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

1

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.

3

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.

6

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.

8

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

1. WHO (2007) Report of the WHO consultation on integrated vector management (IVM) WHO

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

Organization, 2007 (WHO/CDS/NTD/2007.3).

7. Hotez, P. J. Jan H.F. Buss R.P, Alleyne G., Morel C, Breman J. G. (2004) Combating Tropical

Infectious Diseases: Report of the Disease Control Priorities in Developing Countries Project. Clinical

Infectious Diseases 38:6, 871-878.

8. Githure, J. and Toure, Y. Strengthening vector control programmes in Africa: A summary of case

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

Regional Office for Africa.

11. WHO (2003) Guidelines for Vector Control Needs Assessment. Harare, World Health Organization

Regional Office for Africa.

12. WHO (2010) Core training curriculum on Integrated Vector Management (Draft). Neglected Tropical

Diseases Department, World Health Organization, Geneva.

13. Chanon, K.E., et al. (2003) Cooperative actions to achieve malaria control without the use of DDT.

International Journal of Hygiene and Environmental Health 206, 387-394.

14. Manga L., Toure A., Shililu J. (2004) Implementation of Integrated Vector Management in the WHO-

African Region: Progress Report 2000–2003. Washington DC: U.S. Agency for International

Development; 2004.

15. Federal Ministry of Health of Nigeria (2005) Plan of Action for Integrated Vector Management for

Nigeria (2006 – 2009).

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

control. Tropical Medicine and International Health .6, 677–687.

