Members of the United Nations General Assembly Arranged in

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Members of the United Nations General Assembly Arranged in





    Distr.: General 14 February 2005

    English only United Nations



Conference of the Parties of the Stockholm

    Convention on Persistent Organic Pollutants

    First meeting

    Punta del Este, Uruguay, 26 May 2005

    Item 6 (o) of the provisional agenda*

    Technical assistance

    Reports of the case-studies on regional and subregional

    centres for capacity-building and technology transfer under

    the Stockholm Convention**

    Note by the Secretariat

    1. As referenced in document UNEP/POPS/COP.1/31, the annexes to the present note

    contain the results of four case-studies on regional and subregional centres for capacity-building

    and technology transfer, proposed pursuant to paragraph 4 of Article 12 of the Stockholm

    Convention on Persistent Organic Pollutants.

    2. Annex I contains the case-study report of the International Centre of Insect Physiology

    and Ecology (ICIPE) Nairobi, Kenya.

    3. Annex II contains the case-study report of the Universiti Sains Malaysia.

    4. Annex III contains the case-study report of the South Pacific Regional Environmental

    Programme (SPREP)/Basel Convention Regional Centre.

    5. Annex IV contains the case-study report of the Basel Convention Coordinating Centre

    for Training and Technology Transfer for Latin America and the Caribbean, in Montevideo,


    6. The above case-study reports are presented as submitted by the institutions being studied,

    and have not been formally edited.


K0580523 020305

    For reasons of economy, this document is printed in a limited number. Delegates are kindly requested to bring their copies to meetings and not to request additional copies.

Annex I

International Centre of Insect Physiology and Ecology (ICIPE)

    Nairobi, Kenya

    Proceedings of the

    Regional Training Workshop on Persistent Organic Pollutants (POPs) and Alternative Approaches to Malaria Control

    in Africa.

    thth20 - 27 June 2004

    International Centre of Insect Physiology and Ecology (ICIPE)

    Nairobi, Kenya

    September 2004


Acronyms and abbreviations

BEP Best Environmental Practices

    Bti Bacillus thuringiensis israelensis

    CHW Community health workers

    COP Conference of Parties

    DDT Dichloro diphenyl trichloroethane

    GEF Global Environmental Facility

    ICIPE International Centre of Insect Physiology and Ecology IEC Information, Education and Communication

    IPM Integrated Pest Management

    IRS Indoor residual spraying

    ITNs Insecticide treated nets

    IVM Integrated vector management

    KAP Knowledge, Attitude and Practices

    KEMRI Kenya Medical Research Institute

    MoH Ministry of Health

    POPs Persistent Organic Pollutants

    SCS The Stockholm Convention Secretariat, Geneva TOT Training of Trainers

    UNEP United Nations Environmental Programme

    WHO/AFRO World Health Organization, African Regional Office



Executive Summary

    Just as integrated pest management (IPM) has become the method of choice in crop pest management, the WHO/AFRO and ICIPE intends to bring integrated vector management (IVM) to the same level of development and utilization. These integrated strategies will allow for a sharp reduction in the use of pesticides, with lower overall costs and reduced negative environmental effects, while providing the required sustainability, health and environmental acceptability. It is envisaged that further research into alternatives is a pre-requisite for managing and reducing reliance on POPs. ICIPE is well placed to provide countries with the needed capacity strengthening through training and overall technology transfer by applying Best Environmental Practice (BEP) for sound management of POPs through case studies and demonstration projects.

In consultation with the Stockholm Convention Secretariat (SCS) and in recognising ICIPE’s experience

    and expertise, malaria was identified as an issue of major concern in the eastern and southern African region. Considering that DDT, one of POPs under the Convention has been in use for control of malaria vectors and that there is a global move to phase it out or reduce its reliance, ICIPE was requested to conduct a case study to assist countries using DDT or intending to revert to it to implement IVM as a sustainable and effective strategy for vector control. This decision was based on the fact that ICIPE has developed a strong base and expertise on Integrated Pest Management (IPM) and Integrated Vector Management (IVM) as alternatives to chemical control of disease pests and vectors and could therefore assist countries in Africa to reduce the reliance on DDT for mosquito control and instead implement IVM strategy. The urgency of hosting this workshop was realized as more and more countries are considering reverting to the use of DDT.

