GH EnviroLinks (GH): Melissa and Sheleme, thanks so much for chatting with us. Could you introduce yourselves to our readers?
Melissa Yoshimizu (MY): My name is Melissa Yoshimizu. I am an Entomologist and Malaria Technical Advisor on the Vector Monitoring & Control Team (VMCT) and have been with PMI/USAID Washington since January 2020. I serve as PMI’s Activity Manager for the Environmental Compliance Support (ECOS) contract, which many PMI country programs buy into for external environmental compliance assessment. I also serve as environmental compliance point of contact for the PMI interagency (CDC and USAID) Vector Control Team.
Sheleme Chibsa (SC): My name is Sheleme Chibsa. I have been a Senior Malaria Advisor to USAID’s President’s Malaria Initiative (PMI) in Ethiopia since November 2009, and I also serve as the PMI Lead for Ethiopia’s vector control activities.
GH: What is something that you would like everyone to know about the U.S. President’s Malaria Initiative (PMI)?
MY: PMI was launched in 2005 with the goal of reducing and ultimately eliminating malaria-related mortality across high-burden sub-Saharan Africa. PMI started in three African countries and now has programs in 24 sub-Saharan Africa countries, in addition to three programs in the Greater Mekong Subregion in Asia. PMI partner countries collectively have driven a 30% decline in malaria case rates and a 61% decline in malaria deaths. The contributions of PMI, together with other donors and partners, have led to dramatic improvements in the coverage of malaria control interventions.
Many of the prevention interventions – including our vector control campaign programs - have largely continued during the COVID-19 pandemic, with adaptations to ensure protection of healthcare workers and communities from the spread of the virus. Embracing these successes, the reality is that COVID-19 has disrupted malaria service delivery. Examples include sick healthcare workers not being able to provide care to malaria patients, and global container shortages impacting shipping prices and timelines for malaria commodities delivery. While the scale of disruptions is not yet well quantified, PMI Headquarters (HQ) and in-country teams share the concern about losing gains because of COVID-19’s “knock on” effects. This underscores the need to prioritize continuity of malaria service delivery as an integral component of the COVID-19 pandemic response.
SC: Since becoming one of PMI’s focus countries in 2007, Ethiopia has supported the implementation of a national malaria strategic plan. Over 70 million Ethiopians are at risk of malaria infection. Malaria transmission is seasonal and varies yearly and geographically. Two main malaria species, Plasmodium falciparum and P.vivax, are present in Ethiopia, which necessitates a confirmatory diagnosis for treatment and conducting campaigns. Adapting to the varying malaria epidemiology and the country’s specific needs, PMI Ethiopia has been collaborating with the National Malaria Elimination Program (NMEP), and various stakeholders and partners to reduce malaria mortality and morbidity rates in Ethiopia. PMI Ethiopia focuses on critical effective, and impactful interventions, including: 1) Proper use of insecticide-treated bed nets (ITNS); 2) Implementation of targeted Indoor Residual Spraying (IRS); 3) Diagnosis and treatment of malaria with effective drugs; 4) Malaria surveillance; 5) Monitoring and evaluation to obtain real time data and timely intervention; 6) Entomological and insecticide resistance monitoring to inform decision making; and 7) Supporting these interventions with tailored social and behavioral communication (SBC). Over the last 12 years, PMI Ethiopia procured and distributed about 40 million ITNs, 10 million doses of malaria treatments, and over 15 million multispecies Rapid Diagnostic Tests (RDTs) to households and health facilities. Currently, PMI Ethiopia uses Implementing Partners (IPs) to implement its objectives.
GH: What specific vector control mechanisms does PMI utilize globally and specifically in Ethiopia?
MY: PMI’s vector control interventions - primarily ITNs and IRS - represent a substantial proportion of PMI’s investments in malaria control. Both interventions have been critical in reducing morbidity and mortality. ITNs protect people by acting as a physical barrier and by exposing mosquitoes to insecticide when they land on the net. IRS targets mosquitoes which land and rest on the indoor surfaces of the house which have been treated with insecticide. In 2019, globally, PMI distributed over 47 million ITNs and sprayed over 4.9 million homes thus protecting 18.6 million residents. In order for ITNs and IRS to be effective, they must be deployed in the right place at the right time with the right insecticide. This involves monitoring the mosquitoes and developing plans for how to address the growing threat of insecticide resistance.
