Malawi (2013): An assessment on Coartem project -Phase 1 and Phase 2

Malawi has a population of 13.1 million with 17% of the population being children under 5 years . Malaria is endemic in Malawi and transmission occurs throughout the year in most places, hence it is still a major health problem. Peak transmission is experienced during the rainy season from November to April. The entire Malawi population is at risk of malaria. Children aged under 5 and pregnant women are most at risk of complications due to untreated malaria. Malaria prevalence among children under 5 years is around 43% . Malaria mortality can be combated through malaria prevention strategies or early diagnoses and treatment. In Malawi, the treatment guidelines recommend the use of combination ACT therapy to manage uncomplicated malaria. The first line treatment for uncomplicated malaria is a combination of Artemether and Lumefantrine. This is popularly known as LA. The most common source of LA in Malawi is the public sector, which works in partnership with Christian Health Association (CHAM) facilities. The private sector is a minor player in provision of LA mainly because of the high costs associated with obtaining the commodity and market presence of sub-standard ACTs sold at retail prices; lack of knowledge of retailers on malaria diagnosis and treatment and no child-friendly dispersible formulations available in private sector facilities. Although LA is available for free in public facilities, there are a lot of factors that hamper access. These factors include long distances from health facilities and logistics challenges. According to a cost estimation exercise from the 2010 MIS, it was learned that the pharmacies and shops were the most expensive sources of treatment. In February 2012, PSI/Malawi in partnership with the Nation al Malaria Control Program and Novartis introduced Coartem through the non-premium private sector market. The goal of the project is to contribute to the national goal of reducing mortality and severe disease due to malaria. The launch of the project saw the introduction of treatments for all age groups being distributed through private clinics, pharmacies and drug stores in Malawi. As a result, over 65,000 treatments were distributed in 2012 through the private sector . Medical detailing visits were being conducted to raise awareness of health service providers on proper treatment of malaria and Coartem availability. Apart from the detailing visits carried out by the team, 302 service providers were oriented through a series of orientation meetings scheduled throughout the country. The demand to date keeps on increasing. This increase in demand can be attributed to: -Increased awareness among service providers on the need to prescribe and recommend quality ACTs from WHO prequalified suppliers through detailing visits and awareness meetings -Deregulation of Coartem to OTC status which enables drug stores to stock the product -Increased outlets stocking Coartem which increased access by offering an alternative to public sector commodity -Low price of Coartem compared to other ACTs on the market.