Abstract
BackgroundIn 2012, alarmingly high rates of oral artemisinin monotherapy availability and use were detected along Eastern Myanmar, threatening efforts to halt the spread of artemisinin resistance in the Greater Mekong Subregion (GMS), and globally. The aim of this paper is to exemplify how the use of supply side evidence generated through the ACTwatch project shaped the artemisinin monotherapy replacement malaria (AMTR) project’s design and interventions to rapidly displace oral artemisinin monotherapy with subsidized, quality-assured ACT in the private sector.MethodsThe AMTR project was implemented as part of the Myanmar artemisinin resistance containment (MARC) framework along Eastern Myanmar. Guided by outlet survey and supply chain evidence, the project implemented a high-level subsidy, including negotiations with a main anti-malarial distributor, with the aim of squeezing oral artemisinin monotherapy out of the market through price competition and increased availability of quality-assured artemisinin-based combinations. This was complemented with a plethora of demand-creation activities targeting anti-malarial providers and consumers. Priority outlet types responsible for the distribution of oral artemisinin monotherapy were identified by the outlet survey, and this evidence was used to target the AMTR project’s supporting interventions.ConclusionsThe widespread availability and use of oral artemisinin monotherapy in Myanmar has been a serious threat to malaria control and elimination in the country and across the region. Practical anti-malarial market evidence was rapidly generated and used to inform private sector approaches to address these threats. The program design approach outlined in this paper is illustrative of the type of evidence generation and use that will be required to ensure effective containment of artemisinin drug resistance and progress toward regional and global malaria elimination goals.
Highlights
In 2012, alarmingly high rates of oral artemisinin monotherapy availability and use were detected along Eastern Myanmar, threatening efforts to halt the spread of artemisinin resistance in the Greater Mekong Subregion (GMS), and globally
In addition to the outlet survey findings, there are several other lessons from the artemisinin monotherapy replacement malaria (AMTR) project that may be helpful for projects in other malaria-endemic settings struggling with private sector readiness and performance for appropriate malaria case management
A rapid intervention was urgently required to address the availability and distribution of oral artemisinin monotherapy due to the threat to artemisinin drug efficacy. This required working with the private sector and primarily with unregulated outlet types in Myanmar in an attempt to change the most underperforming outlets, where oral artemisinin monotherapy accounted for almost half of the market share among those outlet types
Summary
In 2012, alarmingly high rates of oral artemisinin monotherapy availability and use were detected along Eastern Myanmar, threatening efforts to halt the spread of artemisinin resistance in the Greater Mekong Subregion (GMS), and globally. The malaria burden in Myanmar is far higher than in any other country in South East Asia, accounting for most of the reported malaria cases in the Greater Mekong Subregion (GMS) [1]. Around 35 million people, or 70 % of the Artemisinin-based combination therapy (ACT) has helped to reduce the global burden of malaria, this is threatened by the emergence of malaria parasites that are resistant to artemisinin [4, 5]. Inadequate investment in the health system—overall and for malaria control in particular—has posed challenges to effective malaria case management [8]
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