Financing Indoor Residual Spraying in Uganda: Cost-cutting Options

Renewed interest in large-scale Indoor Residual Spraying (IRS) as a major component of malaria control efforts is evidenced in the government plan to roll out IRS to 55 malaria-endemic districts, by 2020. However, progress towards the expansion of IRS beyond a few highly endemic districts has been dismal. The slow progress is primarily attributed to the perceived high cost of a sizable IRS program versus other vector control methods such as Long Lasting Insecticide Treated Nets (LLINS). There has also been a dearth of evidence on the actual cost of a country-wide roll-out of IRS by implementation modality. To fill the aforementioned evidence gap, this brief document requisite financial resources for funding country-wide, as well as the phased implementation of IRS. Cognizant that the economy is resource-constrained, with competing development priorities and needs, low-cost options for IRS implementation are also explored. The findings show that a total of UGX 235 billion (about 63.5 million US$) is required, to finance country-wide implementation of IRS using a district-led approach. Insecticides take the bulk share – accounting for about 66 percent of the total cost, while the rest are operational costs. The overall cost per structure sprayed and the average cost per person protected is UGX 28,000 (8 US$) and 6,000 shillings (2 US$), respectively. Implementing IRS in a phased manner, starting with most burdened sub-regions requires about 107 billion shillings (29 million US$). The integrated district-led approach of IRS is associated with the least cost - it is about six times cheaper than the project-led approach. Also, IRS is more cost-effective than LLINs and malaria case management. Accordingly, our findings suggest that more investments in malaria prevention using IRS is a less costly venture for the government to take up and presents cost-saving opportunities in the fight against malaria. The government should utilize existing district Local Government and community-based structures, as well as spray logistics in IRS pilot districts as a basis for minimizing IRS cost. Some of the specific low-cost strategies for policy consideration include use of; existing spray logistics on a rotational basis; Community Health Extension Workers or Village Health Teams, the forces, and idle youth as Spray Operators; incorporating IRS Behavioural Change Communication (BCC) within national immunization day BCC; subsidization or fiscal incentives for manufacturing insecticides domestically.