TY - JOUR T1 - New Ways of Approaching Indoor Residual Spraying for Malaria JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 511 LP - 513 DO - 10.9745/GHSP-D-16-00354 VL - 4 IS - 4 AU - Michael Macdonald Y1 - 2016/12/23 UR - http://www.ghspjournal.org/content/4/4/511.abstract N2 - Using health extension workers in Ethiopia as supervisors of the spray team reduced operational costs while maintaining quality. But rethinking IRS calls for (1) adapting equipment and procedures to ensure higher-quality spray applications, and (2) empowering decentralized targeting against malaria transmission foci.See related article by Johns.The article by Johns et. al. on indoor residual spraying (IRS) for malaria control in Ethiopia, published in this issue of GHSP,1 presents a variation on standard IRS operating procedures by essentially replacing the “squad leader,” usually recruited from the district town, with the health extension worker (HEW) from the community. The squad leader supervises the spray operators, who are also recruited from their own communities rather than from various parts of the district as in standard operations. In this new community-based IRS model, other supervisory structures above the level of the squad leader—from the district, zonal, and regional offices—were kept in place. The stated goal of moving from district-based to community-based IRS implementation was cost savings, and indeed there were marginal savings to the operational costs associated with this change. In this era of new, more costly insecticides developed to manage insecticide resistance while programs simultaneously shift from broad implementation of malaria “control” to more targeted malaria “elimination,” the work by Johns and colleagues raises several important issues.Indeed, the average cost per person protected in the community-based IRS districts was lower than in the district-based model—US$0.87 vs. $1.00, respectively, in 2013 and $0.86 … ER -