Geographic location of included studies.

<p>Geographic location of included studies.</p

Health area of focus of included studies.

<p>Health area of focus of included studies.</p

A Systematic Review of the Role of Proprietary and Patent Medicine Vendors in Healthcare Provision in Nigeria

<div><p>Background</p><p>Interventions to reduce the burden of disease and mortality in sub-Saharan Africa increasingly recognize the important role that drug retailers play in delivering basic healthcare services. In Nigeria, owner-operated drug retail outlets, known as patent and proprietary medicine vendors (PPMVs), are a main source of medicines for acute conditions, but their practices are not well understood. Greater understanding of the role of PPMVs and the quality of care they provide is needed in order to inform ongoing national health initiatives that aim to incorporate PPMVs as a delivery mechanism.</p><p>Objective and Methods</p><p>This paper reviews and synthesizes the existing published and grey literature on the characteristics, knowledge and practices of PPMVs in Nigeria. We searched published and grey literature using a number of electronic databases, supplemented with website searches of relevant international agencies. We included all studies providing outcome data on PPMVs in Nigeria, including non-experimental studies, and assessed the rigor of each study using the WHO-Johns Hopkins Rigor scale. We used narrative synthesis to evaluate the findings.</p><p>Results</p><p>We identified 50 articles for inclusion. These studies provided data on a wide range of PPMV outcomes: training; health knowledge; health practices, including drug stocking and dispensing, client interaction, and referral; compliance with regulatory guidelines; and the effects of interventions targeting PPMVs. In general, PPMVs have low health knowledge and poor health treatment practices. However, the literature focuses largely on services for adult malaria, and little is known about other health areas or services for children.</p><p>Conclusions</p><p>This review highlights several concerns with the quality of the private drug retail sector in Nigeria, as well as gaps in the existing evidence base. Future research should adopt a more holistic view of the services provided by PPMV shops, and evaluate intervention strategies that may improve the services provided in this sector.</p></div

Summary of included studies.

<p>Summary of included studies.</p

Costs of Eliminating Malaria and the Impact of the Global Fund in 34 Countries

<div><p>Background</p><p>International financing for malaria increased more than 18-fold between 2000 and 2011; the largest source came from The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Countries have made substantial progress, but achieving elimination requires sustained finances to interrupt transmission and prevent reintroduction. Since 2011, global financing for malaria has declined, fueling concerns that further progress will be impeded, especially for current malaria-eliminating countries that may face resurgent malaria if programs are disrupted.</p><p>Objectives</p><p>This study aims to 1) assess past total and Global Fund funding to the 34 current malaria-eliminating countries, and 2) estimate their future funding needs to achieve malaria elimination and prevent reintroduction through 2030.</p><p>Methods</p><p>Historical funding is assessed against trends in country-level malaria annual parasite incidences (APIs) and income per capita. Following Kizewski et al. (2007), program costs to eliminate malaria and prevent reintroduction through 2030 are estimated using a deterministic model. The cost parameters are tailored to a package of interventions aimed at malaria elimination and prevention of reintroduction.</p><p>Results</p><p>The majority of Global Fund-supported countries experiencing increases in total funding from 2005 to 2010 coincided with reductions in malaria APIs and also overall GNI per capita average annual growth. The total amount of projected funding needed for the current malaria-eliminating countries to achieve elimination and prevent reintroduction through 2030 is approximately US$8.5 billion, or about$1.84 per person at risk per year (PPY) (ranging from $2.51 PPY in 2014 to$1.43 PPY in 2030).</p><p>Conclusions</p><p>Although external donor funding, particularly from the Global Fund, has been key for many malaria-eliminating countries, sustained and sufficient financing is critical for furthering global malaria elimination. Projected cost estimates for elimination provide policymakers with an indication of the level of financial resources that should be mobilized to achieve malaria elimination goals.</p></div

LLIN adjusted costs to eliminate malaria in 34 countries, 2014–2030.