    In this connection ICIPE organized a 5-day training workshop from 21-26 June, 2004 for 14 participants from seven countries in the eastern and southern African region who are involved in vector borne disease control in their countries. The main objective of the workshop was to create awareness on the Stockholm Convention and the national obligations on POPs and to provide technical skills on integrated vector management as an alternative approach to the use of DDT for indoor residual spraying. The ministries of health from 8 countries were requested to nominate 2 officers to attend the workshop in Nairobi. However, only 7 countries nominated participants as follows: 2 each from Kenya, Ethiopia, Zimbabwe, Uganda, and one each from Zambia and Tanzania. 4 were invited from Malawi (due to double nominations) making a total of 14 participants. The program of the workshop included 3 days of lectures and group work and 2 days of field visit to Malindi on the Kenya coast, where the community is involved in malaria control.

    By the end of the workshop, the participants expressed their willingness to collaborate with ICIPE in implementing integrated vector management strategy in their countries as a comprehensive method to vector control in order to reduce reliance on DDT or to stop governments reverting back to its use as some countries have suggested. ICIPE, with assistance from her partners will strive to work with the workshop participants to push the IVM agenda forward.

    4 A Study on the Regional Delivery of Technical Assistance


1.0 Introduction

    In collaboration with WHO/AFRO, ICIPE intends to bring integrated vector management IVM) to

    enhanced levels of development and utilization similar to integrated pest management (IPM) widely used in crop pest management. The use of integrated strategies will lead to a sharp reduction in the use of

    pesticides, with lower costs and reduced negative environmental effects, while providing the required

    sustainability, health and environmental acceptability. Further research into alternatives is a pre-requisite for managing and reducing reliance on POPs pesticides.

The Stockholm Convention especially stresses the need for Best Environmental Practice (BEP) for the

    sound management of POPs. It also encourages research and development of alternatives to DDT. ICIPE

    has the capacity to provide much of the needed technological transfer for countries that continue to rely on DDT for malaria vector control.

The UNEP Chemicals in Geneva identified ICIPE to undertake a case study designed to identify and

    explore issues associated with the regional delivery of technical assistance under the Stockholm

    Convention on POPs under the terms of reference in Annex 1. The training workshop was designed for

    public health professionals who are actively involved in t he management and decision-making process

    related to vector control and vector-borne disease control.

The objectives of the workshop were:

    ? To provide technical and managerial skills on integrated vector management

    ? To strengthen the capacity of national disease control programmes on environmentally sound

    alternatives and management options for POPs, with particular emphasis on reliance on the use of


Expected outcome

    The capability of public health officers and vector control specialists to implement integrated vector

    management as alternative approach to use of pesticides for vector control improved

1.1 Opening remarks by Director General of ICIPE

    The training workshop was formally opened by Dr. Hans Herren, the Director General, of ICIPE . In his

    opening remarks he emphasised the link between capacity building and technology transfer. With regard to DDT, he noted that there are enough alternatives to DDT and in his opinion there is no need to revert to DDT use. Some of the alternatives are even better than DDT. He added that ICIPE has been using

    Integrated Pest Management (IPM) for 10 years and indicated that IPM has proven to be a satisfying

    counterforce to pesticides. Recognising that easy solutions are not sustainable solutions, there was a strong possibility that pesticide use will alternately lead to resistance. He cited ICIPE’s development of the Bacillus thuringiensis israelensis (Bti) demonstration factory as a way of applying environmentally

    friendly solutions to malaria vectors.



1.2 Remarks by UNEP/GEF Regional Office -Takehiro Nakamura

    Mr. Nakamura of the UNEP Division of GEF Coordination Office in Nairobi gave an overview of

    UNEP/GEF activities and emphasised the role of this unit in the GEF family especially emphasising the UNEP/GEF POPs activities.

