Background: Key strategies have been implemented in Madagascar to ensure access to confirmatory testing and Artemisinin Combination Therapy (ACT) for malaria cases. These include public sector scale-up and a private sector copayment mechanism (PSCM), first implemented as the Affordable Medicines Facility- malaria (AMFm) pilot from 2010-2011 and subsequently the Global Fund’s PSCM.
Methods: Nationally-representative malaria outlet surveys were conducted in 2010, 2011, 2013 and 2015. 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: Availability of quality-assured artemisinin combination therapy (QA ACT) has remained above 80% in the public sector since 2010. However, a decline was observed in the most recent survey round to 84% in 2015 compared with 97% in 2013. In the private sector, QA ACT availability increased between 2011 (9%) and 2014 (28%), but declined in 2015 to 11%. The declines were observed across private sector outlet types, with the exception of pharmacies, with a particularly notable drop in availability among drug stores from greater than 50% in 2010, 2011 and 2013 to 17% in 2015.