April
25

Improving malaria diagnosis and treatment in the private sector

Published April 25th, 2019

By: Theodoor Visser, Senior Manager, Global Malaria

Today is World Malaria Day, an international observance commemorated every year to recognize global progress in the fight against malaria.

Although great successes have been achieved since the early 2000s, malaria still contributes to over 400,000 deaths annually. Approximately half of the more than 200 million global cases of malaria, and hundreds of millions of cases of non-malaria febrile illness, seek care in the informal or retail health sector each year, especially in remote rural areas underserved by formal health care facilities.

Yet quality assured diagnostic tools and medications for malaria are often not available or affordable to patients with fever that visit these informal private drug shops.

 

A woman receives a Rapid Diagnostic Test for malaria at an Accredited Drug Dispensing Outlet (ADDO) in Tanzania

CHAI is working with partners to increase access to effective malaria diagnostics and treatments to save lives and drive down malaria transmission. CHAI is helping governments increase the availability and usage of artemisinin-based combination therapies (ACTs)— the recommended first-line treatment for uncomplicated malaria— in all of the locations that patients seek treatment for malaria, including private sector outlets.

Over the past ten years, CHAI and its partners supported several countries to subsidize the cost of ACTs in the private sector. ACTs were frequently sold at higher prices in these outlets, creating a substantial barrier to patients who then purchased cheaper and less effective drugs. In most of the countries where subsidies were provided, availability of ACTs increased dramatically, and prices fell.

With support from United Kingdom’s Department for International Development (DFID), CHAI is also working to increase the availability and usage of malaria rapid diagnostic tests (RDTs). These simple to use, accurate, and inexpensive diagnostic tests quickly confirm malaria in patients exhibiting fever, helping to reduce overtreatment and ensuring that ACTs are only sold to true malaria cases. CHAI negotiated with manufacturers to lower the costs of RDTs and worked with first-line buyers and other stakeholders in endemic countries to increase their availability and use. Since 2015, over 10 million RDTs have been sold to private retailers through CHAI’s program.

Yet, more work remains to be done to ensure high-quality malaria case management in the private sector. In recent years, subsidies for ACTs have been reduced or eliminated altogether, meaning that ACT prices in the private sector will again increase and lead patients to purchase less expensive and potentially less effective antimalarial medications. RDT uptake and use remains relatively low, with private providers and patients often forgoing the test or taking an antimalarial even when the test result is negative, potentially increasing drug resistance.

To help tackle this challenge, CHAI recently initiated a new project in partnership with Duke University. By capturing RDT results through a mobile payment-enabled app downloaded to the private provider’s phone, we can begin to provide antimalarial subsidies in the retail sector only to confirmed malaria cases. It is too early to say whether this approach will have its desired impact, but testing innovative approaches like this one will be necessary to help governments figure out a solution to this ongoing challenge.

CHAI has many partners helping to identify solutions to the problem of improving malaria case management in the private sector, including the World Health Organization (WHO). WHO has recognized the need to engage the private sector in order to achieve its goal of providing universal access to diagnosis and treatment to all patients suspected of having malaria. From May 1-3, WHO will bring together global and country stakeholders to map the key steps toward a coordinated public health engagement of the private sector in improving access to malaria diagnosis and treatment for poor people in low- and middle-income countries affected by malaria.

Over the coming years, CHAI, together with its partners, hope to continue this journey to ensure that patients receive the high quality care they need, irrespective of where they live or seek treatment.