    He said that GEF is funding activities in the search for better alternatives to DDT as well as demonstration projects for alternatives to DDT. In this connection, UNEP is collaborating with other United Nations specialized agencies such as the World Health Organization, World Bank in capacity building at national and regional levels.

1.3 Workshop objectives by Dr John Githure

    Dr. Githure highlighted ICIPE’s mandate which he said is to conduct research, train and develop methods for managing pests and vectors in environmentally friendly ways. ICIPE has developed strong programs on both IPM and IVM as alternatives to chemical control of pests.

    He said that the workshop was convened at ICIPE in response to Article 12 of the Stockholm Convention on POPs through a request from UNEP Chemicals in Geneva to provide technical assistance to countries in the region to fulfill their obligations under the convention on alternatives to DDT.

    Two main outcomes were expected from the workshop. First was that the capability of public health officers and vector control specialists to implement IVM as an alternative approach to use of pesticides for vector control would be improved. Secondly, to have ICIPE established as a UNEP Regional Center for capacity building and technology transfer on POPs.

2.0 Workshop process and deliberations

    The first three days were devoted to learning about malaria vector control in Africa, The Stockholm Convention with specific emphasis on DDT and group work on IVM as the way forward to reducing reliance on DDT. One and half days were devoted to field visit in Malindi on the Kenyan coast where the participants learnt the organizational structure of community initiatives on IVM implementation as well as community based activities undertaken in the control of malaria under the IVM approach as shown in the Programme (Annex 2). The one-week training workshop was attended by 14 participants drawn from Kenya, Uganda, Tanzania, Ethiopia, Zimbabwe, Zambia and Malawi (Annex 3).

2.1 Presentations

    2.1.1 Overview of the Stockholm Convention on POPs: - Francis . Kihumba

    Mr. Kihumba who is the designated national POPs focal point for Kenya, provided an overview of the

    Stockholm Convention. The presentation introduced the main principles and spirit of the convention. The Stockholm Convention is a global treaty to protect human health and the environment from persistent organic pollutants (POPs). POPs are chemicals that remain intact in the environment for long periods, become widely distributed geographically, accumulate in the fatty tissue of living organisms and are toxic to humans and wildlife. POPs circulate globally and can cause damage wherever they travel. In implementing the Convention, Governments will take measures to eliminate or reduce the release of POPs into the environment. The presenter gave the history of the convention from initiation to inception.

2.1.2 National Obligations Related to DDT under the Convention - Dr Paul Saoke 1 must eliminate production and use of DDT, except The Stockholm Convention stresses that all Parties

    Parties that notify the Secretariat that they need it for disease vector control programs. Use of DDT may only be allowed when locally safe, effective and affordable alternatives are not available to the Party. However Parties must set-up special public DDT register and must still comply with reporting and other obligations. All Parties must promote research and development for alternatives to DDT. The use of DDT is subject to review by the Conference of Parties (COP) to see when DDT is no longer needed for disease vector control. The Parties using DDT are asked to develop and implement a plan of action, as part of the implementation plan and that shall include:

    (a) Development of regulatory and other mechanisms to ensure that DDT use is restricted to disease

    vector control

     1 Parties refer to States that have ratified the Stockholm Convention

    6 A Study on the Regional Delivery of Technical Assistance


    (b) Implementation of suitable alternative products, methods and strategies, including resistance

    management strategies to ensure the continued effectiveness of these alternatives.

    (c) Measures to strengthen healthcare and to reduce the incidence of the disease.

2.1.3 Health Impacts

    The participants were orientated on the health impact of DDT. This was essential in decision-making and also to prepare them to make a case for using alternatives to DDT in their respective countries. The presentation noted that concentrations of DDT and its metabolites are clear barometers of exposure. Although DDT levels are noted to be on the decrease globally, there are populations and wildlife that experience concentrations of DDT above critical levels. For instance, investigations in Mexico and South Africa reveal that human breast milk contains DDT at concentrations that exceed the guidelines for the acceptable daily intake by infants as set by the WHO. DDT like other POPs substances is dangerous when it gets into the human body even in minute quantities. Children get exposed to POPs through direct exposure to contaminants but most profoundly in the uterus. Most of the toxicological studies have concentrated on lethal doses in relation to cancers, gross abnormalities and death in order to come up with safe levels.

