A new study by Economic Policy Research Centre (EPRC) has indicated that Indoor Residual Spraying (IRS), one of the malaria control methods has attracted increased interest and commitment from political leadership.

Titled “Financing Indoor Residual Spraying for Malaria Prevention in Uganda: Options for cost minimization”, the report analyses financial resources government requires for countrywide Indoor Residual Spraying for malaria prevention. It alludes government plans to roll out IRS to all malaria endemic districts, by 2020.
However, progress has been slow towards scaling up IRS beyond a few highly endemic districts, Tonny Odokonyero one of the authors of the study said during a seminar held on February 6, 2019 at the School of Public Health - Makerere University.

The major reason for failure to scale up is the perceived high costs of implementing universal IRS program versus other vector control methods such as Long Lasting Insecticide Treated Nets (LLINs).

Odokonyero observes that there has been no empirical evidence to provide insights on actual cost implication of a country-wide and phased roll-out of IRS based on alternative approaches of implementation, for example the integrated district led versus project led approaches of IRS implementation.

The study was conducted under the Supporting Policy Engagement for Evidence Based Decisions (SPEED) for Universal Health Coverage initiative.
According to evidence from the study, implementing IRS using the integrated district-led model of implementation is a cheaper strategy for the government to employ in the fight against malaria.

IRC costs Feb 26 Mps

The evidence reveals that; the integrated district-led IRS model is less costly than project-led approach by more than five times, IRS is cheaper than malaria case management and annual IRS costs are comparable to that of LLINs, yet IRS is the most effective strategy for malaria prevention.

Within the integrated district-led IRS model, the study further identifies IRS cost minimization (reduction) strategies. Depending on the cost reduction strategy implemented, the study reveals that the strategies are capable of reducing IRS implementation costs by 42% - 76%.

The study also analyzes cost implications of implementing IRS in a phased manner. In addition to the engagements had so far, the authors expect to carry out more stakeholder and policy engagement – especially with policy makers, to discuss how recommendations from the study can be actionable.
It urges government to utilize existing District Local Government and community-based structures, consider fiscal incentives for undertaking domestic insecticide production and use of idle youth in IRS programme implementation to reduce costs.

A dialogue held at Imperial Royale in February 26, 2019 to gather stakeholder views on IRS attracted mixed reactions with some participants saying that local insecticide production may be difficult due to huge costs involved. Some feel that politicization of IRS as it was in the past could still affect the renewed efforts.

In 2017 the World Health Organization reported that Uganda is 2nd largest contributor of total estimated malaria cases in East and Southern Africa.
According to 2015 Ministry of Health reports, malaria in Uganda accounts for;
30% – 50% of OPD visits
15% - 20% of hospital admissions
20% of hospital deaths

Additional information by authors Tonny Odokonyero (Research Analyst – EPRC) and Gemma Ahaibwe (Research Fellow – EPRC)

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