Promotion of gender policies led to increased hiring of women in supervisory roles in a large indoor residual spraying (IRS) program with no meaningful differences in IRS output between men and women spray operators.

Development assistance for health programmes is often characterised as donor-led models with minimal country ownership and limited sustainability. This article presents new ways for low-income and middle-income countries to gain more control of their development assistance programming as they move towards universal health coverage (UHC). We base our findings on the experience of the African Collaborative for Health Financing Solutions (ACS), an innovative US Agency for International Development-funded project. The ACS project stems from the premise that the global health community can more effectively support UHC processes in countries if development partners change three long-standing paradigms: (1) time-limited projects to enhancing long-lasting processes, (2) fly-in/fly-out development support to leveraging and strengthening local and regional expertise and (3) static knowledge creation to supporting practical and co-developed resources that enhance learning and capture implementation experience. We assume that development partners can facilitate progress towards UHC if interventions follow five action steps, including (1) align to country demand, (2) provide evidence-based and tailored health financing technical support, (3) respond to knowledge and learnings throughout activity design and implementation, (4) foster multi-stakeholder collaboration and ownership and (5) strengthen accountability mechanisms. Since 2017, the ACS project has applied these five action steps in its implementing countries, including Benin, Namibia and Uganda. This article shares with the global health community preliminary achievements of implementing a unique, challenging but promising experience.

Sending voice and/or text messages to mobilize households for spraying was more costly per structure and less effective at preparing structures than traditional door-to-door mobilization approaches supplemented with radio and town hall announcements. Challenges included: Lack of familiarity with mobile phones and with public health mobile messagingLack of face-to-face communication with mobilizers, making it easier to ignore mobilization messages and preventing trust-buildingLow literacy levelsGender differentials in access to mobile phones