The impact of the private sector co-payment mechanism (PSCM) on the private market for ACT in Nigeria: results of the 2018 cross-sectional outlet and household market surveys

Malaria Journal

Shekarau Emmanuel¹  Rubaiyath Sarwar²  James K. Tibenderana³  Hannah M. Edwards³  Parvez Mahmud⁴  Kolawole Maxwell⁵ 

[1] Case Management Branch, National Malaria Elimination Programme, First Floor, Abia House, Central Business District, Abuja, Nigeria;Innovision Consulting Private Limited, Level 3 & 4 House 26 Road 6 Baridhara J Block Pragati Sarani, 1212, Dhaka, Bangladesh;Malaria Consortium Headquarters, 244-254 Cambridge Heath Rd, E2 9DA, London, UK;Malaria Consortium Headquarters, 244-254 Cambridge Heath Rd, E2 9DA, London, UK;Innovision Consulting Private Limited, Level 3 & 4 House 26 Road 6 Baridhara J Block Pragati Sarani, 1212, Dhaka, Bangladesh;Case Management Branch, National Malaria Elimination Programme, First Floor, Abia House, Central Business District, Abuja, Nigeria;Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT, Nigeria;Malaria Consortium Nigeria, 33 Pope John Paul Street, Off Gana Street, Maitama, Abuja-FCT, Nigeria;

关键词: Private sector healthcare;    Case management;    Health economics;    Malaria control;    Informal health workers;    Private sector engagement;    Targeted subsidy;    Artemisinin-based combination therapy;    Private sector co-payment mechanism;   

DOI  :  10.1186/s12936-021-04039-9

来源: Springer

【 摘 要 】

BackgroundThe 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.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 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.ResultsAvailability 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).ConclusionsThe 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.

【 授权许可】

CC BY