produced by the malaria control program of the ministry of ...ccp.jhu.edu/documents/malaria irs...

THE REPUBLIC OF UGANDAMINISTRY OF HEALTH

Produced by the Malaria Control Program of the Ministry of Health, with support from the Health Communication Partnership, Johns Hopkins Bloomberg School of Public Health, and funded by the United States Agency for International Development (USAID)

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IRS TOOLKIT - Introduction

INTRODUCTION TO INDOOR RESIDUAL SPRAYING (IRS) COMMUNICATION TOOLKIT

In 2006, the Uganda Ministry of Health reintroduced Indoor Residual Spraying (IRS) for malaria prevention with a pilot exercise in Kabale District. Since then, the MoH has begun to scale up IRS to more areas highly affected by malaria.

Upon its approval by the World Health Organization, National Drug Authority (NDA) , National Environmental Management Authority (NEMA) and the Ministry of Health (MOH), the Malaria Control Program began implementing IRS with DDT in 2008. This introduction presented unique communication challenges to the program because of the prevailing controversy over the insecticide.

While to date, IRS interventions in Uganda have proved to be vastly effective in reducing malaria incidence in the areas where IRS is implemented, the success of IRS is limited without effective communication. In a report of the first spray exercise, effective communication, including mass media and community mobilization, was determined to be critical to effective IRS implementation. In 2006, the MoH introduced IRS with DDT. IRS with DDT presents unique communication challenges increasing the need for advocacy and strategic dissemination of basic information.

People in both areas targeted and not targeted for IRS need basic information about IRS and the insecticides used. Both sets of audiences need to know the criteria for selecting targeted areas. In addition, those living in areas targeted for spraying, need to know what they themselves are supposed to do to support the exercise.

The purpose of this toolkit for strategic IRS communication is to help ensure IRS exercises in Uganda are complemented with proven communication approaches. The toolkit was developed to consider lessons learned from previous exercises and includes tools and materials already approved and used by the Malaria Control Program. The toolkit is organized into six modules each of which outlines a key step to implementing IRS communication, including:

1 Assessment, planning and budgeting Pg. 47 - 55

2 Materials Production and Distribution Planning Pg. 56 - 67

3 Orienting Spray Operators in communication and information dissemination

Pg. 68 - 72

4 District Community Mobilization Pg. 73 - 83

5 Monitoring, evaluation and follow up. The entire process is guided by the National Communication Strategy for IRS, 2008.

Pg. 84 - 85

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Introduction - IRS TOOLKIT

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IRS TOOLKIT - Introduction

Conduct training for Spray Operator Trainers in how to use IEC materials to address questions during spray exercise. Include the IRS film in training exercises (ideally 4 months before spraying starts)

Provide ongoing support to trainers as necessary during the spray operator training to ensure they have adequate materials for the training events and are comfortable with the IEC orientation

4. District Community Mobilization Pg. 73 - 83

Finalize sensitization plan for leaders with district personnel including Vector Control Officer and District Health Educator

Finalize all meeting agendas and talking points

Finalize a door to door community mobilization plan with the District Vector Control team and implementing partners

Prepare all presentations and identify and confirm session facilitators for meetings

Alert press- print, radio- about meeting schedules and disseminate press briefings before each event

Confirm radio announcements and schedule with local radio stations to ensure meetings are announced on local radio stations

Implement radio talk show series and DJ mentions ensuring that shows and DJ mentions are broadcast before district meetings and announce the upcoming events

Conduct district launch (optional) ensuring adequate media coverage and a demonstration of spraying

Conduct 1-day district, sub-county and parish sensitization meetings in cascading order; ensure adequate print materials are distributed and the IRS video is screened

Orient Health Educator team to Film Van talking points and IRS film and implement film van education schedule with District Health Education Team

Implement door to door community mobilization with spray team leaders, supervisors and LCs when spraying starts

5. Monitoring, Evaluation and Follow-up Pg. 84 - 85

Develop monitoring tools to track materials’ dissemination and number of meeting attendees; number attending film shows; number of radio programs and spots broadcast

Conduct support supervision visits through the communication coordinator in partnership with DHMT and central Ministry personnel

Compile reports recording activities and lessons learned

Conduct focus group discussions at the end of the exercise to assess effectiveness of communication approaches and the impact of IEC on IRS uptake

Compile final activity report summarizing details of activity implementation; number of activities conducted; number of materials disseminated; challenges and lessons learned.

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The annex of the toolkit includes other helpful tools including: a documentary style video of IRS produced in Uganda; audio files of all radio spots and public service announcements; various planning tools for implementation; production ready IEC print materials; photographs; and a presentation of the entire toolkit to be used by program managers and IRS planning teams.

The checklist below provides a snapshot of the key steps outlined in the toolkit modules. It can be used as a quick reference to guide the planning, implementation and evaluation of IRS communication.

1. Assessment, planning and budgeting Pg. 47 - 55

Designate or hire a Communication Coordinator - he/she should speak local language and have skills in community mobilization

Review and become familiar with IRS Communication Strategy and IRS toolkit

Present the National IRS Communication Strategy and IRS Communication Toolkit for IRS at the introductory district planning and micro-planning meetings

Identify DHMT member responsible for IRS communication. Conduct assessment interviews with DHMT to determine the best partners for implementation; identify ideal media channels and other considerations for effective IRS communication implementation

Conduct focus group discussions with community members and leaders to determine their level of understanding about IRS (optional)

Identify communication partners within the district and design work plans and activity budgets

Work with the district Vector Control office to coordinate the district implementation plan for district, sub-county and parish level sensitization meetings; radio programs and film shows with spray schedules.

2. Materials Production and Distribution Planning Pg. 56 - 67

Determine which IEC materials will be incorporated into the district IRS communication plan

Identify and contract vendors for translations, radio spot production, and printing of leaflets, banners and t-shirts

Translate select materials for print and radio

Pre-test local language translations, finalize materials and produce

Identify and contract local radio stations for media placements for spots, public service announcements and radio talk shows

Conduct orientation with radio station managers and producers on the basic information of IRS and the importance of their role in community education and mobilization

Mobilize appropriate guest speakers for radio talk shows according to the talk show outline and topics

Orienting Spray Operators in Communication and Information Dissemination

Pg. 68 - 72

Work with the Vector Control Team to develop and plan spray training orientation to IRS IEC materials and plans;

Identify and orient the IEC trainer to IRS Orientation Guidelines and IEC materials

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Introduction - IRS TOOLKIT

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IRS TOOLKIT - Material Description

List of Materials available in this toolkit

Tool Tool Name Format Location

Step 1: Assessment, planning and budgeting

1 Template IRS Timeline for Communication Activities

PDF/WORD Toolkit intro annex, CD

1a National Communication Strategy for IRS Hard Copy Toolkit intro annex

2 Template IRS Communication Budget PDF/Excel Toolkit intro annex, CD

3 IRS Sensitization Process Guidelines PDF Toolkit intro, CD

4 IRS toolkit presentation Powerpoint CD

5 Communication Needs Assessment Questions DHMT

Ms word CD

6 Focus Group Discussion Guide for community members

Ms word CD

7 IRS Leader Leaflet PdF CD, annex step 1

8 IRS Frequently Asked Questions (FAQ) PDF CD, annex step 1

9 10 Things on DDT PDF CD, annex step 1

10 FAQ on DDT PDF CD, annex step 1

11 WHO on IRS PDF CD, annex step 1

12 Film “IRS :What you need to know” DVD video Toolkit Annex

Step 2: Materials Production and Distribution Planning

13 All materials pre-test methodology MS Word CD, annex, step 2

14 FGD guide for all materials pretest MS word CD, annex, step 2

15 Pre-test recording sheet MS Word CD

16 Template pre-test budget MS excel CD

17 Radio Spots and PSA scripts in English MS word CD

18 IRS FAQ template- English MS Word CD

19 IRS Leader Leaflet template- English MS word CD

20 Radio talk show outline MS word CD, annex, step 2

21 Template DJ Mentions MS word CD, annex, step 2

22 Special event radio talk show outline MS Word CD

23 IRS video script English MS word CD

24 Template t-shirt text Design file CD

25 Template banner text Design file CD

26 Logos Design file CD

Step 3: Orienting Spray Operators in Communication and Information Dissemination

27 Spray Operator Communication Orientation Guidelines

PDF CD, annex step 3

8 Frequently asked questions on IRS (FAQ) PDF CD

12 Film “IRS :What you need to know” DVD toolkit annex

Step 4: District Community Mobilization

3 IRS Sensitization Process Guidelines PDF CD/ step 1 annex

28 Sensitization meeting invite MS word CD

29 District meeting agenda MS word CD

Tools included in Introductory Annex

The following key documents are included in this introductory section:

IRS Communication template implementation timetable

IRS Communication budget template

National Communication Strategy for Indoor Residual Spraying, 2008

IRS Communication Template Implementation Table:This template timeline was developed through the implementation of several IRS exercises and with input from the Malaria Control Program, district personnel and implementing partners. It considers the lessons learned from previous IRS spray exercises.

While some details of the schedule may be altered, it describes the ideal timeline for the implementation of IRS Communication. The timeline allows for the ideal amount of time to effectively plan communication activities; to broadcast radio programs; to ensure that spray operators are adequately trained.

The last column of the timeline indicates the number of the tool most useful to each particular activity. Each tool can be found in the annex and/or on the accompanying CD in electronic format.

IRS Communication Budget Template:The template budget corresponds with the template timeline and was also developed considering the lessons learned from the previous exercises. The budget is a guide but does not have actual costs because they are variable. One of the most expensive line items on the budget will be sensitization meetings. As much as possible, it is best to keep the costs for per diems and allowances to a minimum to allow for the very important community mobilization activities. The budget is also available on the CD in EXCEL format to allow adaptation.

National Communication Strategy for Indoor Residual Spraying, 2008

The National Communication Strategy for IRS was completed in 2008 through a participatory process with implementing partners, donors and the Ministry of Health. Prior to completing the strategy, representatives from communities, health teams and implementing partners were interviewed to understand their information needs with regards to IRS. The resulting insights and opinions inform this strategy and are addressed through the communication objectives and key messages.

The strategy prioritizes three primary audiences:

Household heads in areas targeted for spraying

Media representatives

Local and National leaders.

The strategy also details the Communication packages for each audience with guidelines as to how each should be used.

All IRS implementers should be familiar with this strategy before implementing IRS IEC.

Staffing Recommendations:Past experience indicates that IRS communication works best if guided by a skilled communication coordinator. This person should have experience in malaria communication and community mobilization. The coordinator should be based in the implementing district and should be responsible for coordinating the implementation of this toolkit. He/she should also provide day to day supervision and support for all activities working closely with DHMT and MoH.

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Material Description - IRS TOOLKIT

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IRS TOOLKIT - Overall Timeline

ITEM: � Overall Timeline

Activity Involved Partners

Time (months) Tools to be used1 2 3 4 5 6 7

Step 1: Assessment, planning and budgeting Spraying begins

Hire communication officer Items: 1Attend introduction IRS meetings in district

MoH/ Contractor

Items: 1, 1a 2, 3, 4, 7, 8, 9, 10, 11, 12

Introduce Communication Toolkit at micro planning district workshops

MoH/ Contractor

Items: 1, 1a, 2, 3, 4, 7, 8, 9, 10, 11, 12

Design work plans and budgets for activities

MoH/Contractor/District or institution officials

Items: 1, 1a, 2, 3

Conduct FGD with DHMT Items: 5Conduct FGD with community members and leaders to determine information and understanding of IRS and insecticides (optional)


Items: 6, 8,


Contract radio stations & schedule broadcasts

Districts/contractor

Items: 1, 2

Conduct orientation with radio station managers and media personnel

Items: 7, 8, 9, 10, 11, 12

Radio Spots/PSA

Translate content for radio spots, PSAs in local language for pretest

MoH/Districts Items: 17

Check and revise local language tranlation

MoH/districts/contractor

Items: 13, 14, 15, 17

Review & approval of radio materials

Districts/MoH/contractor

Produce final spots and PSA in local language

Radio Stations/Districts

Items: 2

Radio Programs

Identify presenters/guests for radio programs

Districts/Radio Stations

Items: 20, 22

Discuss format with stations & determine date/time of shows

Radio Stations Items: 1, 20, 22

Adapt talking points/key messages

District/ MoH/Contractor

Items: 20, 22

Mobilize guest speakers Districts/MoH Items: 20, 22


30 District meeting invite MS word CD

31 Sub-county/parish meeting agenda MS word CD

32 Guidelines for spray operator march MS word CD/ step 4 annex

33 Press release template for launch MS word CD

21 Template for DJ mentions PDF CD/step 4 annex

33 Talking points for film van PDF CD/ step 4 annex

12 Film “IRS : What you need to know” DVD video Toolkit annex

10 IRS FAQ PDF Step 1 annex, cd

7 IRS Leader leaflet PDF Step 1 annex, cd

35 Film van activity report MS word CD

36 Sensitisation meeting talking points PDF CD/ step 4 annex

37 Special event radio talk show outline MS word CD

Step 5: Monitoring, Evaluation and Follow-up

6 Focus group discussion guide for community members

MS word CD


39 Activity sign in sheet MS word CD

40 Radio talk show broadcast report MS word CD

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Overall Timeline - IRS TOOLKIT

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IRS TOOLKIT - Overall Timeline



Order certificates for spray operators

District/Contractor

Develop agenda with District and partner staff

District Items: 1,2,32

Identify and confirm guests and key speaker

District

Write and disseminate press briefings

District/MoH Items: 33, 21

Identify and Hire entertainment

District Items: 2

Invite media representatives

District

Orient and plan spray operator march

District/Contractor

Items: 32

Make announcements in local media

District Items: 21

Conduct launch District/MoHSub County Sensitization meetings

Revise meeting content and agenda

District Items: 2, 3, 31

Develop meeting schedule and budget with district team

District/Contractor

Items: 1, 2, 3,

Conduct Sub county sensitization Meetings

District/Contractor

Items: 3, 7, 10, 12, 36

Community Sensitization Meetings

Organize meeting content MoH/Districts Items: 1, 2, 3, 31

Conduct Community Sensitization Meetings

Sub-Cty Officials; back up from District

Items: 7, 10, 12, 20

Community Mobilization with LCs

Develop community mobilization plan and budget with District team

District/Contractor

Items: 1,2,3,

Identify and orient mobilization team

District/Contractor

Items: 1,7,10, 12

Communicate mobilization and spray schedule to local radio stations

District Items: 1

Conduct community mobilization with LCs

District/Contractor

Items: 10



Print Material-leader fact sheet, IRS Frequently Asked Questions

Adapt and translate IRS FAQ, Leader Leaflet

MoH/Districts Items: 18, 19

Check and revise translation

MoH/Districts/Contractor

Items: 13, 14, 15

Review/approval of final material

MoH/Districts

Finalize and print materials Vendor Items: 2Print IRS t-shirts for sensitization Meetings

