Communicating the AMFm message: exploring the effect of communication and training interventions on private for-profit provider awareness and knowledge related to a multi-country anti-malarial subsidy intervention

Willey, Barbara; Tougher, Sarah; Yé, Yazoumé; Mann, Andrea; Thomson, Rebecca; Kourgueni, Idrissa A; Amuasi, John; Ren, Ruilin; Wamukoya, Marylene; Rueda, Sergio Torres; Taylor, Mark; Seydou, Moctar; Nguah, Samuel Blay; Ndiaye, Salif; Mberu, Blessing; Malam, Oumarou; Kalolella, Admirabilis; Juma, Elizabeth; Johanes, Boniface; Festo, Charles; Diap, Graciela; Diallo, Didier; Bruxvoort, Katia; Ansong, Daniel; Amin, Abdinasir A; Adegoke, C; Hanson, Kara; Arnold, Fred; Goodman, Catherine

doi:10.1186/1475-2875-13-46

Cited by 25 publications

(27 citation statements)

References 20 publications

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“…A core conclusion was that in addition to the availability and distribution of a subsidized ACT, there is an important role for supporting interventions to ensure the success of subsidy programs for public health commodities [ 27 ]. The notable market improvements among pharmacies, general retailers and mobile providers in the intervention area suggests the added value of a product promotion intervention, a finding also supported by others [ 28 – 30 ].…”

Section: Discussionsupporting

confidence: 71%

Oral artemisinin monotherapy removal from the private sector in Eastern Myanmar between 2012 and 2014

Khin

Aung

Thi

et al. 2016

Malar J

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BackgroundIn 2012 the Artemisinin Monotherapy Therapy Replacement (AMTR) project was implemented in Eastern Myanmar to increase access to subsidized, quality-assured artemisinin combination therapy (ACT) and to remove oral artemisinin monotherapy (AMT) from the private sector. The aim of this paper is to examine changes over time in the private sector anti-malarial landscape and to illustrate the value of complementary interventions in the context of a national ACT subsidy.MethodsThree rounds of cross-sectional malaria medicine outlet surveys were conducted, in 2012, 2013 and 2014. Project intervention areas were selected from the Myanmar Artemisinin Resistance Containment (MARC) area. Provider detailing was implemented in these selected areas. Comparison areas were selected outside of this catchment area, from townships in close proximity to the MARC framework. Within each domain, multi-staged sampling was used to select areas for the survey. Outlets with the potential to sell or distribute anti-malarials in the private sector were screened for eligibility.ResultsThe total number of outlets approached for an interview was as follows in the intervention and comparison areas, respectively: 2012, N = 2046 and 1612; 2013, N = 1636 and 1884; 2014, N = 2939 and 2941. The percentage of pharmacies, general retailers and mobile providers (classed as ‘priority outlets’) with oral AMT in stock on the day of the survey decreased over time in the intervention areas (2012 = 68 %; 2013 = 48 %; 2014 = 10 %). Conversely, quality-assured ACT availability increased among these outlets (2012 = 4 %; 2013 = 62 %; 2014 = 79 %). Relative oral AMT market share among priority outlets also decreased over time (2012 = 44 %; 2013 = 18 %; 2014 = 14 %), while market share of quality-assured ACT increased (2012 = 3 %; 2013 = 59 %; 2014 = 51 %). Among priority outlets in the comparison area, similar trends were observed, though changes over time were less substantial compared to the intervention area. Other outlet types (community health workers and health facilities) performed relatively well over time though modest improvements were also observed.ConclusionThe findings point to the successful design and implementation of a strategy to rapidly remove oral AMT from pharmacies, general retailers and mobile providers and to replace its use with quality-assured ACT. The evidence also highlights the importance of supporting interventions in the context of a high-level subsidy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1292-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 71%

Oral artemisinin monotherapy removal from the private sector in Eastern Myanmar between 2012 and 2014

