Background: Key strategies have been implemented in Tanzania to ensure access to confirmatory testing and appropriate treatment for malaria cases. These include a private sector copayment mechanism (CPM), first implemented as the Affordable Medicines Facility-malaria (AMFm) pilot from 2010- 2011 and subsequently the Global Fund’s CPM. To extend quality case management services to the community level, a drug store accreditation program was recently taken to scale across much of the country. Accredited Drug Dispensing Outlets (ADDOs) are accredited drug stores, whereas non-accredited drug stores are known as duka la dawa baridi (DLDB).
Methods: Nationally-representative malaria outlet surveys were conducted in 2010, 2011 and 2014. A census of public and private outlets with potential to distribute malaria testing and/or treatment was conducted among a representative sample of administrative units. An audit was completed for all antimalarials, malaria rapid diagnostic tests and microscopy.
Results: The AMFm continuation under the private sector co-payment mechanism (CPM) has been successful in further improving access to QA ACT in the private sector, where the majority of antimalarials are distributed in Tanzania. In 2014, more than 80% of antimalarial-stocking private sector outlets had QA ACT available. However, QA ACT market share remained below 50%, and half of all antimalarials distributed in 2014 were the non-artemisinin therapy, SP. QA ACT private sector price was the same as the price of SP in 2011, however an increase in price in 2014 meant that QA ACT treatment was 1.3 times more expensive than SP. If a substantial gap in price for QA ACT and SP persists, price may serve as a barrier to QA ACT uptake. Furthermore, the very low availability of confirmatory testing in the private sector suggests that presumptive treatment remains common.