MoH/Contractor

Items:24

IRS Film

Translate IRS film in local languages

District/MoH/Contractor

Items:23

check local language translation and complete

MoH/Contractor

Items:23

Community Film shows

Schedule film vans with MoH

MoH/District Items: 1,2


Conduct Orientation during spray operator TOT (ideally 4 months before spraying starts)

Contractor Items: 8, 12, 27


District Sensitization Meeting and launch

Organize meeting schedule with district

Districts/MoH Items: 1, 2, 3

Invite participants MoH Items: 1, 3, 29, 30

Prepare presentations & identify facilitators

MoH/Contractor/MoH

Items: 3, 29

broadcast radio announcements for meeting

Local radio stations

Items: 1, 21

conduct radio talk show with District officials and key guest (night before meeting)

Local radio stations/ District

Items: 37

Conduct district sensitization meeting

District/MoH Items: 29, 3, 7, 12

District Mini-Launch (districts new to IRS only)

Identify and contract venue District/Contractor

Items: 1,

Order t-shirts, banners District/Contractor

Items: 24, 25

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Overall Timeline - IRS TOOLKIT

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IRS TOOLKIT - Overall Budget Template

ITEM: � Template Budget - IRS Communication Activities1

Template Budget

ACTIVITY UNITS UNIT COST

Ug. Shilling

Comments

Preliminary Planning

Field Trip to implementing district(s)

0 Costs for fuel and travel per diems for visit(s) for Kampala based personnel

Focus Group discussions

Mobiliser’s allowances 0 Allowance to compensate local participant mobilizer - 1-2 days

Training/ Briefing of research assistants: Lunch/Transport refund

0 Lunch and transport refund for local research assistants for 1/2 training to FGD tools

Refreshments for participants

0 Refreshments for FGD participants (approximately 2-4 FGDs per district; 8-10 ppl per FGD)

Transport refund for participants

0 Transport allowance for participants

Air time for co-ordination 0 Air time reimbursement for district coordinator and mobilizer

Facilitator’s fees 0 Fees for facilitators - 2 facilitators per group

Drivers allowance 0 Safari day allowance for district driver per government rate

Fuel for mobilization. 0 Fuel for town running - local mobilization of participants

Stationery 0 Notebooks, pens, newsprint, markers

Radio spots/Talk shows

Translation of radio spots into local language

0 1 PSA and 2 radio spots will be revised translated into local language and checked

Production of radio spots 0 1 PSA and 2 radio spots will produced by local station

Pre-test radio spots in local language

0 PSA and the 2 radio spots will be pre-tested among four FGDs representing target audiences

Air time for radio broadcast radio spots radio stations

0 1 PSA and 2 radio spots will be 1-2 times per day for a period of 8-10 weeks on local stations

Air time for broadcast of Radio talk shows on local station(s)

0 1 show per week per station

1 Available on CD in Microsoft EXCEL format




Make ongoing reports of materials’ dissemination

District/contractor

Items: mate-rials’ dis-semination report 38, 40

Conduct support supervision visits

MoH/Contractor

Items: activ-ity report

Conduct Focus Group discussion/IDIs about IRS communication

District/Contractor

Items: 6

Compile report on IEC activities and FGD findings

District/contractor

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Overall Budget Template - IRS TOOLKIT

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Template Budget


Ug. Shilling

Comments

Reproduce IRS video 0 Copies for District team, film vans, partners for local meetings; on DVD and VHS

District Sensitization Meeting

Venue Hire 0 Hire of Venue for 1 day

Meals and teas 0 Meals and teas for invited guests/VIPs

Participant allowance 0 Allowance for invited participants from District, sub-county (Safari day allowance)


Banners/Advertising 0 Banners to be placed at meeting site

Travel per diem for MoH officials

0 Accommodation and incidentals

Driver’s allowances 0 Accommodation and incidentals

Fuel for the MoH facilitators.

0 Travel from Kampala to district

Fuel for district to coordinate and organize the meeting.

0 Fuel for District vehicles for town running

Facilitation allowance for meeting facilitators

0 Allowance for preparation and meeting facilitation for meeting factilitators

Hire equipment to show IRS video

0 LCD and laptop or DVD/VHS and screen, generator or film van

Sub-County Sensitization Meeting

Participant allowance 0 Allowance for participants (Safari day allowance)

Fuel for district officials to attend meeting

0 Fuel for round trip to sub-county meetings




Hire equipment to show IRS video

0 LCD and laptop or DVD/VHS and screen, generator or film van

Parish Meetings

Participant allowance (optional)

0 Transport allowance

Template Budget


Ug. Shilling

Comments

Facilitation for Guest speakers on local station

0 Two guest speakers per radio talk show will be facilitated to attend each show

Fuel for guest speakers 0 Fuel or transport reimbursement for guest speakers (2 per show; 8-10 shows before and during exercise; 1 after exercise total 11-12 shows)

Perdiem for guest speakers on local stations

0 Perdiem will be given to guest speakers 2 per show for each show recommended 8-10 shows before and during exercise; 1 after exercise total 11-12 shows

Perdiem for the driver to transport guest speakers

0 Perdiem will be given to one driver to transport guest speakers to attend radio talks shows for rural stations

Airtime for mobilization of guest speakers

0 Mobile phone airtime will be spent on mobilization and coordination of radio guest speakers and talk shows

Print materials

Translate materials in local language

0 Existing materials will be revised(if necessary) and translated into local language

Pre-test print materials in local language

0 This amount will include FGD participants allowances and transportation costs

Print fact Leader fact sheet and FAQs

0 Quantities to distribute leader fact sheets at district, sub-county and parish meetings; FAQs to be used in schools and by spray operators

Design and print banners 0 Banners to be placed at district headquarters and insecticide dispensation/storage points. PVC banners, 3-4 colour

Design and print T- Shirts 0 T-shirts distributed to local leaders, district personnel, key stakeholders

IRS Video

Translation of video voicing into local language

0 Translate and revise after pre-test as necessary

Check translation 0 The translation will be pre-tested among the identified target audiences in select districts

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Template Budget


Ug. Shilling

Comments

Film Van Community Mobilization

Fuel for mobilization 0 Fuel for film van within district

Fuel for the generator 0 Generator fuel if required

Health Educators allowance

0 Daily allowance for District Health Educator

MoH health educator’s allowance

0 Daily allowance (per diems and accommodation) for Ministry of Health Educator if required

Drivers allowance 0 Daily allowance for driver

Fuel for the film van to and from Kampala

0 Fuel for film van to and from Kampala

Health Education Talks

Fuel for transportation 0 Fuel for District vehicle

Allowance for HE 0 Safari Day allowance per government rate for HE


Research and Evaluation of communication interventions

Mobiliser’s allowances 0 Allowance to compensate local participant mobilizer - 1-2 days

Training/ Briefing of research assistants: Lunch/Transport refund

0 Lunch and transport refund for local research assistants for 1/2 day training to FGD tools

Refreshments for participants

0 Refreshments for FGD participants (approximately 2-4 FGDs per district; 8-10 ppl per FGD)

Transport refund for participants

0 Transport allowance for participants

Air time for coordination 0 Air time reimbursement for district coordinator and mobilizer

Facilitator’s fees 0 Fees for facilitators - 2 facilitators per group

Drivers allowance 0 Safari day allowance for district driver per government rate

Fuel for mobilization 0 Fuel for town running - local mobilization of participants


IRS communication implementation arrangements

Hire a full time project coordinator (optional)

0 A full time consultant will be hired for a period of six months minimum

Template Budget


Ug. Shilling

Comments



Safari day allowance for sub-county officials to facilitate

0 Government safari day allowance rate

Fuel for s/c staff for motorcycles

0 Fuel for round trip sub-county/parish

Fuel (diesel) for district staff

Fuel for round trip from sub county to all parish meetings


District Launch (optional for new districts only)

One day meeting to launch IRS at district level. Held before implementation of sensitization activities; includes spray march activity

Venue hire 0 1- day venue hire

Lunch and sodas for invited guests

0 Speakers, government reps, district personnel

Per diem for MoH Officials

0 Accommodation and incidentals at government rate

Travel allowance for MoH drivers


Fuel for MoH officials 0 Travel from Kampala to district

Entertainment 0 Brass band, dancing or drama group (optional)

Certificates for spray operators

0 Each graduating spray operator receives certificate

Transport refund for spray operators

0 Transportation allowance for each attending spray operator

Transportation and allowance for Kampala VIPs


Equipment hire for IRS video

0 LCD, projector, generator and fuel or film van

Tents and chairs 0 Hire tents and chairs if required

Community Mobilization day before spraying with LCs and local leaders

Allowance for LCs 0 Safari day allowance for LCs/other local leaders to mobilize constituents door to door throughout spray exercise

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IRS TOOLKIT - Communication Strategy

NATIONAL COMMUNICATION STRATEGY FOR

INDOOR RESIDUAL SPRAYING (IRS)

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ITEM: �a NATIONAL COMMUNICATION STRATEGY FOR INDOOR RESIDUAL SPRAYING (IRS)

Template Budget


Ug. Shilling

Comments

Local Transportation for Coordination

0 Fuel and/or vehicle hire for local transportation

Airtime/internet 0 Communication costs for phone and internet access by local coordinator

Fuel for community sensitization

0 Fuel for community mobilization

Office supplies and photocopying

0 Paper, print cartridge, pens, notebooks

MoH communication staff conduct support supervision visits

0 Fuel and per diem for at least 3 trips from Kampala

Fuel and transportation for MoH staff to attend planning meetings for communication

0 Fuel and allowance for at least 2 meetings

Facilitation to participants during communication planning meetings

0 Safari day allowances, meals and refreshments will be provided to participants during planning meetings

Total Budget

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Communication Strategy - IRS TOOLKIT

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Foreword

It is with great pleasure that I endorse the National Communication Strategy for Indoor Residual Spraying in Uganda. Use of IRS is yet another strategy we have embraced as the Ministry of Health in addition to other available effective malaria control interventions. Indoor Residual Spraying (IRS) which is the application of safe and effective insecticides on the inside walls of houses is a proven and critical part of the National Malaria Control Strategy to eliminate malaria in this Country by the year 2015 as envisaged by the Global Roll Back Malaria Initiative.

The Government of Uganda is committed to strengthening malaria control interventions using approved methods at all levels since Uganda is a signatory to the Abuja declaration of the year 2000 which mandates everyone to contribute to malaria control from their point of advantage.

It is along the above history that in addition to effective treatment using ACTs, supplying Long Lasting Insecticide Treated Nets (ITNs) to vulnerable persons, encouraging mothers to attend ANC early enough to access Intermittent Preventive Treatment (IPT) for malaria during pregnancy, the Ministry of Health is now scaling up the use of Indoor Residual Spraying for the whole country beginning with specific areas for control of malaria epidemics which have been occurring more frequently in the past few years.

The Communication Strategy will therefore support Planners and Managers who are involved in the implementation of activities for Indoor Residual Spraying at National, District and Community levels.

Since effective communication is a critical part of effective IRS and malaria prevention and control, I strongly encourage all stakeholders to embrace this document and abide by its guidance. I therefore endorse its use.

TOGETHER! LET’S FIGHT MALARIA

Dr. Sam Zaramba

Director General of Health ServicesMINISTRY OF HEALTH

Table of Contents

Foreword 19

Acknowledgment 20

Preface 21

Abbreviations 22

Introduction 24

Background 26

Spraying with DDT 29

Communication Strategy Overview 32

Communication Goal for IRS: 33

Audience Analysis 33

Communication Objective 35

Primary Audience: National and local leaders representing areas targeted for IRS 33

Primary audience 2: Heads of households and heads of institutions targeted for spraying 36

Primary Audience 3: Media representatives 39

Communication Objective 40

Channels and Approaches 41

Tools/Channels for media representatives 45

References 46

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Preface

The National Communication Strategy for Indoor Residual Spraying (IRS) has been carefully designed to cater for a mix of channels at different levels to support IRS. The documentation of this guide is a result of the experience gained during the IRS interventions in the Districts of Kabale, Kanungu, Apac, Oyam and the Acholi sub-region where IRS was carried out in IDP Camps.

The IRS Communication Strategy is a complement to the National Communication Strategy for Malaria Control in Uganda 2005-2010 which prioritises the following communication problems and challenges for IRS:-

Few people know about IRS generally: how it is applied, its effectiveness and safety in controlling malaria

Most people do not know who is targeted for IRS or the rationale for targeted spraying;

Leaders and household members in targeted areas do not know what is required of them during the spray exercise

There is widespread misinformation about IRS safety and effectiveness.

The communication goal for IRS is to increase the uptake and acceptance of IRS and the insecticides used through addressing critical information gaps regarding the effectiveness of IRS and the various insecticides used.

The communication approaches described comprise a multi-channel approach that includes Mass Media using print, Radio and Community Mobilization approaches including meetings and a documentary video.

The users of this guide will need to be oriented on how to use it specifically when planning for a district roll out as it aims at streamlining effective communication as a support pillar for IRS implementation.

This is a great achievement for the malaria Control Programme and IRS Partners. I truly appreciate the support extended to the Ministry of Health to have this draft guide in place.

Please forward all your comments to the Health Promotion/ Malaria Control Programme. They will be incorporated in the next edition.


Mary Amanyire Byangire- Sendi

Senior Health Educationist – NMCP

Ministry of Health

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Acknowledgment

I wish to acknowledge the contribution of various partners who have made the documentation of the Indoor Residual Spraying (IRS) communication strategy possible. It is a stepping stone to preparing the community to embrace gradual roll out of Indoor Residual Spraying (IRS) out in the whole country. This move requires consistent and organized information dissemination at all levels. Using the previous experience from the Districts that have conducted this exercise, districts brought on board will be guided to adapt and modify communication channels for better results.

It is on this note that I commend the financial support from United States Agency for International Development (USAID) and the U.S. President’s Malaria Initiative (PMI) through the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU/CCP) that made it possible to develop the National Communication Strategy for Indoor Residual Spraying (IRS).

Special gratitude is extended to the technical team especially Michael Okia the Senior Entomologist and Mary Byangire Senior Health Educationist for providing the much needed technical insights that were crucial for the success of the literature review.

