Background The private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and affordability of, quality-assured artemisinin-based combination therapy (QA-ACT) within this sector, the Affordable Medicines Facility-Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the final stockages of ACT medicines procured under the PSCM. Methods An outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability and cost of anti-malarials, including artemisinin-based combinations subsidised under the PSCM (called green leaf ACT on account of their green leaf logo) and those not subsidised (non-green leaf ACT). A concurrent household survey was conducted to determine demand-side factors related to treatment-seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time. Results Availability of artemisinin-based combinations increased significantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACT remained relatively stable over time, the cost of non-green leaf ACT reduced significantly so that by 2018 they had equivalent affordability. Unsubsidised brands were also available in different formulations and dosages, with double-strength artemisinin-based combination reported as the most frequently purchased dosage type, and child artemisinin-based combinations popular in suspension and dispersible forms (forms not subsidised by the PSCM). Conclusions The PSCM had a clear impact on increasing not only the reach of subsidized QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certification and monitoring.

The recent health service delivery achievements in Bangladesh have been attributed, in part, to partnerships between the government and non-state actors and the early and rapid adoption of innovations. Through the analysis of two case studies, this article examines the factors contributing to successful partnerships for health market innovations in Bangladesh and the extent to which these innovations can contribute to market systems changes that benefit the poor. The first case examines an innovation which aims to address maternal and child health issues by creating access to information on prenatal and post-natal care through mobile phones. The other case illustrates how Bangladesh' s leading NGO partnered with one of the largest pharmaceutical companies in Bangladesh to develop a model for rural distribution of a micronutrient food supplement, 'sprinkles', to tackle the problem of micronutrient deficiency in young children.

Background To avoid misuse of anti-malarials, correct diagnosis of fever prior to drug prescription is essential. Presumptive treatment in the private healthcare sector is a concern in Nigeria, where availability of affordable artemisinin-based combination therapy (ACT) is high following the implementation of subsidy schemes from 2010 to 2017. Similar subsidies have not, however, been implemented for malaria rapid diagnostic tests (RDTs). A market survey in 2018 predominantly designed to assess the ACT market in the private sector also collected data related to RDTs, results of which are presented herein. Methods A 2018 market survey consisted of (i) an outlet survey targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability of RDTs (defined as having stock available for purchase at the time of the survey) and (ii) a household survey to determine demand-side factors related to knowledge of RDTs, healthcare-seeking practices and affordability. Results Availability of RDTs at the time of the survey was low in both outlet types and significantly lower in PPMVs (22.1%, 95% CI) among pharmacies versus (13.6%, 95% CI) among PPMVs (p < 0.01). Reasons for not restocking RDTs included low demand and no supply. The majority of households diagnose malaria based on experience, while one-third would visit a PPMV or pharmacy. Half of households had heard of RDTs (48.4%) and 38.6% thought they were affordable. Conclusions Low availability of RDTs among PPMVs and pharmacies may be attributed to lack of demand, supply-side issues and cost. Increasing household knowledge of RDTs may aid increasing demand, while subsidized RDTs may address supply and price issues. Addressing the deficit in RDT provision is important for targeting of ACT medicines.

BackgroundTo avoid misuse of antimalarials, correct diagnosis of fever prior to drug prescription is essential. Presumptive treatment in the private healthcare sector is a concern in Nigeria where availability of affordable artemisinin combination therapy is high following the implementation of subsidy schemes from 2010 to 2017. Similar subsidies have not, however, been implemented for malaria rapid diagnostic tests (mRDTs). A market survey in 2018 predominantly designed to assess the ACT market in the private sector also collected data related to mRDTs, results of which are presented herein. MethodsA 2018 market survey consisted of i) an outlet survey targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability of mRDTs and ii) a household survey to determine demand-side factors related to knowledge of mRDTs, healthcare-seeking practices and affordability. ResultsAvailability of mRDTs at the time of the survey was low in both outlet types and significantly lower in PPMVs (22.1%, 95% CI [17.7-27.1] among pharmacies versus 13.6%, 95% CI [10.3-17.5] among PPMVs, p<0.01). Reasons for not restocking mRDTs included low demand and no supply. The majority of households diagnose malaria based on experience, while one-third would visit a PPMV or pharmacy. Half of HHs had heard of mRDTs (48.4%) and 38.6% thought they were affordable.ConclusionLow availability of mRDTs among PPMVs and pharmacies may be attributed to lack of demand, supply-side issues and cost. Increasing HH knowledge of mRDTs may aid increasing demand, while subsidised mRDTs may address supply and price issues. Addressing the deficit in mRDT provision is important to prevent over-prescription of ACT medicines.

BackgroundThe private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and affordability of, quality-assured artemisinin combination therapies (QA-ACTs) within this sector, the Affordable Medicines Facility - Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the final stockages of ACTs procured under the PSCM. MethodsAn outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across different regions of Nigeria to assess supply-side market factors related to availability and cost of antimalarials, including ACTs subsidised under the PSCM (called green leaf ACTs on account of their green leaf logo) and those not subsidised (non-green leaf ACTs). A concurrent household survey was conducted to determine demand-side factors related to treatment seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time.ResultsAvailability of ACTs increased significantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACTs remained relatively stable over time, the cost of non-green leaf ACTs reduced significantly so that by 2018 they had equivalent affordability. Unsubsidised brands were also available in different formulations and dosages, with double-strength ACTs reported as the most frequently purchased dosage type, and child ACTs popular in suspension and dispersible forms (forms not subsidised by the PSCM).ConclusionsThe PSCM had a clear impact on increasing not only the reach of subsidised QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certification and monitoring.