Abstract
BackgroundPolicy makers, governments and donors are faced with an information gap when considering ways to improve access to artemisinin-based combination therapy (ACT) and malaria diagnostics including rapid diagnostic tests (RDTs). To help address some of these gaps, a five-year multi-country research project called ACTwatch was launched. The project is designed to provide a comprehensive picture of the anti-malarial market to inform national and international anti-malarial drug policy decision-making.MethodsThe project is being conducted in seven malaria-endemic countries: Benin, Cambodia, the Democratic Republic of Congo, Madagascar, Nigeria, Uganda and Zambia from 2008 to 2012.ACTwatch measures which anti-malarials are available, where they are available and at what price and who they are used by. These indicators are measured over time and across countries through three study components: outlet surveys, supply chain studies and household surveys. Nationally representative outlet surveys examine the market share of different anti-malarials passing through public facilities and private retail outlets. Supply chain research provides a picture of the supply chain serving drug outlets, and measures mark-ups at each supply chain level. On the demand side, nationally representative household surveys capture treatment seeking patterns and use of anti-malarial drugs, as well as respondent knowledge of anti-malarials.DiscussionThe research project provides findings on both the demand and supply side determinants of anti-malarial access. There are four key features of ACTwatch. First is the overlap of the three study components where nationally representative data are collected over similar periods, using a common sampling approach. A second feature is the number and diversity of countries that are studied which allows for cross-country comparisons. Another distinguishing feature is its ability to measure trends over time. Finally, the project aims to disseminate findings widely for decision-making.ConclusionsACTwatch is a unique multi-country research project that threads together anti-malarial supply and consumer behaviour to provide an evidence base to policy makers that can help determine where interventions may positively impact access to and use of quality-assured ACT and RDTs. Because of its ability to detect change over time, it is well suited to monitor the effects of policy or intervention developments in a country.
Highlights
Policy makers, governments and donors are faced with an information gap when considering ways to improve access to artemisinin-based combination therapy (ACT) and malaria diagnostics including rapid diagnostic tests (RDTs)
Governments and donors are faced with an information gap when trying to determine how to improve access to high quality ACT and reduce the use of artemisinin monotherapies; and rigorous approaches are needed to evaluate interventions such as the Affordable Medicines Facility-malaria (AMFm). [10]
Population The project is being conducted in seven malaria-endemic countries: Benin, Cambodia, the Democratic Republic of Congo, Madagascar, Nigeria, Uganda and Zambia between 2008 and 2012 (Figure 1)
Summary
An ACTwatch Advisory Committee was established to help ensure that the project’s methods were rigorous and its outputs relevant to policy makers. The research questions and indicators The research sets out to measure which anti-malarials are available where and at what price, and who they are used by It examines market share of different anti-malarials passing through public facilities and private retail outlets. Three different studies are conducted in each country, as shown, which together provide a comprehensive understanding of the anti-malarial market: 1) an outlet survey gathering information on availability; 2) a household survey in the same geographical areas assessing treatment-seeking behaviour, usage and purchase price and 3) a supply chain mapping including an analysis of mark-up at each level. In order to capture the market as a whole rather than some of its segments, all outlet types with the potential to dispense anti-malarials were included and a census of these within each selected cluster was conducted Outlets with this potential were identified at a country level through consultation with local stakeholders. Areas where P. falciparum parasite resistance to artemisinin is documented ("Containment Zone 1”) or where resistance is feared to have spread but not formally detected ("Containment Zone 2”)
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