I equally acknowledge and appreciate the contributions from the following, both in their individual and institutional capacities, towards the process of developing the document:

1. Mr. Paul Kagwa - MOH 8. Donna Sherard - HCP

2. Michael Okia - MOH 9. Esther Mbidde - HCP

3. Mary Byangire - MOH 10. Tom Emusgut - HCP

4. Dr. John Bosco Rwakimari - MOH 11. Emmanuel Kayongo - HCP

5. DHE - Kabale 12. Richard Okwi - MOH

6. DHE - Apac 13. Sadati - MOH

7. Cheryl Lettenmaier - HCP

To everybody who has contributed in one way or another, please thank you.


Dr. Richard Ndyomugyenyi

Programme Manager/ Malaria ControlMINISTRY OF HEALTH

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Q & A Question and AnswerRDC Resident District CommissionerRBM Roll Back Malaria (WHO)SP Sulfadoxine-Pyrimethamine (Fansidar)TOT Training of TrainersUPDF Uganda National Defence ForcesUPHOLD USAID projectUSAID US (government) Agency for International DevelopmentVCD Vector Control Division (MOH)VHT Village Health TeamWHO World Health Organization

Abbreviations

ACT Artemisinin-based Combination TherapyAMREF African Medical Research FoundationANC Antenatal CareBCC Behaviour Change CommunicationCAO Chief Administrative OfficerCBO Community-Based OrganisationCDC Centres for Disease Control (USA)CDD Community-Based Drug DistributorsCHW Community Health WorkerCORP Community Resource PersonCQ ChloroquineCQ/SP Chloroquine/Sulfadoxine-Pyrimethamine (Fansidar)CSO Civil Society OrganisationCS Capsulated SuspensionDDT Dichloro-diphenyl-trichloroethane DHE District Health EducatorDHMT District Health Management TeamDMO district Medical OfficerDOT Directly Observed TreatmentEPR Epidemic Preparedness and ResponseFBO Faith-Based OrganisationHSSP Health Sector Strategic PlanIDP Internally Displaced PeopleIEC Information, Education, CommunicationIMCI Integrated Management of Childhood IllnessIPT Intermittent Preventive TreatmentIRS Indoor Residual SprayingITN Insecticide-Treated NetJHU/CCP Johns Hopkins Bloomberg School of Public Health/ Center for Communication

ProgramsLC Local CouncilLCV Local Council FiveLLIN Long Lasting Insecticide Treated NetMACIS Malaria and Childhood Illness NGO SecretariatMCP Malaria Control Programme (MOH)MCSP Malarial Control Strategic PlanM&E Monitoring and EvaluationMIP Malaria in PregnancyMOH Ministry of HealthNGO Non-Governmental OrganisationNMS National Medical StoresPEAP Poverty Eradication Action PlanPMI US President’s Malaria Initiative

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In 2008, the MOH launched use of dichlorodiphenyltrichloroethane (DDT) for IRS in Uganda during the first spray round in Apac and Oyam Districts. While DDT is being implemented because it is more cost-effective and lasts longer than other insecticides, its re-introduction presents challenges for IRS communication, as there is a sizeable proportion of the population that lack information about DDT and others who aggressively oppose its use, believing that it is dangerous to humans and to the environment.

However, it is worth noting that Uganda has used DDT successfully for pest control and malaria prevention before. DDT, commonly referred to as “Dudu - maki”, was used in Uganda on a large scale for agricultural purposes, especially for cotton spraying, from the 1940s to the 1970s. The powder form of DDT, commonly called Safi Safi was also used widely in Uganda for preservation of beans, peas, etc against weevils.

Uganda successfully used DDT during a pilot malaria eradication project in Kigezi between 1959 and 1963. During the exercise, Anopheles funestus was practically eliminated and a dramatic reduction of Anopheles. gambiae s.l. densities was also noted (Ministry of Health, Malaria Control Program). Additionally, malaria epidemics were controlled in areas around Lakes Bunyonyi, Muhanga, and Kimbugu and in the current Kabale and Kisoro Districts.

The Ministry of Health intends to use longer lasting residual insecticides for IRS. While several approved insecticides will be used to delay insecticide resistance, DDT will be central to the IRS program. The MoH has chosen DDT because it lasts longer, requires less frequent spraying and as a result, is more cost effective. In instances where DDT is not recommended, the Ministry of Health will employ ICON Capsulated Suspension (CS) as opposed to the Wettable Powder formulation previously used because it lasts at least six months

Using the Communication Strategy, all IRS communication will adhere to the communication goals, objectives and key messages of the National Communication Strategy for Malaria Control in Uganda 2005-2010.

The following document summarizes the national communication strategy for IRS in Uganda. This strategy considers the generic communication needs applicable to all spray exercises and the unique communication issues raised by implementing IRS with DDT.

Introduction

Malaria is endemic in 95% of Uganda. The remaining 5% are epidemic-prone areas in the highlands of the southwest and east of the country. A 1995 Burden of Disease study indicated that 15.4% of life years lost to premature death were due to malaria. Recent Ministry of Health (MoH) data indicates that malaria accounts for as many as 50% of outpatient visits in health centres across the country. The use of indoor residual spraying (IRS) to control and eliminate malaria is one of the strategies of the current Malaria Control Strategic Plan, the Health Sector Strategic Plan and the Poverty Eradication Action Plan.

In 2006, the Ministry of Health conducted a massive pilot Indoor Residual Spraying (IRS) targeting all residential houses in Kabale District. It was funded by the United States Presidential Malaria Initiative (PMI). This was an intervention to reduce the burden of malaria in this epidemic prone region.

As a result of the success achieved, the Ministry of Health embarked on scaling up of IRS roll out beyond Kabale District to take place over the next five years.1 This scale up began in 2007 with the introduction of IRS in additional epidemic prone districts and districts with internally displaced persons (IDP) camps. The districts included in this round of spraying were:- Kanungu, Kabale (second round), Acholi sub region with IDP camps in Gulu, Kitgum, Amuru, Pader and Lango subregion of Oyam and Apac. Each of the districts was chosen because they met specific criteria outlined in the National Policy and Strategy for Indoor Residual Spraying (2006). Kabale and Kanungu were chosen because they are epidemic prone districts located in the South Western part of Uganda highlands. Apac and Oyam because they are the districts reporting the highest incidence of infective mosquito bites per day (Ministry of Health, Malaria Control Program); and IDP camps because those living in highly populated emergency camps are at increased risk for malaria infection.

As part of the scale up, PMI provided support for IRS community education and mobilization during the 2007 spray rounds in Kabale, Kanungu, Apac, and Oyam. Based on experience gained during this exercise, PMI provided assistance to the Malaria Control Programme to develop a ‘tool kit’ for IRS communication to enhance community mobilization during subsequent rounds of IRS.

Available literature about IRS implementation in Uganda including the IRS Kabale Project Report (Research Triangle Institute International, 2006) describes the importance of developing a more strategic approach to communicating about IRS at district, sub-county and community levels. While the south-western spray exercise was generally considered a success based on the high coverage and low household refusal rate (3%)2, the Malaria Control Program concluded that more intensive community mobilization, including the use of loudspeaker messages, should be an important part of future IRS exercises. It was also noted that despite communication efforts, some community members continued to harbour various myths and misconceptions about IRS, and concerns about the safety and efficacy of ICON™, the insecticide that was being used.

In 2007-2008, the Ministry began spraying in IDP camps in Amuru, Gulu Kitgum and Pader. Since the Government of Uganda is currently relocating residents of the IDP camps to their home areas, the exercise presented unique challenges to IRS communication. Those relocated need additional information about malaria prevention once they leave their temporary residences in the camps which have been sprayed and return to homes which are likely to have not been sprayed.

1 Uganda Malaria Control Strategic Plan (2005/6-2009/10), Malaria Control Program Ministry of Health of Uganda, 2 Research Triangle Institute International, Draft Uganda IRS Project Report, Kabale District, October, 2006

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In 2006, the MOH selected Kabale district as the pilot site for large-scale IRS using ICON™ because it continues to be one of the most epidemic-prone districts in the country. Ninety-three percent (93%) of the total population in Kabale is estimated to be at risk for contracting malaria. Additionally, because the transmission is unstable there is a high potential for epidemics to occur. Plasmodium falciparum is responsible for 95% of all malaria cases in Kabale.5

Since the pilot IRS exercise in Kabale, the district has not experienced an outbreak of malaria. Because of this success, U.S. President’s Malaria Initiative (PMI) committed support to the MOH with a second round of spraying in 50% of eligible structures in Kabale, and an initial round of spraying in 70% of eligible structures in Kanungu district, which took place in February and March, 2007.

During the remainder of the year, MOH conducted spraying in other districts of high transmission including IDP camps in Kitgum, Pader, Amuru and Gulu. ICON™ was used in all the districts except for Apac and Oyam where DDT use was reintroduced.

The prevailing national debates regarding IRS have illuminated beliefs about IRS and DDT which are widely held by leaders and community members.

Many of the concerns centre around rationale for how and where IRS is applied; concern about the safety of insecticides, particularly DDT; and lack of clarity about what households are supposed to do before and after their homes have been sprayed.

On the other hand, successful IRS implementation in the south-western and northern regions have revealed considerable support for IRS. Many believe this is a service that the government is obligated to provide urgently without any further delay.

While there is little representative data about people’s knowledge, attitudes and behaviours with regard to IRS, there is overwhelming support of the exercise. A female respondent noted, “From the time you sprayed the houses, we have witnessed a change. Malaria has reduced…the mosquitoes no longer bite us in our houses like they used to do.” (HCP KAP study 2008)

When asked what motivated them to participate in the spray exercise, respondents indicated that they were willing to participate because they had been instructed to by their government and local leaders and did not ‘want to let them down’. Others indicated that elderly people who had participated in the previous exercise years ago in the same area influenced them to accept the spraying in their homes.

Despite the considerable support for IRS, there’s some documented concerns where IRS was conducted in Kabale District6.

Key among the concerns was the following:

The chemical used (ICON™) was not safe;

5 Research Triangle Institute International, Draft Uganda IRS Project Report, Kabale District, October, 2006,6 , Report of IRS Review Workshop. Research Triangle Institute International December 20th, 2006

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Background

IRS is the application of long-acting insecticides inside human and animal dwellings in order to repel and kill adult malaria vector mosquitoes coming to rest on these surfaces thus reducing mosquito abundance, lifespan and human-vector contact. IRS targets mosquitoes which feed and rest indoors.

The primary effects of IRS towards curtailing malaria transmission are:

to reduce the life span of vector mosquitoes so that they can no longer transmit malaria parasites from one person to another

to reduce the density of the vector mosquitoes.3

Widely reported evidence confirms that malaria control by IRS has made epidemics less frequent and reduced or eliminated malaria incidence in countries where it has been introduced on a wide scale basis.4 IRS with DDT was the main method by which malaria was eradicated in the United States, Europe the former USSR and the Caribbean between the 1940’s and 1960’s. Through the use of IRS with DDT in Southeast Asia, Latin America and parts of Africa, malaria was greatly reduced. South Africa is often cited as an IRS success story in Africa. IRS was scaled up in South Africa and as a result, malaria was nearly eliminated.

Uganda participated in the use of IRS during the previous period of wide scale IRS for malaria prevention. The exercise implemented in Kabale between 1959 and 1963 is widely recognized as a successful example of IRS for malaria reduction. While cases of malaria have been reported in that region since that time, the incidence and impact of malaria epidemics were greatly reduced.

The use of IRS to prevent and control malaria, especially in epidemic-prone areas and institutions, is now one of the key strategies for the Malaria Control Strategic Plan (2005/6-2009/2010). To support the appropriate use of IRS, the Ministry of Health has adopted IRS using safe and effective insecticides in the following circumstances:-

Congested areas (i.e. high-density slum settlements);

Institutions (e.g. boarding schools, barracks, prisons, agricultural and industrial estates);

Emergency situations (e.g. Internally displaced person (IDP) and refugee camps)

Malaria Epidemic prone areas (districts prone to epidemics).

In Uganda, malaria epidemics have commonly occurred in the highland areas of the Southwest and East, where malaria is not perennial. The epidemics have resulted in considerable morbidity and mortality which could have been prevented through the timely use of IRS.

The government is in the process of scaling up IRS country wide with emphasis on highly endemic districts in order to rapidly reduce malaria vector population and malaria transmission.

3 World Health Organization (2006) IRS WHO Position: Use of indoor residual spraying for scaling up global malaria control and elimination

4 Musawenkosi L, Mabaso H, Sharp BL and Lengeler C (2004) Historical Review of Malaria Control in Southern African with emphasis on the use of indoor residual house-spraying. Tropical Medicine and International Health 9 (8) 846-856.

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Spraying with DDT

The use of DDT for IRS is largely credited with the eradication of malaria in many developed countries and the reduction of malaria in several African countries including South Africa. Widely published research indicates a dramatic reduction in malaria incidence in Cuba, Jamaica, Venezuela, India, Italy, Yugoslavia and Taiwan after IRS with DDT was used between 1935 and 1962 (Buchel, 1983). Between the 1970’s and mid 1980’s many countries banned DDT. While the bans were put in place for agricultural use only, they resulted in the practical elimination of DDT for public health use and specifically, for malaria control.

Subsequent to its endorsement by the WHO, the Uganda National Environmental Management Authority (NEMA) and the National Drug Authority (NDA) the MOH began using DDT for IRS. IRS using DDT was re-introduced in Uganda in April, 2008 in Oyam and Apac Districts. DDT was chosen because of its cost effectiveness. (it breaks down more slowly), It causes longer lasting protection, and requires less frequent spraying than other insecticides.

The introduction of DDT stimulated a heated national debate in the media and in various public fora largely driven by agricultural and environmental lobbyists and political leaders. Those in support of DDT pointed to the success of its use in eradicating malaria in many parts of the world and its success in the pilot exercise in Kabale between 1959-1963. They stressed the fact that among people who lived in the areas sprayed with DDT, there were no known negative health effects and indicated that reports that DDT had negative health effects including miscarriage, cancer, blindness and genetic defects were largely unfounded (New Vision, March 21, 2007).

In addition, DDT would not be used as an agricultural pesticide, only for IRS as part of malaria control.

Opponents of DDT cautioned against its use indicating that because it is banned in many countries which import agricultural products from Uganda, the country would loose much of its export market. Opponents also argued that for DDT to be used effectively with minimal environmental impact, strict controls for storage and disposal must be maintained – some of which may be impossible in the Ugandan context. Some also pointed to a highly controversial study conducted in 2006 in South Africa suggesting that DDT may have a negative effect on sperm count among men in areas sprayed with DDT (New Vision, March 5, 2008).

