PROJECT REVIEW SHEET
Work Program Inclusion - UNEP International Waters

Project Title: "Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama: Regional Program of
Action and Demonstration of Sustainable Alternatives to DDT for Malaria Vector Control in Mexico and Central America"
Date: 7 January 2002


Work Program Inclusion per criteria
Reference Paragraphs and Explanatory Notes:
established in Draft # 8 of the project
review criteria

1. Country Ownership
· Country Eligibility

· The participating countries are eligible under paragraph 9b of the
GEF Instrument ­ see cover page.
· Country Driveness
Clear description of Project's fit within:
· The project is set in the context of the recently adopted POPs
· National reports/communications to Conventions
Convention, which all countries have either signed or expressed an
· National or sector development plans.
intention to sign, and the North American Action Plan on DDT (para
· Recommendations of appropriate regional
7 and 10).
intergovernmental meetings or agreements.
· Endorsement
· Endorsement by national operational focal points
· Endorsements have been received from all participating countries and
are included in Annex I.
2. Program & Policy Conformity
· Program
Describe how project objectives are consistent with
· The project is consistent with the objectives of Operational Program
Designation &
Operational Program objectives or operational criteria
#10, and of the draft OP on POPs ­ see paragraph 7.
Conformity


· Project Design
Describe:
· The issues, barriers and threats to be addressed by this project are

·
Sector issues, root causes, threats, barriers etc
described in para 1-6, and incremental costs and root cause annexes

affecting global environment
(A and D).

·
Project logical framework, including a consistent ·
The overall goal is the protection of human health and the
strategy, goals, objectives, outputs
environment from DDT. The objective of the project is to
inputs/activities, measurable performance
demonstrate that methods for malaria vector control without DDT or
indicators, risks and assumptions
other persistent pesticides are replicable, cost-effective and
·
Detailed description of goals, objectives, outputs
sustainable, thus preventing the reintroduction of DDT in the region.
and related assumptions, risks and performance
· Project outcomes are detailed in the logical framework matrix (Annex
indicators
B) and include: (i) At the national level, each one of the 8
·
Brief description of project activities, including
participating countries will have the documented results of a well

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Work Program Inclusion per criteria
Reference Paragraphs and Explanatory Notes:
established in Draft # 8 of the project
review criteria

an explanation how the activities would result in
monitored demonstration project of malaria vector control without
project outputs (in no more than 2 pages)
DDT or other persistent pesticides; (ii.) At the regional level the
·
Global environmental benefits of the project.
lessons learned in each country will be exchanged and a regional
·
Incremental cost estimation based on the project
consensus will be built; (iii.) At the global level the results of this
logical framework
project will define replicable models for malaria control based on cost
· Describe project outputs (and related
effective, environmentally sound and sustainable strategies.
activities & costs) that result in global
· A detailed logical framework is included as Annex B. Objectively
environmental benefits
verifiable indicators include nine replicable documented
· Describe project outputs (and related
demonstration projects that test a set of procedures for different
activities & costs) that result in global and
malaria vector control, under well identified environmental and
national environmental benefits
social-economic conditions.
· Describe project outputs (and related
· Activities are grouped into 4 major components and include:
activities & costs) that result in national
Demonstration Projects and Dissemination; Strengthening of National
environmental benefits
Capacity to Control Malaria Without DDT; Elimination of DDT
· Describe the process used to jointly estimate
stockpiles; and Coordination and Management.
incremental cost with in-country project
· The incremental costs analysis in annex A describes the national,
partner
regional, and global benefits to be expected from the project. The
· Present the incremental cost estimate. If
global environmental benefits stem from the reduction of the total
presented as a range, then a brief
load of a ubiquitous persistent and toxic contaminant, DDT.
explanation of the challenges and
· The participating countries' contribution to baseline costs consists
constraints and how these would be
mostly of redirection of malaria control programme funds in the
addressed by the time of CEO endorsement.
demonstration areas.
· Sustainability
Describe proposed approach to address factors
Issues regarding sustainability are discussed in paragraphs 31 ­ 33.
(including financial
influencing sustainability, within and/or outside the
Sustainability depends on the wider adoption of alternative practices that
sustainability)
project to deal with these factors
will be demonstrated during the project.
· Replicability
Describe the proposed approach to replication (for e.g. The nature of the project implies replicability both within each
dissemination of lessons, training workshops,
participating country, and to the benefit of other developing countries that
information exchange, national and regional forum
use DDT for vector control. The whole project design is geared toward
etc.) (could be within project description)
ensuring replicability.
· Stakeholder
· Describe how stakeholders have been involved in · Primary stakeholders are populations in poor rural communities who
Involvement
project development
are affected by malaria; public sector institutions that are responsible
· Describe the approach for stakeholder
for the malaria issue; and agricultural workers and health workers
involvement in further project development and
who have been exposed to DDT and would be again if DDT were
implementation
reintroduced. - see para 34-35.

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Work Program Inclusion per criteria
Reference Paragraphs and Explanatory Notes:
established in Draft # 8 of the project
review criteria

· Project strategy is to strengthen local capacities to control malaria
without DDT. Emphasis will be given to strengthening civil society's
role in addressing the problems caused by POPs and other pesticides.
· Monitoring &
· Describe how project design has incorporated
· Project design has benefited from the experience of developing
Evaluation
lessons from similar projects in the past
alternatives to DDT in Mexico.
· Describe approach for project M&E system,
· Indicators for individual objectives and outputs are described in
based on the project logical framework, including
Annex B.
the following elements:
· Monitoring of project progress will be the primary responsibility of
· Specifications of indicators for objectives and
the UNEP GEF Co-ordination Office and the Bureau of Fund
outputs, including alternate benchmarks, and
Management Services and will be undertaken via Quarterly
means of measurement.
Operational Reports, half yearly and end of year financial and
· Outline organisational arrangement for
substantive reporting in accordance with UNEP's internal guidelines
implementing M&E
for project monitoring and evaluation.
· Indicative total cost of M&E (may be
· A post project implementation review will be undertaken by UNEP 2
reflected in total project cost).
years after the end of the project.
· The indicative cost of the M&E related activities for the
Implementing Agency is 83,000 US$ and is included within the
Implementing Agency Fee.
3. Financing
· Financing Plan
· Estimate total project cost.
· Total project cost is estimated at 11.09 million US$ - see cover page
· Estimate contribution by financing partners.
and budget table 2.
· Propose type of financing instrument
· Estimated contribution from financing partners is 3.62 million US$
(including in-kind contributions) - see cover page.
· Grant financing.
Implementing Agency
Propose IA fee
· 382,000 US $ based on the agreed flat fee.
Fees
· 15,000 US$ premium based on added cost of evaluation in 8
countries.
· Cost-effectiveness
· Estimate cost effectiveness, if feasible
· The approach adopted to rely heavily on demonstration activities
· Describe alternate project approaches considered
provides a cost-effective way to facilitate widespread adoption of the
and discarded
alternatives to DT that will be implemented.

4. Institutional Coordination & Support

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Work Program Inclusion per criteria
Reference Paragraphs and Explanatory Notes:
established in Draft # 8 of the project
review criteria

IA Coordination and
Describe how the proposed project is located within
· The project is to be implemented within the framework of UNEP's
Support
the IA's
activities in Chemicals Management, including early implementation
· Core commitments
· Country regional/global/sector programs
of the POPs Convention.
& Linkages
· GEF activities with potential influence on the
· Links will be established with relevant activities. In particular,
proposed project (design & implementation)
linkages with the proposed UNEP/CAR-RCU project on Reducing
pesticide runoff to the Caribbean.
· Consultation,
· Describe how the proposed project relates to
Discussions are underway to coordinate activities with the relevant
Coordination and
activities of other IAs and 4 RDBs in the
projects and programmes active in the region, and particularly: DANIDA
Collaboration
country/region.
­PLAGSALUD; WHO - Roll Back Malaria; DANIDA - Programme of
between IAs, and
· Describe planned/agreed coordination,
Regional Environmental Management and Sustainable Development in
IAs and EAs, if
collaboration between IAs in project
Central America; GEF/PNUD/PNUMA ­ El Corredor Biologico
appropriate.
implementation.
Mesoamericano: una iniciativa regional de Desarrollo Sostenible; Plan
Puebla-Panamá (PPP) ­ Mexico and Central America sub-regional for
coordinated planning and actions.


5. Response to Reviews
Council
Respond to Council comments at pipeline entry
N/A
Convention Secretariat
Respond to comments from Convention Secretariat.
N/A
GEF Secretariat
Respond to comments from GEFSEC on draft project
N/A
brief.
Other IAs and 4 RDBs
Respond to comments from other IAs, 4RDBss on
Comments received from the WB are supportive and responded to in
draft project brief.
Annex C1.
STAP
Respond to comments by STAP at work program
N/A
inclusion.
Review by expert from
Respond to review by expert from STAP roster
Comments received from STAP roster expert are supportive and
STAP Roster
responded to in annex C1.



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PROJECT BRIEF

IDENTIFIERS
PROJECT NUMBER:

[Implementing Agency Project No not yet assigned]
PROJECT NAME:
Regional (Belize, Costa Rica, El Salvador, Guatemala,
Honduras, Mexico, Nicaragua, and Panama): Regional
Program of Action and Demonstration of Sustainable
Alternatives to DDT for Malaria Vector Control in
Mexico and Central America
DURATION:


3 years
IMPLEMENTING AGENCY:
United Nations Environment Program
EXECUTING AGENCIES:

Regional: Pan American Health Organization (PAHO)
National: Ministries of Health of Belize, Costa Rica, El
Salvador, Guatemala, Honduras, Mexico, Nicaragua, and
Panama
ELIGIBILITY:
The participating countries are eligible under paragraph 9 (b) of
the Instrument for the Restructured GEF. The proposed
intervention is consistent with the provisions of the POPs
Convention.
GEF FOCAL AREA:

International Waters
GEF PROGRAMMING FRAMEWORK: Global Contaminants, Operational Program Number 10





Draft Operational Programme 14 on POPs
________________________________________________________________________
SUMMARY:

During the last decade Mexico and Central American countries have gradually discontinued DDT
sprayings for vector control. Malaria, however, still poses a serious risk for the population of these
countries. This proposal aims to prevent reintroduction of DDT for malaria control by promoting new
integrated vector control techniques and implementing a coordinated regional program to improve
national capacities. Major project components will be: the implementation of demonstration projects of
vector control without DDT or other persistent pesticides that can be replicable in other parts of the
world and which are cost-effective, environmentally sound, and sustainable; the strengthening of national
and local institutional capacity to control malaria without the use of DDT; and the elimination of DDT
stockpiles in the eight participating countries.

COSTS AND FINANCING (MILLION US $):

GEF
Project


:
6.599
Project Support Costs
:
0.528

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PDF B


:
0.330
Project Preparation Costs
:
0.038
Sub-Total GEF

:
7.495

Co-financing

PDF-B (all sources)

:
0.440
CEC


:
0.200
PAHO


:
0.654 (in kind)
Governments


5.1164 (in cash & kind)*
Sub-Total Co-Financing
:
6.4104
____________________________________________________________________________
Total Project Cost

: 13.9054

* This figure represents an in principle commitment from the participating countries to redirect their
malaria program budgets in the demonstration areas to project activities.

OPERATIONAL FOCAL POINT ENDORSEMENTS:

COUNTRY
OPERATIONAL
POSITION
DATE OF
FOCAL POINT NAME
ENDORSEMENT
Belize
Nancy Namis
AG Chief Executive Officer
8/1/02

Ministry of Economic Development
Costa Rica
Licda. Guaria Vargas Executive Director , FUNDECOOPERACION
28/9/01

El Salvador
Ana Maria Majano
Minister of Environment and Natural Resources
29/10/01

Guatemala
Dr. Sergio Augusto
Minister of the Environment
20/10/01
Lavarreda Anieu
Honduras
Ing. Xiomara Gomes
Minister of Environment and Natural Resources
25/9/01

de Caballero
Mexico
Lic. Ricardo Ochoa
Ministry of Finance of Mexico, Director,
5/12/01
International Financial Institutions (SHCP)
Nicaragua
Garcia A. Cantero
Advisor to the Minister
24/9/01
Coordinator for PROTIERRA
Panama
Ing. Ricardo R.
General Administrator, National Environmental
26/10/01
Anguizola M.
Authority

IA CONTACT:
Name: Mr Ahmed Djoghlaf, Executive Coordinator, UNEP/GEF Co-ordination Office, UNEP,

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Nairobi, Tel: (254-2) 624165, Fax: (254-2) 624041, Email: ahmed.djoghlaf@unep.org



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LIST OF ACRONYMS/ABBREVIATIONS

CEC
Commission for Environmental Cooperation (NAFTA)
CDC
Center for Disease Control and Prevention (USA)
CINVESTAV
Centro de Investigación y Estudios Avanzados del Instituto Politécnico

Nacional. Unidad Mérida, Mexico
CIRA-UNAN
Centro para la Investigación en Recursos Acuáticos de Nicaragua,

Universidad Autónoma de Nicaragua
DANIDA
Danish International Development Agency
DDT
dichloromethyltrichloroethane [1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane]
GEF
Global Environment Facility
GIS

Geographic Information System
GTZ
German Agency for Technical Cooperation
HCP
Division of Disease Prevention and Control (PAHO)
HEP
Division of Health and Environment (PAHO)
IDA
International Development Association (World Bank Group)
IDB
Inter-American Development Bank
IDRC
International Development Research Center
LUCAM
Laboratorio Unificado de Control de Alimentos y Medicamentos ­ Guatemala
MAG
Ministerio de Agricultura y Ganaderia ­ Costa Rica
MASICA
Program on Health and Environment in Central American Isthmus
NAFTA
North American Free Trade Agreement
NARAP
North American Regional Action Plan
NGO
Non Governmental Organizations
PAHO
Pan American Health Organization
PDF
Project Preparation and Development Facility
PLAGSALUD
Occupational and Environmental Aspects of Pesticides in the Central



American Isthmus (DANIDA/PAHO)
SHA
Special Program for Health Analysis (PAHO)
SICA
Sistema de la Integración Centroamericana


(Central American Integration System)
RBM
Roll Back Malaria Program (WHO)
UN

United Nations
UNEP
United Nations Environment Programme
USAID
United States Agency for International Development
WB

World Bank
WHO
World Health Organization

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PROJECT DESCRIPTION

BACKGROUND ­ BASELINE COURSE OF ACTION

1.
Malaria is a transboundary problem affecting most tropical countries. It is a protozoal infection
transmitted to human beings by an infected anopheline mosquito bite mainly between sunset and sunrise.
Human malaria is caused by four species of Plasmodium protozoa: P. falciparum, P. vivax, P. ovale
and P. malariae. In Central America and Mexico the main malaria vectors are A. pseudopunctipenis,
A. albimanus, and A. vestitipenis. It is estimated that 89,128,000 people in Mesoamerica live in areas
environmentally suitable (high temperatures and humidity) for the transmission of malaria, of which
23,445,000 (35%) live in highly endemic areas. Migration of infected people and environmental
conditions such as rainfall patterns, altitude and temperature all facilitate the movement of the disease
across national borders. Only an integrated regional approach can address the human and environmental
challenges in malaria prone areas.