<p>Notes: Higher LLIN estimates occur from 2014 to 2020 are associated with higher coverage rates for countries further from elimination years in both scenarios (80% for “high coverage scenario” and 50% for “low coverage scenario”). As elimination year nears, countries move into the next coverage tier of both scenarios (50% for “high coverage scenario” and 30% for “low coverage scenario”). For all endemic countries between the years of 2026 and 2030, coverage rates are at their lowest (30% for high coverage scenario and 15% for low coverage scenario).</p

Estimated costs for malaria elimination and prevention of reintroduction in the 34 malaria-eliminating countries, 2014–2030.

<p>Notes: The decrease in 2020 is due to a number of countries reaching their national target elimination years, at which time, based on our model assumptions, certain interventions cease (CHWs, LLINs). Other interventions, such as treatment continue, decline by reducing coverage levels per declining incidence. Estimated costs for 2021 to 2030 include all projected expenditures for maintaining elimination interventions thorough 2030 for DPRK, Iran, the Philippines, Thailand, Solomon Islands, Vanuatu, and Vietnam. This period also includes expenditures for prevention of reintroduction interventions among countries that have eliminated prior to 2021. Prices are in 2013 USD$.</p

34 malaria-eliminating countries, sorted by identified national target malaria elimination goals.

<p>*Provincial goals, therefore 2030 is assumed for national goal.</p><p>NNG: No National Goal. If no national elimination goal is identified, 2030 is assumed unless otherwise noted in methodology.</p>1<p>Azerbaijan's national goal for elimination was by 2013; however authors have assumed 2014 since no declaration of elimination has been reported.</p>2<p>Elimination goal of 2020 declared under the EMMIE regional initiative.</p><p>34 malaria-eliminating countries, sorted by identified national target malaria elimination goals.</p

Average annual growth rate in Gross National Income per capita between 2000 and 2010 by Gross National Income per capita for 2011.

<p>Notes: The Global Fund income categories are based on the World Bank (Atlas Method) Income Classifications. Lower middle income countries are further divided into two groups: lower-lower middle income countries and upper-lower middle income countries based on the midpoint of the GNI per capita range of the lower middle income category. Classifications are as follows: low income, $1,025 or less; lower-lower middle income,$1,026–$2,530; upper-lower middle income$2,531–$4,035; upper middle income,$4,036–$12,475. GNI per capita average annual growth data for the Democratic People's Republic of Korea was unavailable. Data for China is unreliable, reporting 100% of malaria funding from the Global Fund, and therefore removed. High income countries—Korea, Saudi Arabia, and Turkey—are not shown. ¹Data obtained from the World Bank. If information was not available for 2010, data from the most recent year available was used. ²Data taken from the World Health Organization's 2011 World Malaria Report Annex 2 for the period of 2005-2010, not including contributions reported by donors. Bubble legend to scale.</p

Change in total malaria funding, percentage of Global Fund funding, and API between 2005 and 2010.

<p>Notes: Countries are clustered in the top right quadrant indicating higher reductions in API and an increase in total funding for malaria. Countries in the lower right quadrant have either stagnating or increasing APIs despite increases in funding, likely due to importation issues. In the upper left quadrant, countries have reduced APIs, with a commensurate decrease in funding.</p><p>Source: Data taken from the World Health Organization's 2011 World Malaria Report Annex 2 for total funding for malaria includes country reported government and external funding for the period of 2005–2010, and does not include “Contributions reported by donors”. Additionally, due to sparse data, the percent increase in total funding for malaria was calculated for the following countries during the respective time period: Algeria (2008–2010); Belize (2005–2009); Dominican Republic (2007–2010); El Salvador (2005–2009); Malaysia (2007–2010); Nicaragua (2006–2010); South Africa 2007–2010; Swaziland (2007–2010); Uzbekistan (2005–2009).</p><p>Change in total malaria funding, percentage of Global Fund funding, and API between 2005 and 2010.</p