In June 2008, a series of focus group discussions were conducted with 160 people living and working in areas which had been sprayed with DDT in Apac and Oyam. Community members (men and women) who had either accepted or rejected IRS; representatives from the organic farmer groups who had rejected spraying; spray operators; and representatives from the District Health Team who were involved in the spray exercise were interviewed. Findings indicate that Community members lacked complete information about IRS and DDT. The lack of information seemed to be the most important reason for not accepting IRS.

Among both groups, IRS acceptors and rejectors, many were concerned about the safety and effectiveness of the insecticide and felt there was not enough information disseminated about the potential side effects.

“We have been hearing all this false information that was passed unto people that DDT kills, causes cancer, impotence, etc.”Male IRS acceptor

The fact that you couldn’t see the chemical on the walls meant that the sprayers used only water;

Why certain communities are selected for IRS and not others; and

Lack of awareness about how households were to prepare for IRS.

It was concluded that inadequate communication targeting institution and household heads with information about IRS caused complications to IRS implementation. Because of a limited focus on community level communication, many household heads were not prepared for the spraying on the day the spray operators arrived. Those who had not received advance communication had not removed household items; had not prepared water for the spray operators to use for mixing and in some instances, no one was home and the homes were locked.

During the spray exercise in 2006 and subsequent exercises in 2007, it was made evident that local and political leaders were critical to the success of IRS. With their support, community members were encouraged to support the exercise and were mobilized in advance through community meetings, film vans and educational sessions, door-to door announcements and radio messages to prepare their homes for the spray teams.

Summary information taken from long-term IRS programs in other countries indicates that upon repeat exercises, people become increasingly reluctant to accept spray operators into their homes and some resistance to the insecticides which are sometimes perceived to be bad-smelling or leave stains. (Rozendaal, 1997). This has yet to become an issue in Uganda as to date, only Kabale and Kanungu have had repeated spray rounds.

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Key issues for communication can thus be drawn from the previous IRS experiences as follows:-

The support of National and Local leaders is critical to uptake and the success of IRS for malaria prevention and control;

Communication about the insecticides used must include evidence about their safety and the fact that the insecticides have been approved by WHO, NEMA and the MOH;

The use of DDT for IRS requires targeted, multi-level communication messages specifically designed to address the safety of the insecticide and to counter myths and misconceptions;

Communities should be informed how often their homes need to be re-sprayed. DDT requires spraying once a year; other insecticides including ICON™ require more frequent spraying;

Households should follow pre and post spray instructions

If the post-spraying instructions are followed, there are no side effects;

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“For me, I had made up my mind to participate but a lot of scary rumours about IRS made me change my mind.” Female IRS rejector

“If a hen eats a dead cockroach then it dies and our children are just like those hens.” Female IRS rejector

Others indicated that they didn’t understand why the spraying was conducted inside as opposed to outside of buildings where mosquitoes breed.

Because of the importance of the organic agricultural industry, many people were concerned about the impact of DDT on the viability of their market for goods. Some mentioned that they had been threatened by organic farmers that they would not get high returns for the sale of their products if they accepted spraying.

“The organic company from Lira said that they would buy our ‘sim sim’ cheaply once we accepted our houses to be sprayed.” Female IRS rejector

“I heard that once we spray, our produce will not be bought in markets abroad.” Male Organic Farmer

Others felt that the reason they were given for the use of DDT in the North was not adequate. Some believed that the use of DDT first in the North was a government plot to kill them because of the prevailing political differences with the ruling party. Participants indicated that local politicians exaggerated the political angle on radio and in public meetings.

Among those who accepted IRS, the most common reasons for accepting it were:

They had heard enough information about IRS and DDT either through their local health officials, through the radio or through ‘sensitization’ meetings

They had heard from a respected elder that it was ‘ok’ because DDT was ‘safi safi’ which had been used successfully in the past

They believed that the government was implementing IRS as a means to fight malaria

Both men and women who had positively accepted to have their houses sprayed noted that they had seen positive results due to the spraying: they had had fewer clinical visits for malaria cases; the rats and cockroaches had disappeared; and women stated that their husbands were not impotent. While many were pleased with the results, other acceptors noted with some skepticism that they were waiting for the duration of the 9 months until the next spray round to see if they experienced any side effects in the interim period.

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Communication Goal for IRS:

Malaria is eliminated from areas and populations at high risk

Audiences:

This strategy prioritizes three primary audiences:

National and local leaders in areas targeted for IRS

Heads of households and institutions targeted for spraying

Media representatives

Communication strategies for each of these audiences are described below.

Audience Analysis

Primary Audience:

National and local leaders representing areas targeted for IRS

Secondary Audience:

National and local leaders of areas adjacent to areas targeted for spraying

Leaders primarily targeted for the IRS activities are:

Elected officials (Local Council representatives and their executives);

Sub-county and parish chiefs;

Influential religious leaders;

Popular opinion leaders; and

District representatives, including District Health Teams, District Education Teams and the District Agricultural Teams.

Leaders of Organic Farmer Groups

This audience is likely to be literate, and listens to local FM radio. District leaders usually receive health information for health campaigns through district sensitization meetings. Sub-county leaders usually receive information from district personnel at sub-county meetings. Local parish level leaders including LC1’s receive information at parish level meetings.

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Communication Strategy Overview

According to the MoH’s National Indoor Residual Spraying Policy, 2007 the objective of IRS is to Reduce malaria transmission and to eliminate it from certain areas of Uganda.

The Communication Strategy for Malaria Control in Uganda 2005-2010 prioritizes problems and challenges for IRS communication as the following:

Few people know about IRS generally, how it is applied, its effectiveness and safety in controlling malaria;

Most people do not know who will be targeted for IRS or the rationale for targeted spraying;

Leaders and household members in targeted areas do not know what is required of them during the spraying exercise; and

There is widespread misinformation about DDT, particularly its safety and effectiveness.

The overall objective of IRS communication is to promote and facilitate behaviours supportive of IRS among national and local leaders, household heads, heads of institutions, and media. These supportive behaviours include:

Leaders support access to accurate and up-to-date information about IRS among community members and household heads;

Leaders in targeted spray areas make supportive statements for IRS and encourage household heads and leaders of targeted institutions to prepare their homes and structures for IRS; and

Household heads prepare their homes for spraying and follow instructions for post-spraying.

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Communication Objective

To increase the proportion of national and local leaders who know the important facts about IRS, value its benefits and support its implementation

Key Promises (Benefits): If you support IRS in your community you will:

Be recognized as a responsible and caring leader

Be recognized as a knowledgeable leader

Have a malaria-free, productive population

Support Points

IRS is an effective and safe means of malaria prevention, control and elimination;

IRS is the application of liquid insecticides inside human and animal dwellings to kill mosquitoes and other household pests;

The MOH is currently using DDT and ICON™ for IRS which have been approved by the NDA, the WHO and the National Environmental Management Authority;

IRS will be implemented according to the approved program of roll out in high malaria incidence or are prone to epidemics;

At least 8 out of 10 structures need to be sprayed in an area for IRS to be effective;

IRS using DDT is effective for up to 12 months; IRS using ICON is effective for up to 6 months

Spraying must be conducted prior to the transmission season in areas where transmission is seasonal (i.e.: before the rainy season);

IRS can only be conducted by professional spray operators who represent the community and who have been adequately trained;

IRS is not harmful to the environment;

IRS is conducted indoors;

Households and heads of institutions need to prepare their homes as instructed during the spray campaign.

Household heads and heads of institutions should follow instructions after spraying has occurred to guide inhabitants to stay out of the house for 2 hours including, personal belongings and pets.

Houses should not be painted, re-painted, plastered or re-plastered or smear the walls of their houses after spraying

IRS is provided free by the Ministry of Health;

Even if IRS has been done, everyone should still sleep under an ITN every night;

If anyone has become sick with malaria, they should seek treatment using Artemisinin based Combination Therapy (ACTs) from a qualified health care provider.

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Audience Profile

Trusted, respected, known widely

Married

Regarded as community ‘elders’

Highly influential and powerful

Desired Behaviour

Advocate for IRS with people in their area of influence

Share testimonies about IRS with people in their area of influence

Actual Behaviour

Lack technical support and knowledge about IRS

Provide inconsistent support for IRS

Reasons Why Audience is Not Currently Practicing Desired Behaviour

Concerned about the safety of the insecticides used

Unaware of their role in supporting the exercise

Lack understanding about why certain areas need to be sprayed

Do not understand the process of IRS

Benefits from Actual Behaviour

Gain/maintain popularity by de-campaigning DDT

Audience’s Feeling about IRS for malaria control

They are aware of the problem of malaria and the IRS program, but are hesitant to openly support it because they lack information

They generally support IRS but feel not enough is being done to help community members feel comfortable with IRS

Constraints

Lack of information about IRS

Lack of a communication package for IRS

Afraid of losing popular support if they openly support IRS, particularly DDT

Key Constraint to Practicing the Desired Behaviour

Lack of information about IRS

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Benefits from Actual Behaviour (rejecting IRS)

Protect themselves from harmful chemicals

Protecting agriculture

Audience’s feelings about the issue

They are aware of IRS as a means of malaria prevention and control

Many feel the chemicals, particularly DDT are dangerous

They are aware that there is a problem with malaria and many people especially children die of malaria

They are capable of accepting IRS and preparing their homes in advance if they have adequate information

Constraints

Negative or wrong information from the media, neighbours and local leaders about IRS and insecticides particularly, DDT

Widespread belief in the North that using DDT is a government plot against people of the North

•Poor timing – IRS sometimes implemented during rainy season


Lack of correct information about IRS


Increase the proportion of household heads that have adequate information about IRS and who follow pre, during and post-spray instructions in a timely fashion.

Key Promises (Benefits): If you prepare your home for IRS and accept IRS in your home:

You will protect your family from mosquitoes and other insects for up to 12 months

You and your family will prevent malaria

Support Points

IRS is an effective and safe means of malaria prevention, control and elimination;

IRS is the application of liquid insecticides inside human and animal dwellings to kill mosquitoes and other household pests;

IRS is safe for humans and animals;

IRS will be implemented in selected situations and districts which have high infection rates or are prone to malaria epidemics;

Spray operators wear protective apparel because they are in the home while the spraying takes place and handle concentrated insecticides all day

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Primary audience 2: Heads of households and heads of institutions targeted for spraying

Secondary Audience: Heads of households and heads of institutions in areas adjacent to spray areas and not targeted for spraying

This audience is likely to be semi-literate and listens to local FM radio stations. This audience also gets its information from community leaders, religious leaders, community based volunteers, health workers, neighbours, school children and other family members.

This audience widely knows and refers to IRS as ‘spraying’, ‘indoor house spraying or “fumigation” not IRS.

Audience Profile

Mostly rural

Men are household heads and decision makers

Majority are in a relationship and/or married

Some households are woman or child headed

Desired Behaviour

Heads of households prepare their homes for IRS in a timely fashion and follow pre, during, and post spray instructions as a result of being adequately informed

Actual Behaviour

Many accept IRS even though they lack adequate information because they believe it’s a mandatory government program

Some reject IRS in their homes

Some prepare their homes late or not at all for IRS

Reason Why Audience is Not Currently Practicing Desired Behaviour

Do not understand why their homes should be sprayed

Don’t believe IRS is effective

Believe that the insecticides used are harmful to their health and that of their families

Don’t understand how spraying reduces their risk for malaria

Are not aware that the spray activity is taking place in advance

Lack information about what they are supposed to do before, during and after the spray exercise

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Primary Audience 3: Media representatives

Audience Profile

This audience is both male and female, usually above the age of 25 years. They are literate, with varying levels of formal training in journalism or related fields. Media representatives exercise considerable influence on the actions of the public.

Desired Behaviour

To provide accurate and timely information about IRS and DDT for malaria prevention and control

Actual Behaviour

Often publish negative or sensationalist stories and articles about IRS, DDT and other insecticides and malaria

Reasons Why Audience is Not Currently Practicing Desired Behaviour

Lack of proper information about IRS and malaria generally

Believe that ‘sensational’ angles sell more papers

Benefits from Actual Behaviour

Public recognition

Paid by IRS and DDT opponents

Audience’s Feeling About Problem

Don’t see malaria as much of a priority as other diseases like AIDS

Some believe that insecticides, particularly DDT, are dangerous and not effective for malaria prevention and control

Constraints

Lack proper information about the problem

Have not been specifically targeted for IRS and DDT information

Paid by IRS and DDT opponents


Lack proper information about IRS and DDT

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You can not spray your home or building yourself; only trained spray operators can conduct IRS;

Spray operators are trained and responsible professionals from your community;

IRS will use DDT and/or ICON™ which have been approved by the MOH as safe and effective;

IRS is conducted indoors, not outdoors in the soil or gardens – it does not affect your produce;

You are required to prepare your home or institution for IRS during the spray campaign – remove all people, household goods, and animals from the house; provide a jerry can of clean water for the sprayers;

You are required to follow instructions after spraying – stay out of the house for 2 hours; and keep people, personal belongings and pets out of the house for 2 hours to allow the spray to dry properly and avoid minor irritation;

You should not paint, repaint, plaster or re-plaster or smear the walls of their houses after spraying

IRS does not increase the number of mosquitoes and other insects in your home; after spraying they become agitated and fly around making noise before they die, giving the immediate impression that there are more;

IRS is provided free by the Ministry of Health, you are not required to pay anything for the spraying;

Once spraying has occurred one should still sleep under a treated net every night; and

If you have been infected with malaria, seek treatment using ACTs from a qualified health care provider.

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Channels and Approaches

The following table describes the communication channels that will be used for leaders, household heads and, media representatives.