2.
DDT has been extensively used as an insecticide for malaria vector control and in agriculture in
Mexico and Central America since the 1950's; sprayed not only in households but also on water
surfaces in an attempt to control mosquito breeding. Concerns regarding environmental contamination
by DDT compounds as well as the development of vector resistance to the organochlorine insecticides,
motivated the countries to initiate policies to gradually discontinue DDT sprayings during the 1980's and
the 90's. Belize, for example, had been using DDT up to the year 1999 and Mexico, up to the year
2000. The assessment made during the PDF-B phase revealed that at least 85,000 tons of DDT was
sprayed in households and its surroundings in malaria endemic areas in the last 40 years. Malaria
endemic areas in Guatemala received an average of 204 tons of DDT per year between 1958 and
1979. Nicaragua sprayed 268 tons/year between 1959 and 1962. Mexico sprayed 5,110 tons/year of
DDT between 1957 and 1960, going down to 290 tons/year between 1992 and 1999. El Salvador
sprayed 198 tons/year from 1960 to 1973.

3.
DDT and its metabolites, especially p,p'-DDE, are highly stable toxic compounds that persist in
the environment for many years and can accumulate in living organisms. They can persist decades in
soils in association with organic matter and clay particles. DDT is transported though the water cycle by
rainfall and surface water runoff, and can be carried to remote areas by the atmosphere as well, thus
contributing to environmental contamination at global level. Concerns about DDT residues in water,
sediment and soil, as well as in the food chain in Mexico and Central America were reinforced by data
brought forth sub-regional and national reports developed during the PDF-B phase. An assessment of
DDT and deltamethrin exposure was carried out in Mexico in the two states with the highest prevalence
of malaria and a history of pesticide application. In Chiapas, samples were obtained at the time when
DDT was being used in the malaria control program. In Oaxaca, samples were collected two years
after the final spraying of DDT and two days after deltamethrin (a pyrethroid used as a substitute for
DDT) application. Soils samples collected from the bare dirt floor inside a house that had been sprayed
with DDT and analyzed during the PDF-B phase showed 83 mg/kg of DDT, 41 mg/kg of DDD and 14

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mg/kg of DDE, compared to 0.37 mg/kg of DDT, 0.02 mg/kg of DDD and 0.2 mg/kg of DDE found in
a house that had not been sprayed. Outside the same house, the soil samples had 49 mg/kg of DDT, 13
mg/kg of DDD and 5.7 mg/kg of DDE, compared to 0.6 mg/kg of DDT, 0.6 mg/kg of DDD and 0.2
mg/kg of DDE in the control area. In Nicaragua, samples of sediments taken from coastal lagoons in
malaria endemic area had 50 µg/kg of DDT, 46 µg/kg of DDD and 94 µg/kg of DDE.

4.
Long-term health effects of these compounds on the malaria campaign personnel that were
exposed by spraying DDT, or populations residing in villages where these pesticides were applied are
also of concern, although the specific effects are not well understood. Mean concentration of DDT and
DDE, as measured in whole blood, were 68 and 87 µg/l for children living in Chiapas and 27 and 61
µg/l for adults respectively. Sprayers in Chiapas had the highest levels of exposure with 170 and 190
µg/l of DDT and DDE. As expected, DDT levels were lower two years after the final application in
Oaxaca (20 and 13 µg/l for children and adults respectively). 60 newborn had their umbilical chord
blood tested in Oaxaca coastal zone and DDE was found in a mean level of 13 µg/g. Deltamethrin
exposure was assessed only in children in Oaxaca: 50% of the exposed group had urinary levels above
the limit of detection and 6% had levels above 25 µg/l (five times the limit of detection), with a negative
trend with age. Information related to Central America is reported in the regional report, however, most
of these countries do not have data or documentation on the level of DDT residues.

5.
These environmental and health effects are compounded by the fact that Central American
countries are particularly vulnerable to natural hazards such as hurricanes and earthquakes. After
Hurricane Mitch in 1998, approximately one ton of DDT that was poorly stored was washed into the
Caribbean Sea in Nicaragua. Preliminary studies conducted in Honduras after the hurricane indicated
the presence of DDT in the environment and human population, probably originating from an industrial
plant that had been flooded. The existing DDT stockpiles in these countries, which generally are stored
in improper conditions, therefore pose a great risk of contamination of national and international waters
as well as the possibility of harm to human health and environment under disaster situations.

6.
In the absence of GEF intervention, given the low national budgets for malaria control, weak
national health systems, and lack of institutional and community level awareness about the effects of
DDT exposure on environment and human health, the reintroduction of DDT for malaria control is likely.
Particularly considering its low cost and relative effectiveness as an insecticide. Countries such as
Guatemala, Honduras and Belize, where national malaria campaigns have been weak, might contribute
to increase the regional problem because of transboundary spread of the malaria disease. The benefits
of the isolated initiatives to develop new techniques of malaria vector control, that have flourished in
Mexico, Costa Rica, Nicaragua and Panama during the last few years, could be lost in the long run due
to lack of coordination and exchange of experience. The recent experience of South Africa that has had
recently to resolve itself using DDT to fight a malaria outbreak exemplifies the difficulty of phasing-out
DDT in a sustainable manner, and the need to demonstrate conclusively the efficiency of an array of
alternative methods.


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GEF Programming Context

7.
This project conforms with the "Contaminant-based" Operational Programme No 10 and will
"help demonstrate ways of overcoming barriers to the adoption of best practices that limit
contamination of the International Waters environment". The proposed activities are also
consistent with several provisions of the recently adopted Stockholm Convention on POPs, and with the
draft Operational Programme on POPs under development. Five of the participating countries have
already signed the POPs convention: El Salvador, Honduras, Mexico, Nicaragua and Panama. The
other three countries have expressed their intention to sign it.

Implementing Agency Programming Context

8.
UNEP is the task manager for chapter 19 of agenda 21 on toxic substances and the Secretariat
for the Stockholm Convention on Persistent Organic Pollutants which was adopted in May 2001.
UNEP will facilitate the coordination between this project and the other POPs projects developed
under its aegis. In particular links with the UNEP/GEF project under development "Reducing Pesticide
Runoff to the Caribbean Sea" which is focused on Colombia, Costa Rica and Nicaragua will be
consolidated through participation of the national coordinators to the respective national committees and
participation of the regional project manager to the respective steering committees. Contacts have been
established with the regional coordinator of the GEF/UNDP/UNEP project "El Corredor Biologico
Mesoamericano: una iniciativa regional de Desarrollo Sostenible" for future coordination of
environmental activities, particularly related to community participation and awareness in the areas of
demonstration projects in Costa Rica and Panama.

Executing Agency Context

9.
PAHO has an office in each country in the region and has a central role in providing technical
cooperation for both the establishment of malaria control programs and prevention of adverse effects
related to the use of pesticides. PAHO has been called upon by UNEP to play a strategic role in Latin
America and the Caribbean in the implementation of Governing Council Decision 19/13C (1997) which
mandates a series of immediate actions on POPs, including exchange of information. As part of the
initiative for the Sustainable Development of the Central American Region, PAHO, with strong support
of the Nordic Countries, has launched the "Program on Health and Environment in the Central American
Isthmus", known by its Spanish acronym MASICA (1990). This program has focused on obtaining
political commitments to integrate environment, health and development actions. One of its main
components is the Project PLAGSALUD (Occupational and Environmental Aspects of Pesticides in the
Central American Isthmus), established in 1994 with funding from DANIDA. Using a bottom-up
approach, this project has been active in all seven Central American countries for the last six years.
Enjoying government and civil society support, it has already achieved important results such as the
improvement of the surveillance and control of acute intoxication from pesticides, the revision of
pesticide legislation, the establishment of local pesticide committees, and more specifically the

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improvement of the protection of malaria and other vector control personnel from exposure to
pesticides. This proposal will build on and complement the groundwork already accomplished by
PLAGSALUD.

National and Regional Context

10.
In 1996 the Parties to the North American Free Trade Agreement (NAFTA), working with the
Secretariat for the North American Commission for Environmental Cooperation (CEC), approved a
North American Regional Action Plan (NARAP) to reduce the exposure of humans and the
environment to DDT compounds through phasing out the use of DDT for malaria control in Mexico,
transferring this experience to other countries, and eliminating illegal uses of DDT. The CEC continued
its holistic approach to malaria control in Mexico during the PDF-B phase by executing demonstration
projects which brought together an integrated vector control management strategy with the full spectrum
of related public health activities and services. This program maintains a regional perspective that
encourages sharing of experiences with other Latin American and Caribbean countries to ensure that
malaria is controlled throughout the Region by environmentally sound methodologies, with participation
of local communities, non-governmental organizations, business and industry sectors, state and municipal
government institutions, academia, and technical and policy experts. The proposed project has received
very strong support from the health sectors of the participating countries, as evidenced by the letters of
support received from the Ministries of Health (Annex J).

11.
In 1991, 1260 tons of DDT were sprayed in Mexico, in 1997 477 tons, and in the year 2000
no DDT was sprayed. Belize discontinued the use of DDT during the PDF-B phase. Three different
pilot projects were undertaken in the State of Oaxaca in Mexico to assess the effectiveness of
alternative malaria control measures including field assessment of bed nets as a complementing measure
to control malaria and field evaluation of delthametrin as a substitute to DDT as well as environmental
actions to prevent the proliferation of malaria vector. The successful methodologies tested in these pilot
projects will be replicated in the demonstration projects. Guatemala, Nicaragua and Honduras have had
positive experience in using Bacillus thurigiensis and Bacillus sphaericus as a biological tool for
malaria vector control. Honduras and Guatemala have also experimented controlling mosquito breeding
by using larvae eating fishes. Guatemala has been experimenting with Neem tree, an African specie of
plant with repellent properties. Costa Rica, El Salvador and Panama reported positive malaria vector
control by improving the sanitary conditions in malaria endemic areas. Physical barriers such as
mosquito nets have also been adopted as complementary strategies in all participating countries.


RATIONALE AND OBJECTIVES

12.
There is a need to strengthen institutional technical capacity at a regional scale for assessment
and control of malaria disease vectors. Countries with less capacity to address malaria control without
DDT need help from their neighbors who have had successful experiences. Only a long-term regional

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cooperative program can help deter some countries from returning to use DDT or using other persistent
pesticides to control endemic malaria vectors. The participating countries are committed to developing
and implementing comprehensive management practices that will build and strengthen awareness about
the importance of environmental conservation and sound water management in the control and
prevention of endemic diseases with the active participation of local communities, particularly in
immigration corridors. The principles which form the basis for the proposed project are: integrated
inter-institution and inter-sectoral (environment and health) approaches; broad community participation
in all steps of the project; integration of the work to existing national institutions so that no parallel
structures are created; technical, financial and organizational sustainability of the new approaches to
malaria control; and widespread dissemination of the information generated by the project.

13.
The proper storage and eventual disposal of POPs presents a problem throughout the Region.
The PDF-B has identified approximately 135 tons of DDT stored throughout the region, some in very
bad conditions in leaking containers as the 15 tons in Guatemala. Current methods of storage in old
warehouses are insufficient to prevent environmental contamination and human contact. Nicaragua and
Honduras have already received international help to dispose of their DDT stockpiles, but assistance is
required for the other six countries for this endeavour.

14.
In the execution of the PDF-B Grant, the following lessons were learned: (i) The experimental
projects developed in Mexico showed that integrated vector management with community participation,
in addition to new ways of monitoring and treating the disease, can eliminate the use of pesticides after 2
years of continuous actions; (ii) The communication network initiated during the PDF-B facilitates the
exchange of technologies in use in different countries as was seen in the 3 regional meetings where the
participating countries presented and were questioned about their malaria control strategies; (iii) In
order to be replicable in other parts of the world, in different ecosystems and socio-economic
conditions, the Mexican and Central American experiences of malaria control without DDT need further
detailed documentation and close monitoring of activities and results; (iv) There is a need for
standardization and validation of laboratory procedures for monitoring the presence of DDT in the
environment and in people, and for malaria detection, in order to have comparable data; (v) there is a
need for national and local institutional capacity building in order to achieve sustainability of the new
methodologies of malaria control, and (vi) a specially designed Webpage and the application of a GIS
are useful tools for malaria risk assessment, epidemiological analysis, monitoring and evaluation of the
effectiveness of interventions, decision making in health/environment related issues, and will contribute to
the sustainability and replicability of the project activities.

15.
The overall objective of the project is to demonstrate that methods for malaria vector control
without DDT or other persistent pesticides are replicable, cost-effective and sustainable, thus preventing
the reintroduction of DDT in the region. Human health and the environment will be protected in Mexico
and Central America by promoting new approaches to malaria control, as part of an integrated and
coordinated regional program. The establishment of a regional network will facilitate the exchange of
best practices and lessons learned among neighboring countries. A major outcome will be increased

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government and local community awareness of DDT and other pesticides hazards to the environment
and human health, and adjustment of future behavior regarding the use of persistent pesticides.

16.
The results of this project will be felt at three levels: (i) At the national level, each one of the 8
participating countries will have the documented results of a well monitored demonstration project of
malaria vector control without DDT or other persistent pesticides; (ii.) At the regional level the lessons
learned in each country will be exchanged and a regional consensus will be built; (iii.) At the global
level the results of this project will define replicable models for malaria control based on cost effective,
environmentally sound and sustainable strategies. These models which will be thoroughly tested and
documented in a series of interconnected demonstration projects will constitute a set of best practices
which may be applied in other regions of the world.


