Artemisinin-based combination therapy (ACT) is now recommended by the WHO as the first line treatment of P. falciparum malaria. Countries across sub-Saharan Africa, Asia and Latin America changed their national treatment guidelines from less effective or failing drugs, such as the monotherapy Chloroquine, to ACT as a result. However, despite relatively swift national treatment policy changes and increased financing for malaria control, there are indications of widespread reliance on antimalarial monotherapies rather than the recommended combination treatments in most endemic countries. This is a major concern for the global malaria control community, as the widespread availability and use of Artemisinin monotherapies in particular is a key driver for the development and spread of resistance in malaria parasites, undermining the effectiveness of ACT over time.
In order to better understand the evolution of antimalarial markets, Population Services International (PSI) in partnership with the London School of Hygiene and Tropical Medicine (LSHTM) launched in 2008 a five-year multi-country research project called ACTwatch. The ACTwatch project is made up of three components:
(1) Outlet survey which provides nationally representative data on the price, availability and volumes of antimalarials as well as provider behavior in the public and private sectors;
(2) Household survey which aims to better understand the behavior of mothers and other care-givers seeking fever treatment for children under five; and
(3) Supply chain research which seeks to clarify wholesaler volumes, components of consumer prices and mark-ups from wholesaler to service delivery points.
Together the three components provide an overview of the antimalarial markets in seven countries: Benin, Cambodia, D.R Congo, Madagascar, Nigeria, Uganda and Zambia. Results are disseminated to decision and policy-makers at the country and international level. ACTwatch surveys are also being used to evaluate global drug subsidy programmes such as the Affordable Medicines Facility – malaria (AMFm).
ACTwatch methodologies, tools and reports are available at: www.actwatch.info.