SC: PMI Ethiopia primarily uses ITNs and IRS. In Ethiopia, PMI has supported the implementation of these known and effective interventions since 2008, along with entomological and insecticide resistance monitoring.
GH: Do environmental conditions like climate risks and/or adjacency to water resources, agricultural areas, or nearby sensitive ecological areas impact where, when, and which types of vector control are implemented?
MY: Our goal for vector control implementation is to have universal coverage with the right vector control tool in the right place. As such, not only are elements of the mosquito biology considered when deciding the where, when, and which type of intervention to deploy, country-specific environmental conditions (such as proximity of agricultural rice paddies to a village) are also taken into account. More broad environmental conditions such as climate are monitored and data are incorporated into decision-making, as available. Climate plays a major role in the geographic and temporal distribution of the malaria-transmitting mosquitoes, and hence can shape decisions on malaria-related vector control interventions. Changes in climate can play a role in altered seasonal rain patterns. In a given area, changes to the rainy season can directly impact mosquito populations, which can possibly alter the malaria transmission season, and also alter when and where IRS might be conducted.
SC: In Ethiopia, the altitude and density of malaria vector breeding sites are the main determinants of malaria transmission risk. Accordingly, PMI Ethiopia vector control interventions target areas that are below 2,000 meters above sea level and are moderate to high malaria risk areas.
GH: How do you plan to go about improving the environmental soundness of your projects this year? Are you making changes from previous years?
SC: PMI Ethiopia collaborates with the Ministry of Health and partners in target area communities to ensure activities are environmentally sound. PMI Ethiopia ensures its IPs follow the best practices for environmental compliance, which are incorporated into the contract or cooperative agreement. In addition, PMI Ethiopia includes environmental compliance in its routine supportive supervision and monitoring. There are no major changes from previous years except for building on the previous year’s gains and lessons learnt to improve environmental compliance practices.
MY: PMI takes the responsibility of ensuring environmental compliance very seriously and is judicious in selecting the appropriate intervention tool(s) for a given geographic area. PMI works to ensure that environmental compliance documents are updated as required, that any new interventions are in accordance with the United States Government (USG) 22 Code of Federal Regulations (CFR) § 216 requirements, and that mitigation and monitoring plans are closely adhered to. PMI HQ as well as PMI in-country teams work with IPs to refine and standardize existing systems, resulting in improved environmental compliance, greater efficiency, and cost-savings. Due to COVID-19 travel restrictions, the 2020 regional environmental compliance training, hosted by PMI’s central vector control IP, was shifted to a virtual format. This provided the opportunity to engage a larger number of participants per country and, moving forward, could change the content and frequency of the training offerings.
GH: What specific examples can you provide regarding how Ethiopia PMI and the Washington Office collaborate to manage these environmental challenges?
SC: The Washington-based mechanism ECOS conducts independent environmental compliance assessments of PMI Ethiopia’s IRS activities every two years. Besides the availability of standing environmental best practice guidance, live field practice monitoring to directly observe spray operations in action provides more practical and contextual insights about maintaining or improving environmental compliance practices. Such field assessments allow PMI Ethiopia to learn a lot and improve its environmental compliance practices.
MY: In addition to facilitating external independent environmental compliance assessments of IRS activities through ECOS, PMI Ethiopia and PMI HQ work collaboratively to address the environmental impacts associated with other vector control measures being implemented in country. Ethiopia recently detected an invasive mosquito that in other areas of the world is capable of transmitting malaria effectively. This species is unlike most malaria-transmitting mosquito species as it thrives in urban areas. It is resistant to many of the commonly used insecticides and evades common mosquito collection methods. Thus, in addition to understanding more about the biology and determining the extent of the invasion in the Horn of Africa, strategies to best control this mosquito species are being considered. And, as with all vector control interventions, particularly those which involve insecticides, environmental impact considerations are paramount.
GH: Melissa and Sheleme, thank you very much for your time!
Subscribe to GH EnviroLinks to receive our quarterly newsletter, including future spotlights, direct to your inbox! To learn more about USAID’s environmental procedures, officers, and initiatives, visits the USAID Environmental Procedures Hub. If you have specific questions related to the GH’s environmental program, please contact ghcompliancesupport@usaid.gov.