PROJECT ACTIVITIES / COMPONENTS AND EXPECTED RESULTS

17.
After a consultation process, led by PAHO and the CEC, consisting of meetings and studies
implemented during the PDF B phase, four different groups of actions were identified as necessary to
address countries' needs to lower their vulnerability to using DDT for malaria control. The actions, as
presented in Annex B (Logical Framework), are organized under the following four components:

18.
Component 1: Demonstration Projects and Dissemination. The objective is to implement,
evaluate, and disseminate the alternative strategies of malaria vector control without use of DDT which
were developed during the PDF-B phase. The main outcome is to avoid future reintroduction of DDT
or other persistent pesticides in national malaria control programs. This component represents a major
part of this project and most of the resources will be concentrated on it. A total of nine demonstration
projects will be implemented under specific ecological conditions in each of the participating countries,
using a set of integrated methods of malaria control according to the RBM/WHO and the Mexican
experience of malaria control without DDT. The nine sites for demonstration projects were defined and
delimited in each country during the PDF-B according to government suggestions about local needs.
The alternatives tested in each demonstration projects will be closely assessed and evaluated in terms of
their technical and economic effectiveness.

19.
The activities that will be implemented in the demonstration projects are described in Annex F.
The settings for demonstration areas include different malaria vectors, endemic levels of the disease, and
environmental and social-economical conditions. A technical manual will provide basic information on
malaria vector control without use of DDT while confronting different vector species and different
ecological conditions in each country. Workshops will be organized locally for health and environment
personnel, community leaders, and NGOs involved in each demonstration project. The exchange of
information and experiences of all 8 participating countries on malaria vector ecology and entomology,
integrated malaria vector control methods, field operations, as well as community participation
techniques will be facilitated. Community awareness, community training and public participation are

6

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important tools in the implementation of integrated vector control strategies and will be encouraged and
supported through workshops, training courses, participation in demonstration projects, preparation of
material for wide diffusion, media campaigns, educational activities, etc.

20.
A region-wide information system on DDT and malaria control will be the basis for gathering
and disseminating data adequate to the needs of government in the decision-making process. Links with
other regions of the world will facilitate the exchange of information related to malaria control, and the
sharing and dissemination of the results of the demonstration projects on a world-wide basis. The
electronic platform developed during the PDF B phase includes a Web and an Intranet page. It will
provide access to project documents, national reports, technical studies, reports of meetings and
workshops, as well as results of demonstration projects and will facilitate communication among project
participants.

21.
In the demonstration projects areas, the population and environmental compartments (water,
soil, sediment and biota), as well as the malaria programs personnel, will be monitored for exposure to
DDT and newly introduced pesticides for malaria control. An inter-laboratory control program will be
implemented to ensure that analytical results are reliable and comparable across the participating
countries and at the international level. A current baseline of DDT exposure will be established in each
demonstration project area. Training on exposure assessment techniques will be provided, including
sampling and laboratory techniques. Exposure risk areas will be identified and mapped, and the
generated data will integrate national and regional information systems. Epidemiological assessment of
malaria personnel will be implemented in each participating country. Educational and public information
material will be formulated to raise awareness about the risks of exposure to DDT and other pesticides.

22.
The outcomes of this project component address needs at several levels. Local health services
will be strengthened and communities involved in demonstration projects will learn participatory and
integrated techniques for malaria control and will become aware of DDT exposure hazards. National
institutions in the health, environment and other sectors will establish links in formulating an integrated
and preventive approach to malaria vector control. At the Global level, the documented experience of
each demonstration project will constitute a set of malaria control techniques replicable in other parts of
the world under similar ecological conditions. This component includes workshops and training of local
technicians and community, assessment of all activities, and evaluation of results. The estimate of costs
for each demonstration project was based on the Mexican experience. Each country will contribute to
this component through redirection of its budgetary malaria control program in the demonstration areas.
Based on information provided by each participating country after definition of the areas where the
demonstration projects will be implemented, the total cost of demonstration projects is estimated at
US$ 8,873,400. Of this amount, US$ 5,026,400 will be provided by the countries and US$ 350,000
by CEC and PAHO (Table 2). GEF is requested to provide US$ 3,497,000 (for details see Annex E).

7

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23.
Component 2: Strengthening of national institutional capacity to control malaria without
DDT. The objective is to strengthen national and local institutional capacities to control malaria with
methods that do not rely on DDT or other persistent pesticides. The outcome of this component will be
strengthened national capacities of malaria risk assessment, development of analytical laboratory
infrastructure, community participation and training regarding malaria vector control and pesticide
management. The activities described in Annex E will provide the tools for countries to make well-
informed decisions about malaria control based on new methods. National Action Programs aiming at
decentralization and implementation of integrated methods will be reinforced. Government authorities of
health, environment, and agriculture of the participating countries will have the opportunity to exchange
and discuss the existing alternative strategies that will be tested and documented through the
demonstration projects.

24.
Laboratory analysis capacity for chemical assessment will be strengthened in Mexico
(Universidad Autónoma de San Luis Potosí and Centro de Investigación y Estudios Avanzados del
Instituto Politécnico Nacional - CINVESTAV ­ Unidad Merida), Guatemala (Laboratorio Unificado
de Control de Alimentos y Medicamentos - LUCAM), Nicaragua (Centro para la Investigación en
Recursos Acuáticos de la Universidad Autonoma de Nicaragua ­ CIRA/UNAM), Panama (Instituto
Gorgas de Estudio de la Salud), Costa Rica (Laboratorio del Ministerio de Agricultura y Ganaderia -
MAG), El Salvador (Ministerio de Agricultura y Ganaderia), and Central Laboratory of Belize.

25.
The Geographic Information System which was developed during the PDF-B phase (cf. Annex
G for demonstration) will include geo-referenced data on malaria control, population at risk,
environmental and ecological factors related to vector distribution, malaria vector control interventions,
health system coverage, etc. A specific GIS will be developed for use at local levels with selected
indicators to monitor project data related to pesticide use and environmental and health impacts of
DDT. These computerized tools will strengthen: the institutional capacities to monitor and disseminate
information related to malaria control under integrated health/environmental approach; the regional
capacity for epidemiological analysis the health workers; the national epidemiological surveillance
systems; the regional epidemic forecasting and preparedness; and the detection of insecticide resistance,
inter alia.

26.
A substantive Final Report will be printed in book format and CD to disseminate the results of
the project and the methodologies for malaria control without DDT tested in the demonstration projects.
It will include maps of malaria risk areas, extensive descriptions of the methodologies and results of each
demonstration project, the effects of DDT exposure documented during the implementation of this
project. The document will provide national governmental institutions with the information needed to
support the sustained phasing-out of DDT in public health programs.

27.
Details of these activities and their related costs are shown in Annex E (Description of Project
Activities and Costs). The electronic platform containing Webpage, Intranet, and GIS will be developed
by the Special Program for Health Analysis (SHA) of PAHO which will facilitate the future maintenance

8

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and continuation of the services. A special effort aimed at the sustainability of these activities will be
made by building local capacity. Specific detailed Terms of Reference for all contracted services will be
prepared by HEP/PAHO in close consultation with UNEP during the first quarter of the project. The
total cost of this component will be US$ 1,608,000.

28.
Component 3: Elimination of DDT stockpiles. This component will address the existing
problem of stockpiles in six of the eight participating countries (Nicaragua and Honduras have already
received international support for final disposal of their DDT stockpiles). All activities will be
documented and management plans will be put into place to prevent further accumulation of stockpiles
of pesticides. During the PDF-B, approximately 135 tons of DDT were identified in Belize (13 tons),
Costa Rica (9 tons), El Salvador (6 tons), Guatemala (15 tons), Mexico (87 tons), and Panama (5
tons). The national inventories will be completed, including finding and quantifying evidence of DDT
uses in agriculture or other sectors. All obsolete stocks in leaking containers will be repackaged and
prepared for shipment. The objective of this component is to eliminate the existing DDT stockpiles,
repack materials as required, and arrange ways to eliminate DDT in an environmentally sound manner
consistent with the provisions of the Stockholm and Basel Conventions. The total cost of activities under
this component is US$ 450,000.

29.
Component 4: Coordination and Management. A regional coordinator will be hired for this
project under terms of reference established by the steering committee. The regional coordinator be
hired by PAHO and be based in one of the participating countries. Each country will have a national
coordinator, based in the PAHO country office, with the main tasks of organizing and coordinating all
activities implemented in the demonstration projects, facilitating local community participation, and
monitoring and evaluating all activities, results, and data generated by the demonstration projects. This
component also includes three annual meetings of the steering committee, three regional meetings for
planning and evaluation of activities, and three regional annual reports. The total costs are US$
1,638,000.


RISKS AND SUSTAINABILITY

30.
Drawing on the experience gained during the PDF-B phase, when participants from the eight
participating countries were brought together in regional meetings, several assumptions about inherent
risks can be made. These include: the possibility of a large scale malaria resurgence; unexpected natural
hazard phenomena (earthquakes and hurricanes) that could create difficult conditions for implementing
the proposed vector control strategies; lack of adequate community participation in the demonstration
projects; lack of capacity of national malaria control surveillance systems; persistent transmission of
malaria in areas close to demonstration projects. These risks will be mitigated by monitoring them very
closely and by the communication network which will be put into place and will facilitate rapid
discussion and search for adequate solutions.


9

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31.
All participating countries are signatories of several international conventions and their
governments have decided to use this project as an instrument to update and upgrade their malaria
control programs for the benefit of public health, the environment and sustainable development.
Consequently, significant co-financing is available in each of the participating countries which can ensure
post-project sustainability of the initiatives developed in the course of the project. Local communities
will be involved in each demonstration project and public awareness on the problems related to DDT
use will be the key factors for the sustainability of the new approaches to malaria vector control
generated by this project.

32.
Sustainability will also result from the integration of project activities with the ongoing work of
participating institutions. For example, epidemiological surveillance of pesticide problems is already an
integral part of the national health surveillance systems supported by national Health Ministries in most
countries. The PLAGSALUD project has activities related to agricultural use of pesticides, community
involvement and public awareness on pesticides. The integration among these projects will enhance
sustainability of pesticide control strategies developed by the DDT phase out effort. At the local level
the project will work through the existing health service structure, thus avoiding distorting host country
activities and resource capabilities in an unsustainable way. Regional level activities that enhance local
and national level capacities will be emphasized. This approach is consistent with the increasing
emphasis on decentralization promoted by PAHO within the health sector throughout the region.

33.
It is expected that the local level experience generated by the demonstration projects will form a
model that will be adopted at country level and later can be applied at a global level. The "bottom-up"
approach based on the active participation of local communities, government technical officers, NGOs
and local level institutions is designed to bring the desired sustainability to the models introduced by this
project.

10

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STAKEHOLDER PARTICIPATION AND IMPLEMENTATION ARRANGEMENTS

34.
The primary beneficiaries of this project will be: a) populations in poor rural communities who
are affected by malaria, b) public sector institutions that have to deal with the malaria problem, and c)
agricultural workers and health workers who have been exposed to DDT and would be again if DDT is
reintroduced. All stakeholders will benefit from the incorporation of integrated malaria vector control
principles into the existing framework of national health policies; the strengthening of the new strategies
for malaria control without DDT or hazardous pesticides; the involvement and training of local
communities in malaria vector control techniques; the elimination of the existing DDT stockpiles;
improved inter-sectoral collaboration especially between the health and environment ministries; and the
strengthening of health surveillance and pesticides monitoring systems. The Governments of the 8
participating countries, local NGOs, research centers, and universities have demonstrated their
willingness to cooperate and coordinate activities during the implementation of this project. This
proposal has been formulated with the active participation of representatives of the governments and
other stakeholders. The final draft was presented and discussed during the 2nd Steering Committee
Meeting in Mexico city.

35.
One of the main strategies of this project is to strengthen local capacities to control malaria
without DDT. Great emphasis will be given to strengthening civil society's role in addressing the
problems caused by POPs and other pesticides, by integrating local NGOs, church groups, etc into
meetings, workshops and planned actions related to the demonstration projects. The project will
provide information and technical support to civil society initiatives by providing technical manuals and
reports on Malaria control without DDT in an accessible language.

36.
PAHO, due to its historic involvement in the region and its role in implementing activities under
related projects, will be the lead regional Executing Agency. The Division of Health and Environment
(HEP) in Washington D.C. PAHO headquarters will be responsible for the management of the project.
PAHO will be implementing the actions with close participation of its local officers in each of the
participating countries. Technical assistance will be provided by other PAHO units (Office of External
Relations (DEC), Program on Human Resources Development (HSR), Special Program for Health
Analysis (SHA), and Program on Communicable Diseases (HCT)). The lead institution responsible for
project execution in each country will be the Ministry of Health. Additionally, the project will involve the
Ministries of Environment and Agriculture, the Plagsalud national pesticide commissions, and the local
health care systems, as well as civil society organizations such as NGO's, research centers, and
universities.

37.
The project will have a regional coordinator contracted by PAHO, living in one of the
participating countries. Each country will have a national focal point for this project, appointed by the
executing ministry, and a national technical coordinator to be contracted by PAHO in consultation with
the governments and UNEP for the full 36 months of the project. A National Operational Committee

11

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will be established in each participating country under the coordination of the national focal point, with
the participation of the technical coordinator and representatives of community organizations and NGOs
involved in the project. Its role will be to promote the active participation of all stakeholders and to
advise on the orientation of the project. It will be co-chaired by the national focal point and technical
coordinators and will be the mechanism for the coordination of national actions. A Regional Operational
Committee will be formed by the national focal points (Ministries of Health and national technical
coordinators) and will be chaired by the regional coordinator. This will be a technical body to discuss,
plan and evaluate the technical activities of the project.

38.
The Steering Committee will be composed by representatives of the Ministers of Health,
PAHO, UNEP, CEC, CCAD, other relevant projects in the region and NGOs, as well as the national
focal points and technical coordinators. This will be the highest organ of the project and will meet at
least once a year to approve the workplans of the countries, the terms of reference of the demonstration
projects, and provide advisory functions. Any significant change to programs and budgets must be
approved at this level.