Tools/Channels for

Leaders

Objective Additional Details

Leaders’ fact sheet on IRS

Increase district and local leaders’ knowledge about IRS and provide guidance for answering questions about IRS from the public

Will guide discussion during public meetings, radio programs, film van mobilization activities

Not to be left behind with community members

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Radio Spots Increase knowledge about IRS among leaders to aid their communication to respective constituents and address key messages in a timely fashion

Targeting leaders in addition to household head

45 second spots

‘What is IRS?’ describes the process, the chemicals used, the benefits and will be aired before and throughout the exercise

‘How to Prepare’ describes the preparation process for the home and will be aired before and throughout the exercise

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Radio PSA Increase public knowledge about IRS

‘IRS is Coming’ 45 second PSA presented with an authoritative voice letting people know IRS is coming and that it’s safe and effective

Broadcast starting 2-3 weeks before spray exercise and throughout spraying

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Radio Talk Show

To increase knowledge about IRS in detail and address myths and misconceptions with correct information

Targeting household heads, community leaders

Local language

On air participants include District Health representatives, local political leaders, satisfied users of IRS, sprayer operators

11-part , 1-hour, weekly series discussing the key issues of IRS in more detail; first broadcast the night before the district sensitization meeting with Director General of MOH

Call in for question and answers

Broadcast for 8-11 weeks of spray exercise

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To increase the proportion of media representatives that disseminate correct information about IRS and insecticides used including DDT

Key Promises (Benefits): If you give out correct information about IRS, you will:

Be recognized by the community as reliable/credible source of information

Be recognized by the community as a partner in protecting the health and well being of Ugandans

Support Points

You have the power to make a positive difference in malaria prevention and control in Uganda;

IRS is an effective and safe means of malaria prevention and control;

IRS is the application of liquid insecticides inside human and animal dwellings to kill mosquitoes and other pests;

IRS is safe for humans and animals;

The MOH is currently using DDT and ICON™™ for IRS which have been approved by the NDA, the WHO and the National Environmental Management Authority;

IRS has been used successfully for malaria prevention and control in many African countries and in Uganda;

Areas are chosen for IRS based on the level of malaria infections and risk;

DDT is being used because it lasts longer and is less expensive than other insecticides;

IRS will be implemented in selected situations and districts which have high infection rates or are prone to malaria epidemics;

Spray operators are trained and responsible professionals chosen from the communities they spray;

IRS is conducted indoors, not in the soil or gardens – it does not affect produce;

IRS is provided free by the Ministry of Health;

IRS using DDT is effective for up to 12 months; using ICON™ is effective for up to 6 months;

Spraying must be conducted prior to the transmission season in areas where transmission is seasonal (e.g. before the rainy season);

IRS can only be conducted by professional sprayers who represent the community and who have been adequately trained;

IRS is not harmful to the environment; and

8 out of 10 structures need to be sprayed in an area for IRS to be effective.

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Tools/Channels for Household

Heads


IRS FAQ Pocket Reference on IRS

Increase spray operators’ knowledge about IRS and provide guidance on answering questions about IRS from household heads during spray exercise

For use by spray operators during the spray exercise to answer questions of household members

Carried in pocket; not left behind

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Radio Spots Increase public knowledge about IRS and address key messages in a timely fashion

45 second spots targeting household members, community at large

‘What is IRS?’ describes the process, the chemicals used, the benefits and will be aired throughout the exercise

‘How to Prepare’ describes preparation process for the houses and will be aired throughout the exercise

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Radio PSA Increase public knowledge about IRS

‘IRS is Coming’ 45 second PSA presented with an authoritative voice letting people know IRS is coming and that it’s safe and effective

Broadcast starting 2-3 weeks before spray exercise and throughout spraying

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Radio Talk Show

To increase knowledge about IRS in detail and address myths and misconceptions with correct information

Targeting household heads, community leaders

Local language

On air, participants include District Health representatives, local political leaders, satisfied users of IRS, sprayers

11-part, 1-hour, weekly series discussing the key issues of IRS in more detail; first broadcast the night before the district sensitization meeting with Director General of MOH

Call in for question and answers

Broadcast for 11 weeks of spray exercise

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Radio DJ mentions

To inform household heads of the spray schedule at least 24 hours before spray teams are schedule to arrive

Radio announcements made by local station DJs with details of spray schedule by parish

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Tools/Channels for

Leaders


District Sensitization Meetings

To Increase district leaders’ knowledge about IRS; gain their support; and encourage them to inform S/C leaders and household heads about IRS

1-day meetings to sensitize district leaders and area MPs on the implementation of spray exercise

1 meeting per district conducted at least 3 weeks before spraying and before sub-county and parish meetings

Addresses key messages

Allows question and answer of District Health team and Ministry of Health team, IRS contract workers

National and local media coverage

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•Sub-county Sensitization Meetings

To increase sub-county leaders’ knowledge of IRS; gain their support; provide instruction on how to carry out parish meetings

1-day meetings at sub-county level to sensitize sub-county leadership on IRS and address key messages

1 meeting per sub-county conducted shortly before spraying and 1 week before parish meetings

Allow questions and answers session from participants

Local media coverage

Show IRS video

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T-Shirts To encourage awareness and support of the IRS exercise among leaders; to encourage leaders to discuss the exercise with their constituents and peers

Short messages encouraging spraying

English and local language

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Banners To encourage support among leaders and community members of spray exercise

Placed at insecticide storage and dispensation sites at the district and sub-county health buildings

Marked with IRS slogan and MOH logos

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Tools/Channels for media

representatives


Media Outreach Activities

To inform media representatives (radio station managers, editors, journalists) about IRS and to encourage them to report accurate information about IRS and insecticides including DDT

1-hour interactive meetings conducted at the key media houses (print and electronic media) by IRS implementing partners

Discussion and question and answer format

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Schools and other institutions

To disseminate correct information to household heads about the spray exercise and DDT

Talking points for the head of the institutions using the FAQ on IRS Card

Distribution of print materials to the school and other institutions

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Materials’ Marking Guidelines

All materials will include the campaign slogan already developed by the MOH:

“Support House Spraying…Kill Mosquitoes, Fight Malaria.”

All print materials will be marked with the Ministry of Health ‘Fight Malaria’ logo (see below) and the Ministry of Health Coat of Arms. No other organizational logos or credits will be included.

Tools/Channels for Household

Heads


Parish sensitization meetings

To increase knowledge of household heads about IRS; give them instruction on how to prepare their home; answer questions about chemicals used and safety; discuss the benefits of malaria prevention using IRS; reiterate the importance of net use and treatment using ACTs

½ day meetings with community members at parish level

1 meeting per parish conducted shortly before spraying commences

Facilitated by district health team/sub-county health team

Show video

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Spray operators’ graduation ceremony

To increase community confidence in professionalism of sprayers and officially announce the completion of sprayer training and the commencement of IRS in the district

½ day ceremony conducted on last day of spray operator training

1 event per district in a chosen sub-county

Spray operator trained on how to use the spray operators’ pocket reference with household heads and given certificates

Spray operators march through the sub-county in protective apparel with banners on IRS and brass band

Local media coverage

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•Community mobilization with film van and district health mobilizer

To help household heads understand the benefits of IRS, how it’s applied and the safety and effectiveness of the chemicals used

1-event per parish—more if budget allows

Health educator presents IRS video to mobilize participants;

Conducts information session detailing key messages for IRS

Answers questions of community members

Informs community when IRS will be starting

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References

Rozendaal JA (1997) House Spraying with insecticides. World Health Organization 357-384

Research Triangle Institute International (October 2006) Uganda IRS Project, Kabale District. Project Report.

Malaria Control Program, Ministry of Health Uganda. Draft Policy and Strategy for Indoor Residual Spraying (2006)

Health Communication Partnership (2007). Draft Report of Focus Group Discussions on IRS in Kabale.

World Health Organization (2006) IRS WHO Position: Use of indoor residual spraying for scaling up global malaria control and elimination

Curtis, C (2000) Comparison of House Spraying and Insecticide Treated Nets for Malaria Control. Bulletin of the World Health Organization 78 1389-14000

Musawenkosi L, Mabaso H, Sharp BL and Lengeler C (2004) Historical Review of Malaria Control in Southern African with emphasis on the use of indoor residual house-spraying. Tropical Medicine and International Health 9 (8) 846-856.

Batega, D. (2004). Knowledge Attitudes and Practices about malaria treatment and prevention in Uganda; a Literature Review. Health Communication Partnership

Gunasekaran K, SAhu SS, Jambulingam P and Das PK (2005) DDT Indoor Residual Spray, still an effective tool to control Anopheles fluviatilis-transmitted Plasmodium falciparum in India. Tropical Medicine and International Health 10 (2) pp 160-168.

IRIN Humanitarian News and Analysis. January 2006. Uganda: DDT and the quick fix debate (www.irinnews.org)

Aneck-Hahn, N., Schulenberg, G., Bornman M., Farias, P., de Jager, C. (2006) Impaired Semen quality associated with environmental DDT exposure in a malaria area in Limpopo Province, South Africa. Journal of Andrology. Published ahead of print.

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IRS TOOLKIT - Step 1

Step � ASSESSMENT, PLANNING AND BUDGETING

Objective:

To assess the current communication infrastructure in the district, including relevant partners and unique IRS communication issues, and design the communication implementation plan.

Summary:

Step 1 is divided into three main components: Assessment, Planning and Budgeting. During this step, the IRS planning team will begin the process of planning the implementation of communication activities for the district. This step should begin at least 5-6 months before the actual spraying is scheduled to allow for adequate implementation. It is critical that the IRS communication component is implemented in tandem with the other IRS planning activities from the very beginning.

Planning/Budgeting:

Step 1 should first start with planning the communication activities in tandem with the district planning team. During the first District Planning Meeting the Communication Team should present the IRS Communication Toolkit (Using the Toolkit Presentation) outlining the steps which need to be considered for communication. The Communication team should come prepared with IRS Frequently Asked Questions and Leader Leaflets to answer questions about IRS.

During the planning stage, the District Team should also draw up the budget and timeline for communication implementation (Using template budget and timeline and District Sensitization Process). Communication team members should be identified at the district and they should represent multiple sectors including Health Education, Vector Control and Education and Local Government.

Assessment:

During the initial planning meetings, the communication team should conduct assessments of the communication needs and infrastructure in the district (IRS Communication Needs Assessment Questionnaire). This assessment will help planners identify how to position communication materials and messages; which channels and media houses are best to use; and to understand any unique communication issues particular to the district. The findings should be presented to the rest of the district IRS implementation team.

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Step 1 - IRS TOOLKIT

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IRS TOOLKIT - Step 1 - Breakout Timeline

BREAKOUT TIMELINE - STEP �



Step 1: Assessment, planning and budgeting Spraying begins

Hire communication officer Items: 1Attend introduction IRS meetings in district

MoH/ Contractor

Items: 1, 1a 2, 3, 4, 7, 8, 9, 10, 11, 12

Introduce Communication Toolkit at micro planning district workshops

MoH/ Contractor

Items: 1, 1a, 2, 3, 4, 7, 8, 9, 10, 11, 12

Design work plans and budgets for activities


Items: 1, 1a, 2, 3

Conduct FGD with DHMT Items: 5Conduct FGD with community members and leaders to determine information and understanding of IRS and insecticides (optional)


Items: 6, 8,

Step 1 Tools to Reference:


Step 1: Assessment, planning and budgeting

1 Template IRS Timeline for Communication Activities

PDF/WORD Toolkit intro annex, CD

1a National Communication Strategy for IRS Hard Copy Toolkit intro annex

2 Template IRS Communication Budget PDF/Excel Toolkit intro annex, CD

3 IRS Sensitization Process Guidelines PDF Toolkit intro, CD

4 IRS toolkit presentation Powerpoint CD

5 Communication Needs Assessment Questions DHMT

Ms word CD

6 Focus Group Discussion Guide for community members

Ms word CD

7 IRS Leader Leaflet PdF CD, annex step 1

8 IRS Frequently Asked Questions (FAQ) PDF CD, annex step 1

9 10 Things on DDT PDF CD, annex step 1

10 FAQ on DDT PDF CD, annex step 1

11 WHO on IRS PDF CD, annex step 1

12 Film “IRS : What you need to know” DVD video Toolkit Annex

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Item 3 - The Sensitisation Process for Indoor Residual Spraying - IRS TOOLKIT

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IRS TOOLKIT - Item 3 - The Sensitisation Process for Indoor Residual Spraying

Materials

Materials used during the communication portion include:

IRS Communication Toolkit Presentation highlighting the program development and description as well as experience in the first districts, the role of different stakeholders in promoting and implementing the program.

IRS toolkit

IRS Video

District Communication Needs Assessment Questionnaire (from toolkit)

Copies of Leader Leaflet – describing the role of leaders in supporting IRS

Copies of the ‘Frequently Asked Questions’ about IRS in English

WHO DDT fact sheet

Product for IRS Communication

By the end of the meeting, the key products are:

A sensitised DHMT

A plan and budget for sensitising health workers and community leaders at Sub-county level (and if the budget allows), at lower levels.

A focal person for the program in the district, chosen from among the DHMT members. His/her role will be to co-ordinate program activities in the district, becoming the link between the district, HSD and Ministry of Health.

DISTRICT LEADERS’ SENSITISATION

Planning

Planning for the District leaders’ sensitisation begins at the DHMT meeting. The first target audience is the District Local Council (LC V) together with the district administrative heads of departments and opinion leaders. This includes all councilors at LC V, the Chief Administrative Officer (CAO) and heads of departments in the district administration (e.g. District Education Officer, District Information Officer, and District Community Development Officer) as well as heads of religious groups in the district.

The Meeting

The already sensitised members of the DHMT facilitate meetings with support from the Malaria Control Program.

The Agenda

The agenda for the meeting is similar to that of the DHMT, without the detailed planning for sensitisation of the community leaders. However, the councilors are requested to participate in this activity as and when they are available to do so.

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Item: � The Sensitisation Process for Indoor Residual Spraying

Letting everyone know about the programme allows the different stakeholders to play their part in assisting the district to effectively implement indoor residual spraying and eliminate malaria. One of the main thrusts of the communication strategy of IRS implementation is the Sensitisation Campaign. This targets the District Health Management Team (DHMT), District/Community Administrative and Political Leaders.

DHMT SENSITISATION

Planning

One-day sensitisation meetings are held with the DHMT of each district. While the meetings cover the entire IRS program, a significant portion should include an agenda for planning IRS communication.

The meetings are planned with the District Director Health Services (DDHS) so that all members of the team are invited and are able to attend. These members include the DMO, Deputy DMO (if applicable), District Health Visitor (DHV), District Vector Control Officer, District Nursing Officer (DNO), District Health Educator (DHE), District Health Inspector (DHI), District Malaria Focal Person, District Surveillance Officer or HMIS Officer, District Drug Inspector, representatives of key NGOs operating in the district. The average number of people invited to the meeting is 20, but in the larger districts it may reach 25.

The Meeting

The meetings are facilitated by a central team of supervisors from the Malaria Control Program

The Agenda

The agenda for the meeting is as follows:

Welcome and Introduction

Background and History of malaria in Uganda and in the district

IRS Program Description

Experience to date

Review of IRS video

Assessment of needs using needs assessment

Review of IRS communication materials

Guidelines for the District Work Plan for implementing IRS

Budget Amount

Timeline

Developing Work Plan

Creating a Corresponding Budget

Identifying Support Needs

Closing Remarks

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Item 3 - The Sensitisation Process for Indoor Residual Spraying - IRS TOOLKIT

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IRS TOOLKIT - Item 3 - The Sensitisation Process for Indoor Residual Spraying

Product


Sensitised Sub-County Leaders.

