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Summary ## Publication Information **Publisher:** Rwanda Biomedical Centre (RBC) **Publishing Division:** Malaria and Other Parasitic Diseases Division (MOPDD) **Publication Year:** 2020 **Reporting Period:** July 2019 - June 2020 **Document Type:** Annual Performance Report **Pages:** 86 pages ## Executive Summary The 2019-2020 fiscal year marked a turning point for Rwanda's malaria control program, demonstrating exceptional progress in reducing malaria burden through evidence-based interventions and strategic program adaptations. Rwanda achieved remarkable success with malaria incidence decreasing from 321 per 1,000 person-years in 2018-2019 to 198 per 1,000 in 2019-2020, representing a 38% reduction and meeting the national strategic target ahead of schedule. ## Key Performance Achievements ### Malaria Burden Reduction - **Incidence Reduction:** 38% decrease from 321 to 198 per 1,000 person-years - **Slide Positivity Rate:** Declined from 44.4% to 34.5% - **Uncomplicated Cases:** 37% reduction from 3.9 million to 2.5 million cases - **Severe Malaria:** 38% decrease from 7,054 to 4,358 cases - **Malaria Deaths:** 55% reduction from 372 to 167 deaths ### Vector Control Interventions - **LLIN Distribution:** 5.56 million nets distributed including innovative PBO (1.4M) and IG2 (769K) technologies - **Mass Campaign Coverage:** 23 districts covered through household distribution campaigns - **IRS Expansion:** Scaled up from 10 to 12 districts with 99.3% structural coverage (1.23M of 1.24M structures) - **Population Protection:** 4.87 million people protected through IRS interventions - **Next-Generation Tools:** Introduction of PBO-treated nets and IG2 technology for resistance management ### Entomological Surveillance & Innovation - **Resistance Monitoring:** Comprehensive testing across 25 sites revealing pyrethroid resistance patterns - **Vector Species Composition:** Dominance of Anopheles arabiensis (97%) with declining An. gambiae s.s. (3%) - **Drone Technology:** First-ever drone-based larviciding trials covering 336 hectares in Gasabo district - **Integrated Vector Management:** Bio-larvicide applications and 20 million Tilapia fingerlings stocked for larval control - **Climate Surveillance:** Enhanced monitoring linking rainfall patterns to mosquito density variations ### Case Management Excellence - **Community Treatment:** 58% of all malaria cases managed at community level by CHWs - **Diagnostic Coverage:** 99.9% of suspected cases received parasitological testing - **Treatment Quality:** 100% of confirmed cases received appropriate ACT treatment - **Early Care Access:** 95% of children and adults received treatment within 24 hours at community level - **Severe Case Management:** Enhanced referral systems and quality assurance protocols ### Health System Strengthening - **CHW Performance:** 1.7+ million malaria tests and treatments delivered by community health workers - **Quality Assurance:** Data verification factors of 1.02 and 1.00 for key indicators showing excellent data quality - **Supply Chain Management:** Robust commodity management with no stock-outs reported - **Real-time Monitoring:** RapidSMS system for stock monitoring and severe case notification ### Neglected Tropical Diseases Control - **MDA Coverage:** >95% coverage achieved in mass drug administration campaigns - **Village-Based Approach:** First-ever village-level MDA implementation improving accessibility - **Target Populations:** Comprehensive coverage of pre-school and school-aged children nationwide - **Multisectoral Coordination:** Enhanced collaboration across health, education, and WASH sectors ## Innovation and Research Highlights ### Technological Innovations - **Drone-Based Vector Control:** Pioneering aerial larviciding using Bacillus thuringiensis israelensis (Bti) - **School Health Program:** Integration of malaria diagnosis and treatment in educational settings - **Mosquito Repellent Distribution:** 294,611 repellent products distributed through social marketing - **Digital Health Systems:** Enhanced e-LMIS implementation for supply chain optimization ### Research and Development - **Operational Research:** Multiple studies on net durability, resistance management, and intervention effectiveness - **International Collaboration:** Partnerships with Emory University, University of Maryland, and other institutions - **Evidence Generation:** Comprehensive evaluation of new intervention technologies and delivery strategies - **Capacity Building:** Training programs for entomologists, researchers, and program managers ## Program Coordination and Financing ### Financial Performance - **Total Budget:** USD 68.16 million with 96% execution rate - **Funding Sources:** Global Fund (90% execution), PMI (100% execution), Government of Rwanda (98% execution) - **Resource Mobilization:** Successful Global Fund grant renewal (USD 55 million) and sustained PMI support - **End Malaria Fund:** Development of domestic resource mobilization strategy ### Strategic Partnerships - **Global Coordination:** Leadership in East African Community malaria initiatives - **Technical Collaboration:** WHO, RBM, ALMA, and other global health partnerships - **Implementation Partners:** Comprehensive network of implementing organizations - **Cross-Border Initiatives:** Great Lakes Malaria Initiative development ## COVID-19 Impact and Adaptations ### Program Adaptations - **Service Continuity:** Maintained essential malaria services during pandemic restrictions - **Distribution Challenges:** COVID-19 impact on LLIN distribution in 7 districts - **Innovation Response:** Adapted distribution strategies and safety protocols - **Budget Implications:** Additional resources required for pandemic-compliant operations ## Strategic Implications This report demonstrates Rwanda's exceptional progress toward malaria elimination goals while maintaining robust NTD control programs. The 38% reduction in malaria incidence, combined with significant decreases in severe disease and mortality, positions Rwanda as a regional leader in evidence-based malaria control. The successful integration of innovative technologies, community health system strengthening, and comprehensive vector control strategies provides a model for other malaria-endemic countries. The achievements documented in this report reflect the effectiveness of Rwanda's integrated approach to disease control, combining high-coverage interventions with robust surveillance systems, quality assurance mechanisms, and adaptive management strategies. These results inform the development of the next National Strategic Plan (2020-2024) and contribute to global evidence on malaria control and elimination strategies. ## Citation Rwanda Biomedical Centre. (2020). *Rwanda Malaria and Neglected Tropical Diseases Annual Report 2019-2020*. Kigali: Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Centre.