The private commercial sector distribution chain for antimalarial drugs in Benin - Findings from a rapid survey

In November 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would administer the first phase of an ambitious scheme to increase the availability of effective treatment for malaria, the Affordable Medicines Facility – malaria (AMFm). Artemisinin‐based combination therapies (ACTs) are highly‐effective, but remain prohibitively expensive for those who are most vulnerable to malaria infection.  AMFm aims to reduce significantly the price of ACTs by offering a co‐payment for ACTs purchased by eligible buyers at the top of the supply chain.    Recognizing that the public and private sectors are important sources of antimalarials in most endemic countries, both public and private sector buyers will be entitled to purchase subsidized ACTs.  The involvement of the private sector is an innovative element of AMFm, as many countries already have experience distributing ACTs in the public sector. To ensure that subsidized ACTs reach patients at the lowest possible cost, it is necessary to gain a better understanding of the private sector supply chains for antimalarials in each country participating in AMFm.   The objective of the rapid supply chain survey was therefore to assist Benin, which is one of the 11 countries invited to apply to the first phase of AMFm, in the development of an effective implementation plan by providing an understanding of the current supply chain for antimalarials, and the way in which subsidised ACTs are likely to travel through this chain to reach patients.  This report presents the findings of a series of semi‐structured interviews conducted with government officials and private suppliers of malaria treatment operating at the various levels of the chain.   At the time of the survey, antimalarial products sold in the private commercial sector were procured from international and domestic manufacturers by 3 active registered wholesalers and Benin’s public sector procurement agent: the Centrale d’Achat des Médicaments Essentiels et des Consommables médicaux (CAME). Manufacturers do not have sole distributorship agreements for registered pharmaceuticals, or other special relationships with particular wholesalers. Consequently, each wholesaler regularly stocks a large proportion of the antimalarials registered in Benin. CAME is responsible for procuring the generic medicines on the National Essential Medicines List. In practice CAME procures and supplies antimalarials not included on the National Essential Medicines List, as it is currently out of date

The private commercial sector distribution chain for antimalarial drugs in Nigeria - Findings from a rapid survey

In November of 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would administer the first phase of an ambitious scheme to increase the availability of effective treatment for malaria, the Affordable Medicines Facility-malaria (AMFm). Artemisinin-based combination therapies (ACTs) are highly effective, but remain prohibitively expensive for those who are most vulnerable to malaria infection.1 The AMFm aims to significantly reduce the price of ACTs by offering a co-payment for ACTs purchased by eligible buyers at the top of the supply chain. Recognizing that the public and private sectors are important sources of antimalarials in most endemic countries, both public and private sector buyers will be entitled to purchase subsidised ACTs. The involvement of the private sector is an innovative element of AMFm, as many countries already have experience distributing ACTs in the public sector. To ensure that subsidised ACTs reach patients at the lowest possible cost, it is necessary to gain a better understanding of the private sector supply chains for antimalarials in each country participating in the AMFm. The objective of the rapid supply chain survey was therefore to assist Nigeria, which is one of the 11 countries invited to apply to the first phase of the AMFm, in the development of an effective implementation plan by providing an understanding of the current supply chain for antimalarials, and the way in which subsidised ACTs are likely to travel through this chain to reach patients. This report presents the findings of a series of semi-structured interviews conducted with government officials and private suppliers of malaria treatment operating at the various levels of the chain. Supplemental sections include brief discussions on the Nigerian drug monitoring system, on the proposed tax exemption for subsidised ACTs under the AMFm, and also on the private sector capacity to repackage and re-label imported subsidised ACTs. In addition, data from the December 2008 report on the first round of the ACTwatch Outlet Survey in Nigeria were used to estimate key variables, such as antimalarial market shares

ACTwatch 2009 Supply Chain Survey Results, Zambia

In Zambia, as in many low-income countries, private commercial providers play an important role in the treatment of malaria. To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access. However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Cambodia, Uganda, Zambia, Nigeria, Benin, Madagascar and the Democratic Republic of Congo). Other elements of ACTwatch include Retail Outlet and Household Surveys led by Population Services International (PSI). This report presents the results of a cross-sectional survey of antimalarial drug wholesalers conducted in Zambia between February and May 2009

