How has the private sector for antimalarials and malaria testing changed in Benin? Trends from the ACTwatch Lite market study 2016 to 2023.

Background: Since 2016, substantial policy shifts have influenced the private sector market for malaria treatment and diagnostics in Benin. This study aimed to provide updated evidence on malaria product availability, pricing, market share, and wholesale distribution networks for the private sector following these changes Methods: A nationally representative cross-sectional market survey was conducted from June 12 to July 19, 2023 in 84 arrondissements. All private retail and wholesale outlets with the potential to distribute malaria diagnostics or treatments were screened. Outlets were eligible if they had antimalarials or malaria blood testing in stock on the day of the survey, or reported having them in stock in the three months before the survey. An audit captured all available antimalarials, rapid diagnostic tests (RDTs), and microscopy services. Results: The informal sector’s share of antimalarial sales declined sharply from 80% in 2016 to 11% in 2023, with for-profit health facilities and pharmacies emerging as the primary retail sources. Artemisinin-based combination therapy (ACTs) availability rose from 45% in 2016 to 79% in 2023 (p<0.001), comprising 89% of the private market share. Sales of Sulfadoxine-pyrimethamine (SP) decreased, and no oral artemisinin-based monotherapies were found. Diagnostic availability increased, from 6% in 2016 to 42% in 2023 (p<0.001), with highest levels in for-profit (91%) and not-for-profit (88%) health facilities, but remained low in pharmacies (1%). Conclusion: From 2016 to 2023, Benin’s private antimalarial market experienced substantial improvements, including a shift the informal sector and towards health facilities and pharmacies. ACTs now dominate, and diagnostic availability has increased. However, further efforts are needed to expand access to testing, particularly in pharmacies.