2.1.4 Science based decision making for DDT

    This presentation introduced several alternatives that have been incorporated into IVM strategies. These include the use of pyrethroids, which have been stabilized and now have long residual capacity, insecticide-treated nets (ITNs), house spraying, space spraying, larviciding, IVM and biological control methods. The Mexican successful shift from DDT is an example that could well work in the eastern African region. DDT is arguably cheap but what is cheap might end up costing more in the long term. Malaria control programs therefore require more investments in alternatives to DDT and also need to be integrated into development programs and other activities to guarantee success.

2.1.5 DDT in the environment, Kenya situation - Dr. Paul Saoke

    In order to illustrate the persistence of DDT in the environment, the result of the recently launched National Inventory of POPs (specifically DDT) was presented. It noted that DDT was first introduced in Kenya as an acaricide in 1956 to combat tick menace. It was then banned for use in livestock in 1976. It was subsequently banned for agriculture in 1986 but was restricted for use only in disease vector control. A study carried out in Kenya in the mid- 1980s indicated that high levels of DDT was used in both agricultural and public health undertaking. High levels of DDT were observed from a test of 367 domestic eggs from 61 farms in Central Kenya and 41 maternal blood, milk, subcutaneous fat and umbilical cord blood samples from mothers who delivered through caesarean section at the Kenyatta National Hospital. It means that other Kenyans have been exposed to DDT through the food pathways and have bequeathed the DDT and other persistent organic pollutants soup to their children who are now more than 20 years old.

2.1.6 Eliminating/reducing the use of DDT by selecting alternative management strategies

    Francis Kihumba

    Participants were briefed on document UNEP/POPS/IN^/7/4 which highlights on information and guidance needed to assist for evaluating continued need for DDT use for disease vector control and also discussed broadly the alternative regimes for controlling malaria vectors.

    The participants covered information gathering on production and use of DDT, its alternatives and systems strengthening. The document provided a framework for collecting information on reliance on DDT and highlighted various alternatives to DDT, namely, biological, chemical and environmental controls as well as general human, and environmental safety issues.

    It also gave participants an idea of what information they need to collect with regard to alternatives to DDT which can eventually help their countries comply with the convention.

3.0 Summary of Country Reports

    Prior to the commencement of the workshop, participating countries had been requested to prepare country reports using a structured questionnaire (Annex 4). The exercise was aimed at gaining insights on the basic understanding of the Stockholm Convention in general and its phase out program for DDT especially with regard to introduction of DDT alternatives among the countries.

    Participants presented their country reports (Annex 5) in which the following issues were common to all



the countries that participated in the workshop:

    ? All are signatories to the Convention,

    ? Two countries (Ethiopia, Malawi) are parties

    ? Others except Kenya were not sure what status or ratification process has been


    ? All participants work with vector borne disease departments.

    ? All claimed malaria to be a major problem in their country

    ? One country (Ethiopia) currently uses DDT for spraying to control vector borne diseases

    while Uganda is in the process of reverting back to DDT use.

    ? Few had accurate inventories of DDT or sectors where it is used. 4.0 Integrated Vector Management

4.1 ICIPE’s role in capacity building on IVM - Dr Githure

    ICIPE plays a crucial role in malaria control in Africa by providing guidance and technical assistance to the

    national malaria control programs in Africa especially on the ecology and behavior of malaria vectors. The

    institute seeks to strengthen vector control capability in the national research and teaching institutions in

    Africa. Currently the institute is working towards promoting use of IVM strategies in different ecological

    settings in Africa. ICIPE has been designated as a WHO Collaborative Center on IVM and has conducted a

    six-weeks Regional Training Course on IVM for 17 senior level malaria control managers drawn from 16

    countries. Current projects at ICIPE cover larval control of malaria vectors, behavioral and chemical

    ecology of malaria vectors, vector competence of malaria vectors, bio-prospecting for mosquito repellents

    and larvicides from plants and control of mosquito larvae using microbicides. A demonstration factory to

    produce Bacillus thuringiensis israelensis for larval control has been set up at the institute.

