The ACTwatch Outlet Survey involves quantitative research at the outlet level in ACTwatch countries (Cambodia, Uganda, Zambia, Nigeria, Benin, Madagascar and the Democratic Republic of Congo). Other elements of ACTwatch research include Household Surveys led by Population Services International (PSI) and Supply Chain Research led by the London School of Hygiene & Tropical Medicine (LSHTM). This report presents the results of a cross-sectional survey of outlets conducted in Zambia from the 17th March to 22nd May 2011. The objective of the outlet survey is to monitor levels and trends in the availability, price and volumes of antimalarials, and providers’ perceptions and knowledge of antimalarial medicines at different outlets. Price and availability data on diagnostic testing services is also collected.
A nationally representative sample of all outlets that could sell or provide antimalarials to consumer was taken through a census approach in 38 wards across two strata (urban and rural areas) in Zambia. A cluster sampling approach was used because there were no reliable lists of all outlets stocking antimalarials. Clusters were wards, with an average of 10,000 to 15,000 inhabitants. Clusters were selected with probability proportional to size (PPS)—a sampling technique in which the probability that a particular commune is selected is proportional to its population size. Oversampling of public health facilities and registered pharmacies was conducted to ensure adequate representation of these outlet types in the survey.
The inclusion criteria for this study were outlets that stocked an antimalarial at the time of survey or had stocked antimalarials in the previous three months. An outlet is defined as any point of sale or provision of commodities for individuals. Outlets included in the survey are as follows: 1) public health facilities (1st, 2nd, and 3rd level hospital, hospital affiliated health centre, urban health centre, rural health centre, and health post); 2) not-for-profit health facilities (NGO/mission hospital); 3) pharmacies (pharmacies licensed by the Pharmaceutical Regulatory Authority); 4) drug stores; 5) private health facilities (private hospital, private clinic, and surgery); 6) general retailers (grocery store, super/mini markets/petrol stations, kiosk/tuck shop, kantemba/market stand, and container). Refer to the appendices for definitions and numbers of each type of outlet included in the analysis.
Four questionnaire modules were administered to participating outlets: 1) Screening questionnaire, 2) Antimalarial audit sheet, 3) Rapid diagnostic test (RDT) audit sheet and 4) Provider questionnaire. For all outlets, trained interviewers administered the screening questionnaire to collect information on outlet type, location including the outlet’s longitude and latitude, and information on availability of antimalarials. Among those outlets that stocked antimalarials at the time of survey, the audit sheet was administered. For each antimalarial, information was recorded on the brand, manufacturer, and generic names, strengths of the active ingredients, whether the outlet experienced stock-outs of the drug, whether the drug was expired, amount sold in the last week, and price sold to the consumers. In addition, interviewers collected information on the availability and price of microscopic tests and RDTs. An RDT audit sheet was administered where information on the brand name and manufacturer, amount sold in the last week, and price sold to consumers was obtained. Among outlets that stocked antimalarials at the time of the interview or the past three months, the interviewer collected information on provider’s demographics, knowledge, and perceptions. Interviewers also observed the storage conditions of medicines.