INCREMENTAL COST AND PROJECT FINANCING

39.
Table 1 presents the baseline of this intervention and the incremental costs of achieving global
environmental benefits. This is discussed in Annex A. Table 2 presents the project financing by
components. During the Steering Committee meeting in Mexico City, on September 11-12, 2001 the
average cost per capita for alternative techniques of malaria vector control was established, based on
Mexico's experience during the PDF-B phase, at $2.2 US dollars. This cost includes various activities
such as community training, campaigns for creating community awareness, local environmental actions
related to cleaning vector breeding sites, treatment of infected people, etc. The amount necessary for
each country to develop their demonstration project was then established by multiplying the per capita
cost by the inhabitants present in the malaria risk areas chosen by the countries as their demonstrative
sites. It was asked to the governments that they should meet at least 50% of the expenses related to
their demonstrative projects by redirecting part of their national malaria program budgets, to be used in
the demonstration areas, especially in actions related to the treatment of infected people. Significant co-
financing is available from malaria control programs in the participating countries as seen in the letters of
endorsement (Annex J). The estimated co-financing includes US$ 5,026,400 from national budgets for
malaria control programs specifically oriented to the population of the demonstration project areas. US$
654,000 are in kind contribution from PAHO (10% of 3 PAHO Technical Regional Advisors, 10% of
7 PAHO's PLAGSALUD Technical Support Agents, 5% of 7 PAHO National Environmental Health
Advisors, 15% of PAHO's Environmental Health Advisor in Mexico, and 5% of 3 PAHO Supervisors.
The CEC is contributing US$ 200,000 to be directed to assessment of pesticides residues in the two
demonstration project areas in Mexico. The total Cost of the project is estimated at US$ 13,905,400
of which US$ 7,495,000 is requested from the GEF.


12

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Table 1 Baseline & Incremental Costs of achieving domestic & global environmental benefits

000 US$
Baseline
Alternate
Increment
GLOBAL ENVIRONMENTAL BENEFITS
1,773
9,268
7,495
PDF-B phase
440
770
330
Comp. 1 Demonstration projects and dissemination
1,064
4,561
3,497
Comp. 2 Strength. Natl. capacity to ctrl malaria without DDT
64
1,308
1,244
Comp. 3 Elimination of DDT stockpiles
25
425
400
Comp. 4 Coordination and Management
180
1,638
1,458
Executing Agency Project Support Costs
0
566
566
DOMESTIC ENVIRONMENTAL BENEFITS
1,825
1,825
0
PDF-B phase
0
0
0
Comp. 1 Demonstration projects and dissemination
1,500
1,500
0
Comp. 2 Strength. Natl. capacity to ctrl malaria without DDT
300
300
0
Comp. 3 Elimination of DDT stockpiles
25
25
0
Comp. 4 Coordination and Management
0
0
0


Table 2. Project budget summary and component financing (000 US $)






Co-financing

COMPONENT
GEF
TOTAL
PAHO
Government
CEC
1. Demonstration Projects and Dissemination
3,497
150*
5,026.4**
200
8,873.4

2. Strengthening of national capacities to control
1,244
364*


1,608
malaria without DDT
3. Elimination of DDT stockpiles
400
50*


450

4. Coordination and Management
1,458
90*
90*

1,638

SUB-TOTAL
6,599
654*
5,116.4
200
12,569.4

Project Support Costs ­ PAHO (8%)
528



528

Project preparation costs recovering***
38



38
PDF-B phase
330
100*
240*
100
770

TOTAL
7,495
754
5,356.4
300
13,905.4


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* In kind contribution
** National budget for malaria control program in the demonstration areas
*** As of writing agreement reached during the PDF negotiations


MONITORING, EVALUATION AND DISSEMINATION

40.
The administrative, technical and financial reporting framework will be provided in the
framework of the standard UNEP and GEF reporting protocols. Indicators will be implemented through
the establishment and integration of monitoring tools into project components, as agreed by the Steering
Committee. A monitoring and evaluation plan, consistent with GEF criteria, will be prepared by the
PAHO and CEC, and submitted to the Steering Committee and UNEP. The objective of this
monitoring is to contribute to improving, and, if needed, adapting management of work program
activities as well as creating the basis for project evaluation. The work plan and terms of reference for
project staff and consultants will be discussed and agreed at the first and second meetings of the
Steering Committee. A post project implementation review will be undertaken by UNEP two years
after the end of the project.

41.
Incorporated into the action plan are specific components (see Components 1 and 2) which
explicitly aim to promote and disseminate the experiences obtained through the project implementation
process to the Mexican and Central American stakeholders and communities within the region. Program
activities encourage and facilitate technology transfer and information dissemination through programs of
public participation, stakeholder involvement, and professional and community-based education and
information dissemination. States and municipal governmental organizations, NGOs and citizen
involvement in project execution will also contribute to the dissemination of information on specific
technologies and techniques that contribute to the sustainable environmental management and public
health development. Finally, the electronic platform with a web site and GIS will also facilitate the
dissemination of the results of the project as well as the new strategies and techniques of malaria vector
control.

42.
The Final Report of this project will have a book format consisting of an extensive report on
different strategies for malaria control without DDT under different ecosystems and socio-economic
conditions, containing data and results from all the five project components, illustrated by data, maps
and pictures showing and/or reflecting the following achievements:
· An established regional epidemiological information system for malaria control and related pesticide
problems integrated into the national health surveillance systems of each country.
· Improved diagnosis of the effects of pesticides used in public health for the control of malaria in
people and the environment in each country.
· Strengthened involvement at local, national and regional levels of NGO's, research institutions, and
other civil society organizations on avoiding DDT reintroduction and supporting new strategies of
malaria control.
· Strengthened reliance upon the results of the demonstration projects developed in the region, and

14

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strengthened promotion of these alternatives by organizations and institutions collaborating with this
project.
· Established regional and local capacities to monitor and respond to DDT related problems in a
multi-sectoral and coordinated fashion.
· Strengthened inter-institutional cooperation and dialogue on malaria problem-solving, with particular
attention to improving the capacity of the health, environment, and agriculture sectors to counteract
the more traditional set of interests involved in pesticide application policy.
· Achievement of pesticide policy reforms, in particular the banning of persistent pesticides.


15

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TIMETABLE, WORKPLAN AND GEF DISBURSEMENT SCHEDULE FOR THE IMPLEMENTATION OF THE
COMPONENTS AND ACTIVITIES (IN 000 US $).
Duration of the Project - 36 months
Total
COMPONENT/ACTIVITIES
6
12
18
24
30
36

COMPONENT #1 ­ DEMONSTRATION PROJECTS AND DISSEMINATION







9 Demonstration Projects of malaria control in 8 different countries/ecosystems
600
600
600
600
600
185
3,185
Local meetings for preparing community participation and training
40





40
Communication plan to promote public awareness on DDT and educational campaign

20

20

16
56
Implement Web and Intranet pages

25

25


50
Assessment of environmental, biota, and human exposure to DDT and newly introduced pesticides
20
20
20
20
20
20
120
DDT compounds risk evaluation and risk maps


10



10
Local meetings for annual evaluation project)

15

15

6
36
SUB-TOTAL: COMPONENT #1
660
680
630
680
620
142
3,497
COMPONENT #2 ­ STRENGTHENING OF NATIONAL CAPACITIES TO CONTROL MALARIA

Workshop for government authorities of health, environment and agriculture (decision making personnel) to promote the
30





30
new techniques for malaria control without DDT and create awareness on DDT hazards
Technical Manual with the main guidelines for malaria vector control without DDT to guide the demonstration projects
15





15
A total of 8 training courses (one in each Demonstration Project area) for health and environment personnel
32





32
Regional technical workshop to exchange experience and information on new approaches to malaria control
40





40
Improve laboratory analysis capacity
160

160

160

480
Strengthen reference centers for malaria control
60

60



120
Workshop for lab technicians on laboratory analysis standardization and quality control
30





30
Rapid test validation

30

20


50
Inter-laboratory quality control program and capacity building
50

50



100
Malaria surveillance system and exchange of information on malaria control

15




15
Travel fellowship for technical training

50




50
Implement GIS application and specific GIS
100

50

50

200
Travel and local meetings for technicians to exchange experience on alternative malaria vector control techniques

16

16


32
Publication of the Final Report on strategies for malaria control without DDT (book and CD format)




25
25
50
SUB-TOTAL: COMPONENT #2
517
111
320
36
235
25
1,244
COMPONENT #3 ­ ELIMINATION OF DDT STOCKPILES

Repack and elimination of stocks (Belize, Costa Rica, El Salvador, Guatemala, Mexico, and Panama
200
200




400
SUB-TOTAL: COMPONENT #3
200
200




400

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Duration of the Project - 36 months
Total
COMPONENT/ACTIVITIES
6
12
18
24
30
36

COMPONENT #4 ­ COORDINATION AND MANAGEMENT







Regional coordination and supervision
76
100
100
100
102
95
573
8 national project coordinators
103
123
123
123
123
65
660
3 Steering Committee meetings
30


30

30
90
3 Regional Technical meetings for planning and evaluation (Operational Committee)

40

40

40
120
3 Regional annual reports with results and geo-referred data

5

5

5
15
SUB-TOTAL COMPONENT #4
178
253
203
278
183
190
1,458
SUB-TOTAL: PROJECT COMPONENTS






6,599
PROJECT SUPPORT COSTS ­ PAHO (8%)






528
PROJECT PREPARATION COSTS RECOVERY






38
PDF-B PHASE (already disbursed)






330
TOTAL GEF






7,495


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LIST OF ANNEXES

Annex A:
Incremental Costs Analysis of the Project "Regional Program of Action and
Demonstration of Sustainable Alternatives to DDT for Malaria Vector Control
in Mexico and Central America"
Annex B:
Logical Framework Matrix
Annex C:
STAP Roster Technical Review
Annex C1: Response to STAP/Council/IA comments
Annex D:
Outline of the Root Causes of the Contamination of the Environment by DDT
in Mexico and Central America
Annex E:
Detailed Description of Project Activities and Costs to the GEF
Annex F:
Demonstration Projects: Objectives, Strategies, and Activities
Annex G:
Examples of Products of the Geographic Information System Developed in the
Framework of the PDF-B Phase.
Annex H:
Bibliographical References of the Documents Produced in the PDF-B Phase.
Annex I:
Letters of endorsement from GEF Operational Focal Points.
Annex J:
Commitment of Co-financing and support from Ministries of Health of
Participating Countries.





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ANNEX A - INCREMENTAL COSTS ANALYSIS OF THE PROJECT:
REGIONAL PROGRAM OF ACTION AND DEMONSTRATION OF SUSTAINABLE ALTERNATIVES TO
DDT FOR MALARIA VECTOR CONTROL IN MEXICO AND CENTRAL AMERICA


Background

The overall objective of the project is to support the phase-out of DDT, globally, in a sustainable
manner by validating and widely disseminating an array of alternative methods for malaria
vector control that do not rely on DDT or other persistent pesticides. The project is to be
implemented chiefly through demonstration projects in Mexico and the seven Central American
countries - Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama.

The analysis of the incremental costs attached to this intervention requires a discussion of the
baseline and additional costs associated with achieving domestic and global benefits
respectively. The regional scope of this project also requires a consideration of the regional
benefits achieved through the intervention.


Global and Regional Benefits

The global environmental benefits resulting from this project stem from the reduction of the
releases to the environment of DDT and its metabolites. These are recognised global
contaminants which have the capacity, once introduced in the environment, to persist for long
times, be transported far away from point of origin, and bioaccumulate and elicit toxic chronic
effects in biota, including humans. As the participating counties all border the Caribbean Sea,
global benefits are also derived from the protection of its biodiversity and coastal resources from
contamination from pesticides. Although the direct immediate global environmental benefits to
be expected from the project will be relatively modest ­ resulting from the reduction in pesticide
use in the demonstration areas and reduced risks posed by obsolete stockpiles of DDT, the mid to
long term benefits will be much greater as the alternative methods validated by the
demonstration projects are disseminated and replicated naionally in the particpating countries,
and globally. In addition to the benefits to the environemnt, human health benefits accrue
globally from improvements in countries' capacity to address malaria, resulting in reduced
morbidity and mortality, as well as from reduced exposure of malaria control personnel and
populations to DDT and other toxic pesticides.

Regional benefits that will accrue as a result of taking an integrated regional appraoch, in
addition to the improvement of the quality of the environment, will stem from the greater
emphasis placed on the mitigation of transbounday issues ­ from the better protection offered to
temporary migratory workers to the mitigation of the risks of resurgence of malaria because of
temporary weaknesses in the malaria control program of one of the countries.
A- 1

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National (domestic) benefits

The most immediate benefits resulting from this project at the national level will be mostly
savings on the health systems resulting from reduced impact of malaria in the areas of
demonstration projects. Indirect further benefits will result from the adoption and systematic
replication of the best practices and lessons learned during the implementation of the
demonstration projects. Greater public awareness about the hazardous effects of DDT
compounds on environmental and human health will be an important tool to prevent
reintroduction of DDT use in the participating countries. Other benefits will derive from: the
incorporation of integrated malaria vector control principles into the existing framework of
national health policies; the training of public health officers; the involvement and training of
local communities in malaria vector control techniques; the elimination of the existing DDT
stockpiles, the improved inter-sectoral collaboration, particularly between the health and
environment sectors; and the strengthening of national health surveillance and pesticides
monitoring systems.


Baseline Actions

All participating countries are engaged in national and regional actions to control the use of and
risks from pesticides. One of such activities is the MASICA program and the PLAGSALUD
project led by PAHO in the Central American countries, with support from the Nordic countries.
This has already resulted in positive developments such as improvement of the surve illance and
control of acute intoxication from pesticides, the revision of pesticide legislation, the
establishment of local pesticide committees, and more specifically the improvement of the
protection of malaria and other vector control personnel from exposure to pesticides. In
particular, the national reports prepared during the PDF-B phase show that every country has
been experimenting new and integrated approaches to malaria vector control during the past
years. Mexico has been working on developing alternatives to DDT in order to phase-out DDT
in a sustainable manner in the context of the North Ameirican Regional Action Plan on DDT.
These activities contribute directly to the baseline on which the project relies by providing the set
of tools that will be systematically applied, asessed, and validated. In addition, Nicaragua and
Honduras have already disposed of their DDT stocks with international help.

