Changing the Market for Antimalarial Medicines in the DRC

Posted September 17, 2015

By Alena Sims, Malaria and Child Survival Communication Associate, PSI

drug_store_owner_in_nigeria_holding_a_box_of_amfm_co_paid_acts — Credit: The Global Fund

With 97% of the population living in areas of high malaria transmission, the Democratic Republic of Congo (DRC) sees upwards of 6.5 million cases of malaria each year – making it the second most malaria-affected country in the world.

The majority of people diagnosed with malaria seek treatment within drug stores, pharmacies or private health facilities where a range of antimalarial options exist. But with 80% of the population living on less than $1 a day, consumers tend to opt for the cheapest treatment option, unaware of the difference in terms of quality and without proper guidance from a provider. These cheaper options are often ineffective antimalarials or artemisinin monotherapies that are either no longer considered efficacious or lack proper quality assurance.

The use of such substandard treatments not only fails to treat the disease but also has the potential to drive the emergence and spread of artemisinin resistance, today’s most critical issue in the fight against malaria. Drug resistance to three formerly recommended treatments (i.e., chloroquine, sulfadoxine-pyrimethamine, and mefloquine) has already occurred, causing artemisinin-based combination therapies, or ACTs, to be adopted as the only recommended first line treatment among health care professionals.

In the DRC, the average cost of an adult course of Quality Assured ACT is $6.45, over six times what most people subsist on each day. Unsurprisingly, only 7.8% of antimalarials dispensed in the DRC market are actually Quality Assured ACTs.

So how do we change the market to reduce the use of non-recommended antimalarials and increase demand and use of Quality Assured ACTs?

With funding from DFID, PSI’s “Support to Malaria Control in the DRC” project aims to change the private sector in the DRC, where the majority of antimalarials are distributed. By working with providers, manufacturers, and distributors, we seek to build the market for Quality Assured ACTs within the private sector and to eliminate the market of potentially harmful artemisinin monotherapies and outdated antimalarials. A pilot project is currently underway in DRC’s capital city of Kinshasa which will incorporate a market-based approach and two integral steps:

Reduce the price for Quality Assured ACTs for consumers. PSI will work with manufacturers who agree to provide Quality Assured ACTs to importers at a fixed discounted price. A proportion of the discounted price will be paid to manufacturers in the form of a subsidy, or “co-payment” ensuring that importers will only pay the remainder of the sales price. This will reduce the cost the importer pays to bring Quality Assured ACTs into DRC and reduced prices will then be passed on to private wholesalers and ultimately to consumers. PSI will also work with the DRC Government to lobby for tax and tariff reductions on ACTs and all antimalarial commodities. As the demand for Quality Assured ACTs increases, and taxes and tariffs are reduced, PSI believes we will be able to gradually phase out the subsidy while maintaining the lower cost for Quality Assured ACTs.

Generate consumer demand. Reducing the cost and increasing the availability of ACTs in the market is not enough to ensure their use. Consumers frequently do not know which treatment is recommended, nor can they recognize it in the marketplace. Most providers also don’t know the difference in terms of quality in the range of antimalarials so they cannot guide the consumer effectively. By requiring that manufacturers include a specified Greenleaf logo on all packaging and marketing the logo as a symbol for quality assured, affordable malaria treatment consumers are empowered to ask for the ACT with the Greenleaf logo. At the same time, PSI and the Ministry of Health will work with health providers in Kinshasa to ensure that they know ACTs are the recommended first line of treatment for Malaria, and with pharmacies and drug shops to ensure that they are readily available.

Private sector markets have a vital role to play in empowering people to live healthier lives all across the globe. The “Support to Malaria Control in DRC” project is a critical step in evolving the private sector in DRC into an entity that increases access to affordable, high quality malaria treatments. Find out more about PSI’s private sector partnerships and malaria programs on our website.

Photo Credit: Courtesy of PSI

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Changing the Market for Antimalarial Medicines in the DRC

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