeled through the national malaria office; they say “the national malaria control office which is managed by the Ministry of Health did not cooperate with us (RTI), because they did not manage the money.”

Karema dismissed such allegations as baseless, she said, “RTI manages only 5US million dollars, PNILP manages 100 US million dollars, and we have partners that manage larger budgets that RTI. We cannot be jealous with RTI because of money.” She added that other malaria control organisations like Twubakane have a budget of 20 million US dollars, “all we require of our partners is to their activities aligned to our strategic plan. And besides most of that RTI money is going to the communities we cannot sabotage the funds that are in the interest of ministry of health,” Karema added.

For long malaria and is related infections have been responsible for 60 percent of deaths in the country. Development experts have stated that bottleneck to efforts in reducing poverty in the Sub Saharan African region. Today, Rwanda is the model country among developing nations that the cost of malaria can be reduced and eliminated with good approach.

Kramer said Rwanda is performing very well in fighting malaria; “we are on top of Africa in controlling malaria, we also a model country by WHO in fighting the disease. You cannot achieve that with cases sabotage in your team. I don’t have a word for such allegations.”

Kramer confirms the effectiveness of IRS, he says that the insecticide used to spray inside the homes which is branded as ICON by its American manufacturers@@@@ was tested by the World Heal Organisation and the government of Rwanda to be the best one available in fighting malaria spreading mosquitoes. Kramer adds; “this is an effective measure but we don’t want to start the program when we are not sure of its long term implications, we needed a concrete plan before spraying continued.”


A reliable source within RTI says they had trained enough Rwandans to take on the job but they were stopped from using their sprayers by PNLIP’s Karema. The source adds that the campaign was stopped abruptly even when RTI had invested a lot of money and time in preparations for the second phase; ‘we had our officials stuck in hotels for none days because Karema would not meet them to discuss why IRS was stopped,” he adds.


However the RTI officials have not been idol since the suspension of the exercise, the source says that they have been outsourced by their international office to teach other African countries how to carry on the exercise, “our managers have been taken to teach IRS spraying teams in Ghana, Mali, and Benin where RTI is also contracted to carry out spraying.

Professor Michael Kramer the director of TRAC PLUS said such allegations are an embarrassment to stakeholders involved the malaria control programme, “IRS is a large undertaking that needs a lot of logistics. The first round was quite successful but we had problems with the implementation of the second phase and we have informed our partners.”

The first round which saw 159000 homes sprayed in Kigali alone was labeled highly successful by PNILP but the second round of the IRS was postponed on 14th February 2008 a day before RTI had organized to resume spraying in Kirehe.
This was about the same time that the Rwandan rainy seasons began which would technically present problems to spraying teams and the efficiency of the spray.

Kramer says there were problems with RTI’s implementation teams; “we suggested some recommendations to the implementers of the campaign, I don’t know why they did not to what we proposed and this was about the same time that the El Niño seasons began. This was jointly agreed between us our partners including USAID.”
Kramer said a senior USAID official had recently been in Rwanda about “their concern with our decision to suspend the IRS and he agreed with our suggestions.”

The United States International Development Agency-USAID is financier of IRS and the project is part of the US president George Bush Presidential Malaria Initiative.

With the launching of PMI President Bush challenged the world to reduce the burden of malaria dramatically as a major killer of children in sub-Saharan Africa, and pledged to increase funding of malaria prevention and treatment by more than $1.2 billion over five years. The goal of this effort is reduce malaria deaths by 50 percent in each of the target countries after three years of full implementation.

USAID currently provides bilateral assistance for malaria control to Angola, Benin, Burundi, Democratic Republic of Congo, Eritrea, Ethiopia, Ghana, Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Nigeria, Rwanda, Senegal, Sudan, Tanzania, Uganda, and Zambia.



A total of 1.3, million Rwandans were expected to have been protected from malaria through the indoor residual spray program by end of 2008.
RTI is a US based sub contractor that has been offered the job of handling the technical issues related with spraying the insecticide in all the benefiting countries.
Spray operators use ICON, inside the walls and it remains effective for three to six months after it is applied. In 2007, the U.S. Government contributed US$4.6 million to IRS efforts in Rwanda.

Karema said arrangements were underway to have IRS spraying resuming in June; “we hope to resume spraying in June but we are not unilateral in these decisions, if all our partners in malaria control are ready the spraying will go ahead in Kirehe.”

On side effects of ICON insecticide; Karema; “this insecticide comes from the family of pyrethrums and it is recommended by WHO, it has the lowest recorded side effects and they are minor. They include, skin irritation if the body is close contact with the drug. It is also efficient for use in boarding schools, military barracks, and prisons and inside homes, because one spray benefits many people at a once.”