For the purpose of this analysis, however, the only baseline costs that are considered in a
conservative manner (as shown in Table 1) are the costs incurred directly by the participating
countries (as well as PAHO and the CEC) in the implementation of project activities. The bulk
of this baseline is represented by the redirection of the budgetary resources of the malaria control
programs in the demonstration areas of each country. During the year of 1999, the national
Malaria Control Programs of the 8 participating countries (according to governmental
information provided to PAHO) spent the following amounts with the population of malaria risk
areas, which is the basis for the estimate of a baseline contribution from the participating
countries of US$ 2,214,000 to project component No 1 "demonstration projects and
dissemination:
A- 2

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Country
Malaria Program
Number of
Cost per capita
(US$)
population in
(US$)
malaria risk area
Mexico
15,349,724
50,338,000
0.31
Nicaragua
5,972,907
4,938,000
1.21
Panama
783,700
461,000
1.70
Honduras
388,956
5,667,000
0,07
Guatemala
730,232
5,371,000
0.14
El Salvador
3,307,167
6,154,000
0.54
Costa Rica
2,664,000
1,332,000
2,00
Belize
51,598
220,000
0.23


In addition, PAHO will support the project with an in-kind contribution estimated at US$
654,000, representing the cost of technical assistance to the participating countries directed
specifically to this project. CEC will contribute with US $200,000 for the assessment of DDT
contamination in the environment and people in the areas of demonstration project in Mexico.
The eight participating countries are committed to implementing this project as stated in the
endorsement letters (Annex A1). Five of them have already signed the Stockholm Convention on
Persistent Organic Pollutants of May 2001. There is a regional willingness and preparedness to
the adoption of techniques of vector malaria control which do not depend on DDT or other
persistent pesticides. This project will however enhance the adoption of new vector control
techniques by facilitating the transfer and exchange of experience between countries.

Incremental Actions

The GEF intervention is necessary to ensure that activities in the eight participating countries are
coordinated and sustained. Indeed, without the GEF intervention, it is likely that countries will
lack the capacity and the financial resources necessary to shift from an ad hoc testing of
alternatives to DDT to their systematic application. Moreover, shifting the emphasis from the
national/regional to the global level, the project will demonstrate that viable alternatives can be
implemented that are safe, efficient, and cost-effective. Indeed, the bulk of the GEF financing is
directed to project component No 1 "Demonstration projects and dissemination". The project
will add significantly to the baseline of national and regional activities by providing the
participating countries the means to systematically and strategically validate alternative measures
to control malaria vector, and assess, document, and widely disseminate the results.
A- 3

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ANNEX B - LOGICAL FRAMEWORK MATRIX

Project Purpose: To contribute to protecting human health and the environment in Mexico and Central America by promoting new approaches to
malaria control, as part of an integrated and coordinated regional program.
Overall Objective
Objectively Verifiable Indicators
Means of Verification
Critical Assumptions and Risks
(Monitoring focus)
To prevent the reintroduction of Malaria vector control programs in each Regional Information Network with data on Malaria and DDT That the Governments of the
DDT for malaria control in
of the eight participating countries adopt residues implemented and functioning.
participating countries will scale-up
Mexico and Central America by techniques of vector control that do not National health programs in Mexico and Central America are the methodologies used in the project
demonstrating and
rely on DDT or other persistent
able to lower malaria rates by adopting new approaches for
and will apply them in the rest of the
disseminating techniques of
pesticides.
malaria vector control that do not rely on DDT.
country, if proven successful. This
vector control without DDT or
Raised public awareness on DDT hazards in environment,
seems likely in view of the strong
other persistent pesticides, that
food chain and population prevents reintroduction of DDT for support that this project has been
are replicable, cost effective and
malaria control.
receiving in the region.
sustainable.

Outcomes
Objectively Verifiable Indicators
Means of Verification
Critical Assumptions and Risks
(Monitoring focus)
Global level: New, affordable,
Nine replicable documented
Reports from each demonstration project result in a Case
That national governments and local
cost effective and sustainable
demonstration projects test a set of
Study of procedures of malaria vector control without DDT
authorities will accept the arguments
models for malaria vector
procedures for malaria vector control
tested for specific vectors, under different ecological and
put forward. The impetus created by
control without DDT are tested without the use of DDT or other
social-economical conditions.
the POPs Convention should ensure
in different ecosystems and
persistent pesticides, under well
Technical manual of new techniques for malaria vector
that other governments will be willing
geographic locations and can be identified environmental and social-
control.
to adopt the process and design of
replicated in other parts of the
economic conditions, during a 3-year

DDT-free malaria vector control is
world.
period.
likely.
Regional level: Strengthened
Regional network for sustained capacity Information on new techniques for malaria control and
National governments are willing to
institutional capacities to control building (laboratories, vector control
databases related to the demonstration projects are available
exchange information, lessons
malaria with methods that do
technology, etc); and communication
through regional network.
learned, and results of their
not rely on DDT.
and information exchange among the
Reference centers strengthened, laboratories validated and
experiences of malaria control
participating countries (GIS, Web page, connected to network.
without DDT. Collaborative efforts
publications, etc).

initiated during the PDF-B augur well
for this.
National level: National
Malaria control programs in each of the National Health Programs incorporate new methods of
That the Governments of the
institutions establish links
participating countries shift away from
malaria control.
participating countries are willing to
between health, environment,
reliance on DDT and consider

adopt techniques for malaria control
and other sectors to ensure a
alternative methods.
without DDT or other persistent
sustainable and integrated

pesticide. This is likely if
approach to malaria vector
demonstration is made of the
control that relies on
availability of cost-effective
epidemiological surveillance
alternatives.
systems, epidemic forecasting,
detection of insecticide
B- 1

---

resistance, judicious use of
chemicals and application of
effective alternative control
methods without DDT.

Local level: communities
Workshops held in each demonstration
Report of workshops.
Local communities are receptive and
involved in demonstration
project site with the participation of
Community participation section in methodology manual.
are willing to collaborate and
projects are aware of new
community leaders and local NGOs.
Description of process and outcome of community
participate in the activities of each
participatory and integrated
participation in Demonstration Projects Case Studies and in
demonstration project. Experience
techniques for malaria vector
final report.
shows this can be the case provided
control and are aware of the
local communities are an integral part
hazards of exposure to DDT.
of project planing and preparation.
Results
Objectively Verifiable Indicators
Means of Verification
Critical Assumptions and Risks
(Monitoring focus)
1. Dissemination of information Region-wide information network on
Project's Web Page and Intranet functioning.
That the existing malaria reference
related to new techniques for
DDT and new techniques of malaria
Geographical Information System (GIS) accessible,
centers in Mexico, Guatemala,
malaria vector control.
vector control (Web page, Intranet and
containing digitized maps, malaria database for each
Nicaragua, Panama, and Costa Rica
GIS).
participating country, geographical and environmental data
are willing to integrate the regional
relevant to malaria vector control.
Malaria Reference Center Network.
Electronic platform containing reports, documents, maps and
database related to malaria control and exposure to DDT.


2. Strengthened regional
Strengthened national laboratory
Results from inter-laboratory comparison exercises.
That trained personnel can be retained
institutional capacity to assess
analysis capacity for chemical
Governments and local communities are aware of
to perform technical tasks.
environmental and human
assessment and monitoring.
environmental and human contamination due to past exposure
exposure to DDT compounds
Protocols to produce comparable data.
to DDT.
and newly introduced pesticides
3. Final disposal of DDT
The existing 135 tons of DDT stockpiles Report from disposal operations.
That public opinion in receiving
stockpiles.
already identified in the region are
countries is such that no country can
disposed on a cost-effective basis.
accept DDT waste. This seems
unlikely to happen in all potential
receiving countries in the immediate
future.
Components/Activities
Objectively Verifiable Indicators
Means of Verification
Critical Assumptions and Risks
(Monitoring focus)
Component 1: Demonstration
- Demonstration projects of malaria
- Reports showing the results of each demonstration project in That the Demonstration Projects are
Projects and Dissemination.
control in each country.
terms of technical and economical feasibility, environmental
well managed and the new techniques

- Costs and feasibility of the new
soundness and community participation.
can be demonstrated to be

methods for malaria control evaluated in - Information on new approaches to malaria vector control
environmentally sound, technically
different countries and ecosystems.
and DDT compounds hazards to environment and human
efficient, and cost effective. This risk
- Assessment of environment, biota and health available by the electronic platform and printed
is mitigated by the fact that the
human exposure to DDT and other
reports.
participating countries can already
pesticides used for vector control.
- Web page with results of demonstration projects, national
rely on a body of experience and
- Regional workshop on new approaches reports, technical studies, information on participating
expertise, and by the active
to malaria control.
institutions.
involvement of PAHO's experts in
B- 2

---

- Local meetings to facilitate community - GIS with geo-referred data on malaria control, DDT and
the execution of the project.
participation and training.
insecticide use, malaria cases and population at risk; vector
- Implementation of Web and Intranet
distribution, control interventions; environmental and
pages, and GIS.
ecological factors, health system coverage.
- 3 annual evaluation meetings.
- Reports from workshops and meetings.
- Communication plan to promote public - Distribution of educational material.
awareness on DDT hazards including
printed educational materials and
educational Campaign.

Component 2: Strengthening
- Technical manual on methodologies to - Publication and distribution of manuals.
That the Governments of the
of regional institutional
be used in demonstration projects.
- Publication and wide dissemination of report.
participating countries have the will
capacities to control malaria
- Final technical report on new strategies - Reports of meetings and workshops.
to support and encourage institutional
without DDT.
for malaria vector control
- Number of training and fellowships awarded.
strengthening in this field. This seems

- 8 national workshops and training
- System for monitoring and evaluating human and
likely to be realised in light of the

courses for malaria and environment
environmental exposure is implemented in the demonstration strong support and enthusiasm

personnel on malaria vector entomology projects.
generated during the PDF-B phase.
and ecology, integrated malaria vector
- Annual reports of national reference centres.
control methods, field operations and
- Inter-laboratory quality control program for standardization
community participation techniques.
of assessment procedures is put in place.
- Technical training and travel

fellowships for technical personnel.

- Strengthening of national reference

centers for malaria control with
personnel capacitated in risk assessment,
community education and participation
regarding to malaria control without
DDT or other persistent pesticide.
- Strengthening of laboratory analysis
capacity.
Component 3: Elimination of
- Materials stored in leaking or
- Government warehouses are cleaned and all remaining
That the stockpile elimination
DDT stockpiles.
inadequate containers are repacked in
materials are packed and stored in a safe manner.
operations do not uncover great

United Nations approved containers.
- Elimination of obsolete stockpiles scheduled and/or
amount of yet unsuspected stockpiles.
- Shipment for final disposal of all 135
implemented.
tons of DDT already identified.

Component 4: Coordination
- 1 Project Coordinator.
- Issuance of contracts.
That hiring of regional project
and Management.
- 8 national technical coordinators to
- Reports from meetings.
coordinator and of national technical

conduct the demonstration project
coordinators can proceed
activities.
expeditiously.
- 3 Steering Committee meetings
- 3 regional technical meetings.
- 3 annual reports of the demonstration
projects.
B- 3

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ANNEX C: STAP ROSTER TECHNICAL REVIEW

The phasing out of DDT in favor of alternative methods more benign to the environment and
maintaining and improving human health in all aspects, remains a difficult, but necessary and
worthwhile endeavor. For this to be successfully implemented in a region as vast and populated
as Mexico and Central America, requires an approach of great scope and ambition. To combine
the various malaria control activities of eight different countries will require a number of steps to
accomplish. This proposed project will build on the past and present efforts of PAHO and other
organizations in this regard, and could very well serve as a catalyst for further expansion and
implementation of alternative malaria control methods, here and elsewhere.

The scope of this project is vast, but so is the disease. The gains that have been achieved with
traditional malaria control practices are great, and these gains should not be compromised with
short-sighted, short-term or unsustainable practices, that could introduce risks at levels other that
those that are currently in effect. On the other hand, the known and insidious effects of DDT on
humans and the biota are also not acceptable. To move away from DDT needs attention on an
integrated and sustainable strategy to combat the disease on all fronts available for intervention.
This project aims to achieve this for a large area, where smaller or disjunct efforts will, of
necessity and design, have less impact. This project then very sensibly builds upon, and will
strengthen local experience.

The results of an eventual successful adoption and implementation of cost effective and
acceptable alternatives to DDT will not only be felt in the stated objectives alone, but will also
support economic development of the region, as the burden of disease will be reduced. There is
therefore a great responsibility upon the managers and all participants in this project to continue
collaboration and communication through difficult times that undoubtedly will be experienced
during this project. I therefore, have no hesitation to support this project design in all four of its
components. There are however a number of areas where more attention can be given to, and
these will be outlined below. In some cases these concerns might have been taken care of
implicitly in the design process (logframe) or intention, and, if so addressed and understood, will
therefore be moot. It is my opinion however, that the urgency of this project is such that
improvements to the design can be made by the different levels of planning, management and
supervision involved, without delaying the inception of this project.

TERMS OF REFERENCE

KEY ISSUES

1. Scientific and technical soundness of the project

Judged from the broad basis of the presentation of the project (Annex A), as well as the good
detailed objective strategies of the demonstration projects provided (Annex F), it is clear that this
is the product of wide participation in preparation of this brief and outline.

- Although the role of agriculture is mentioned, the root cause ana lysis has one obvious short-
coming. This is the potential of the concomitant use of pesticides, also intended for malaria
C- 1

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control (most likely pyrethroids, but also others), to compromise sustainable use of such
pesticides for malaria control, by contribut ing towards pesticide resistance. Although this was a
root cause identified for the unstable use of DDT (i.e. the likelihood or resistance developing in
mosquitoes to DDT), this is also valid for other pesticides. Agricultural use of alternatives was
the cause of the multiple resistance development that led to the forced re-introduction of DDT in
South Africa.

Resistance development was not as such identified as a possible cause for the re-introduction of
DDT, due to the vectors becoming resistant to the alternatives. This concern should be
incorporated into the objectives of the demonstration projects. This is especially the case for the
demonstration projects in Honduras and Panama, where high agricultural use of pesticides is
obvious from cotton and bana na plantations near by. An effort should be made to incorporate the
assessment of the agricultural use of pesticides close to the demonstration projects.

- In addition, activity 2.1.3 (Annex E) should also include the training to determine resistance in
mosquitoes, as a basic assessment tool to determine and protect the sustainability of alternatives.

- Overall, and both on a national and regional level, the management of resistance should receive
attention so that the methods that show promise in the demonstration projects, can be
implemented on a larger scale, during the follow-up of this project. Information gathering
relevant to a possible regional policy on resistance management, should therefore be part of the
objectives of this project. This could be included as one of the outcomes on the regional level.

- An additional capacity that would be very useful to acquire (or incorporated if available), is that
of "Risk Assessment". The introduction of alternatives does have risks that are not negligible.
The risk assessment process, that depend on data and information form the demonstration
projects, will be a valuable addition to Component 3 of the logframe (Annex B) and "Expected
Results" 1.5 (Annex E). The logical consequence of risk assessment is risk management, an
aspect that should be taken note of at this stage, but will likely play a much bigger role in large-
scale implementation of alternative measures, following this project.