A commitment by the leaders to advocate for and support IRS

PARISH SENSITISATION

The third target audience are local leaders and influential community members living and working at parish level.

The Meeting

Sensitized leaders from the sub-county along with the District Health Education Team.

The Agenda

Similar to Sub-County agenda with time allowed for question and answer.

Materials

Materials used during the sensitisation meeting include:

Presentation of the IRS toolkit

IRS toolkit.

IRS video

Leader Leaflet

Frequently Asked Questions about IRS

WHO DDT fact sheet

Product


Sensitised Parish Leaders and community members.

A commitment by the leaders and local influentials to advocate for and support IRS

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IRS toolkit.

IRS video

Leader Leaflet


WHO DDT fact sheet

Product


Sensitised district leaders.

A commitment by the leaders to advocate for and support IRS

SUB-COUNTY LEADERS’ SENSITISATION

The second target audience is the LC III councilors, who are the political leaders at Sub-county level. These also include leaders from parish level, with some members of Parish Development Committees. Sub-county Chiefs, who are the administrative arm of the CAO’s office at Sub-county level and religious/opinion leaders in the community, are also invited to this meeting as in the case of the LC V meeting. If the budget allows, community leaders at lower levels (parish and village) should also be sensitised.

The Meeting

The already sensitized leaders from the District facilitate meetings with support from the Malaria Control Program and the District Health Education Team.

The Agenda

The agenda for the meeting is similar to that of the District Sensitization Meeting, without the detailed planning for sensitization of the community leaders. However, the councilors are requested to participate in this activity as and when they are available to do so.

Materials



IRS toolkit.

IRS video

Leader Leaflet


WHO DDT fact sheet

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Item 7 - Leader’s Fact Sheet - IRS TOOLKIT

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IRS TOOLKIT - Item 8 - FAQs for The Community on House Spraying for Malaria Control

Item: � Frequently Asked Questions FOR THE COMMUNITY ON HOUSE SPRAYING FOR MALARIA CONTROL

ENGLISH


• Allow spray teams to enter your houses and spray;

• Stay outside the house for at least two hours after spraying;

• Sweep and mop the floor of the house after two hours before children and pets are allowed to re-enter the house;

• Collect dead insects and water used to mop and pour them both in a pit latrine;

• Do not smear, plaster (or re-plaster) or paint (or re-paint) interior walls after spraying for 9 months.

How often should my home be sprayed?The insecticide remains active against malaria mosquitoes for a long period of time.It is advisable to spray once a year, depending on the local climate and the conditions of the sprayed walls.

Am I allowed to spray my own house?No. There are people specifically trained for this exercise. It requires the right type of sprayers, recommended insecticides and protective wear.

Will the bushes be sprayed as well?No. Spraying targets the mosquitoes that transmit malaria which feed and rest inside houses.

Is Indoor House Spraying free?Yes. It will be provided free by the Ministry of Health

Why should I stay outside for 2 hours after spraying my house?To allow the insecticide to dry properly.When will my house be sprayed?The LC leader will inform you when the spray teams will be coming to your house.

Support Indoor House Spraying... Kill Mosquitoes,

Fight Malaria

Produced by the Malaria Control Programme of the Ministry of Health. Funded by the United States Agency for International Development

FREQUENTLY ASKED QUESTIONS (FAQS) ABOUT INDOOR HOUSE SPRAYING

FOR MALARIA CONTROL

How to use this card:

The questions on this card are the questions which have been most asked by community members during Indoor House Spraying in Uganda. Use this card to answer questions asked by community members. If community members have additional questions refer them to their local health worker or local health centre.

What insecticide are you going to use for Indoor House Spraying in this area?DDT is the insecticide currently being used. It is a safe and effective insecticide that has been approved for use by the World Health Organization (WHO), Ministry of Health, National Drug Authority (NDA) and the National Environmental Management Authority (NEMA). It has been used successfully for controlling malaria in many countries.

Why are you using DDT?DDT has been proven as safe and effective for fighting malaria. It is not harmful to humans or animals. DDT lasts up to 9 months, longer than other insecticides. If DDT is used, houses only need to be sprayed once per year, so it is very cost effective.

How does DDT work?When malaria carrying mosquitoes come into contact with sprayed walls, they become restless and confused. They keep flying around until they either fly out of the house or die.

Why has this area been selected for spraying?This area has been highly affected by malaria and many malaria patients and deaths have been recorded. Hence, it is important to control malaria in this area with approved and effective methods such as Indoor House Spraying.

What is Indoor House Spraying?Indoor House Spraying is the spraying of safe and effective insecticide on the walls and ceilings of houses. Because malaria is spread by mosquitoes which bite and rest indoors, Indoor House Spraying will only be conducted on the inside walls of houses. After spraying, mosquitoes carrying malaria in your house will die.

What does a community member need to do to support the exercise?

• Remove portable household items especially food stuffs, water, valuable items, cooking utensils, etc. before spraying;

• Ensure that sick people, domestic animals and birds are also moved outside before spraying;

• Provide a jerry can of clean water for Spraying;

Item: � Leaders’ Leaflet

ENGLISH

Malaria is a leading cause of illness, death and poverty in Uganda. It is transmitted by the female Anopheles mosquito when it bites a human being. Therefore, killing mosquitoes controls the spread of malaria.

The Ministry of Health has adopted Indoor House Spraying as one of the most effective interventions for prevention and control of malaria.

Indoor House Spraying is the application of insecticides with long lasting effects on the inside walls of houses in order to kill malaria carrying mosquitoes.

Your area has been selected for Indoor House Spraying because it has one of the highest rates of malaria in Uganda and many malaria patients and deaths have been recorded. The insecticide used is DDT.

DDT is safe, effective, cost effective and has been approved for use by the World Health Organization (WHO), the Ministry of Health, National Drug Authority (NDA) and the National Environmental Management Authority (NEMA). It has been used successfully in many countries.

Indoor House Spraying will be conducted by trained spray operators and team leaders who are selected by community members in each sub-county. The exercise will be closely supervised by the District Health Team and the Ministry of Health.

The District Health Team and the Ministry of Health are requesting that local leaders support this exercise by:

• Mobilizing the community to support and participate in this exercise;• Informing community members about the benefits of the exercise and linking them with the spray

teams; • Ensuring that all houses in their villages are sprayed in order to have full effect;• Helping community members to get assistance if they have concerns about the way the spraying was

conducted in their home;• Reporting anyone seen misusing insecticides to District Officials. This insecticide is to be used ONLY

for malaria control.

The District Health Team and the Ministry of Health are also requesting that leaders educate and prepare their communities to support the exercise. Leaders should make sure that community members do the following:

• Remove portable household items especially food stuffs, water, valuable items, cooking utensils, etc. before spraying;

• Ensure that sick people, domestic animals and birds are also moved outside before spraying;• Provide a jerry can of clean water for spraying; • Allow spray teams to enter your house and spray;• Stay outside of the house for at least two hours after spraying; • Sweep and mop the floor of the house after two hours before children and pets are allowed to re-enter

the house; • Collect dead insects and water used to mop and pour them both in a pit latrine.• Do not smear, plaster (or re-plaster) or paint (or re-paint) interior walls after spraying for 9 months.

For Indoor House Spraying to be effective, it is important for the entire community to cooperate.

If any person(s) have questions or concerns about the Indoor House Spraying program, kindly contact:The office of the Director District Health Services or your nearest Health Facilityfor further information.


Support Indoor House Spraying... Kill Mosquitoes,

Fight Malaria

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Step � MATERIALS PRODUCTION AND DISTRIBUTION PLANNING

Objective:

To identify and contract vendors for materials’ production and plan materials dissemination.

Summary:

Step 2 begins the IRS Communication implementation process. Careful planning during this step will ensure that materials are produced in adequate numbers and are ready when sensitization and mobilization activities begin. Schedules for all district sensitization and mobilization including film van schedules should be completed during this stage. Key activities in Step 2 include: Contracting media partners and vendors and briefing media houses on IRS; developing media schedules; adapting all radio and print materials and producing them in local language(s).

Sub-Contracting:

The planners should identify and contract vendors for radio, print materials, banners and t-shirts production. Selected radio stations should be recognized as reliable and accessible by the target audiences. Agreements with each media house should include time for the IRS Communication Team to orient the media representatives, station managers and editors to the basic facts of IRS to ensure they are comfortable with the information they will disseminate.

Developing Media Schedules:

This is typically done with media houses at the time of sub-contracting. The Communication team will refer to the planned spraying schedule when determining when radio broadcasts (talk shows, DJ mentions and spots) will begin and when specific topics will be covered.

Adapting radio, video and print materials:

This toolkit includes Microsoft Word versions of print, radio and video materials in English and several local languages in Microsoft Word and in PDF versions. Among them: Frequently Asked Questions on IRS; Basic Information on IRS for Leaders; banners; t-shirts; scripts for 1 public service announcement and 2 radio spots; and a radio talk show outline and template DJ mentions.

Copies of template materials and scripts are included in Microsoft Word to allow for revisions and adaptations as necessary and then translation. PDF files or audio files of previously produced materials are included for review.

Additionally, a copy of the IRS video, “IRS: What you need to know” and the script in English is enclosed. These materials have been widely pre-tested in the areas they were used. Ideally the print and radio materials would only need slight local adaptations and translations to local languages before they are reproduced. The IRS film should be merely translated and voiced in local language(s) as necessary.

The WHO has also produced several fact sheets on IRS and DDT which may be useful and which can be reproduced. The PDF files are also included in this Toolkit.

2 It is recommended that once the materials are adapted, even if it is just to translate, that they are pre-tested for understanding in the local language.

The Communication team should refer to the sensitization plans, the National IRS Communication Strategy and available resources to determine quantities of print materials to produce.

During this step it is also recommended that the Communication Team becomes familiar with the Radio Talk Show outline and begins to mobilize guest speakers and adapt talking points as necessary.



13 All materials pre-test methodology MS Word CD, annex, step 2

14 FGD guide for all materials pretest MS word CD, annex, step 2

15 Pre-test recording sheet MS Word CD

16 Template pre-test budget MS excel CD

17 Radio Spots and PSA scripts in English MS word CD

18 IRS FAQ template- English MS Word CD

19 IRS Leader Leaflet template- English MS word CD

20 Radio talk show outline MS word CD, annex, step 2

21 Template DJ Mentions MS word CD, annex, step 2

22 Special event radio talk show outline MS Word CD

23 IRS video script English MS word CD

24 Template t-shirt text Design file CD

25 Template banner text Design file CD

26 Logos Design file CD

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Step 2 - Breakout Timeline - IRS TOOLKIT

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IRS TOOLKIT - Item 20 - IRS Radio Talk Show Outline





Contract radio stations & schedule broadcasts

Districts/contractor

Items: 1, 2

Conduct orientation with radio station managers and media personnel

Items: 7, 8, 9, 10, 11, 12

Radio Spots/PSA

Translate content for radio spots, PSAs in local language for pretest

MoH/Districts Items: 17

Check and revise local language tranlation

MoH/districts/contractor

Items: 13, 14, 15, 17

Review & approval of radio materials

Districts/MoH/contractor

Produce final spots and PSA in local language

Radio Stations/Districts

Items: 2

Radio Programs

Identify presenters/guests for radio programs

Districts/Radio Stations

Items: 20, 22

Discuss format with stations & determine date/time of shows

Radio Stations Items: 1, 20, 22

Adapt talking points/key messages

District/ MoH/Contractor

Items: 20, 22

Mobilize guest speakers Districts/MoH Items: 20, 22Print Material-leader fact sheet, IRS Frequently Asked Questions

Adapt and translate IRS FAQ, Leader Leaflet

MoH/Districts Items: 18, 19

Check and revise translation

MoH/Districts/Contractor

Items: 13, 14, 15

Review/approval of final material

MoH/Districts

Finalize and print materials Vendor Items: 2Print IRS t-shirts for sensitization Meetings

MoH/Contractor

Items:24

IRS Film

Translate IRS film in local languages

District/MoH/Contractor

Items:23

check local language translation and complete

MoH/Contractor

Items:23

Community Film shows

Schedule film vans with MoH

MoH/District Items: 1,2

Item: �0 IRS Radio Talk Show Outline

Purpose of the multi-part talk show radio programs:

To inform the audience about malaria situation in the district and the country, how it spreads, economic burden on the household, community and at district level and why the district is most vulnerable to malaria epidemic outbreaks.

To inform the audience about the recommended vector control interventions (IRS and ITNs).

To encourage the audience to prevent malaria through participation in the recommended strategy of intervention ( IRS)

To inform audience about other areas in the national malaria prevention and control strategy

To allow audience to ask questions and to get accurate information about IRS for malaria prevention and control.

TOPIC ONE: Facts about malaria in general

Introduce that this will be a multiple-part series on malaria prevention, treatment and control and particularly about indoor residual spraying ‘spraying’ that will be conducted by the MoH in the area

Content:

Define what is malaria

How it is transmitted from one person to the other

The burden of malaria to Uganda, at district, community and household level

The burden of malaria at facility level (Describe daily or weekly, monthly malaria cases recorded or received at facility level)

Introduce the next topic

TOPIC TWO: Vector Control -Main focus on Indoor Residual Spraying (IRS)

Content:

Describe what is meant by ‘IRS’

What is involved in IRS? Planning, Training of sprayers, sensitization of political leaders etc

Give experiences of where IRS has been implemented in Uganda, e.g. kabale, Kanungu, Amuru, Kitgum, Apac, Oyam etc

Discuss the safety and effectiveness of IRS

Introduce next topic

TOPIC THREE: Who is at risk of getting infected with malaria?

Content:

Describe that everybody is at risk for malaria

Talk about the times when one is bitten by mosquitoes

Talk about the most vulnerable populations (children <5 years, pregnant women, sickly, HIV positive, everybody)

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Item 20 - IRS Radio Talk Show Outline - IRS TOOLKIT

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Discuss the importance of prevention


TOPIC FOUR: Implementation of IRS in District (select district)

Content:

Describe rationale for selecting district for IRS

Talk about benefits of malaria prevention using IRS to an individual, community, district and at national level.

Describe how IRS will be implemented in Uganda (timeline and activities)

The other advantages of IRS; ie; malaria prevention relieves household of other insects ( spiders, bedbugs, etc)

Describe the role of the community during the implementation of IRS activity


TOPIC FIVE: Different types of insecticides used in IRS

Content:

List the different types of insecticides used in vector control and the government policy

Specifically mention the several types of insecticides approved by MOH and WHO, NEMA, NDA

Talk about the safety, effectiveness of these insecticides

Explain why the Ministry of Health is using several types insecticides


TOPIC SIX: The use of Dichlorodiphenyltrichloroethane (DDT) to fight malaria in Uganda

Content:

What is DDT?

