New Ways of Approaching Indoor Residual Spraying for Malaria

The article by Johns et. al. on indoor residual spraying (IRS) for malaria control in Ethiopia, published in this issue of GHSP, 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 communitybased 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.