Khin

Aung

Thi

et al. 2016

Malar J

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“…26 Intensive communication campaigns via television and radio mass media were an effective means to improve private-sector provider awareness and knowledge of malaria case management, particularly in areas comparable to western Kenya. 29 Quality assurance systems that integrate routine reporting systems such as district health information software 2 and Foundation for Innovative New Diagnostics' troubleshooting guide for mRDTs 30 offer an opportunity to monitor and improve provider performance. 23 All patients, including pregnant women, should receive malaria parasitological testing to ensure appropriate treatment and prevent complications.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Adherence to the National Guidelines for Malaria Diagnosis in Pregnancy among Health-Care Providers and Drug-Outlet Dispensers in Rural Western Kenya

Riley

Dellicour

Ouma

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Prompt diagnosis and effective treatment of acute malaria in pregnancy (MiP) is important for the mother and fetus; data on health-care provider adherence to diagnostic guidelines in pregnancy are limited. From September to November 2013, a cross-sectional survey was conducted in 51 health facilities and 39 drug outlets in Western Kenya. Provider knowledge of national diagnostic guidelines for uncomplicated MiP were assessed using standardized questionnaires. The use of parasitologic testing was assessed in health facilities via exit interviews with febrile women of childbearing age and in drug outlets via simulated-client scenarios, posing as pregnant women or their spouses. Overall, 93% of providers tested for malaria or accurately described signs and symptoms consistent with clinical malaria. Malaria was parasitologically confirmed in 77% of all patients presenting with febrile illness at health facilities and 5% of simulated clients at drug outlets. Parasitological testing was available in 80% of health facilities; 92% of patients evaluated at these facilities were tested. Only 23% of drug outlets had malaria rapid diagnostic tests (RDTs); at these outlets, RDTs were offered in 17% of client simulations. No differences were observed in testing rates by pregnancy trimester. The study highlights gaps among health providers in diagnostic knowledge and practice related to MiP, and the lack of malaria diagnostic capacity, particularly in drug outlets. The most important factor associated with malaria testing of pregnant women was the availability of diagnostics at the point of service. Interventions that increase the availability of malaria diagnostic services might improve malaria case management in pregnant women.

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“…16 Improvements in communication can help raise awareness of AMFm products, and could be used to counter the use of untested herbal products, but in the absence of secure drug supply this will only have limited impact. 19 This is especially important as the herbal-based AM are freely advertised on radio in this setting and for many people, especially in the rural areas, these would be the AM they would know by name. Client preferences may influence which AM shopkeepers stock most 16 and this may explain why in this setting, herbal-based AM constituted, on average, 40% of all AM stocked.…”

Section: Discussionmentioning

confidence: 99%

Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy

et al. 2016

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BackgroundMost people with febrile illness are treated in the private drug retail sector. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility – malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and ‘crowd out’ artemisinin monotherapies.MethodsThree censuses were carried out 2 months before (2010), 2 months after and 2.5 years after (2013) the first co-paid ACTs to assess changes in antimalarial (AM) availability and price in private retail shops in a Ghanaian rural district to assess the sustainability of the initial gains. Supply, stock-out and cost were explored.ResultsOf 62 shops in the district, 56 participated with 398, 388 and 442 brands of AMs in the shops during the 3 censuses. The proportion of ACTs increased over the period while monotherapies reduced. Herbal-based AM preparations comprised 40–45% of AMs in stock with minimal variation over the period. ACTs were the most sold AM type for all ages but overall buying and selling prices of Quality Assured-ACTs increased by 40–100%.ConclusionsInitial gains in ACT availability were sustained, but not improved on 2.5 years after AMFm. Widespread availability of unproven herbal medicines is a concern; AMFm had little impact on this.

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Communicating the AMFm message: exploring the effect of communication and training interventions on private for-profit provider awareness and knowledge related to a multi-country anti-malarial subsidy intervention

Cited by 25 publications

References 20 publications

Oral artemisinin monotherapy removal from the private sector in Eastern Myanmar between 2012 and 2014

Oral artemisinin monotherapy removal from the private sector in Eastern Myanmar between 2012 and 2014

Knowledge and Adherence to the National Guidelines for Malaria Diagnosis in Pregnancy among Health-Care Providers and Drug-Outlet Dispensers in Rural Western Kenya

Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy

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