What happened to anti-malarial markets after the Affordable Medicines Facility-malaria pilot? Trends in ACT availability, price and market share from five African countries under continuation of the private sector co-payment mechanism

Tougher, Sarah; Hanson, Kara; Goodman, Catherine

doi:10.1186/s12936-017-1814-z

Cited by 43 publications

(91 citation statements)

References 27 publications

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“…The packaging of AMFm-subsidized QAACT was marked with a distinctive green leaf logo for easy identification. By the end of 2011, approximately 14.35 million co-paid QAACT treatments were delivered to Kenya’s public sector and 14.1 million to the private sector [ 9 ]. The AMFm independent evaluation reported significant improvements in availability, price, and relative market share of QAACT in Kenya, and especially in the private sector [ 8 , 10 ].…”

Section: National Malaria Control Strategies and Interventions For Camentioning

confidence: 99%

“…In 2015, only 6.85 million treatments were delivered to the private sector through the CPM. The ACT subsidy was also decreased to wholesalers from 90 to 70% for all pack sizes [ 9 ], lending to a recommended retail price of $1.00 to the consumer, for both children and adults. Finally, while several mass communication activities were implemented to increase demand and consumer awareness of QAACT, these were discontinued in mid-2015 [ 9 ].…”

Section: National Malaria Control Strategies and Interventions For Camentioning

confidence: 99%

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The malaria testing and treatment landscape in Kenya: results from a nationally representative survey among the public and private sector in 2016

Musuva

Ejersa

Kiptui

et al. 2017

Malar J

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BackgroundSince 2004, Kenya’s national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals.ResultsA total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxine–pyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (< 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas.ConclusionAlthough public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share.Electronic supplementary materialThe online version of this article (10.1186/s12936-017-2089-0) contains supplementary material, which is available to authorized users.

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Section: National Malaria Control Strategies and Interventions For Camentioning

confidence: 99%

Section: National Malaria Control Strategies and Interventions For Camentioning

confidence: 99%

The malaria testing and treatment landscape in Kenya: results from a nationally representative survey among the public and private sector in 2016

Musuva

Ejersa

Kiptui

et al. 2017

Malar J

View full text Add to dashboard Cite

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“…The success may in part have been attributable to a concurrent private sector ACT subsidy program improving access to affordable first-line ACT treatment in the private sector [ 25 ]. Indeed, it may have been the private sector ACT subsidy programme implemented in Nigeria from 2010 to 2016 that led to initial reductions in market share for oral AMT [ 16 ]. Future strategies to remove oral AMT from the market in Nigeria must start with product registration as evidence suggests that oral AMT products are still granted legal registration by NAFDAC.…”

Section: Discussionmentioning

confidence: 99%

“…The study was powered to detect change over time in the availability of quality-assured (QA) ACT (QAACT) and malaria blood testing. QAACT was defined as ACTs that achieved accredited status from the WHO, European Medicines Authority (EMA) or the Global Fund [ 16 ]. A series of calculations identified minimum sample size requirements to detect an increase or decrease in two key indicators: (1) proportion of outlets with QAACT available, among outlets with antimalarial(s) in stock on the day of the survey; and (2) proportion of outlets with malaria blood testing (RDT or microscopy) available, among outlets with antimalarial(s) in stock on the day of the survey or within the past 3 months.…”

Section: Methodsmentioning

confidence: 99%

When it just won’t go away: oral artemisinin monotherapy in Nigeria, threatening lives, threatening progress

Ujuju

Anyanti

Newton

et al. 2017

Malar J

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BackgroundOral artemisinin monotherapy (AMT), an important contributor to multi-drug resistant malaria, has been banned in Nigeria. While oral AMT has scarcely been found for several years now in other malaria-endemic countries, availability has persisted in Nigeria’s private sector. In 2015, the ACTwatch project conducted a nationally representative outlet survey. Results from the outlet survey show the extent to which oral AMT prevails in Nigeria’s anti-malarial market, and provide key product information to guide strategies for removal.ResultsBetween August 10th and October 3rd, 2015 a total of 13,480 outlets were screened for availability of anti-malarials and/or malaria blood testing services. Among the 3624 anti-malarial outlets, 33,539 anti-malarial products were audited, of which 1740 were oral AMT products, primarily artesunate (n = 1731). Oral AMT was imported from three different countries (Vietnam, China and India), representing six different manufacturers and 11 different brands. Availability of oral AMT was highest among pharmacies (84.0%) and Patent Propriety Medicine Vendors (drug stores, PPMVs) (38.7%), and rarely found in the public sector (2.0%). Oral AMT consisted of 2.5% of the national anti-malarial market share. Of all oral AMT sold or distributed, 52.3% of the market share comprised of a Vietnamese product, Artesunat®, manufactured by Mekophar Chemical Pharmaceutical Joint Stock Company. A further 35.1% of the market share were products from China, produced by three different manufacturers and 12.5% were from India by one manufacturer, Medrel Pharmaceuticals. Most of the oral AMT was distributed by PPMVs accounting for 82.2% of the oral AMT market share. The median price for a package of artesunate ($1.78) was slightly more expensive than the price of quality-assured (QA) artemether lumefantrine (AL) for an adult ($1.52). The median price for a package of artesunate suspension ($2.54) was three times more expensive than the price of a package of QA AL for a child ($0.76).ConclusionOral AMT is commonly available in Nigeria’s private sector. Cessation of oral AMT registration and enforcement of the oral AMT ban for removal from the private sector are needed in Nigeria. Strategies to effectively halt production and export are needed in Vietnam, China and India.Electronic supplementary materialThe online version of this article (10.1186/s12936-017-2102-7) contains supplementary material, which is available to authorized users.