4.2. IVM Philosophy - Dr Novak

    A background understanding on the principles of IVM was deemed necessary for the participants since

    vector control is an essential component of any vector borne disease control program. IVM was defined as

    the ―the rational use of all appropriate means of control in a mutually compatible, safe and cost-effective

    manner in order to achieve vector suppression and control of disease transmission‖. A holistic and

    ecological definition expounds the above definition by WHO by stating that it is ―a unified plan of control

    that selects the most appropriate methods of control, based on the environmental conditions and the

    population dynamics at a level that does not cause health problems‖. The main objectives of vector control

    are to reduce vector breeding sites to the strictest minimum wherever possible, reduce the abundance and

    longevity of disease vectors and to reduce the human vector contact. The presenter acknowledges that

    there is no ―silver bullet‖ and that intervention models have to be developed based on ecological



    4.3. Practices of IVM - Dr J Shililu

    A practical and step-wise development of an IVM strategy was provided to the participants. This

    presentation highlighted the primary need to develop an IVM control strategy based on disease

    stratification, identification of target vectors, and selection or integration of control methods. A key factor

    in this process is to identify obstacles to the introduction of IVM. The criteria for selection of IVM tools

    should consider cost-effectiveness, long-term economic advantage, benefits, operational applicability,

    safety, suitability for the local conditions, acceptability and administrative/logistical feasibility.

5.0 Group work reports

    The participants broke into two groups to discuss the POPs convention, alternatives to DDT, capacity

    building and technology transfer. The groups noted the following:

5.1 Capacity to implement the Stockholm Convention and Technology transfer

    o There is need to prepare countries for phasing out and elimination of DDT use

    o Countries intending to introduce DDT need to be made aware of the implications of their


    o There is need to assist malaria endemic countries to identify appropriate alternatives to DDT

    8 A Study on the Regional Delivery of Technical Assistance


    o There is need to identify a regional centre that coordinates activities leading to DDT phase out and

    introduction of alternatives

5.2. Research needs

    o Conduct field testing and demonstration projects on IVM in different eco-epidemiological settings

    o Conduct cost benefit analysis of DDT and alternatives

    o Evaluate the health and environmental impacts of DDT and alternatives

    o Monitor pesticide/insecticide resistance

5.3. Networking

    o Information exchange is lacking amongst disease endemic countries

    o Underutilization of locally available expertise (no readily available inventory of

    o Reactivate or set up coordination structures and mechanisms

6.0 Relevance of case study site in Malindi

    Malindi District is located on the Kenyan coast north of Mombasa. It is one of the major tourist

    destinations on the Kenyan coast. Malaria is endemic in the region and like other parts of the Coast

    Province, the disease has a major impact on the economic and social conditions. It is the leading cause of

    morbidity and mortality accounting for more than 14,000 outpatients seen annually at the District Hospital.

The field visit and training was conducted by community-based workers. The participants visited sites

    where non-chemical control measures for mosquitoes spearheaded by the community were successful. The

    idea of using grass-root communities to introduce alternatives to DDT was effectively demonstrated at the

    field site and this is expected to be replicated in countries with similar socio- cultural and economic


It was evident that mosquito bleeding in the area is as a result of man-made alteration to the ecosystem.

    Unfortunately, municipalities are not doing enough and this prompts communities to take action to remedy

    the malaria menace. For example, the communities regularly clean up their compounds and participate in

    the National Malaria Day. Many groups are also joining up to address malaria issues supported by the

    business community. These groups are involved in buying mosquito netting materials making mosquito

    nets and environmental management such as filling up stagnant pools of water and burning debris.

    Information on mosquito ecology and life cycle is provided to community organized groups by KEMRI

    and ICIPE staff.

