Availability, Price and Volume of Antimalarials in Seven Malaria Endemic Countries: A Summary of Results from Multi-Country Outlet Survey Research 2009-2010

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Artemisinin-based combination therapy (ACT) is recommended by the WHO as the first-line treatment of Plasmodium falciparum malaria. By 2006 most malaria endemic countries had changed their national treatment guidelines to follow these recommendations [1], but despite increased financing for malaria control over the last decade [2], the global target of at least 80% of children under five with malaria receiving an effective antimalarial is far from being met [3]. Today, the use of ineffective monotherapies remains widespread [4], and the development of artemisinin resistance [5] has raised specific concerns around how to reduce the use of artemisinin monotherapies in order to contain resistance to this drug, largely seen as the only effective treatment option currently available [6].

Many countries are accelerating their efforts to increase coverage of ACT, with support from funders including the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President’s Malaria Initiative and the World Bank Booster Programme. In 2010 alone, more than 200 million doses of ACT were forecasted to enter the market [7]. The most significant recent intervention is the Affordable Medicines Facility – malaria (AMFm), launched in 2010, that aims to increase access to high-quality ACT in the public and private sectors through a novel copayment fund worth $216 million in Phase 1 [8]. To date, orders for over 150 million treatments have been placed mainly by the private sector in the nine pilot programmes operating in eight countries [9].

Despite these and other on-going efforts to increase access, robust evidence on the availability and use of the different antimalarials is scarce. Policy makers, 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 AMFm [10]. Furthermore, following the WHO recommendation that antimalarials be restricted to patients with a confirmed malaria diagnosis [11], information on the availability of diagnostic services and tools such as rapid diagnostic tests (RDTs) in the market has become crucial.