Background: In 2008, a Public Private Mix (PPM) program was initiated in southern Lao PDR to increase the availability of the first-line artemisinin combination therapy (ACT), artemether lumefantrine (AL), and malaria rapid diagnostic tests (mRDTs) in the private sector at little to no cost to the consumer. AL and mRDTs are provided free of charge from the Center for Malaria Parasitology and Entomology (CMPE). Providers are permitted to sell AL for approximately USD $0.12 and mRDT services for USD $0.25. Providers receive training on malaria case management and are expected to report data to the nearest health center or district antimalarial nucleus (DAMN).
Methods: A 2015 malaria outlet survey was conducted in 25 PPM districts and 16 non-PPM districts across five southern provinces (Savannakhet, Champasack, Salavanh, Attapeu and Sekong). Approximately 95% of the country’s total malaria burden is concentrated in these five provinces. All outlets with the potential to sell antimalarials were screened for study eligibility among 41 of 42 districts (Figure 1). This included pharmacies and private for-profit facilities in PPM (N=351) and non-PPM districts (N=300). In the antimalarial stocking facilities, an audit was completed for all antimalarials and mRDTs. Data were retroactively analyzed to present indicators on availability, market share and provider knowledge among outlets located in the PPM and non-PPM districts.
Results: Access to first-line ACT and mRDT was higher in PPM district antimalarial- stocking private sector outlets compared with non-PPM outlets. However, CQ availability and distribution was high in both PPM and non-PPM districts. Expansion of the PPM program could increase availability of mRDT and ACT, as well as improve provider treatment and dosing knowledge, all of which are paramount in the context of national malaria elimination goals in Lao PDR. However, interventions aimed at provider preference and consumer demand may also be necessary to reduce CQ availability and market share in the private sector.