Editor's Note: This edition of our regular database at a glance series excerpted an upcoming brief produced by Onil Bhattacharyya of the T-HOPE Group at the University of Toronto. Arjun Vasan and Rose Reis from the Center for Health Market Innovations also contributed to the post.
Malaria, a 4,000-year old disease that evolved with man, still causes 219 million sicknesses and 660,000 deaths each year. While mortality has decreased by a quarter in the last decade due to increased use of insecticide-treated bed nets and artemisinin-based combination therapies, most people at risk still do not have access to these products.
For malaria to be controlled—and eventually eliminated—prevention, diagnosis, and treatment methods must be made available to all, particularly in Africa, where 90% of malaria deaths occur.
With our colleagues at the University of Toronto, we at CHMI have been looking closely at malaria programs on our digital platform to discover what practices are emerging at the grassroots and global level to eradicate this stubborn disease and save millions of lives. In this post, we are pleased to share an excerpt from a brief on malaria that we will be issuing soon.
In many low- and middle-income countries, the private sector delivers a substantial amount of services, including prevention, diagnosis, and treatment of malaria. According to the All-Party Parliamentary Group on Malaria, an estimated 400 million of the total 550 million treatments provided in 2006 were distributed through the private sector. In addition, according to the Roll Back Malaria Partnership, 40-50% of anti-malarial medications were distributed by the informal private sector. Bednets are also often sold by private vendors.
Provider training helps ensure practitioners and distributors will deliver appropriate care. Information communication technology can help monitor the prevalence of malaria and track the supply of medications to prevent stock-outs. Supply chain enhancements can improve program efficiency and increase the distribution of life-saving supplies.
Among the emerging practices CHMI identified around the world were:
Using vouchers to increase coverage of insecticide-treated nets (ITNs):
Several CHMI-profiled programs, such as NetMark and the Tanzania National Voucher Scheme, have used vouchers to help low income families afford ITNs, which are often promoted through social marketing schemes. Vouchers are distributed to a targeted group and these consumers can purchase bed nets from participating retailers at a reduced price.
In Tanzania, Hati Punguzo vouchers can be redeemed by pregnant women and mothers of infants at more than 6,600 retailers nationwide.
Scaling up Rapid Diagnostic Tests
Rapid Diagnostic Tests are used at the point-of-care to quickly diagnose patients in remote settings where microscopy—the “gold standard” test for malaria—is unavailable or of poor quality. These tests are inexpensive, mobile, and quick, and they can be used by community health workers, and even retail outlets.
The m-health platform ChildCount+, which uses SMS to facilitate and coordinate the activities of community workers across ten Sub-Saharan African countries, provides support for home-based Rapid Diagnostic Tests and Artemisinin-based combination therapies (ACTs).
Subsidizing the supply of malaria drugs
ACTs are now the first line treatment of choice but can be up to 20 times more expensive than older drugs; subsidies are needed to reach the poor. The Global Fund established the Affordable Medicines Facility-Malaria (AMFm), an innovative financing program to expand access to affordable ACTs through price negotiation and subsidies.
The AMFm has been piloted in eight countries (Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania, and Uganda), while other CHMI programs, such PSI Sudan, have distributed ACTs at subsidized costs. The final report of an independent evaluation of the AMFm’s pilot phase was made public in October 2012, and an overview of this report can be found here.
Tracking the supply chain and distribution of malaria health products with mobile phones
Mobile phones are increasingly being utilized to track inventory levels and, in turn, decrease the likelihood of stock-outs, which leave health workers without the tools to diagnose malaria and patients without immediate access to treatment.
SMS for Life tracks the supply chain of ACTs and quinine injectables in Tanzania, using a combination of mobile phones, SMS messages, and electronic mapping technology delivered to all health facilities on a weekly basis.
Protecting employees and communities
Many companies invest in malaria prevention and treatment for their employees, families, and communities, especially in rural areas with limited access to health services. The Corporate Alliance on Malaria in Africa encourages member companies to use the ABCD approach, which starts with Awareness and public education, Bite control, Chemoprophylaxis, and early Diagnosis and treatment.
Many GBCHealth members including Chevron have led sustained awareness campaigns around malaria. Companies sometimes develop solutions tailored for remote settings like Chevron’s River Boat Clinic. The boat has provided medical serves along the Benin and Escravos rivers in Delta State, Nigeria. The Delta State government deployed staff to the clinic and paid salaries, while Chevron provided logistics, drugs, dressings, and other equipment.
Which of these approaches is demonstrating evidence? We look forward to sharing a brief on innovations in malaria that will delve into these practices and the evidence behind them from both the peer-reviewed and gray literature. Please also contact me if you know of other programs working to improve the quality and affordability of malaria care in the private health sector.
View other blogs in our database at a glance series to learn about the emerging practices our data is uncovering in countries where the private sector delivers the majority of health care.