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 Gotulwengke@yahoo.co.uk

2 David M.

Dekoker Mr Ghanzi District Council Botswana

3 Dieudonne P.

Sankara Dr Ministry of Health

Burkina

Faso

Sankdieup@hotmail.com

pneug_bf@cenatrin.bf

4 Thierry

Quedraogo Dr

Programme National de

Lutte contre le Paludissme

Burkina

Faso prgpalu@fasonet.bf

5 Solomon

Patchoke Mr Ministry of Public Health Cameroon Patchoua2000@yahoo.fr

6 Peka Mallaye Mr Ministere de lajante Chad peka_mallaye@yahoo.fr

7 Patrick Bitsindou Dr DGRST B.P Congo pbitsindou@yahoo.fr

8 Mansinsa D.

Philemon Mr

National Program of

Human Trypanosomiasis Congo diabakana@yahoo.fr

9 Ngoran Koffi Mr INHP Abidjan Cote

d'Ivoire ngorakofi@yahoo.fr

10 Germaine C.

Metannou Ms CREC DRC metonnouc@yahoo.fr

11 Zawadi Bifuko Ms National Program of

Onchocerciasis of DRC DRC Ontobifuko@yahoo.fr

12 Mesfin Haile

Assfaw Mr Federal Ministry of Health Ethiopia mesbase@yahoo.com

13 Abdrie Seid

Hassen Mr

Environmental Protection

Authority Ethiopia esid@ethionet.et

14 Sheleme Chibsa Mr Ministry of Health Ethiopia ohbmcd@telecom.net.et

15 Teshome Gebre-

Michael Dr Addis Ababa University Ethiopia teshomegm@yahoo.com

16 Fekede Balcha Mr Institute of Pathobiology Ethiopia f_balcha@yahoo.com

17 Amadou Wurie

Jallow Mr Ministry of Health Gambia awjallow@yahoo.com

18 Paul Kiptoo Mr Division of Malaria

Control Kenya pkiptoo@domckenya.or.ke

19 Mercy Ingosi Ms Pest Control Products

Board Kenya mercyibner@gmail.com

20 Dunstan Mukoko Mr Ministry of Health Kenya scfisto@africaonline.co.ke

21 Eric Muchiri Dr Ministry of Health Kenya dvbd@wananchi.com

22 Joseph Njagi

Kiambo Mr Ministry of Health Kenya schisto@africaonline.co.ke

23 Samuel Muiruri Mr Ministry of Health

(DVBD) Kenya dvbd@wananchi.com

24 Philip Kangethe Mr Ministry of Health

(DVBD) Kenya dvbd@wananchi.com

25 Emmanuel M.

Rakotontaibe Mr Ministry of Health

Madagasca

r

ramanuel@iris.mg

maroafyemmanuel@yaho..fr

26 Juwo Juwish

Sibale Mr

Ministry of Energy, Mines

and Environment Malawi jjsibale@yahoo.co.uk

27 Shadreck Mr Nkhotakota District Malawi shadmulenga@yahoo.com

21

Name Institution Country Email Addresses

Mulenga Hospital

28 Lutho Innocent

Zungu Mr

Ministry of Health

(CHSU) Malawi luthoz@yahoo.co.uk

29 Alwin Mbene Mr Ministry of Health, Mzuzu

central hospital Malawi alwinmbene@yahoo.co.uk

30 Doreen Ali Mrs Ministry of Health

(NMCP) Malawi alidoreen@yahoo.com

31 John

Chiphwanya Mr

Ministry of Health,

community health science

unit

Malawi johnchiphwanya@yahoo.co.u

k

31 Iita Erastus

Amukushu Mr Ohanngwina Region Namibia

33 Choma N.

Amajoh Mrs Federal Ministry of Health Nigeria diabakana@yahoo.fr

34 Ordu Donald Mr Federal Ministry of Health Nigeria donordu@hotmail.com

35 Emmanuel

Hakizimana Mr NMCP Rwanda ehakizimana@gmail..com

36 Eliezer N.

Rusakana Mr

Rwanda Environment

Management Authority

(REMA)

Rwanda rusakanael@yahoo.fr

37 Diouf Mame

Birame Dr Ministry of Health Senegal Bibi_7@hotmail.com

38 Sarr Moussa

Dieng Mr Ministry of Health Senegal mdiennsarr@yahoo.fr

39 Mogale John

Khutamo Mr Malaria Centre

South

Africa

40 Charles Swai Mr Vice President's Office-

Div. Of Environment Tanzania charlesswai@yahoo.com

41 Jubilate Minja Ms MOHSW-Preventive

department Tanzania jubbybm@yahoo.com

42 Winfred J.

Mwafongo Mr

National Malaria Control

Centre Tanzania nmcp@twiga.com

43 Charles Dismas

Mwalimu Mr Ministry of Health (HQ) Tanzania dismasi@yahoo.com

44 Tom

Byembabazi Mr Ministry of Health Uganda bye3149@yahoo.com

45 Tom Lakwo Mr Ministry of Health Uganda Notf@imul.com

lakwo2001@yahoo.com

46 Michael Eluga

Okia Mr Ministry of Health Uganda meokia2000@yahoo.com

47 Joseph Okello-

Onen Dr

Livestock Health Research

Institute Uganda jonen65@hotmail.com

48 Maxwell

Mwewankoya Mr

Environmental Council of

Zambia Zambia maxnkoya@yahoo.com

49 Chadwick H

Sikaala Mr

National Malaria Control

Centre Zambia chsikaala@yahoo.co.uk

50 Wambinji

Kapelwa Dr

National Malaria Control

Centre Zambia wkapelwa@nmcc.org.zm

51 Paul Banda Mr National Malaria Control

Centre Zambia paul.banda@kcm.co.zm

52 Chadwick

Sikaala Mr

National Malaria Control

Centre Zambia chsikaala@nmcc.org.zm

53 Emmanuel

Chanda Mr

National Malaria Control

Centre Zambia Echanda@nmcc.org.zm

54 Macdonald

Kadzatsa Mr Ministry of Health Zimbabwe mkadzatsa@healthnet.zw

22

Name Institution Country Email Addresses

55 Moses Chimbari Dr University Lake Kariba

Research Station Zimbabwe ulkrs@telco.co.zw

56 Elijah Chirebvu Dr Ministry of Health &

Child Welfare Zimbabwe ulkrs@telco.co.zw

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