Global plan for insecticide resistance management in malaria vectors

Part 2Collective strategy against insecticide resistance2.2 Country activitiesOverview of recommendations at country level (pillars Iand II of the GPIRM strategy).Figure 18: Recommendations at country level: two parallel activitiesIPlan and implementIRM strategiesStep 1Establish baselineand situation analysisStep 2Design national insecticideresistance management strategyStep 3Modify current vectorcontrol planImplement continuously, includingupdating vector control planon basis of new informationFuture IRM strategies to be anintegral part of vector control plansIIEnsure proper monitoringand data managementIRM, insecticide resistance managementDesign monitoring planBuild and maintain capacity for monitoringAlign monitoring planwith IRM strategyConsistent, timelyData-sharingImplement continuously,updating planon basis of new informationLocal andglobal databasesAdjust vector control planon basis of insecticideresistance dataPlan and implement IRM strategies. The first element ofthese parallel efforts is for countries to identify how to modifytheir current vector control programmes to address insecticideresistance (see section 2.2.1). The starting point is to establishand analyse the current situation of insecticide resistance. This willrequire comprehensive collection of the available data, includinginformation from neighbouring countries. To fill any gaps in thedata, additional susceptibility tests will be necessary in mostcountries to identify the state of resistance. 1The next step is to design a national IRM strategy, on the basisof analysis and interpretation of the data. Support from national,regional and global experts should be sought, as required. Currentvector control plans should then be modified to incorporate thestrategy.Ensure proper, timely monitoring and data management.The second element to be implemented at country level is toincrease monitoring (see section 2.2.2). For this, countries shouldundertake two activities simultaneously: design a monitoringplan, which should include entomological monitoring, monitoring1 Unless there are comprehensive recent data (within the past 12 months) on insecticide resistance andon the resistance mechanisms at an appropriate number of sentinel sites.insecticide resistance, and monitoring the quality of vector controlinterventions; and, particularly in sub-Saharan Africa, buildcapacity and expertise in handling and interpreting entomologicaland resistance data. This includes the design of routine datacollection, hypothesis generation and situation analysis, as well aspractical skills for sampling mosquitoes in the field by a variety ofmethods.Countries should not wait until they have established monitoringcapacity before analysing their resistance situation and takingaction. Capacity-building will take time and investment, possiblyover several years in some countries. In the meantime, countriesshould quickly identify their resistance situation, use supportnetworks and institutions for technical advice and capacity, asrequired, and adjust their vector control programmes accordingly.Ongoing implementation (orange boxes in Figure 18). Inthe longer term, implementation and updating of vector controlprogrammes and monitoring should be closely aligned and basedon new information. Groups monitoring insecticide resistance mustensure consistent, timely sharing of data, especially at subregionallevel and across sectors. Local and global insecticide resistancedatabases should be set up and the new information added.52GLOBAL PLAN FOR INSECTICIDE RESISTANCE MANAGEMENT IN MALARIA VECTORS (GPIRM)