Evidence to practice: Assessing the supply and demand in order to improve access to antimalarial medicines

Introduction: Funded by the Bill & Melinda Gates Foundation, Population Services International (PSI) in partnership with the London School of Hygiene and Tropical Medicine (LSHTM) launched a five-year multi-country research project called ACTwatch in 2008 to monitor antimalarial supply and demand in seven malaria endemic countries in Africa and Asia. Nationally-representative surveys have been conducted in Benin, Cambodia, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia.

Methods: On average, three rounds of outlet surveys into the retail market for antimalarials were conducted in each country. Outlet surveys covered both the public and private sector, including informal private outlets. In addition, two rounds of household surveys focused on treatment-seeking behavior for fever among children under five. Outlet survey results focus on the availability and price of rapid diagnostic tests (RDTs) for malaria.

Results: ACTwatch provides a comprehensive picture of the antimalarial market in target countries. In 2011 53% of private sector outlets in Nigeria and 23% in Benen stocked quality-assured ACT. In comparison, 92% of private sector outlets in Nigeria and 69% in Benin stocked ineffective chloroquine treatments. In Benin, 30% of private sector market share was chloroquine in 2011, compared to 17% quality-assured ACT. Additional data will be presented on availability, market share, and usage of antimalarials.

Conclusions/policy implications: Given the well-documented role of the private sector as a treatment source in sub-Saharan Africa, timely data on the availability, price and market share for antimalarials and diagnostics can help inform programming and health promotion campaigns. The second phase of ACTwatch will provide researchers, donors, and governments detailed data on RDT and ACT availability, with the potential to inform programs and improve access. Donors such as UKAID and UNITAID use ACTwatch data to develop their landscape of malaria medicines, which helps focus the donors' efforts in improving access to the medicines. In addition, ACTwatch data has resulted in international donors funding projects that improve access to malaria diagnostic services, as a strategy to minimize resistance towards ACTs.