THE ONGOING Covid-19 crisis will not deter the Indoor Residual Spraying (IRS), an exercise aimed at eliminating malaria-causing mosquitoes to a tune of a whopping $36 million. Indoor Residual Spraying involves the application of a residual insecticide to internal walls and ceilings of housing structures where malaria vectors may come into contact with the insecticide. The Head of the Malaria and other Parasitic Infections Unit at the Rwanda Biomedical Centre, Dr Aimable Mbituyumuremyi, told this publication in an exclusive interview that the exercise falls between July to June every year and is done in different rounds. The plan involves spraying twelve districts and a few sectors in Rusizi district. They include all the seven districts in the Eastern Province, five districts in Southern Province which are Kamonyi, Ruhango, Nyanza, Huye, Gisagara and some areas in Rusizi District. That is the plan for July 2020-June 2021,” he explained. Mbituyumuremyi explained that, so far, the districts of Nyagatare, Kirehe, Ngoma, Kamonyi and Ruhango had been sprayed while the exercise is underway in Huye, Nyanza and Gisagara this week. In March, the exercise will shift to Bugesera, Gatsibo, Rwamagana, Kayonza and Rusizi districts. Why 12 districts Mbituyumuremyi said that the 12 districts are chosen based on the malaria burden. “These are the most affected districts. We are spraying in the same exact districts that we sprayed even in 2019/2020 because it is better to build on what we have done and sustain the momentum,” he said. However, he said that the limitations in funding mean that three other districts that should be on the list are not benefitting from the exercise. “On average, to be able to do indoor spraying in one district, we need about $3m per year. This means that with about Rwf2.5bn, we can spray one district. The entire year costs about $36m,” he explained. Of the twelve, USAID supports the spraying of three districts and these are Kirehe, Nyagatare and Ngoma. The rest are jointly funded by the government and Global Fund. Mbituyumuremyi explains that the funds have been impactful and have played a significant role in reducing the number of malaria deaths and infections. “It may seem like a lot of money but it is very impactful. When we do these indoor spraying exercises, it helps us to save on other areas like malaria tests and drugs because the cases are reducing and we are saving lives,” he said. He said that besides other provinces, in Kigali, the spraying is being done in Jabana sector, Gasabo district. “We spray every two weeks and we have been doing it since March last year. We are using drones for that and we target wetlands,” he said. Drones have the capacity to fly for about 15 minutes on a single battery and ability to spray an area of 40 hectares in a day. Covid-19 setbacks Although Covid-19 posed some challenges in terms of some delays last year, none have so far been registered this year since the program kicked off on schedule. However, Mbituyumuremyi says that the outbreak of the pandemic influenced the changes in the budget. “Obviously the pandemic put a strain on our budget because we now have to include other logistics involved in covid-19 prevention like sanitisers. We also had to think about the cost of the changes in transport where cars can only take a particularly small number of people,” he said. Financing gap Last year, the government was sourcing for $73 million to bridge the funding gap in the funds needed to fight malaria between 2020 and 2024. The Rwanda National Strategic Plan 2020-2024 to fight malaria drawn up in June 2020 indicates that although the implementation requires Rwf295bn ($280 million), the government already had funding commitment to the tune of $206.8m (equivalent to 74 per cent). According to the strategic plan, a copy of which The New Times has seen, this leaves a gap of $73 million which it hopes to mobilize from different sources. The breakdown With these funds, the government is seeking to protect at least 85 per cent of the population with preventive interventions and to work towards promptly testing and treating suspected malaria cases by 2024. To achieve this, the biggest chunk of the funds will be invested in malaria prevention to a tune of $186m, an equivalent of 66 per cent of the entire budget. The rest of the money will be allocated to program management $44.8m (16 per cent) and malaria case management $30.7m (11 per cent). A total of $10.6m (four per cent) will go to Health System Strengthening while Surveillance, Monitoring, Evaluation and Operational Research (SMEOR) will take $7.9m (three per cent) Trials still prevail While the reduction of malaria in Rwanda can also be attributed to the dedication of community health workers who deal with an estimated 57 per cent of the patients, an increased workload has led to challenges in proper reporting. In its annual Malaria and Neglected Tropical Diseases Report, the Ministry of Health says that the national malaria incidence reduced from 401 cases per 1,000-person in 2017-2018 fiscal year to 200 cases per 1,000-person in 2019-2020.