Improving access to subsidized ACTs through the private sector in Uganda Preliminary thoughts

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Improving access to subsidized ACTs through the
private sector in UgandaPreliminary thoughts

Ministry of Health, Uganda Dr. J.B. Rwakimari,
Dr. Ambrose Talisuna Medicines for Malaria
Venture, Geneva Penny Grewal, Renia Coghlan
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Where should a subsidized ACT be available to
achieve health impact?
ACT availability
Home based management
Non-premium private
Public /not-for profit sector
Premium private

• ACTs not available (prescription only)
• Price is key driver
• SP / chloroquine best sellers
• Caters to 40-60 of patients

• Reasonably good availability in health facilities

• Pilots underway

• ACTs available
• Expensive
• Caters to small of population

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Challenges

• Displace chloroquine / SP through highly
  subsidized ACTs
• Ensure better diagnosis, case management,
  compliance than with CQ /SP
• Reach adequate scale
• Geographical coverage
• Age groups

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What is the minimum package needed to ensure
health impact with a subsidized ACT?

• Policy and regulatory framework
• Logistics / supply chain
• Network of ACT retail outlets
• Training of drug retailers
• Social marketing / community information
• Monitoring

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Operational research Achieving health impact
through private sector in Uganda

• Introduce highly subsidized ACT through private
  sector for under 5s
• Presumptive management of fever
• High transmission districts
• Selection criteria for intervention areas
• No shared borders with other countries
• Any leakage of drugs stays within country
• No other pilots on-going (e.g. home based
  management)
• Malaria transmission dynamics mapped
• Availability of efficacy data

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Some areas of operational research in Uganda

• What level of coverage leads to health impact
• reduced occurrence of severe malaria among under
  5s
• What margins are required to keep the trade
  interested in stocking a subsidized product?
• Uptake of the subsidized ACTs by the type of
  retail outlets and patients (SES)
• Predictors for trade survival to reduce drop-out
  rate of trained outlets?
• Evaluation of different training approaches based
  on health impact
• Consumer perspective / adherence to treatment