Financing Indoor Residual Spraying for Malaria Prevention in Uganda: Options for Cost Minimization

Uganda is the second largest contributor of total malaria cases in East and Southern Africa. Domestically, the burden of malaria is enormous and persistent (high morbidity, mortality, and economic loss). Among other strategies, the government has proposed large-scale Indoor Residual Spraying (IRS) intervention as a major component of current malaria control efforts, and recently, the political leadership voiced solidarity towards fighting malaria through the “Mass Action Against Malaria” campaign. This paper was motivated by the paucity of evidence on requisite financial resources to fund country-wide and phased IRS implementation. Additionally, given that the economy is highly resource constrained and is faced with innumerable competing development priorities and needs, it is imperative to explore low-cost options for IRS implementation. Therefore, this paper was aimed at analysing the costs of the country-wide roll out of IRS under different IRS delivery models, the cost implications of implementing IRS in a phased manner, and identifying cost-minimization strategies. We used the latest Uganda National Household Survey, market price data, and data from IRS pilot districts.

The results show that 235 billion shillings (approximately 63.5 million US$) is required to finance country-wide implementation of IRS using an Integrated District-Led (IDL) approach. The overall cost per structure and average cost per person protected are 28,000 shillings (8 US$) and 6,000 shillings (2 US$), respectively. The largest cost driver for an IRS programme is the insecticide, which accounts for about 66% -81% of the total cost depending on the mechanism of implementation. If IRS is implemented in a phased manner, starting with the most burdened eight sub-regions, a total financing of approximately 106.7 billion shillings (29 million US$) is required. The integrated district-led approach is associated with the least cost—it is about six times cheaper than the project-led approach. The estimated annual cost of implementing LLINs is comparable to the IRS cost; however, IRS is the optimal option. IRS is also cheaper than malaria case management; the annual cost of case management more than doubles that of IRS.

Accordingly, our findings suggest that more emphasis or investments in malaria prevention using IRS is a less costly venture for the government to undertake and presents cost-saving opportunities in the fight against malaria; hence, it is a seemingly more sustainable measure. The government should utilize existing District Local Government and community-based structures, as well as spray logistics in IRS pilot districts, to minimize the cost of IRS implementation. Some of the specific IRS low-cost strategies for policy consideration include the following: using existing spray logistics on a rotational basis; using locally available human resources as SOPs; incorporating IRS Behavioural Change Communication (BCC) into the immunization BCC; using subsidies or fiscal incentives to manufacture insecticides domestically; sourcing insecticides at competitive rates; financing IRS domestically; and using a private-sector model of service delivery combined with a public health approach.