Good supply chain management is key to ensuring that antimalarials recommended in national malaria treatment policies are actually available at the point of care. MMV worked with the College of Medicine Malawi and Martin Auton (consultant in pharmaceutics management) to analyze the antimalarial medicines market in six districts in Malawi. Data on the current distribution and prices of antimalarials will be given to the Ministry of Health. The objective of this project was to identify which products are sold for the treatment of malaria, relative affordability of different products, gaps in availability of first line treatment (ACTs) and to identify possible means of addressing these gaps.
College of Medicine Malawi, Pharmacy Department Staff: Mr. R Mwale (Lecturer), Dr L. Alfazema (Head of Department), N. Dzabala (Lecturer), Dr C. Feil (Lecturer), Dr F. Dzinjalamala (Lecturer)
Interview with Nettie Dzabala, College of Medicine Malawi
1. Why was the College of Medicine Malawi interested in conducting this survey?
Malaria is a major public health problem in Malawi. It is the leading cause of morbidity and mortality, especially among children under the age of 5 and pregnant women.
As a college of medicine, our mission is to be an academic centre of excellence, responsive to the health needs of Malawi by training professionals, providing clinical services and medical research. Our students are the country’s future policy makers and pharmacists. This was a great opportunity for them to learn about data collection and evidence-based policy making, as well as supply management and the impact that it has on availability and access to first-line malaria treatment.
2. How did you benefit from working in partnership with MMV?
Working in partnership with MMV provided us with the financial and technical assistance required to carry out this survey quickly and efficiently over a wide area in Malawi. With PDAs1 and GPS2 , we were able to gather geographically verifiable data. Through this collaboration, we were able to cover 6 districts (over 25,850 Km²), with a population of 2,519,956, and visit 1,142 outlets that sold antimalarials. MMV’s experience in this area of work was invaluable.
3. Which aspect of the findings was most interesting for you?
Several findings were of interest:
- Availability of recommended antimalarials in the public sector is generally good and in fact better than in the private sector.
- While retail shops and market vendors have the largest geographic spread of access to antimalarials, they continue to provide non-recommended products such as SP and CQ.
- A large number of unregistered antimalarials, including monotherapies are available on the market.
- Antimalarials are free in the public sector, but in the private sector, the price jump with the change in first-line treatment is huge. For example, AL suspension is 34 times more expensive than SP for a treatment course for children under 5 years, while AL is 23 times as expensive as SP for an adult course.
4. What will be the next steps for Malawi?
- In the public sector, primary health facilities are a strong distribution network. Therefore data management and logistics must be improved to improve stock levels and availability.
- Registration processes need to be strengthened to ensure only registered and recommended antimalarials are available on the market.
- Affordability & consumer demand drive product choice in the private sector, therefore recommended antimalarials need to be made more affordable and accessible through subsidies. As ARVs, are subsidized in some private outlets, doing the same for ACTs would increase access.
- Given that retail shops and vendors provide good, geographical access, it would be wise to deregulate3 ACTs, thereby increasing access significantly.
1. Personal Digital Assistant - A mobile device that functions as a personal information manager that is easy to carry, requires no paper and the results can be uploaded onto a computer.
2. Global Positioning System - A space-based global navigation satellite system that provides location and time information. In this case, it assisted in the mapping of various outlets, where a population lives in respect to those outlets, and what service provision looks like within a certain distance of their house.
3. Deregulation of ACTs - Allows ACTs to be purchased without a doctor’s prescription from qualified outlets.