The online version of this article (doi:10.1186/1475-2875-11-356) contains supplementary material, which is available to authorized users.
AOT, PGD, AB, TE, BP, RC, ML, GB, JB and JG were at the time of the study affiliated with MMV a product development partnership-PDP for different anti-malaria drugs. KN, KR, ND work for Surgipharm Pharmaceuticals, which at the time of the pilot study was the company designated to distribute Coartem in Uganda. All the other authors declare no competing interest.
The members of the Consortium for ACT Private Sector Subsidy-CAPSS are the designated authors of this paper: AOT and PG (MMV) conceptualized the CAPSS pilot study, were the overall leaders of the management team and drafted the manuscript; JB, AB, GB, ML, RC and JG (MMV) were involved in the design and implementation of the pilot study and reviewed the manuscript; GBR, RN, MB, PK, FS and FK (Ug-MoH) were involved in the design and implementation of the CAPSS study and reviewed the manuscript; DN and AB (NDA) were involved in the regulatory aspects of CAPSS, training on safety monitoring and reviewed the manuscript; SMM, PB, JL, and AB (PACE) designed and implemented the secondary packaging and communications programme and reviewed the manuscript; GN and JT (MC) were responsible for the design and implementation of the training programme; KN, KR and ND (Surgipharm Pharmaceuticals) were involved in the design and management of the supply aspects of CAPSS; SR (I+Solutions) was involved in supply side and logistics training, SK (Management Sciences for Health-MSH) was involved in the design of the study and policy oversight and reviewed the manuscript; BP and TE (MMV) provided substantial input in the implementation of the field surveys and performed the geographical information system (GIS) and statistical analysis and reviewed the manuscript. All authors read and approved the final manuscript.
Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa. Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to ACT in the private sector could be improved through the provision of a high level supply chain subsidy.
Four intervention districts were purposefully selected to receive branded subsidized medicines - “ACT with a leaf”, while the fifth district acted as the control. Baseline and evaluation outlet exit surveys and retail audits were conducted at licensed and unlicensed drug outlets in the intervention and control districts. A survey-adjusted, multivariate logistic regression model was used to analyse the intervention’s impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial.
At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, “ACT with a leaf” accounted for 69% of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8% at baseline to 26.2% (95% CI: 23.2-29.2%) at evaluation in the intervention districts. In the control district, it rose modestly from 1.8% to 5.6% (95% CI: 4.0-7.3%). The odds of purchasing ACT within 24 hours in the intervention districts compared to the control was 0.46 (95% CI: 0.08-2.68, p=0.4) at baseline and significant increased to 6.11 (95% CI: 4.32-8.62, p<0.0001) at evaluation. Children less than five years of age had “ACT with a leaf” purchased for them more often than those aged above five years. There was no evidence of price gouging.
These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda.
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- Closing the access barrier for effective anti-malarials in the private sector in rural Uganda: consortium for ACT private sector subsidy (CAPSS) pilot study
Ambrose O Talisuna
Penny Grewal Daumerie
John Bosco Rwakimari
- BioMed Central
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