Why will the government apply DDT to fight malaria in Uganda

Talk about the safety of DDT, being approved by WHO, MOH and NEMA

Dispel the myths about DDT

Talk about the procedures in place to ensure proper use and disposal of DDT


••

••

••

••

•••••

••••••

TOPIC SEVEN: What is the role of district leaders during the spray exercise?

Content:

Discuss responsibilities for the district leaders – what they need to do to encourage support of IRS in their communities

Discuss responsibilities for the community

Discuss responsibilities for each household– what to do before, during and after spray exercise


TOPIC EIGHT: Political Support of IRS

Content:

Suggestion: Invite an area member of parliament or RDC from the same district or a neighboring district where spraying has already been conducted. Select someone who has already had their home sprayed. Let the political leader share his/her experience with the listeners.

Introduce the guest to the listeners

Let him/her inform the listeners where she/he comes from e.g. Area MP, RDC

Ask her/him guiding questions on the following issues:-

o How s/he learnt about the spraying

o Why he/she participated in the spraying

o How his/her constituency has benefited from spraying exercise

o What advice s/he has towards the listeners

TOPIC NINE: Community Support of IRS as a guest speaker

Content:

Suggestion: Invite a spray operator and a person whose house has been sprayed to come on this program and give her/his experience about the spraying exercise to the listeners. The person whose house was sprayed can tell people about how nice it is to have all the insects gone, able to sleep, no more mosquito bites etc.

Introduce the guest to the listeners

Let him/her inform the listeners where she/he comes from e.g. sub-county parish, village

Ask him/her guiding questions on the following issues:-

o How s/he learnt about the spraying

o Why he/she participated in the spraying

o How s/he was treated by the Spraying team

o What s/he did to prepare her house to be sprayed

•

•••

•••

•••

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TOPIC TEN: Malaria treatment/Case management

Describe MOH approach to treat malaria patients

Talk about the new malaria treatment policy (ACTs)

Why the MOH introduced the new malaria treatment

How ACTs are administered (dosage) depending on age and weight

Where to get ACTs and cost of ACTs (free from public health facilities)

The importance of seeking early medical advice for malaria if you detect malaria symptoms after spraying


TOPIC ELEVEN: Wrap up session/Question and Answer

This last session might include a question and answer session which would be used to make clarification on issues which would have not had sufficient time to be handled during the previous shows.

Possible questions

Clarifying myths and misconceptions about IRS in Uganda

Why is the Ministry applying IRS in particular districts and not others?

Why is the MOH using DDT to fight malaria?

Why is malaria a very serious problem now compared to the early 50s?

Why doesn’t the government give free nets to all the people of Uganda rather than applying DDT?

Is there a mechanism for handling any emergency that might arise as result of failing to observe the safety guidelines?

Do I still need to sleep under a treated net when my house has been sprayed?

Where will the next spraying activity take place in Uganda?

TOPIC TWELVE: Why the community should observe new malaria treatment protocols using ACT (Artemisinin based combination therapy) (optional)

Content:

Talk about peoples’ behaviors towards malaria treatment

Importance of getting proper treatment within 24 hours of noticing symptoms

Importance of completing the entire dose

Importance of proper diagnosis before self-medication

Importance of not sharing medicine with others

All the above practices lead to drug resistance; complicated malaria turns into severe malaria, death


••••••

•

1.

2.

3.

4.

5.

6.

7.

8.

••••••

•

The following sessions are optionalThe following sessions are optional

TOPIC THIRTEEN: Vector Control – ITNs (optional)

Content:

Describe what is meant by ‘vector control’

Talk about the breeding sites of the mosquitoes

Briefly talk about the recommended methods of vector control by MoH (ITNs, window screens, IRS).

Talk about importance of nets even if house is sprayed

What are ITNs, where they could be assessed and how they are used

Talk about regular use and re-treatment of ITNs.

Talk about benefits of malaria prevention to an individual, community, district and at national level


TOPIC FOURTEEN: How to look after your Long Lasting Insecticide Treated Mosquito Net (LLIN) (optional)

Content:

Explain what is meant by Long Lasting Insecticide Treated Mosquito Nets (LLINs)

Give examples of approved LLINs in Uganda

Talk about the mechanisms of accessing these nets ( free nets, subsidized, commercial nets)

How to handle your LLINs in a home( hanging, use, washing, storage, repairing)

Talk about the free net re-treatment exercises done by the ministry

TOPIC FIFTEEN: Malaria in Pregnancy (optional)

Content:

Describe what is meant by Malaria in Pregnancy

Talk about the three key components of malaria in Pregnancy

Talk about the dangers of malaria during pregnancy

Talk about the preventive strategies (ITNS and IPT)

Talk about the importance of partner support/male involvement during pregnancy

•••

••••

•

•••••

•••••

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IRS TOOLKIT - Item 13 - Pre-test Methodology for IRS Leader Leaflet and IRS FAQs

______________________________________DISTRICT

Radio Talk Show Schedule

Date Time Topic Moderator Guest Speaker

Item: �� Pre-test Methodology for IRS Leader Leaflet and IRS FAQs

Objective of the pre-test

To establish whether the materials convey messages about malaria that are complete, clear, attractive, understandable, acceptable, believable and convincing in local language

Target population

The materials will be pre-tested with key audiences. The IRS Frequently Asked Questions will be pre-tested with men and women living in urban and rural areas targeted for spraying between 18 and 45 years.

The Leader Leaflet will be pre-tested with groups of leaders in areas targeted for spraying

Description of Focus Groups

The Focus Groups discussions will be conducted by a moderator who will be accompanied by a recorder. The moderator and recorder must be the same gender as the focus group participants and must speak the same language as the focus group participants

Each focus group will be comprised of 8-10 people screened as follows:

All participants should speak the same language

All participants should be either male or female

All participants should be between 18-45

All participants should be able to read and understand the language in which they are being pre-tested

Use a recording sheet to record all responses for pre-test. Please remember to indicate the language and topic of the item on the recording sheet.

••••

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Item 14 - Pre-test Focus Group Discussion Guide - IRS TOOLKIT

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IRS TOOLKIT - Item 14 - Pre-test Focus Group Discussion Guide

Item: �� Pre-test Focus Group Discussion Guide

Step 1:

Greet the participants as follows:

Good morning/ afternoon. My name is____________________and my colleague is _____________________. We work with [insert organization]. We are working to help adapt a set of malaria materials for indoor residual spraying for your local language.

The purpose of this discussion is to pre-test a [insert item] about IRS. The pre-test will help us to determine whether the communication materials convey messages that are appropriate, acceptable, relevant and understandable in your language. We would like your input to help us finalize the materials before they are produced and disseminated in their final form. As such, we value your contribution very greatly.

We are going to look at the [insert item] first and then we will ask you a few questions.

Please relax, and feel free to ask any questions you would like to ask.

The discussion will last about 2 hours. We are here to share views hence there are no right or wrong answers. Everyone is encouraged to say what they feel

Step 2:

Start by asking some general questions then ask those related to the materials. (Let the participants know you are doing this – the general questions should take a short time.)

General Questions

What is malaria?

What causes malaria?

How is malaria transmitted (i.e. spread from one person to the other)

Step 3:

Distribute [material] to each of the participants, give them time to read through the section you are interested in.

Step 4:

After each one of them has finished reading, ask them the following questions (please make sure to ask all questions):

1. Pretest questions for the [material] Cover

What is the message of the leaflet?

1.

2.

3.

•

Who is this leaflet written for? (Describe that person)

Is there anything unclear in these two pages? If so, what?

What did you like on this page?

What did you dislike in this page?

How can this page be improved?

2. Pretest Questions for each article (page)

What message did you get from this section of the leaflet?

What do you see in the picture?

Is there anything unclear in this section? If so, what?

What did you like about this section?

What did you dislike about this section?

How can this section be improved?

3. Pretest Questions for entire item

What is the main message of the leaflet?

Who is this leaflet written for? Describe the person.

Does the leaflet ask you to do anything? If yes, what?

Does the leaflet give enough information about IRS? If not, what should be added?

What is the general comment about the entire leaflet (i.e. layout and design; is it easy to follow and understand, why or why not)?

What can be done to improve the leaflet?

Step 4:

Thank them for their time.

•••••

••••••

•••••

•

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Step � ORIENTING SPRAY OPERATORS IN COMMUNICATION AND INFORMATION

DISSEMINATION

Objective:

Spray Operator Trainers are oriented to IRS communication plans; their role in IRS communication and the IRS communication materials

Summary:

The Spray Operators are a critical component of effective IRS communication. They are the primary contact for household heads and heads of institutions during the spray exercise. As a result, it is important that they are able to answer questions posed by community members and refer people with more detailed questions or concerns to the appropriate district personnel.

During this step, the IRS Communication Team works with the District Planning Team to plan and implement training for Spray Operators which includes a module on effective IRS communication. It is recommended that the communication team trains the Spray Operator Trainers who use the guidelines in their training sessions with spray operators. After this initial training, the Communication Team can provide some support supervision to Spray Operator trainings as required.

Upon developing the Spray Operator TOT schedule, the Communication Team should identify a trainer and make sure the trainer is familiar with the IRS Communication Orientation Guidelines detailing how the session should be conducted; the Frequently Asked Questions on IRS card and the IRS video provided in this toolkit. The trainer should be fluent in English and the local language most commonly spoken.



27 Spray Operator Communication Orientation Guidelines

PDF CD, annex step 3

8 Frequently asked questions on IRS (FAQ) PDF CD

12 Film “IRS :What you need to know” DVD Toolkit annex

3 BREAKOUT TIMELINE - STEP �




Conduct Orientation during spray operator TOT (ideally 4 months before spraying starts)

Contractor Items: 8, 12, 27

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Item 27 - Spray Operator Communication Orientation Guidelines - IRS TOOLKIT

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IRS TOOLKIT - Item 27 - Spray Operator Communication Orientation Guidelines

Item: �� Spray Operator Communication Orientation Guidelines

Objective:

Spray Operator Trainers understand how to orient spray operators to use IEC materials to communicate basic information about IRS with household and institution heads during spray exercise.

Materials Required:

100 copies of IRS FAQ (enough for everyone to have several copies); IRS video; DVD player and television or computer with LCD projector; newsprint; markers

Duration:

1.5 Hour; to be conducted during the Spray Operator TOT

Time Discussion Topic Format

5 mins. Introduce the objective of the session Lecture

10 mins. Introduce the components of effective communication

Lecture/Discussion

20 mins. Exercise on Effective Communication Group Activity/discussion

20 mins. Introduce Trainers to IRS Frequently Asked Questions (FAQ)

Read through each section as group; question and answer

25 mins. Film “IRS : What You Need to Know” Show video and answer questions

5 mins. Wrap up session Group

Introduce Session Objective:

Step 1:

Introduce self and indicate to the group that the overall objective of this session is:

Spray Operator Trainers understand how to orient spray operators use IEC materials to communicate basic information about IRS with household and institution heads during spray exercise

It is important that spray operators are able to communicate the benefits of IRS to household heads and institutions targeted for spraying. Spray operators are key to making sure people of correct information about IRS. People expect spray operators to be knowledgeable, informed and professional.

Step 2:

Introducing Effective Communication (Facilitator)

Definition of Communication: “Communication is a dialogue between equal partners who exchange information and come to a mutual understanding and ideally end with action and a shared vision.

This means that two or more people come together to share information and experiences in order to come to an understanding together.”

There are different types of communication including the following:

Verbal (where speech is involved)

Non verbal (usually uses body language, signs)

Mass media and electronic (email, fax, internet)

Written (reports, minutes, letters, etc)

Brainstorm with the group the factors that affect whether or not communication is successful.

The list may include:

Lack of a common language

Distraction

Failure to listen to each other

Brainstorm as a group a list of key communication skills and record them on newsprint.

Step 3:

Demonstrate communication skills (Exercise)

The purpose of this exercise is to help the spray operator trainers understand the components of good communication and its importance to effective IRS.

Active listening

Ask 2 volunteers to come to the front of the room to compete in an acting game. Then choose one person from the group who can tell a story about the best day of his childhood to the actors as if they were telling a story to a group of friends. For the first minute of the story, instruct the actors to show bad listening -- looking at the ceiling, yawning, etc. After one minute, stop the game. For the second minute, ask the actors to demonstrate good listening – eye contact, nodding, asking questions, etc.

Ask participants to list the things that the listeners did that conveyed their interest or disinterest in their partners’ stories.

Summarize Exercise

Summarize the session by letting the group know that spray operators will be expected to listen and answer questions professionally as they are conducting the spraying and any mobilization activities. It is important that they demonstrate active listening skills and refer people to the District Health Team if they are unable to answer questions.

••••

•••

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Item 27 - Spray Operator Communication Orientation Guidelines - IRS TOOLKIT

Step 4:

Getting Familiar with the Frequently Asked Questions on Indoor Residual Spraying fact sheet

Distribute copies of the IRS FAQ to all participants

Let participants know that this material is to be used to help spray operators to answer questions raised during the spray exercise. They will not have enough copies to leave behind in every household but they should refer to it to answer questions.

Ask volunteers to read each section aloud. Once each section is read, ask if there are any questions about the content and then proceed to the next section until the entire FAQ has been read as a group.

Step 5:

Show IRS Film

Introduce the IRS film. The film was produced in Uganda for the Ministry of Health to help people understand how IRS is implemented and what people need to do to support the exercise. The film will be shown to community members and leaders during the sensitization activities.

Show the film (approximately 15 minutes)

Ask the group if there are any questions about the film and discuss

Step 6:

Wrap up session

Answer any further questions. Let them know they will be expected to conduct this session during their spray operator training. They will receive print materials and a copy of the video before their training events.

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Step � DISTRICT COMMUNITY MOBILIZATION

Objective:

Leaders and community members at district, sub-county and parish level are informed about IRS and prepared to participate in the exercise

Summary:

Step 4 begins the implementation of cascaded sensitization meetings and door to door community mobilization once the spraying begins. All of these interpersonal forms of communication are complemented with ongoing radio programming and the implementation health education talks with film vans at community level.

