Improving the efficiency of Indoor Residual Spraying to protect rural Ethiopia from malaria: Comparison of two implementation models

 Indoor Residual Spraying (IRS) is a resource-intensive and costly intervention. In 2012, IRS constituted 40 percent of total malaria-related expenditures in Ethiopia. The purpose of the study is to compare the cost of two IRS implementation models to better guide program efficiencies and help maximize the use of limited resources. 

 The President’s Malaria Initiative, through its Africa IRS project (AIRS), piloted a community-based IRS (CB-IRS) model in Ethiopia where IRS staff is hired directly from the community where they spray. The CB-IRS model eliminates any transport of staff and equipment from district capitals to the communities, as it is traditionally employed via the district-based (DB-IRS) model for the majority of IRS spray campaigns.

AIRS used annual expenditures from financial records with a focus on operational (non-insecticide) costs and compared the costs of conducting CB-IRS in 2013 with DB-IRS in 2012 and 2013 in five selected districts. Compared to DB-IRS in 2012, CB-IRS in 2013 protected 4,650 more people per district, and reduced the average cost per person protected by $0.27. Total costs of CB-IRS are 15 percent and 1 percent lower than DB-IRS in 2012 and DB-IRS 2013, respectively. Results suggest that CB-IRS is less expensive than DB-IRS but the extent of savings may not be considered significant. It is important to consider all factors related to an IRS program to determine the choice of implementation model. Additional analysis of non-cost factors is recommended for Ethiopia and other countries considering a wider adoption of the CB-IRS model.