The Malindi community initiative was started by training two groups of TOTs for experts drawn from

    Ministry of Health, Malindi municipality and schools. They were taught methods of mosquito control as

    well as communications skills.

The knowledge gained has helped the community to recognize that 90% of the breeding habitats of

    mosquitoes are man-made. Each group has developed mosquito scouting teams that identify the sites

    where mosquitoes are breeding and implement control action

6.1. Field Visits

    The participants visited the following communities:

The Shella Women Group

    The group’s main focus is preparing ITNs which has led to a dramatic reduction in malaria cases.

The Ngala Community Group

    This group promotes malaria awareness through drama and skills. They also participate in draining pools

    of stagnant water. They do environmental management as well as promote personnel protection of workers.

    The group involves school children, elders and the unemployed youth as well as school leavers.

The Maweni Women Groups

    This group also cooperates with the Ngala women group to identify areas that have stagnant pools of water

    in the estate and drain them.



The Shilago Group

    This group is coordinated by teachers of Bahari Secondary School which also educates communities to

    reduce mosquitoes at source. It also has environmental activities such as tree planting. .

Malindi Solid Waste Management Project

    The Project concept appreciates that most of the receptacles that hold water in which mosquitoes breed are

    also a solid waste problem. They include cans, plastic containers, and coconut shells. Schools are

    encouraged to collect plastics, metal cans and the school with the largest mass wins a price. It was apparent

    that the community has very innovative ideas to re-use plastics.

The community leaders reported that at least 80% of the population associate malaria with mosquitoes.

    They reported that cases of malaria have gone down as a result of knowledge dissemination and the use of

    environmental management and use of insecticide treated nets.

The achievements made by the community were listed as follows:

    1) The have recorded that over 90% of the mosquito larval habitats in Malindi are man-made and that they

    can easily be eliminated by environmental management.

    2) More than 40% of the people use bed nets

    3) Many community-organized groups are providing technical assistance in the control of mosquitoes and


    4) Through consultations with the Municipal Council, the Ministry of Health and other stakeholders they

    have developed and started to implement innovative community-based environmental management and

    larviciding with safe bio-pesticides.

The participants carried out a review of the field work and responded as follows:

    o All participants noted that the workshop and field visit stimulated their eagerness for their

    institutions to collaborate with ICIPE on community based malaria control programme.

    o The field experience was useful as it put into perspective practical application of the plenary

    sessions given to them

    o Cost effective way to deal with mosquitoes as an alternative to chemicals is environmental

    management and larval control.

    o The use of ITN has a definite role as alternatives to DDT.

    o Women groups are dynamic as channels for reaching the wider community and they should be

    encouraged to implement IVM strategy.

    o ICIPE tested technologies should also be tested in individual countries prior to implementation.

    Capacity building should consider human resource development and laboratory improvement.

    7.0. Conclusions and Recommendations

    1. There is need to assist malaria endemic countries to identify and evaluate appropriate

    alternatives to DDT.

    2. There is need to identify a regional center that coordinates activities leading to DDT

    phase-out and introduction of alternatives, and act as the reference point on technologies

    relating to the phase-out of DDT.

    3. There should be linkages and modalities for permanent partnership within the region for

    organizations and institutions involved in the implementation of the Stockholm

    Convention on persistent organic pollutants.

    4. More data/information on adverse effects of DDT need to be disseminated as a basis and

    foundation of a complete switch to alternatives.

    5. There should be focal point in each country to address the effective implementation of

    IVM and introduction of other alternatives to DDT

    6. The Stockholm Convention focal points in every country need to organize awareness

    creation forums/meetings with policy makers for introduction of alternatives to DDT and

    IVM in particular.

    7. There should be regional information sharing and exchange mechanism between and

    among all the countries in the region on implementation of IVM.

    8. Strongly recommended the creation of a regional website on IVM

    9. Funding should be made available for the implementation of control programs based on

    the IVM initiative.

    10 A Study on the Regional Delivery of Technical Assistance

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