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“…Several health system challenges are likely contributing to inadequate clinical management of the disease and thus to the enduring malaria mortality burden among young children [ 26 ]. First, caregivers often do not seek formal facility-based care for children with malaria symptoms, instead using over-the-counter medications, informal care, or no care at all [ 27 – 29 ]. Second, even children who are seen by a formal provider may not receive appropriate care [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of clinical management of children diagnosed with malaria: A cross-sectional assessment in 9 sub-Saharan African countries between 2007–2018

et al. 2020

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Background Appropriate clinical management of malaria in children is critical for preventing progression to severe disease and for reducing the continued high burden of malaria mortality. This study aimed to assess the quality of care provided to children under 5 diagnosed with malaria across 9 sub-Saharan African countries. Methods and findings We used data from the Service Provision Assessment (SPA) survey. SPAs are nationally representative facility surveys capturing quality of sick-child care, facility readiness, and provider and patient characteristics. The data set contained 24,756 direct clinical observations of outpatient sick-child visits across 9 countries, including Uganda (2007), Rwanda (2007), Namibia (2009), Kenya (2010), Malawi (2013), Senegal (2013–2017), Ethiopia (2014), Tanzania (2015), and Democratic Republic of the Congo (2018). We assessed the proportion of children with a malaria diagnosis who received a blood test diagnosis and an appropriate antimalarial. We used multilevel logistic regression to assess facility and provider and patient characteristics associated with these outcomes. Subgroup analyses with the 2013–2018 country surveys only were conducted for all outcomes. Children observed were on average 20.5 months old and were most commonly diagnosed with respiratory infection (47.7%), malaria (29.7%), and/or gastrointestinal infection (19.7%). Among the 7,340 children with a malaria diagnosis, 32.5% (95% CI: 30.3%–34.7%) received both a blood-test–based diagnosis and an appropriate antimalarial. The proportion of children with a blood test diagnosis and an appropriate antimalarial ranged from 3.4% to 57.1% across countries. In the more recent surveys (2013–2018), 40.7% (95% CI: 37.7%–43.6%) of children with a malaria diagnosis received both a blood test diagnosis and appropriate antimalarial. Roughly 20% of children diagnosed with malaria received no antimalarial at all, and nearly 10% received oral artemisinin monotherapy, which is not recommended because of concerns regarding parasite resistance. Receipt of a blood test diagnosis and appropriate antimalarial was positively correlated with being seen at a facility with diagnostic equipment in stock (adjusted OR 3.67; 95% CI: 2.72–4.95) and, in the 2013–2018 subsample, with being seen at a facility with Artemisinin Combination Therapies (ACTs) in stock (adjusted OR 1.60; 95% CI:1.04–2.46). However, even if all children diagnosed with malaria were seen by a trained provider at a facility with diagnostics and medicines in stock, only a predicted 37.2% (95% CI: 34.2%–40.1%) would have received a blood test and appropriate antimalarial (44.4% for the 2013–2018 subsample). Study limitations include the lack of confirmed malaria test results for most survey years, the inability to distinguish between a diagnosis of uncomplicated or severe malaria, the absence of other relevant indicators of quality of care including dosing and examinations, and that only 9 countries were studied. ...

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What happened to anti-malarial markets after the Affordable Medicines Facility-malaria pilot? Trends in ACT availability, price and market share from five African countries under continuation of the private sector co-payment mechanism

Cited by 43 publications

References 27 publications

The malaria testing and treatment landscape in Kenya: results from a nationally representative survey among the public and private sector in 2016

The malaria testing and treatment landscape in Kenya: results from a nationally representative survey among the public and private sector in 2016

When it just won’t go away: oral artemisinin monotherapy in Nigeria, threatening lives, threatening progress

Quality of clinical management of children diagnosed with malaria: A cross-sectional assessment in 9 sub-Saharan African countries between 2007–2018

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