Saving lives through increased access to Artemesin-Based Combination Therapy (ACT): The experience in Malawi

Malaria is endemic in Malawi and is the leading cause of death for children under five. Malaria cases account for 40% of outpatient care and are the largest single cause of hospital admissions (39%).

The Malawi National Malaria Control Program's (NMCP) five year plan aims to reduce malaria mortality by 50% by the year 2010. One of the major interventions to achieve this goal is to expand access to ACT—the WHO approved treatment for uncomplicated malaria. The President's Malaria Initiative is supporting this effort through the provision of 15 million ACT treatments and technical assistance in case management and supply chain strengthening.

In less than two years, Malawi was able to rapidly expand access to ACTs through the public sector and faith-based facilities and establish the systems to maintain a continual supply of ACTs. This was accomplished by an initial ACT distribution in October 2007, establishing an information system that provides stock status and consumption at all levels, conducting regular supervision, monitoring and adjusting procurement plans, developing tools for managing four different ACT presentations (adjust for substitution), and monitoring order fill rates.

Preliminary results include: distributing 2.6 million treatments to 560 facilities in less than two weeks, identifying and responding to consumption 27% greater than forecast, and limiting stock outs of all four presentations to less than 15%.

By understanding the critical success factors that contributed to Malawi's achievements, policy makers and program managers can work to strengthen their treatment programs and expand access to ACTs.