- It is probably implicit in the objectives of the data gathering that these will be collected on a
comparable basis across all the demonstration projects. As it is likely that, as there are already
such activities in each country, that there will be differences between them. Care should be taken
to ensure comparability for further evaluation and possible risk assessment. Development of
explicitly stated indicators of success (including aspects such as social acceptability of
alternative measures) could be another benefit, if comparability of data gathering is achieved.

- Since a large portion of this work concerns social aspects, the relationship and attitudes of the
people regarding malaria control will be crucial. It is therefore incumbent upon the project team
members to concentrate on this aspect, as acceptability of alternative measures, which may
include alteration of habits and activity patterns, be handled with care and sensitivity. The ethical
component of some of the activities are important as well (e.g. monitoring of levels of pesticides
in people, the administration of questionnaires, etc). To obtain formal ethical approval on
appropriate levels does take time (and is therefore urgent) and this must be incorporated in the
planning. I suggest that the obtaining of ethical approval be stated explicitly as one of the
C- 2

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activities under 4.2.1 (Annex F), so that it can be included under workplans. The basis for ethical
approval will largely be common for all demonstration projects, and economy of effort will be
obtained on this level.

- Depending on the development of the project, changes in the activity patterns and habits of
people, may in itself have economic and or social advantages or disadvantages. These should be
documented where possible, as it will have a bearing on the analysis of the cost effectiveness of
these methods.

- Since one of the criteria mentioned at the outset of this project refers to cost effectiveness, the
basis and assumptions for this is not explained. From activity 1.1.1 I assume that this is covered
by the budget stated, but care must be taken that enough money will be available at the suitable
stage of the project, to conduct this exercise. Since DDT is relatively cheap, cost effectiveness in
this regard will have to include reference to difficult quantifiable measures of environmental
health, the pollution of international waters, and others.

- The sites for the demonstration projects seem to be well chosen, judged from the information
required.

- It is also probably implicit in the intent of this project, that the information needs of the
implementers of malaria control measures be served by the GIS system that is to be developed.
The experience gained from the various demonstration project (that are located in different
geographic areas), can be used to predict areas where alternatives measures can be implemented
(or not), provided the information needs for this is taken care of during the design and
improvement of the GIS system.

- The time frame is quite short. Care should therefore be taken that the effect of seasonality does
not result in the loss of one season, as the start-up phase of the project (when the demonstration
projects are not yet active) might conceivably coincide with a transmission season.

- The South African experience has shown two things.

1) The implementation of alternative methods, when tested on a small scale, showed good
promise. There were however, factors present on the larger scale, that were not apparent during
the initial development and testing, which had serious consequences. It will not always be
possible to foresee these factors or considerations, and implementation on a large scale will
therefore need to take account of this during the planning. Deliberations on possible large scale
considerations should already start during the final phase of this project, as the experience and
insight from the people at the demonstration projects will be invaluable and should not be lost.

2) To manage the risk of possible failure of implementing alternatives, as well as to bolster the
malaria control capabilities of the countries, the final phase of this project should deliberate on
back-up mechanisms if necessary. From my own experience the malaria control officials on the
ground are extremely protective of the people they protect. A fall-back strategy will be very
useful to obtain their cooperation, as well as those from any other structures involved.

C- 3

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2. Global benefit / drawbacks

Although the direct benefits of this three year project will only have local benefits (these are
demonstration projects), the results of this project will give a much better basis from which to
determine the global benefit. This restriction is inherent in the intent and scope of this project.
Defining the potential benefit that can be obtained by this project is therefore operative at this
stage.

3. GEF context and goals

Within the GEF, the OP10 is the current and valid structure, as well as the draft POPs OP.
Eventually the POPs OP will probably be the more applicable one. Care should however be
taken by GEF that the continuity of the funding and support of the project scope and intent will
not be negatively affected by any technical or administrative difficulties that might be
experienced by such a changeover. Any positive support to this project emanating from the
activation of the POPs OP should however, be encouraged where possible.

Otherwise the GEF context is clear. There seem to be little large scale risk, considering the scope
of the project, but proposed habitat alterations or introductions of biological control mechanisms
(such as mosquito-eating fish), especially if these could impact on natural areas (biodiversity)
and processes, may pose a risk. These impacts should be included in a risk assessment. The
impact of effective alternative measures (that are as yet not known) on the environment might be
significant, if implemented on a larger scale. An Environmental Impact Assessment and a
sustainability assessment might therefore be required at a later stage.

4. Regional context

This project is clearly regional, including all the countries.

5. Replicability of project in other areas

The results from this project will be replicable in other areas, but more likely on a project
development or process basis, than in the details. Environmental, social, vector and parasite
conditions vary across the world, but much can be learned from this project, on how to find
solutions, and how to avoid the pitfalls.

6. Sustainability of the project

The sustainability of this project, given the level of funding and short time period, does not seem
to be a problem. The implementation of the findings on a larger scale will be subject to the usual
economic and social considerations, given the high level of importance of malaria, to both the
region and its people. The advantage of this project design is that local knowledge will be
incorporated. This aspect should not be neglected through the participatory approach inherent in
the design. Failure to obtain the cooperation of the population is an obvious and stated risk
(Annex B - local level).
C- 4

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SECONDARY ISSUES

1. Linkages to other focal areas

There might be linkages to biodiversity, as risks to biota in this species rich region will likely be
present (either positive or negative) by implementation of alternative measures.

2. Linkages to other progra ms

These are stated in the documents provided. The Stockholm Convention would be another
linkage, when it becomes effective. The Basel Convention would be an additional linkage for the
disposal of DDT.

The South African Malaria Control Program has had gr eat success in the development and
implementation of a GIS in its combat of malaria over large areas. Contact with this group could
be considered to aid in the development of the GIS system for this project.

3. Other beneficial or damaging environmental effects

The reduction of the release of DDT to the environment will be an obvious immediate benefit.
The risks associated with alternative measures, such as other pesticides or habitat alteration
needs to be taken into account. Alterations to water bodies might for instance increase the risk of
flooding, or affect the water table. This is the reason to incorporate elements of both risk
assessment and risk management in this project at some stage.

4. Degree of involvement of stakeholders

There is a high degree of involvement of stakeholders. This in itself creates of course its own
complexity that needs good communications, as well as effective project management to
maintain and derive the potential benefits. The major drawback of such a complex system of
collaborative involvement will be unexpected delays.

The agricultural community should play a major role in this project.

5. Capacity-building

There are good and strong elements of capacity building in this project. If the other capacities
mentioned above could also be included, it will further strengthen the project.

6. Innovativeness of the project

This project will build on the innovativeness of previous efforts as such. The project is also
innovative in its scope and intent which spans eight countries.

C- 5

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Prof. Henk Bouwman
School for Environmental Sciences and Development
Potchefstroom University
P Bag X 6001
Potchefstroom 2520
South Africa

Tel +27 18 299 2377
Fax +27 18 2992370
drkhb@puknet.puk.ac.za
C- 6

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ANNEX C1 ­ IMPLEMENTING AGENCY RESPONSE TO STAP/COUNCIL/
IMPLEMENTING AGENCIES COMMENTS


Response to STAP Roster Review

The STAP Roster Expert's comments are very supportive of this project in terms of its scope,
objectives and design. Prof. Bouwman makes a number of valid suggestions and
recommendations which, as he points out, do not necessarily imply changes in project design but
will improve the chances of success of this project, if followed.

UNEP and PAHO agree with the comments of the reviewer and offer the following response to
some of the issues raised.

a) Root cause analysis: The potential development of malaria vectors resistance to pyrethroids
or other pesticides used in agriculture is a risk that has to be monitored. This concern will be
incorporated into the objectives of the demonstration projects. The growing problem of
vector's resistance will require further investigations and investments towards resistance
management procedures, preferably in coordination with agricultural programs promoting
integrated pest management. Discussions are underway with DANIDA for further
cooperation and funding.

DANIDA/PAHO's PLAGSALUD project will provide the needed information on the
agricultural use of pesticides in the demonstration project areas and their surroundings. The
linkages between these two projects will facilitate the exchange of information related to
types and quantities of pesticides used in the area. The need for assessment and
identification of mosquito resistance to any of the newly introduced pesticides was discussed
by the representatives of the participating countries during a meeting held in Mexico in the
framework of the PDF-B, September 11-12 2001. We concur that the suggested "training to
determine resistance in mosquitoes" should explicitly be included in the training workshops
which will be conducted for the malaria control personnel involved in the project (item 2.1.3
Annex E). We further concur that "gathering relevant information for a possible regional
policy on resistance management" will be one important outcome at the regional level.

b) Risk Assessment : We agree on the importance of risk assessment related to the introduction
of alternatives for malaria control. This is explicitly considered in item 1.5 (Annex E) "Risk
assessment of environmental and health effects of DDT, newly introduced pesticides, or
other alternatives, in the areas and populations of demonstration projects".

c) Comparability of data: It is implicit in Annex E, items 1.4.1, 1.5.1, 1.5.2, that the data will
be collected on a comparable basis across all the demonstration projects for further
evaluation and possible risk assessment of the alternative techniques of malaria control.

d) Social aspects: We concur with the importance of social and ethical aspects related to the
introduction of alternative measures which may require alteration of habits and activity
patterns. An important asset for this project is the fact that DANIDA/PAHO's
C1- 1

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PLAGSALUD program has been building community participation and public awareness on
pesticides in Central America and Mexico since 1994. Most of the activities concerning
social aspects will be developed in close collaboration with PLAGSALUD.

e) Cost effectiveness: Besides the assessment of environmental impacts and approval by the
local communities, cost effectiveness is one fundamental aspect that will have to be
evaluated as the project aims to develop replicable models of malaria control. UNEP and
PAHO are aware of the complexity involved in this cost effectiveness due to the difficulty to
quantify parameters related to effects of past use of DDT on environmental health, pollution
of waters resources and others. On the positive side, the project will benefit from, and build
upon, previous evaluation work, including work carried out in the participating countries.

f) Sustainability of the project: Special importance will be given to the incorporation of local
knowledge and the participation of local community in all activities of the demonstration
projects. Access to information and public participation at all stages of the demo nstration
projects, from workplan design to final evaluation, is the main strategy for the sustainability
of this project.


Response to Implementing Agencies Comments

Comments were received from the World Bank. These comments are supportive, and only
lament the lack of inclusion of some Caribbean Island States that could benefit from such a
program. In view of the difficulty of the task proposed, however, an approach which initially
focuses on a limited number of countries with experience of sub-regional collaboration on this
particular issue is preferred.



C1- 2

---

ANNEX D ­ OUTLINE OF THE ROOT CAUSES OF THE CONTAMINATION OF THE ENVIRONMENT BY DDT IN MEXICO AND CENTRAL AMERICA

Major Problems
Transboundary Elements
Main Root Causes
Types
of
Action
Contamination of global
· Transport of DDT and metabolites by transboundary
· Toxic properties of DDT as a persistent organic
· T
ecosystems by DDT
waters through the water cycle
pollutant
· A
metabolites
· Transport of DDT and metabolites through air
· Large amounts of DDT have been used during the last 5
· DDT resistance to degradation
decades in malaria prone areas
· Negative impacts on biodiversity
· Accumulation of DDT metabolites in terrestrial and
aquatic ecosystems
· DDT stocks in leaking containers
Unsustainable use of DDT for · Provisions of the POPs Convention that has included
· Malaria vector resistance
· T
malaria vector control at
DDT among the 12 first compounds candidates for
· Adverse effects caused by DDT in all stages of its life
· A
global level
international action
cycle
· Increased global awareness of DDT related problems
Possibility of reintroducing
· Illegal use of DDT specially in areas of transboundary · DDT traditionally known as a cheap and effective tool for
· T
the use of DDT for malaria
migrant farm workers
controlling malaria vectors
· A
control in countries where it
· Lack of awareness about adverse effects of DDT
· Lack of safe, effective and affordable alternatives for
has been phased-out
among indigenous and migrant population
malaria vector control

· Existing DDT stockpiles in mo st countries (135 tons as
known at present)
· Availability of DDT at international level
· Lack of awareness about the negative effects of DDT on
human health and environment
Low institutional and
· Growing international concerns resulting from local
· Lack of general environmental awareness
· T
community awareness about
exposure to DDT during malaria control campaigns,
· Lack of data and information on effects of DDT exposure
· A
effects on human health and
in particular impacts upon women and, through them,
to environment and human health
environment due to exposure
upon future generations
to DDT

D- 1

---

Deficient national systems for · Inadequate implementation of existing regional and
· Lack of interaction between health and environment
· T
monitoring environment and
national legislation on persistent pollutants
sectors at institutional level
· A
health
· Lack of national capacity for monitoring effects of DDT
on environment and human health
· Low technical capacity of laboratories in Central
American countries for monitoring DDT residues in
environment and population previously exposed in malaria
control campaigns
Worsened human related
· Decreased quality of life due to contamination of
· Inadequate institutional capacity at national and local level · T
conditions (lower quality of
water, soil and food chain
· Insufficient coordinated inter-sectoral actions
· A
life, poverty, socio-economic
· Difficulty in controlling farm workers migration
· Inadequate financial mechanisms and support
decline) as a consequence of
· Particular risk upon indigenous communities due to
· Lack of community involvement in actions related to
uncontrolled malaria disease
the biomagnification of DDT and contamination of
malaria vector control
and/or contamination with
their traditional foods
DDT metabolites
· Increase of malaria disease if not controlled efficiently

Types of Action

Technology Transfer (T)
· Demonstration of environmentally sound and cost effective alternative methods for malaria control without DDT
· Training courses, workshops, publications, travel fellowships to increase regional and national knowledge of problems
related to DDT use
· Qualification and international standardization of national laboratories and reference centers for malaria control
· Agreement on standard methodologies for monitoring contamination of environment
· Repackage and disposal of obsolete DDT stockpiles
Awareness Raising (A)
· Involvement of local communities in the activities of the demonstration projects
· Involvement of private sector and NGOs in the project
· Monitoring environment and health in the areas of demonstration projects
· Worldwide dissemination of the results of demonstration projects
· Electronic platform to facilitate the exchange and dissemination of information on malaria risk assessment and malaria
vector control techniques without DDT
· Training courses and workshops about the relation between malaria, environment and potential hazards of DDT

