The shortcomings in public health pesticide management as identified by the 13 selected countries are most likely undermining the effectiveness and safety of pesticides. Moreover, previous results have indicated that the shortcomings are widespread across malaria-endemic countries and regions [21, 22]. It will be a major challenge for countries to strengthen their policy, legislation and capacity necessary to enable the implementation of the existing global standards on public health pesticide management. The presented strategies of regional policy development, in-depth country support, and thematic support across countries, provide valuable lessons for reinforcing and expanding the international support to countries in need. The support should be provided within the context of IVM, where pesticides are not seen as the only option for vector control [15]. The three strategies are expected to increase capacity needed for IVM by improving country-level decisions on selection and use of vector control insecticides.
The strategy of regional policy development resulted in consensus building and/or policy statements among country representatives in five WHO regions. The outcomes were most advanced in the Eastern Mediterranean Region, where a resolution and a regional action plan were adopted. In general, the regional consultations have raised awareness among country representatives about the urgency of sound public health pesticide management. Moreover, the published frameworks, guidelines and resolutions are expected to uplift the issue on the national political agenda. The regions took different approaches to strengthening policy on public health pesticide management, either to develop a regional policy (with or without framework) or guidelines for policy making at country level. It would seem appropriate that regional policy is accompanied by a guidelines document, and vice versa, in order to raise pesticide management on the regional agenda while also providing the methods to facilitate policy development at country level.
Clearly, regional policy development should not be a stand-alone activity but must be supplemented by country support, lest the regional policy may not be adopted and implemented. In turn, it is expected that country support for pesticide management will be more fruitful if endorsed by a regional policy. Continued monitoring on the implementation of regional frameworks and action plans by individual countries is required in the years ahead.
The multifaceted situation, with various shortcomings in pesticide life-cycle management per country and with context-specific differences between countries, demands a systematic and well-targeted approach to supporting individual countries. In this respect, the strategies of in-depth country support and thematic support across countries appeared to be complementary, by addressing each country’s context while also prioritizing common problems among countries. The in-depth support for situation analysis and action planning according to each country’s unique context of legislative, institutional and biological factors has demonstrated to be a vital starting point, but demands considerable investment of time and energy. The exercise contributed to an increased awareness among key stakeholders about the deficiencies in pesticide management. However, the large number of shortcomings identified by individual countries resulted in the development of rather ambitious and unfocused national action plans that would be difficult to accomplish unless further priority setting is conducted. Consequently, the existing methods on situation analysis need revision to provide clearer indicators for use in situation analysis and tools to aid in prioritization, needs assessment and action planning [29]. Countries should be supported, where needed, in the development of proposals for mobilization of resources.
The results of thematic support on pesticide quality control demonstrated how a prioritized issue can be efficiently and effectively addressed across a number of countries to achieve tangible results. This strategy depends largely on the availability of standard methods and tools and on international expert inputs. As a strategy, however, the thematic support could be further strengthened, for example, by setting criteria for the selection of themes and countries, and by conducting feasibility studies at baseline.
Both country-level strategies (in-depth support and thematic support) will present well-defined options for donor funding and programmatic response. For example, thematic support of West African countries on insecticide resistance monitoring of malaria vectors will constitute a viable package for external funding. Alternatively, disposal of obsolete pesticides could be efficiently implemented across countries, following the example of the Africa Stockpiles Programme [44]. At individual country level, in-depth analysis and planning on pesticide management could be appropriate as stand-alone project or for incorporation into new or ongoing development programmes. Also, countries should require suppliers or manufacturers of pesticides to contribute towards sound pesticide management of their products, for example, by stipulating stewardship support for quality control in public tenders for procurement of pesticides.
Every strategy should emphasize a multisectoral approach, because many pesticides are used in more than one sector, and the life-cycle management of a pesticide generally involves the actions of several sectors. Also, it is important to bear in mind that the global insecticide use for vector control constitutes is only a minor fraction of the global consumption of insecticides (1.5% of total) or pesticides (0.3% of total) [6, 45]. Household insecticides are estimated to take up between 5 and 10% of the total global insecticide market [46]. The lion’s share of all pesticides is for use in agriculture.
Intersectoral coordination should aim to harmonize legislation and practices across sectors. The experiences from the 13 selected countries showed that coordination between sectors was weak at baseline but recent task forces and workshops brought together the stakeholders from several sectors to share information, conduct situation analyses and develop common action plans on pesticide management. Future work should capitalize on these achievements. In line with a multisectoral approach, the external support provided at global and country level should be coordinated between specialized international organizations. Several organizations, notably WHO and FAO, together with industry and research institutions, have recently strengthened their collaboration at global level through the development of guidelines and standards on pesticide management (van den Berg H, Yadav RS, Zaim M: Setting international standards for the management of public health pesticides: where are we now?, submitted). However, the international organizations need to improve their coordination and collaboration in their support on pesticide management to individual countries in need.
Thus far, the WHO has taken a lead in providing country support on public health pesticide management in collaboration with FAO [26]. Indeed, several components of public health pesticide management are specific to the health sector and are commonly implemented by disease control programmes. This refers to pesticide procurement, application and monitoring of insecticide resistance. However, the other components of public health pesticide management overlap with those of pesticides used in other sectors, predominantly agriculture, in a number of ways.
In most countries, legislation covers all pesticides. Also, registration is commonly conducted by one central authority, in accordance with the Code of Conduct [8, 20]. Likewise, quality control facilities generally cover all pesticides, to make efficient use of available resources. Nevertheless, a number of countries still have legislation that does not cover public health pesticides; have more than one registration authorities; or have pesticide quality control that does not include public health products [21]. Several other components of pesticide management that would ideally cover all pesticides are: monitoring of exposure and poisoning, disposal, public education, information exchange and Regional cooperation.
Considering the tasks ahead, future support for capacity building at country level should be coordinated and shared between the international agencies, noting their technical capacity and resources. WHO, FAO and UNEP should intensify their collaboration in providing policy options, shaping research agendas and providing international technical support in the life-cycle management of pesticides.