Malaria is one of the world’s most elusive killers and defies a one-size-fits-all solution. For example, establishing an epidemic alert system and conducting indoor spraying can be a priority in seasonal malaria hot spots. Yet where malaria is a threat throughout the entire year, widespread bed net coverage and usage might be a greater priority. Moreover, efforts to control the disease are vulnerable to frequent misdiagnosis by some health practitioners who over-prescribe malaria medicine – even when the test is negative – simply because the patient has a fever. In countries with weak regulatory systems, some physicians prescribe a single malaria drug compound rather than the recommended combination therapy, and pharmacists often sell any number of ineffective remedies to people without a prescription. This state of therapeutic chaos not only adds to the suffering of the patient, but can also lead to drug resistance. More than many others, the battle against malaria demands strong management systems and robust problem-solving skills.
CHAI’s global team of more than 700 paid employees and 100 volunteers – 70 percent of whom are based in endemic countries – bring a unique set of skills to the fight against malaria. Most of our team members have private sector backgrounds and take an effective business-oriented approach to distribution, marketing, and training challenges. “You wouldn’t want an MBA performing your heart surgery,” says Bruno Moonen of our malaria team. “But often, they can bring a unique and useful perspective toward designing your health department’s procurement and distribution systems.”
Often, low-cost managerial changes can result in big wins. For example, the Government of Botswana, despite their limited budget, wanted to increase the use of bed nets to prevent malaria transmission. After carefully analyzing the situation, CHAI created a free door-to-door marketing and distribution model for bed-nets and then piloted it in one district.
Bed net ownership rates shot up from 12 to 91 percent in that district over two years and convinced the government to adopt the new model as national policy.
Increasing Access to Effective Treatment
CHAI’s work on malaria treatment began in Tanzania, which was, like most of Africa, flooded with cheap, ineffective malaria drugs called monotherapies. While government programs were making the switch to effective ACTs (artemisinin-based combination therapies), this treatment remained prohibitively expensive at the pharmacies where most Africans buy their drugs.
Donors and partners questioned whether a subsidy could work, so we launched a proof-of-concept pilot program in Tanzania that provided a co-pay at the top of the supply chain to bring the cost of ACTs in line with monotherapies. Although most pilots take two years, our rapid response produced tangible results in just a few months. Coupled with marketing campaigns to educate consumers, this strategy began to help push the ineffective drugs out of the market.
Just four months after the Tanzania pilot began, the number of patients buying ACTs in private drug stores shot up from 1 percent to 44 percent. This evidence convinced donors to launch the Affordable Medicines Facility-malaria (AMFm). To date, over 150 million doses of subsidized ACTs have been ordered in nine AMFm countries at prices that have been reduced by 80 to 90 percent.
Today, CHAI supports AMFm by providing technical assistance to governments, helping them apply for and implement AMFm, and roll out marketing campaigns that educate people about treatment.
Transforming Malaria Diagnosis
Even with the increased availability of effective rapid diagnostic tests in remote villages, malaria’s long and lethal history leads people – including health professionals – to habitually believe that every fever is malaria. Often it is not. CHAI assists governments in training clinicians to make accurate diagnoses and help patients understand their condition and access proper treatment instead of automatically prescribing anti-malarial medicines for every fever.
Building on Success
CHAI is working with AMFm countries to expand access to malaria treatment by increasing the market penetration of ACTs to over 50 percent in the next year. This initiative includes helping new ACTs gain market entry and uptake by providing technical assistance, regulatory expertise, and cost-optimization support to the companies that manufacture them.
We are also continuing our work to improve the sustainability and efficiency of malaria financing, including the exploration of novel mechanisms like cash-on-delivery, which pays for progress made toward targets. Additionally, CHAI is helping Swaziland advance toward becoming the first mainland African country to eliminate malaria by ramping up effective surveillance to track down and diagnose every case. Even a few years ago, people thought that eliminating malaria in a sub-Saharan African country was impossible and yet Swaziland is now on the verge of achieving that remarkable feat.