D- 2

---

ANNEX E ­ DETAILED DESCRIPTION OF PROJECT ACTIVITIES AND COSTS TO THE GEF

Project Component
Expected Results
Activi ties
Products
Costs (total for 3 years
and objective
in US$)
Component # 1:
1.1.Documented
1.1.1. Implement, monitor and evaluate 9 malaria control demonstration
9 demonstration projects
$ 3,185,000
Demonstration
demonstration projects of
projects (2 in Mexico and 1 in each of the 7 Central American countries), in implemented and evaluated
Projects and
alternative malaria vector
areas of different ecological characteristics, public health and/or social-

Dissemination
control without DDT or
economic conditions. Document each experience and evaluate the cost

other persistent pesticides,
effectiveness of the different methods.
Objective:
in selected sites, using

implement, evaluate
alternative techniques of
and disseminate the
malaria vector control.
alternative strategies
of malaria vector
1.2. Community
1.2.1. Organize and implement local meetings and workshops in each of the Local meetings with
$ 40,000
control without DDT participation and
demonstration projects with participation of local health and environment
community participation and

educational strategies to
professionals to emphasize and support local community participation in the training on techniques for
build public awareness on
process of alternative malaria vector control strategies, and to strengthen the malaria vector control in
new strategies for malaria
activities of local health services.
each of the demonstration
vector control and the
projects.
negative effects of DDT
use.
1.3.Strengthened regional
1.3.1. Develop a communication plan with participation of NGOs, and
Communication plan to
$ 56,000
institutional capacity to
educational, environmental, and health national sectors, to support the
promote public awareness on

disseminate information
evaluation of DDT and newly introduced pesticide effects on human health
DDT and educational
related to malaria control
and environment , as well as to create awareness on DDT and integrated
campaign on new
methods that do not rely on methods of malaria control of populations in risk areas.
approaches of malaria
DDT or other persistent
control.
pesticides.
1.4. A region-wide
1.4.1. Implement the web and intranet page designed during the PDF phase Information available
$ 50,000
information system on DDT to facilitate the exchange of information and experiences among the
through the Internet. Results
and malaria control as a tool participating countries, including collecting and validating existing regional and lessons learned from
for gathering and
information related to the project (documents, national reports, technical
demonstration project are
disseminating data adequate studies, participating institutions, regional reports); as well as the results of
shared among participating
to the needs of government
demonstration projects and analysis of DDT exposure.
countries and other parts of
in the decision-making
the world
process.
1.5. Risk assessment of
1.5.1. Assessment of environmental and human exposure to DDT and newly Results of assessment of
$ 120,000
environmental and health
introduced pesticides in the areas of demonstration projects.
environmental and human
effects of DDT, newly
exposure to DDT and other
introduced pesticides, or
pesticides used for malaria
other alternatives, in the
control are available.
areas and populations of
15.2. Identify and map areas previously sprayed with DDT which are under Priority areas for risk
$ 10,000
demonstration project.
risk of contamination by DDT compounds and have this information
evaluation are identified and

available in digitized format
mapped
E- 1

---

1.6. Demonstration projects 1.6.1. Support and facilitate community participation in demonstration
Annual reports of each
$ 36,000
are evaluated with
projects, and disseminate the alternative techniques for malaria control
demonstration project and

community participation,
without DDT. Organize 3 annual local meetings in each demonstration
organization of the
results are available in CD
project area with the participation of community, local NGOs, local health
information to be presented
and printed format, and
services, environment and agriculture technicians to plan and evaluate the
at the regional meeting
disseminated through the
implemented activities.
electronic platform and Web
Page.

Subtotal for project component #1

$ 3,497,000
Project Component
Expected results
Activities
Products
Costs (US$)
and objective
Component # 2:
2.1. Strengthened national
2.1.1. Organize and provide support for a workshop in Mexico (Oaxaca) for A two-day regional
$ 30,000
Strengthening of
institutional capacities for
national government authorities (decision making personnel) of health,
workshop for 4
national institutional malaria risk assessment, and environment, and agriculture ministries on the alternative strategies that will representatives of each
capacities to control malaria control without
be applied in the demonstration projects, the assessment of DDT effects on
country (health,
malaria
DDT.
human health and environment, and discussion of strategies for disposing
environment, and agriculture


the existing stockpiles of persistent pesticides and avoiding the formation of personnel).
Objective:
new ones.
Strengthen national
2.1.2 Develop and print a technical manual for training malaria control
Technical manual of basic
$ 15,000
and local institutional
personnel, and providing technical assistance on alternative strategies for
procedures for integrated
capacities to control
malaria vector control to be used under different ecological conditions
malaria vector control
malaria with methods
without DDT
that do not rely on
2.1.3. Organize and implement eight training courses for health and
8 national training courses
$ 32,000
DDT or other
environment personnel who will be involved in each of the demonstration
for qualified technicians

environmentally
projects on basic malaria epidemiology, malaria entomology (including
from each country on
persistent pesticides.
determination of resistance in vectors), integrated malaria vector control
Alternative Strategies for

methods, field operations, and community participation techniques, taking
Malaria Vector Control and

into consideration the different vectors, the endemic levels, and different
Field Operations
environmental and social-economic conditions in each country.
2.1.4. Organize, provide supporting material, and implement a regional
Regional technical workshop
$ 40,000
workshop for malaria control personnel, and representatives of environment to exchange experience and
and agriculture ministries of the eight participating countries to exchange
information on new
experience and information on new approaches to malaria vector control,
approaches to malaria vector
DDT residues assessment and alternatives for stockpile disposal
control.
2.1.5. Strengthen reference centers for malaria control in the participating
Reference centers for
$ 120,000
countries, such as Mexico's Centro de Investigaciones en Paludismo (CIP)
malaria control are qualified,

and facilitate the regional exchange of information on malaria among
maintain recognized
laboratories and existing reference centers in the eight participating
international standards and
countries through the region-wide information network established by the
carry out information
project (described in item 1.2)
exchange
2.1.6. Establish a malaria surveillance system and exchange of information
Malaria control programs of
$ 15,000
on malaria control at regional level
participating countries are

integrated and sharing best

experiences and lessons
learned
2.1.7. Short-term travel and local meetings for malaria control technicians
Malaria technicians prepared
$ 32,000
to exchange experience on alternative integrated malaria vector control
to use alternative integrated
techniques
vector control techniques
E- 2

---

2.2. Strengthened analytical 2. 2.1. Improve laboratory analysis capacity for chemical assessment in
Equipped laboratories with
$ 480,000
laboratory infrastructure
Mexico (Universidad Autónoma de San Luis Potosí and CINVESTAV-
technical capacity for

and technical capacity
Merida), Guatemala (Laboratorio Unificado de Control de Alimentos y
chemical assessment of
regarding pesticide analysis, Medicamentos ­ LUCAM), Nicaragua (CIRA-UNAM), Panama (Instituto
environmental
and assessment of
Gorgas), Costa Rica (MAG) , El Salvador (Ministerio de Agricultura y
contamination under
environmental and human
Ganaderia), and Central Laboratory of Belize, as well as the exchange of
international standards.
contamination
information among them and other institutions

2.2.2. Organize, provide support materials and implement a regional
Workshop for 2 laboratory
$ 30,000
workshop for 2 laboratory technicians from each participating countries to
technicians of each

establish mechanisms for standardization of assessment techniques,
participating country on
laboratory equipment, sampling techniques, georeferrenced data,
laboratory analysis
interpretation of results, data base for GIS application
standardization.
2.2.3. Support the development of rapid inexpensive and easy to use assays Rapid test validated
$ 50,000
for pesticides screening in human samples (based on ELISA or DELFIA

methods) with collaboration of the Center on Environmental and
Occupational Health Impact Assessment and Surveillance (Quebec,
Canada).
2.2.4. Implement an inter-laboratory control program and capacity building
Training courses, manual
$ 100,000
on DDT compounds and other pesticides analyses in the participating
for assessment of exposure
countries to ensure that analytic results will be comparable across the
to DDT and other newly
participating countries and at international level through the participation
introduced pesticides is
and support of internationally recognized institutions of excellence.
implemented and available,
travel fellowships for
pesticide analists
2.2.5. Travel fellowships for qualified personnel for laboratory training for 8 Technicians with capacity to
$ 50,000
technicians from Central American countries.
work under international
standards.
2.3. GIS application
2.3.1. GIS system to gather, organize and analyze the geographical and
A GIS application with
$ 200,000
providing data on DDT
statistical components of malaria control and exposure to DDT and
maps, geographic and

residues and new methods
alternative pesticides used in the sub-region and in each demonstration
statistical data related to
of malaria vector control in
project including standardized data on effects of exposure to DDT in
malaria control, DDT and
Mexico and Central
Mexico and Central America, geo-referenced data on malaria control in the
alternative pesticides used in
America
demonstration projects, spatial distribution of malaria vectors and
the sub-region and

populations at risk; distribution of control interventions; health system
information on the

coverage, etc
demonstration projects.

2.3.2. Organize, prepare and print a substantive Final Report (CD and book Printed final report showing
$ 50,000
format) to disseminate information on the results of the demonstration
results of different strategies

projects, information and maps of malaria risk areas, strategies for malaria
for malaria control without
control in different ecosystems without use of DDT, and analysis of effects DDT under different
of DDT and alternative pesticide exposure on human health and
ecosystems and social-
environment at the sub-regional level.
economical conditions,
illustrations in color, maps
and information on malaria
risk areas, data on effects of
DDT exposure on human
health and environment
Sub-total for project component #2

$ 1,244,000
E- 3

---

Project component
Expected Results
Activities
Products
Costs (US$)
and objective
Component # 3:
3. Existing DDT stocks
3. 1. Disposal of 135 tons of DDT identified during PDF-B phase: Belize
Existing DDT stockpiles
$ 400,000
Elimination of DDT disposed of
13; Costa Rica 9; El Salvador 6; Guatemala 15; Mexico 87; Panama 5.
repacked and disposed

stockpiles




Objective: To

eliminate the existing

DDT stockpiles

identified during

PDF-B phase,

repackage materials

as required, and

arrange for

elimination of DDT

on a cost effective

basis.

Sub-total for project component #3

$ 400,000
Project Component
Expected Results
Activities
Products
Costs (US$)
and objective
Component # 4:
4.1. All project activities in
4.1.1. Hire and support a regional coordinator for the project during the
Project activities are
$ 573,000
Coordination and
the sub-region are
period of 32 months.
developed in a coordinated
Project
coordinated and supervised;
way and within the approved
Administration
common objectives

timetable

expressed by the countries

Objective : Regional are achieved

coordination of the

project and related

activities, and

management of the

project
4.1.2. Hire and support a national coordinator in each participating country. Activities developed by the
$ 660,000
implementation
project are coordinated,
documented, evaluated and
made available by Web and
printed material.
4.1.3. Organize and implement 3 steering committee meetings.
Report of steering committee
$ 90,000

meetings

4.2. Operational Committee 4.2.1. Organize and implement 3 regional meetings (Operational
Workplans and annual
$ 120,000
annual meetings for
Committee) with the participation of government representatives on national reports prepared and

planning and evaluation of
health and environment, NGOs and community representatives to prepare
approved by the Operational
activities and approval of 3 workplan and discuss the results achieved with the project in each
Committee
annual reports .
participating country

4.2.2. Print 3 regional annual reports and prepare data for the electronic
Results, geo-referred data,
$ 15,000
platform (Web page and GIS) on the demonstrative projects and all project
and digitized maps are

activities.
organized and available
through the electronic
platform, CD format and
printed report
4.3. Public awareness and
4.3.3. Make available printed information and promote community meetings Printed educational material
Plagsalud
community participation
and workshops as part of each country's Communication Plan
and support for local

meetings.
E- 4

---

4.4.1. Support public awareness campaigns and events related to malaria
Events related to schools
Plagsalud
control in schools located in malaria risk areas
located in malaria risk areas
4.4.2. Support strategies to create a communication network among
Educational events,
Plagsalud
communities in malaria risk areas.
publication of leaflets,
community meetings.
Sub-total for project component #4

$ 1,458,000
SUB-TOTAL (project Costs)
$ 6,599,000

Project Support Costs ­ PAHO (8%)
$ 528,000
Project preparation costs recovering
$ 38,000
PDF-B (already disbursed)
$ 330,000
TOTAL
$ 7,495,000



E- 5

---

ANNEX F - DEMONSTRATION PROJECTS: OBJECTIVES STRATEGIES AND ACTIVITIES

1.
Overall objective:

Develop a series of cost effective models for malaria vector control without the use of
persistent pesticides which are applicable in different ecosystems and geographic locations with
a participatory and integrated methodology, sensitive to the environment and the needs of
different social groups, in common agreement with local governments and communities.


2.
Specific objectives:

a) Promote the concept of disease prevention and the relation between environment and human health at the
level of local communities ensuring that the activities to prevent and control malaria will improve local
living conditions.
b) Identify the correlation between different malaria vectors and environmental factors as temperature,
altitude, vegetation, land use, superficial water distribution, time of the day, etc.
c) Identify and implement adequate environmental interventions with community participation as removing
green algae, moss and mud in water bodies to prevent mosquito breeding.
d) Monitor and register all activities implemented in each demonstration project in order to establish
environmentally sound models which are replicable under similar environmental conditions.
e) Reduce the API (Annual Parasite Index = Number of malaria cases per 1000 population) of malaria fever
among the stable population in each demonstration project site.
f) Reduce the percentage of positive malaria slides (Smear Positive Rate) in each demonstration site by at
least 40%.
g) Reduce the number of people with gametocytes in blood film, meaning earlier diagnosis and less
likelihood that mosquitoes will transmit the disease.
h) Reduce the amount of insecticides used, comparing data from the years prior to the project and at the end
of the project.
i) Reduce mosquito-breeding sites within 500 meters of households (survey before and at the end of
project).
j) Increase the accessibility to fast malaria diagnosis and treatment.
k) Reduce the length of time for obtaining a malaria diagnosis (time between having blood smear taken and
the diagnosis).
l) Reduce the time people take to seek treatment (time between onset of malaria fever and person's seeking
diagnosis and treatment).
m) Decrease the number of persons with more than one episode of malaria per year (repeaters).
n) Decrease the number of households with more than one person affected with malaria per year.
o) Decrease the number of children under 5 years of age and between 5-9 with malaria.
p) Collect and register all activities related to malaria control implemented in each demonstration project
area.
q) Identify and incorporate local knowledge on malaria control strategies.
r) Organize and strengthen community participation.

