In 2008, the government of Uganda and MMV, in alliance with partners including Malaria Consortium, PSI/PACE and Surgipharm, undertook a groundbreaking two-year pilot to assess the impact of introducing subsidized ACTs via private drug sellers in access-deprived rural communities in Uganda. This project, CAPSS  (Consortium for ACT Private Sector Subsidy), went on to demonstrate that subsidized ACTs, combined with effective social marketing campaigns and proper training and education, could generate a significant shift in patient buying patterns in favor of quality ACTs for malaria treatment. This represents one of the underlying tenets of the experimental AMFm , currently being piloted in 8 countries.
With the AMFm phase 1 now operational, new opportunities are arising to evaluate what enhancements may allow subsidized treatment programs to create even greater health impact.
One of the critical questions that the WHO and public health specialists have asked is how efforts to expand access to affordable malaria medicines can also bolster better overall case management of patients with fever. In specific terms, can private drug sellers help ensure that patients get treated “for what really ails them”, by providing patients with diagnosis before they choose to buy antimalarial medicines to treat unconfirmed malaria? This question has become increasingly urgent, as studies indicate that as many as 80% of fevers treated as malaria are actually caused by other infections1 (in children, this is often due to respiratory and gastrointestinal infections) and that mismanagement with antimalarials could lead to severe pneumonia or even death.2 While the public sector is now operationalizing integrated community case management of malaria, pneumonia and diarrhoea, most efforts in the private sector have so far been single-disease oriented.
To address these concerns, in September 2011, Makerere University (Uganda), Karolinska Institute (Sweden) with a grant from the Einhorn Family Foundation, and Medicines for Malaria Venture (MMV) kicked off an expanded pilot to evaluate the feasibility and acceptability of introducing rapid diagnostic tests (RDTs) and respiratory timers into private drug seller environments. Appropriately named CAPSS Plus, this new research project is focused on the CAPSS pilot districts and is assessing the potential for improved management of fevers via the private sector. The pilot includes training of drug shop-keepers on the correct use of RDTs and respiratory timers, and teaches them how to respond to patients with non-malarial fevers (including remedies for acute respiratory infections and infant diarrhea). It also monitors the acceptability and uptake of diagnostics via private drug shop-
The program kicked off in Kamuli and Kaliro districts in Uganda with training of shopkeepers and the arrival of subsidized ACTs, RDTs, respiratory timers, oral rehydration therapy (ORS)/Zinc and antibiotics. Scheduled to run for 12 months, this pilot will generate important new evidence about proper case management in the private sector, and may provide critical insights to guide future refinements to the AMFm.
For more information, please contact Professor Stefan Peterson (Stefan [dot] Peterson [at] ki [dot] se) at Karolinska Institutet, Dr Wamani Henry (wamanih [at] gmail [dot] com) of School of Public Health, Makerere University College of Health Sciences, or George Jagoe  at Medicines for Malaria Venture.
1. PLoS Medicine : Estimating the Number of Paediatric Fevers Associated with Malaria Infection Presenting to Africa's Public Health Sector in 2007
2. PLoS Medicine : Time To Move from Presumptive Malaria Treatment to Laboratory-Confirmed Diagnosis and Treatment in African Children with Fever