ACTwatch 2009 Supply Chain Survey Results, Benin

In Benin, as in many low‐income countries, private commercial providers play an important role in the treatment of malaria.  To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and identify the factors that influence their stocking and pricing decisions.  Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access.  However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Benin, Cambodia, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia).  Other elements of ACTwatch include Retail Outlet and Household Surveys led by Population Services International (PSI).  This report presents the results of a cross‐ sectional survey of antimalarial drug wholesalers conducted in Benin in June 2009

ACTwatch 2009 Supply Chain Survey Results, Nigeria

In Nigeria, as in many low-income countries, private commercial providers play an important role in the treatment of malaria. To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access. However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Nigeria, Cambodia, Benin, the Democratic Republic of Congo, Madagascar, Uganda and Zambia). Other elements of ACTwatch include Retail Outlet and Household Surveys led by Population Services International (PSI). This report presents the results of a cross-sectional survey of antimalarial drug wholesalers conducted in Nigeria between July and September 2009

ACTwatch 2009 Supply Chain Survey Results, DRC

In the DRC, as in many low‐income countries, private commercial providers play an important role in the treatment of malaria.  To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and identify the factors that influence their stocking and pricing decisions.  Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access.  However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (the Democratic Republic of Congo, Cambodia, Benin, Madagascar, Nigeria, Uganda and Zambia).  Other elements of ACTwatch include Retail Outlet and Household Surveys led by Population Services International (PSI).  This report presents the results of a cross‐sectional survey of antimalarial drug wholesalers conducted in the DRC between January and March 2010

A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in the Democratic Republic of Congo, 2010

In Democratic Republic of Congo (DRC), as in many low-income countries, private commercial providers play an important role in the treatment of malaria. To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers, and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access. However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Benin, Cambodia, DRC, Madagascar, Nigeria, Uganda and Zambia). This report presents the results from qualitative interviews with antimalarial drug wholesalers, retailers and other key stakeholders conducted in DRC between January and March 2010. To provide a complete description of the supply chain for antimalarial drugs, this report should be read in conjunction with the report on the results of the quantitative supply chain survey also conducted as part of this study, available at www.actwatch.info

ACTwatch 2009 Supply Chain Survey Results, Uganda

In Uganda, as in many low-income countries, private commercial providers play an important role in the treatment of malaria. To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access. However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Uganda, Cambodia, Zambia, Nigeria, Benin, Madagascar and the Democratic Republic of Congo (DRC)). Other elements of ACTwatch include Retail Outlet and Household Surveys led by Population Services International (PSI). This report presents the results of a cross-sectional survey of antimalarial drug wholesalers conducted in Uganda between February and April 2009

A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in Zambia, 2009

Alongside the public and non‐profit sectors, private commercial providers are also sources of malaria treatment in Zambia. To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers, and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access. However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Zambia, Cambodia, Benin, the Democratic Republic of Congo (DRC), Madagascar, Nigeria and Uganda). This report presents the results from qualitative interviews with antimalarial drug wholesalers, retailers and other key stakeholders conducted in Zambia between February and May 2009. A summary of the key findings is given below. To provide a complete description of the supply chain for antimalarial drugs, this report should be read in conjunction with the report on the results of the structured supply chain survey also conducted as part of this study, available at www.actwatch.info

The private commercial sector distribution chain for antimalarial drugs in Madagascar: Findings from a rapid assessment

ACTwatch is a research programme funded by the Bill and Melinda Gates Foundation that aims to provide and promote evidence and recommendations for policy makers on methods to increase availability and decrease the consumer price of quality‐assured Artemisinin‐based Combination Therapies (ACTs) throughout the private sector. Research has been carried out in seven countries (Cambodia, Uganda, Zambia, Nigeria, Benin, Madagascar and D.R. Congo) and encompasses Household Surveys, Outlet Surveys, as well as Supply Chain Surveys and Assessments.   As is the case in many developing countries, the private sector in Madagascar plays a pivotal role in facilitating access to malaria treatment. The Household and Outlet surveys conducted in Madagascar suggest that the general population tends to seek treatment through the private sector, and that private sector outlets make up a substantial portion of outlets that carry antimalarials.   In order to design future interventions that will improve access to diagnostic and effective treatment options, it is important to understand the structure of the private sector distribution chain for antimalarials, as well as the incentives, restrictions and challenges that actors within the market face. Despite the important role of the private sector in the supply of antimalarials, there is limited rigorous evidence on the subject. This report contributes to addressing this gap for Madagascar