Sensitization Meetings:

Each district should begin sensitization about IRS with a meeting to orient district leadership about the upcoming exercise; its importance to malaria control and to inform leaders of their specific role. The district sensitization meeting typically kicks off a schedule of sub-county meetings followed by parish meetings. Each follows the same format and agenda. Previous experience indicates that the parish and community level activities were most important to successful IRS. This should be taken into account when allocating resources to the district meeting. The meetings at parish level are typically facilitated by the Health Educator team. The IRS video should be shown at all levels of meetings if possible and each participant should receive copies of print materials.

Optional District Launch:

If the district is implementing IRS for the first time, the district may choose to hold a district ‘launch’. The launch is typically held immediately before spraying begins and after all sensitization meetings are complete. A launch event can include a exercise during which Spray Operators march out in full protective apparel with a brass band through the town and to the launch venue. At the end of the event, spray operators lead participants to watch the spraying of an actual home.

Door to door Mobilization:

While the Communication team may support the door to door mobilization with key talking points and materials, this activity is usually implemented through the spray team in partnership with local council members. Spray Team members accompanied by LCs move door to door informing households that their home will soon be sprayed to prevent malaria and that they need to prepare their homes in advance. This is typically done 24 hours before the spray team arrives. This schedule must be coordinated with the spray team once the spray schedules are confirmed. This activity should also be complemented on radio with DJ mentions announcing when particular parishes and communities will be sprayed.

Film Vans/Health Education Talks:

The Ministry of Health can schedule a film van to be deployed in areas targeted for spraying. The film van typically serves to mobilize people to participate and inform them about the basics of IRS for malaria prevention. Typically members from the District Health Education Team will ride with the truck giving talks about IRS and malaria after the film has shown. This schedule also must be coordinated with the spray teams to ensure that the film van is coordinated with the spray schedule.

4

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District Sensitization Meeting and launch

Organize meeting schedule with district

Districts/MoH Items: 1, 2, 3

Invite participants MoH Items: 1, 3, 29, 30

Prepare presentations & identify facilitators

MoH/Contractor/MoH

Items: 3, 29

Broadcast radio announcements for meeting

Local radio stations

Items: 1, 21

Conduct radio talk show with District officials and key guest (night before meeting)

Local radio stations/ District

Items: 37

Conduct district sensitization meeting

District/MoH Items: 29, 3, 7, 12

District Mini-Launch (districts new to IRS only)

Identify and contract venue District/Contractor

Items: 1,

Order t-shirts, banners District/Contractor

Items: 24, 25

Order certificates for spray operators

District/Contractor

Develop agenda with District and partner staff

District Items: 1,2,32

Identify and confirm guests and key speaker

District

Write and disseminate press briefings

District/MoH Items: 33, 21

Identify and Hire entertainment

District Items: 2

Invite media representatives

District

Orient and plan spray operator march

District/Contractor

Items: 32

Make announcements in local media

District Items: 21

Conduct launch District/MoHSub County Sensitization meetings

Revise meeting content and agenda

District Items: 2, 3, 31



3 IRS Sensitization Process Guidelines PDF CD/ step 1 annex

28 Sensitization meeting invite MS word CD

29 District meeting agenda MS word CD

30 District meeting invite MS word CD

31 Sub-county/parish meeting agenda MS word CD

32 Guidelines for spray operator march MS word CD/ step 4 annex

33 Press release template for launch MS word CD

21 Template for DJ mentions PDF CD/step 4 annex

34 Talking points for film van PDF CD/ step 4 annex

12a Film “IRS : What you need to know” DVD video Toolkit annex

10 IRS FAQ PDF Step 1 annex, cd

7 IRS Leader leaflet PDF Step 1 annex, cd


36 Sensitisation meeting talking points PDF CD/ step 4 annex

37 Special event radio talk show outline MS word CD

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Step 4 - Breakout Timeline - IRS TOOLKIT

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IRS TOOLKIT - Item 20 - Radio Talk Show Talking Points Special Event Talk Show

Item: �0 Radio Talk Show Talking Points Special Event Talk Show

Special Talk Show: Pre-event Radio Talk Show in (select district)

Purpose of the pre-event talk show programs:

To encourage audience to participate and support the upcoming IRS event (launch, district sensitization meeting)

To introduce the implementation schedule for IRS and encourage the audience to support IRS

To allow the audience to ask questions and to get accurate information about IRS for malaria prevention and control.

Content:

Describe rationale for selecting district for IRS

Talk about benefits of malaria prevention using IRS to an individual, community, district and at national level.

Describe how IRS will be implemented in Uganda (timeline and activities)

Describe the community’s role during the implementation of IRS activity

Inform audience of the upcoming event and its significance to the IRS program (either launch or district sensitization activity)

Suggested Guests:

Malaria Control Manager, Director General of MoH, LCV representative from organic farmer group, community member

1.

2.

3.

••

•••



Develop meeting schedule and budget with district team

District/Contractor

Items: 1, 2, 3,

Conduct Sub county sensitization Meetings

District/Contractor

Items: 3, 7, 10, 12, 36

Community Sensitization Meetings

Organize meeting content MoH/Districts Items: 1, 2, 3, 31

Conduct Community Sensitization Meetings

Sub-Cty Officials; back up from District

Items: 7, 10, 12, 20

Community Mobilization with LCs

Develop community mobilization plan and budget with District team

District/Contractor

Items: 1,2,3,

Identify and orient mobilization team

District/Contractor

Items: 1,7,10, 12

Communicate mobilization and spray schedule to local radio stations

District Items: 1

Conduct community mobilization with LCs

District/Contractor

Items: 10

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Item 21 - Sample DJ Mentions - IRS TOOLKIT

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IRS TOOLKIT - Item 34 - Talking Points for IRS Film Van

Item: �� IRS Community Mobilization through Film Vans Film Van Crew Talking Points

1. What causes malaria?

Malaria is transmitted by anopheles mosquito carrying malaria parasites when the female anopheles bites a human being

Dispel myths: Malaria is not caused by eating raw mangoes; drinking un-boiled water; running in the rain, etc.

2. What is Indoor Residual Spraying (Indoor House Spraying) IRS?

Indoor residual spraying (Indoor House Spraying) is the spraying of safe and effective insecticide on the walls and ceilings of houses. Because malaria is spread by mosquitoes which bite and rest indoors, spraying will only be conducted on the inside walls of houses. After spraying, mosquitoes carrying malaria in your house will die.

3. Spraying will begin soon. This area has been chosen for IRS for malaria control because:

There is a high malaria incidence and illness

Many deaths are reported due to malaria

4. What Insecticide is used for Malaria?

The insecticide being used is safe, effective and has been approved for use by the Ministry of Health and World Health Organization (WHO), National Drug Authority (NDA) and The National Environment Management Agency (NEMA). The insecticides used have been used successfully for controlling malaria epidemics in many districts in Uganda.

5. It is important that all community members support the spray exercise. All households should do the following to support IRS:

Remove portable household items especially food stuffs, water, valuable items, cooking utensils, etc. before spraying;

Ensure that sick people, domestic animals and birds are also moved outside before spraying;

Provide a jerry can of clean water for spraying;

Allow spray teams to enter their houses and spray;

Stay outside of the house for at least two hours after spraying;

Sweep and mop the house after two hours before children and pets are allowed to re-enter the house;

Collect dead insects and water used to mop and pour them both in a pit latrine.

Do not smear, plaster or paint interior walls after spraying for 9 months.

a.

a.

b.

a.

b.

c.

d.

e.

f.

g.

h.

Item: �� Sample DJ Mentions

DJ Mentions are short radio announcements made in between scheduled programming and advertisements by the broadcasting DJ. They can be used throughout the spray exercise to generate excitement, announce changes in the spray schedule or to make last minute announcements.

DJ Mentions are typically no longer than 10-15 seconds.

Announcement Purpose Sample Announcement

Raise awareness and generate attendance for the IRS Launch

“All LCs, cultural leaders, district health management team members are kindly requested to attend the launch of IRS presided over by [name of chief guest] on [date] at [venue] at [time] thank you.”

Generate Attendance for the District Sensitization Meeting

“All LCs, cultural leaders, district health management team members are kindly requested to attend the District Sensitization meeting for IRS on [date] at [venue] at [time] thank you.”

Generate Attendance for the Sub-County, Parish Meeting

“All LCs and local leaders are kindly requested to attend the [insert parish or sub-county] Sensitization meetings for IRS on [date] at [venue] at [time] thank you.”

Inform Audience of spray schedule (supplements meetings and other mobilization activities)

“Spraying for malaria prevention will commence in the following areas [name of villages/locations] on the following dates. Please make sure you prepare your home in advance of the spray team arrival. Thank you”

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Item 34 - Talking Points for IRS Film Van - IRS TOOLKIT

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IRS TOOLKIT - Item 32 - Spray Operator ‘March’ Guidelines

Item: �� Spray Operator ‘March’ Guidelines

During the day of the IRS launch events in Uganda, spray operators participated in a parade through the district headquarters in full protective apparel with their spray cans. The purpose of the ‘march’ was to draw attention to the upcoming spray exercise and launch event and to generate support for IRS.

Spray operators marched through the town with a brass band before the launch event; marched to the launch venue and attended the launch event. After the event, spray operators led participants to a nearby home of a district official to conduct a spray demonstration.

The following guidelines can be used to help prepare for this optional activity.

Materials Needed for ‘Spray Operator March’:

At least three spray operator teams, team leaders and spray team supervisors (ideally, no less than 30 ppl)

Full protective apparel and spray cans

IRS banner

Brass band (optional)

Local and national media representatives

Pre-selected home of District Official already prepared for spraying – should be nearby launch venue.

Timeline:

Starting 45 minutes before launch event Spray Operators led by brass brand commence march from District Headquarter building through the town carrying banners supporting IRS

Spray Operators end march at launch event grounds standing in formation while band plays;

After launch event ends, Spray Operators and brass band lead participants to pre-selected home of District Official

Selected Spray Operator conducts spray of District Official’s home

Band commences playing, announcing end of the launch event

•

•••••

•

••

••

6. IRS is implemented as part of a strategy to prevent malaria. The strategy includes: Effective treatment, insecticide treated nets and malaria prevention during pregnancy.

People should continue to seek treatment for malaria within 24 hours of symptoms recognition, sleep under a treated mosquito net and pregnant women should take SP (Fansidar) at 4th and 7th month of pregnancy

7. Spraying is provided free of charge by the Ministry of Health. Spraying can only be conducted by professionally trained spray operators who come from your community.

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Item 36 - Talking Points for Sensitization Meetings - IRS TOOLKIT

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IRS TOOLKIT - Item 36 - Talking Points for Sensitization Meetings

Do not smear, plaster (or re-plaster) or paint (or re-paint) interior walls after spraying for 9 months.

For IRS to be effective, it is important for the entire community to cooperate.

LET’S WORK TOGETHER TO ERADICATE MALARIA.

SUPPORT INDOOR HOUSE SPRAYING… KILL MOSQUITOES, FIGHT MALARIA.

•

•

Item: �� Talking Points for Sensitization Meetings

Malaria is the leading cause of illness and death in the country [insert data from local district]. The Ministry of Health has embarked on an intensive program of reducing malaria in the district through Indoor Residual Spraying (IRS).

The District council endorses the Indoor Residual Spraying as a good intervention that will relieve our communities of the burden of malaria.

IRS is being implemented in this area because it is highly affected by malaria and IRS is extremely effective in eliminating malaria deaths and disease.

Indoor Residual Spraying (IRS) is the application of insecticides in with long lasting effects on the inside walls of the houses in order to kill malaria carrying mosquitoes.

The insecticides used are safe, effective, and cost effective and have been approved for use by the World Health Organization (WHO) the Ministry of Health, National Drug Authority (NDA) and the National Environment Management Authority (NEMA).

IRS will be conducted by trained sprayer operators and team leaders who are selected by the community members in each sub-county. The exercise will be closely supervised by the District Health Team and the Ministry of Health.

The spray schedule for this district will take place during [details schedule for area]

The District Health Team and the Ministry of Health are requesting us the District leaders to support this exercise by:-

Mobilizing the community to support and participate in this exercise by;

Informing community members about the benefits of the exercise and linking them with the spray teams;

Ensuring that all houses in your villages are sprayed in order to have full effect;

Helping community members to get assistance if they have concerns about the way the spraying was conducted in their home;

Reporting anyone seen misusing insecticides to District Officials. This insecticide is to be used ONLY indoors for malaria control.

The District Health Team and the Ministry of Health are also requesting us the District leaders to educate and prepare our communities to support this exercise.

We should make sure that our electorates/constituents do the following:-

Remove portable household items especially food stuffs, water, valuable items, cooking utensils, etc. before spraying;

Ensure that sick people, domestic animals and birds are also moved outside before spraying;

Provide a jerry can of clean water for spraying;

Allow spray teams to enter your houses and spray;

Stay outside of the house for at least two hours after spraying;

Sweep and mop the floor of the house after two hours before children and pets are allowed to re-enter the house;

Collect dead insects and water used to mop and pour them both in a pit latrine.

•

•

•

•

•

•

••

••

••

•

•

•

•••••

•

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Step � MONITORING, EVALUATION AND FOLLOW-UP

Objective:

To monitor IRS Communication Activities and conduct programmatic assessment

Summary:

During Step 5, Program Managers monitor the implementation of the communication activities and report progress in a timely fashion. If time and resources allow, program managers can conduct a qualitative assessment of the communication component. It is anticipated that the overall program evaluation would include an impact assessment of all activities including communication. This process is not detailed in this toolkit.

Throughout the implementation of IRS communication, program managers should monitor the following: number of meetings held; number of meeting attendees; number of film van presentations conducted; number of materials distributed; number of radio spots, programs broadcasted; estimated number of people in target audience reached through radio and film vans.

The Communication Team should make regular reports of these activities during the implementation team meetings. These reports should also provide lessons learned and allow for input to consider changes as necessary.

As part of a wrap up exercise to understand how the program could be improved for subsequent spray rounds, the communication team may want to conduct interviews with community members, key leaders, members of the health management team, and other implementing partners to understand their perception of the IRS communication component. A report of this activity should also be compiled in a summative document and shared with all implementing partners.



6 Focus group discussion guide for community members

MS word CD


39 Activity sign in sheet MS word CD

40 Radio talk show broadcast report MS word CD

5 BREAKOUT TIMELINE - STEP �




Make ongoing reports of materials’ dissemination

District/contractor

Items: mate-rials’ dis-semination report 38, 39

Conduct support supervision visits

MoH/Contractor

Items: activ-ity report

Conduct Focus Group discussion/IDIs about IRS communication

District/Contractor

Items: 6

Compile report on IEC activities and FGD findings

District/contractor

produced by the malaria control program of the ministry of ...ccp.jhu.edu/documents/malaria irs...

Documents