3.
Criteria for the Selection of Areas for Carry out Demonstration Projects:

a) Malaria risk: Demonstration Projects will be carried out in areas where malaria is endemic and
populations are under high risk of infection.
b) Access: The areas should be readily accessible throughout the year, in order to ensure that actions can be
carried out without delays.
c) Environmental characteristics: Demonstration areas will have geographical/environmental
characteristics which represent different types of climate (temperature and rainfall), topography (flat
lands, low hills, mountains, etc), natural vegetation (mangroves, rainforest, etc.), and geographical
location (coastal areas, interior regions, border zones, etc.).
d) Budget: Each demonstration project will receive government national and local budgetary allocations to
complement the financial resources provided by GEF.

F- 1

---

4.
Detailed activities to be undertaken in each of the Demonstration Projects:

Step # 1: Diagnosis of the malaria problem

a) Identify incidence rates of malaria fever in the demonstration project area.
b) Identify type of Plasmodium most prevalent in the population.
c) Identify groups of people or families in the project area with the greatest number of malaria cases in the
previous year.
d) Identify vectors responsible for the transmission of the disease in the locality.
e) Identify permanent and potential breeding sites of vectors in a radius of 500 meters of each house where
malaria infection has occurred.
f) Identify periods of the day when there is greater vector density.
g) Identify potential health activists within the community (volunteers, midwifes, community leaders, etc.).
h) Identify health centers closest to the community.
i) Determine number and type of local health center personnel.
j) Inventory services available at local health center and/or hospitals (traditional diagnosis of malaria by
microscopic analyses, availability of drugs, etc).
k) Identify criteria and treatment regimens used for suspected and/or diagnosed cases of malaria in the localities
including: frequency of visit of malaria specialists for sampling and treatment of suspects. Determine if house
spraying with insecticides was carried out; if there is participation of personnel outside the malaria service,
etc.
l) Identify the length of time between collection of blood samples, diagnosis, and adequate treatment.
m) Identify historical use of insecticides in the area.
n) Inventory schools and churches in the area.
o) Identify sources of jobs or subsistence of local population.
p) Identify temporary migratory movements of people in the area.
q) Identify and quantify indigenous populations in the selected area.
r) Carry out fast tests for malaria diagnosis in international border areas.

Step # 2: Determination of environmental characterization of the area

a) Identify the climatic characteristics of the area (yearly distribution of rain and temperatures) and its relation to
vector density and activity.
b) Identify the relation between altitude and the distribution of the malaria vector.
c) Identify the relation between malaria vector breeding sites and superficial water distribution.
d) Identify the relation between malaria vector breeding sites and the existing natural or introduced vegetation
cover.
e) Identify the relation between malaria vector breeding sites and the location of agricultural fields.

Step #3: Implementation of environmental interventions

a) Mapping of vector breeding site locations identifying species of Anopheles mosquito present.
b) Implementation of breeding site clean-up with community participation by removing garbage and other
materials that could facilitate the breeding of mosquito larvae.
c) Elimination of green algae, moss and mud in creeks to prevent mosquito breeding (with community
participation, once a month).
d) Biological control of breeding sites (optional according to each country experience and decision). Available
strategies are:
-
Bacillus thurigiensis and/or Bacillus sphaericus (positive experience in Guatemala, Nicaragua and
Honduras);
-
Larvae eating fish (Honduras and Guatemala);
-
Use of alcohol to control larvae (Mexico);
-
Natural repellents produced from leaves of Neem tree (Guatemala).
e) Drainage of temporary deposits of stagnated water and cleaning of water canals
f) Spraying of non-persistent pesticides or oil components on water surfaces not subject to drainage to interrupt
larvae breeding.
g) Collection (with local community involvement) of organic, recyclable and non-recyclable trash and
facilitating its adequate disposal.
F- 2

---

h) Promotion of domestic hygiene practices among the local population.
i) Spraying non-persistent insecticides in households where malaria has been persistent or had occurred in the
last year. Determination of correct adjustments of volume and time in relation to specific vectors present at
the site (A. pseudopunctipennis or A. albimanus).
j) Promotion of the use of physical barriers and personal protection such as bednets and repellents.

Step #4: Treatment of malaria

Different options for malaria treatment are available and may be incorporated in the practices employed in
each demonstration project, i.e., "single dose" (sequence of 3 consecutive monthly doses and 3 months of rest
is repeated during 3 years), "radical cure" in 3 days, "radical cure" in 5 days, or "radical cure" in 14 days.

Step #5: Organization of Community Participation

a) Organize working teams for diagnostic activities and environmental interventions.
b) Organize and implement meetings, workshops, training courses, etc. with local community in each
demonstration area.
c) Identify and promote training on malaria control strategies for local leaders.
d) Build capacity of local volunteers to promote preventive strategies of malaria control among local people.

Step #6: Collection and analysis of data, and dissemination of results

a) Identify people in the community and local health service centers to be trained in malaria diagnosis,
identification of vectors, and identification of breeding sites.
b) Identify and locate by GPS the existing malaria vector breeding sites.
c) Determine the number of persons living in each demonstration area.
d) Identify the main epidemiological variables including: migratory movements of workers, type of malaria
vector present, and time of the year or season of great concentration of the vector (relation to climate),
susceptibility of the vector to the insecticides utilized in vector control, immunological response of the
population, degree of endemicity and distribution of different strains of the parasite, cultural behavior of the
indigenous population, and socio-economic activities of the region.
e) Identify number of microscopes available in the area for rapid diagnostic tests.
f) Identify persons who do not respond to the applied treatment.
g) Complete provided forms with field information on environmental conditions and malaria vectors.
h) Register all implemented activities and results obtained related to the integrated strategies for preventing and
controlling malaria.
i) Organize the geo-referenced database (with use of GPS) and provide data for the GIS.
j) Integrate the data to the National and Regional Information System (WebPage and GIS).
k) Monitor and register the impacts of the interventions.
l) Monitor and register all costs related to the malaria control interventions in each demonstration project.

F- 3

---

SITES SUGGESTED FOR DEMONSTRATION PROJECTS:

PLACE
Location
Environmental Characteristics
LAND USE
Vectors
Parasite
Existing
Community
Notes
and
Anopheles
Plasmodiu
Health
Participation
Altitude
m
system
BELIZE
89W/16.5
Low and swampy Atlantic coast with Agriculture:
A. albimanus
P. vivax
Good
Good
Immigrant
Districts of
N
lagoons, hills and valleys in the
rice, citrus
(predominant)
(99%)
system,
workers from
Toledo,
<600
southern portion uplands. Subtropical fruits (orange
A.vestitipennis
P.
currently
Guatemala,
Cayo and
meters
climate, mean temperatures between
and
A. darlingy
falciparum
with
Honduras and
Stann Creek
above sea
23°C in December to 29°C in July.
grapefruit),

foreign
El Salvador,

level
Annual rainfall around 2000 mm,
bananas.
medical
and villages of
20,000
with a dry season from February to
doctors
refugees from
inhabitants under
May, rain season from June to
participatin
El Salvador
risk
December. Natural vegetation:
g in a
(UN); good
Approx. 10,000
mangroves, swamp forests close to
program of
terrestrial
km2
rivers, parklike savanna in the coastal
health
communication
plains.
assistance
s.
for the
villages.
COSTA RICA
84W/9N
Mountains flanks and tablelands
Agriculture:
A. albimanus
P. vivax
Good
Well
Easy access,
Huetar Atlantica
<1000
made fertile by volcanic ash
bananas and
(predominant)
(100%)
coverage of established
immigration
(Cantón
meters
extending to swampy coastal plains;
organic
medical
and active.
from Panama
Talamanca)
above sea
hot and humid climate (27°C) on the
cocoa.
services
and Nicaragua,
30,000
level
coast, cooler with altitude; moist
indigenous area
inhabitants under
northeast rains can bring rain
(some with
risk
throughout the year (3200mm);
difficult access)
Area: 2,809 km˛
Tropical broadleaf forests cover most
and other ethnic
of the area, while palms and
communities
mangroves thrive in the coastal plain.
EL SALVADOR 90W/14N
Pacific lowlands and coastal hills;
Agriculture:
A. albimanus
P. vivax
Good
180
Good access to
Sonsonate
<500
tropical climate (hot and humid)
coffee, and
network of
volunteers
the area.
La Paz, Usulutan
meters
temperature varies with altitude
sugarcane
rural
already
120,000
above sea
(annual average 23°C), hottest
medical
organized for
inhabitants under
level
months are April and May, rainy
services, 20 malaria
risk
season from May to November (1800
health
control in the
mm/year). Tropical grassland and
services
area
deciduous broadleaf forest.
units in the
area.
GUATEMALA
90W/17N
Flat interior region, tropical climate,
Hardwood
A. albimanus
P. vivax (in 10
Low
Good access
Peten Sur, Alta
<600
average temperature 37řC (30 to 40ř forests,
(predominant),
general)
physicians
community
with exception
Verapaz, Quiche
meters
C) in the Northern part, rains in
livestock
A.
P.
per 100
participation
of Peten where
(Ixcan)
above sea
winter, (the entire year in Peten),
production.
pseudopunctipe
falciparum
000
access is
Population:
level
tropical rainforest

nnis.
inhabitants
possible only by
360,000
A. darlingy in
boat on the Río
F- 4

---

inhabitants under
the Northern
la Passion.
risk.
part and A.

albimanus in

the southern
part
HONDURAS
87W/16N
Interior uplands and low ranges
Cattle
A. albimanus
P. vivax
Satisfactor
Volunteer
Migration from
Region VI.
<1000
extending to swampy coastal
ranching and
(in winter)
(93%)
y health
network
other parts of
Atlántida
meters
lowlands. Climate: coastal lowlands
agriculture:
A. darlingi (in
P.
service
(1200 of 7000 the country, as
(10
above sea
are hot and humid (average 30°C),
banana,
summer)
falciparum
coverage.
persons
well as from El
municipalities)
level.
but the upland interior is cooler and
maize, coffee,
throughout
Salvador and
280,000
much drier, little variation in
cotton, rice
the region).
Guatemala.
inhabitants under
temperatures throughout the year,
and citrus
Good access.
risk.
rains from May to September (about
fruits.
Area: 10,247 km˛
2700 mm/year) and dry season from
December to April. Vegetation:
evergreen tropical rain forest and
swamps.
MEXICO
108W/26N Pacific coastal plain, with slopes and Corn, citrus
A.
P. vivax
1 per 1,000 Good
Region with
Oaxaca, Chiapas
<900
valleys. Tropical climate with rainfall fruits,
pseudopunctipe
inhabitants
experience of

meters
from May to October, temperatures
papaya,
nnis (winter)
malaria control
Population:
above sea
from 23°C to 35°C. Tropical dry
coffee,
A. albimanus
without DDT
2,800,000
level
broad leaf forests.
timber,
(summer)
Temporary
inhabitants under
livestock,
migrant
risk
tourism.
workers from
other parts of
the country.
MEXICO
108W/27N
3 main environmental units: the
Livestock,
A.
P. vivax
Good
Good
Remote areas
Sonora, Sinaloa,
200-1,200
Pacific marshy coastal lowlands with coffee,
pseudopunctipe
and P.
with endemic
Chihuahua,
meters
deltas of rivers that descend from
timber, and
nnis (winter)
falciparum
malaria.
Durango
above sea
Sierra Madre Occidental, the
tourism.
A. albimanus
(imported).

level.
piedmont ridges with isolated hills
and A.
Population:
and slopes, and the interior lava
vestitipennis.
3,000,000
plateau with fertile soil. The hills and
inhabitants under
plateau areas are agriculturally very
risk.
productive with irrigation. Climate is
semiarid with rainfalls concentrated
from June to December; average
temperatures from 20­35°C.
NICARAGUA
86W/12N
Pacific coastal lowlands with
Agriculture:
A. albimanus
P. vivax
7.3
Good
60% of the
Chinandega
<500
volcanic ash covering large areas and sugarcane,
(97-98%)
physicians
Network of
population is in
(13
meters
very fertile soil; climate hot and
corn,
P.
per 10000
volunteers,
the coastal
municipalities)
above sea
humid (27°C), annual rainfall of near
bananas,
falciparum. inhabitants
participate in
zone.
180,000
level
2000 mm, rainy season from May to
peanuts;
the cleaning

inhabitants under
October, dry season from December
recent
of mosquito
Migratory
risk
to April; tropical forest and savanna
commercial
breeding sites workers from El
F- 5

---

grassland with forests along rivers.
shrimp
Salvador and
fishery.
Honduras.
PANAMA
77.5W/8.5
Caribbean coastal lowlands and
Agriculture:
A. albimanus
P. vivax, is
Good
Two health
Border with
Bocas del Toro
N
swamps; very rainy tropical climate
banana
presented
assistance
educators and Costa Rica.
(Cankintú,
<1200
(3000 mm of rainfall a year), rains on plantations
in
of health
20 promoters
Problem with
Usapin, Guabito)
meters
most days throughout the year;
for export
outbreaks
services in
of community drinking water

above sea
tropical broadleaf forest.
(with
(not
Changuinol
participaiton
(groundwater is
55,000
level
intensive use
endemic).
a. Cankintu
not good). More
inhabitants under
of
and Usapin
than 50% of
risk
agrochemical
are
population is
s), potatoes,
indigenous
indigenous.
sugar cane,
areas with
Most access to
coffee and
difficult
this region is by
others.
access and
water. Migrant
lower
workers
health
exchange with
assistance
Costa Rica.

F- 6

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ANNEX G: GEOGRAPHIC INFORMATION OF THE PROJECT AREA

(Report of the PDF-B phase of the GIS group of the Special Program for Health Analysis ­ SHA/PAHO in
collaboration with the Division of Health and Environment)

INTRODUCTION

As a part of the preparation phase (PDF-B) for the project "Comprehensive Action Program to
Prevent Reintroduction of DDT for Malaria Control in Mexico and Central America", the prototype of
a Geographic Information System (GIS) was developed in order to facilitate the regional analysis of
health and environmental problems. This Annex shows some of the techniques utilized to generate
interactive thematic maps with preliminary results on the geographical distribution of malaria in
Mexico and Central America, as well as the strategies that have been used for malaria control in the
participating countries. Examples on the application of various methods of spatial analysis were
incorporated in the GIS for the sake of identifying spatial standards in the distribution of malaria
control and the use of pesticides.

The main objective of the GIS application in this Project is to compile, standardize and map data
related to the use of DDT and newly introduced pesticides in Mexico and Central America, and
include geo-referenced information on ma laria control, positive cases of malaria and population
at risk, distribution of vectors and interventions of control, environmental and ecological factors,
and the distribution of the health system.


G- 1

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